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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Charles H. McBurney, MD


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

Charles H. McBurney, MD (1845- 1913). British surgeon and anatomist, Dr. McBurney studied at Harvard University, and received his MD from the Colombia University in New York. At the forefront of the aseptic technique revolution, Dr. MacBurney, following Halsted's example, required the use of surgical gloves and strict aseptic technique in his operating room, considered the "first modern operating room in America"

His studies focused on appendicitis, and demonstrated a point of maximum tenderness at a point "exactly between an inch and a half and two inches from the anterior spinous process of the ileum on a straight line drawn between that process and the umbilicus". This point has become known as the eponymic "McBurney's point". There is a discrepancy between the original description of this point by McBurney and some medical publications. Continuing his research on the surgical approach to the inflamed vermiform appendix, in 1894 Dr. MacBurney presented an approach that used a small incision for appendectomy. This incision is know today as "McBurney's incision."

Sources:
1. "Charles Heber McBurney (1845 – 1913)" Yale,SH and Musana, KA Clin Med Res. 2005 August; 3(3): 187–189.
2. "Charles McBurney (1845–1913)—point, sign, and incision"  JAMA 1966;197:1098–1099
3. "The first modern operating room in America"  Clemons BJ AORN J. 2000 Jan;71(1):164-8, 170

Original imagecourtesy of National Institutes of Health.
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Cardiac apex

The word [apex] is Latin and means "the top". It refers to the highest point in a mountain or in a pyramid; the point furthest from the base. The plural form is [apices].  There are several anatomical apices in the human body.

The cardiac apex (also known by the Latin term apex cordis) is a misunderstood term. It refers to the "top" of the heart, but this is clear only when you place the heart in such a way that the apex is actually pointing "up" (see image). In this position the heart is like a pyramid and the base will be the surface opposite the apex. The anatomical location of the apex of the heart is posterior to the left 5th intercostal space in adults, just medial to the left midclavicular line.

Click on the image for a larger picture.

Human heart - Cardiac apex
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Endo-

The prefix [endo-] is of Greek origin and means "inner or within". There are many uses of the term as follows:

Endocardium: the root term [card] means "heart" and the suffix    [-ium] refers to a "layer or membrane" - Inner layer of the heart
Endocrine: the suffix [-crine] means "secretion", the word meaning "inner secretion". Refers to a gland that deposits its secretions within the bloodstream. The products of endocrine glands are known generically as "hormones"
Endometrium: the root term [-metr-] is Greek, meaning "uterus" . The word endometrium means "inner layer of the uterus"
Endoscope: the term [-scope] refers to an instrument used for viewing. There is a consensus that a viewing instrument that enters through a natural body cavity will be called an "endoscope" (see image). All others will adopt the name of the cavity that is being viewed, as a laparoscope, a thoracoscope, an arthroscope, etc.

Original image courtesy of  Wikipedia.

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Benign / Malignant

These two opposing terms are used to describe key characteristics of a tumor. [Benign] derives from the Latin term [benignus], meaning "good" and "gentle". The medical application of the word denotes a condition (or tumor) that is not bad (malignant), and that it is favorable for treatment and recovery.

The term [malignant] derives from the Latin word [malus], meaning "ill-disposed, malicious, or bad". The medical application is to a condition or tumor that is unfavorable to treatment and recovery. Over time the term malignant has become synonymous with "cancer".

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Anterior - Posterior

These two opposite terms must be studied together. Both words are used as directional anatomical and surgical terms, and most importantly, they are relationship terms, that is, they express the spatial location of one structure in reference to another.

The term [anterior] is Latin and means "in front of". It is related to the prefix [ante-] which means "before", or "anterior" and the Latin [anticus], which means "in the very front".

The term [posterior] is more complex. Although it is based on a Latin term meaning "after", the prefix [poster-] is used as a comparative to mean "behind (a structure of reference)". Following are some examples of the proper use of these terms:

- The aorta is anterior to the spine
- The sternum is anterior to the heart
- The occipital bone is the most posterior bone of the cranium
- The trachea is anterior to the esophagus 

Because a human body is always studied in the anatomical position, in the hand, the anterior aspect is the palm and in this case a synonym for anterior is [volar].  

Image property of: CAA.Inc. Artist: Victoria G. Ratcliffe

Anterior - Posterior
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Salomon Hakim, MD


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

Dr. Salomón Hakim (1922 - 2011). Dr. Hakim was born in the city of Barranquilla, Colombia. He started medical school in 1944 and elected neurosurgery as his specialty. He had special interest in electricity and physics, which he used extensively in his research.

In 1957 Dr. Hakim was exposed to a strange case of a young man with what was known then as "symptomatic occult hydrocephalus". Until that time the accepted knowledge was that hydrocephalus was due to an increase in intracranial pressure of different etiology. The problem was that the young man had normal pressure, yet had a hydrocephalus and enlarged ventricles. Dr. Hakim applied his knowledge of physics and laid the conceptual basis for what became known as "Normal Pressure Hydrocephalus" a condition until then unrecognized and that is found in aging patients with dementia, Alzheimer's, and other pathologies.

Working at home, Dr. Hakim developed a pressure-regulating shunt  to drain the excess cerebrospinal fluid (CSF) from the ventricular system of the brain. These valves were later produced by medical industry. His son Carlos has continued his legacy and now the Hakim programmable valve is one of the best CSF shunt systems in the world.

Original image courtesy of The Hydrocephalus Association

I had the pleasure of meeting Dr. Hakim in 1993 in Santiago, Chile, and again later in the US, as he presented his valve system to a group of neurosurgeons.  This short article does not do justice to the physician, researcher, and family man. I encourage you to read more in the following links. Dr. Miranda

Sources:
1. "Salom?n Hakim and the Discovery of Normal-Pressure Hydrocephalus" Wallenstein, MB; McKhann, GM. Neurosurgery (2010) 67;1:155-159
2. "The Reprieve: Reversing Dementia" online article byRose Tibayan
3. "Salom?n Hakim, alma y vida de cient?fico"Article by Paulina Ortiz
4. 
"Salom?n Hakim: Un milagro de Colombia para el mundo"

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