Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Jean-Louis Petit

Jean Louis Petit
(1674 – 1750)

French surgeon and anatomist, Jean Louis Petit was born in Paris in on March 13, 1674.  His family rented an apartment at his house to Alexis Littre (1658 – 1726), a French anatomist. Petit became an apprentice of Littre at seven years of age, helping him in the dissections for his lectures and at an early age became the assistant in charge of the anatomic amphitheater.

Because of Petit’s dedication to anatomy and medicine, in 1690 at the age of sixteen, became a disciple of a famous Paris surgeon, Castel.

In 1692, Petit entered the French army and performed surgery in two military campaigns. By 1693 he started delivering lectures and was accepted as a great surgeon, being invited to the most difficult operations.  In 1700 he was appointed Chief Surgeon of the Military School in Paris and in the same year he received the degree of Master of Surgery from the Faculty of Paris.

In 1715 he was made a member of the Royal Academy of Sciences and an honorary member of the Royal Society of London. He was appointed by the King as the first Director General of the Royal Academy of Surgery when it was founded in 1731.

Petit’s written works are of historical importance.  “Traite des Maladies des Os” ( A Treatise on Bone Diseases);  “Traite des Maladies Chirurgicales et des Operation” (A Treatise on Surgical Diseases and their Operations” This last book was published posthumously in 1774. He also published a monograph on hemorrhage, another on lachrymal fistula, and others.

He was one of the first to perform choIecystotomy and mastoidotomy. His original tourniquet design for amputations saved many in the battlefield and the design of the same surgical instrument today has not changed much since its invention by him.

His name is remembered in the lumbar triangle, also called the "triangle of Petit", and the abdominal hernia that can ensue through that area of weakness, the lumbar hernia or "Petit's hernia".

Sources:
1. “Jean Louis Petit – A Sketch of his Life, Character, and Writings” Hayne, AP San Fran Western Lancet 1875 4: 446-454
2. “Oeuvres compl?tes de Jean-Louis Petit” 1837 Imprimerie de F. Chapoulaud
3. Extraits de l'eloge de Jean-Louis Petit Ius dans Ia seance publique de I' Academie royale de chirurgie du 26 mai 1750” Louis A. Chirurgie 2001: 126 : 475- 81


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Surface anatomy

Surface anatomy art by Danny Quirk - with permission
Surface anatomy art by Danny Quirk - with permission

UPDATED: Surface anatomy is a subset of human anatomy that studies the relationship of external anatomical landmarks and deeply situated structures. These landmarks are created by cartilage, bones, tendons and muscles. In some cases they may be caused by a hypertrophic or diseased organ. Palpation is and art and my favorite book on the subject is the "Trail Guide to the Body" series by Andrew Biel

Surface anatomy is a core clinical skill for physicians, physical therapists and other health care professionals (HCP), as palpation in specific locations can lead to rapid diagnosis in certain cases.  It is also used in surgery to determine the appropriate place for incisions or insertion of a trocar in the case of minimally invasive surgery.

It is true that individual habitus and anatomical variations must make the HCP wary of potential mistakes, but in the majority of cases these anatomical landmarks and diagnoses are correct.

Many book chapters have been written on the topic, but unfortunately, the need to dedicate time to modern discoveries have reduced the time spent on this wonderful learning tool to the point that modern books of anatomy barely touch upon the subject. Many feel today that the need for this tool has been made irrelevant by the bed-side availability of ultrasound imaging.  I have to agree with Standring (2012) when she states “I am not convinced that surface anatomy is under growing threat from modern imaging technology…” There is and always will be the need for applied surface anatomy, although maybe not in the way and depth it was used in the past when imaging technology was scarce and expensive.

In order to make the importance of surface anatomy relevant in medical schools, some have added body painting as a tool in their anatomical curriculum with great results. Will it be used everywhere? I doubt it, but here again is a link between human anatomy and art, which our contributor Pascale Pollier presents through her art in "Artem Medicalis".

The artwork in this article is by Danny Quirk. Click on the image for a larger depiction. The video links are for the RMIT University Muscle Man and the Skeletal Man body paintings from the class by Dr. Claudia Diaz.

Personal note: One of the best book chapters on Surface Anatomy was written in "The Anatomical Basis of Clinical Practice" by Becker, Wilson and Gehweiler (1971). Unfortunately, although the content is very good, the images used, the tongue-in-cheek humor,  and writing style used by the authors, plus the times at which the book was published forced the publisher stop the sales of this book. It was banned from use in medical colleges through the country. Known to many as the "green book" because of its cover, it is today considered a collector's curiosity. In the "sources" section of this article you can find a links to a journal article on the subject as well as images of the book. Dr. Miranda.

Sources:
1. “Evidence-Based Surface Anatomy” Standrig, S J Clin Anat (2012) 25:813–815
2. “Giving Color to a New Curriculum: Body paint as a Tool in Medical Education” Den Akker, JW. Et al J Clin Anat (2002) 15:356–362
3. “Body-Painting: A Tool Which Can Be Used to Teach Surface Anatomy” Nanjundaiah, K. J Clin Diag Res (2012) October, Vol-6(8): 1405-1408 Copy of the article here
4. “RMIT students paint anatomical man into human textbook” RMIT Dr. Diaz, C. Copy of the article here
5. “Should We Use Body Painting to Teach Anatomy?” Gambino, M article at Smithsonian.com  
6. “The role of Fresh Tissue Dissection and Anatomic Body Painting in Anatomy Education” Bennet, C. PPT presentation on PDF here
7. " The anatomical Basis of Medical Practice" Becker, RF. Wilson, JW, Gehweiler, JA 1971, Baltimore, Williams & Wilkins
8. "The Pornographic Anatomy Book? The Curious Tale of The Anatomical Basis of Medical Practice" Halperin EC, Acad Med (2009) 84:2; 278-283 Article here
9. "The Objectification of Female Surface Anatomy" Ruiz, V. Internet article. Click here