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Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We will post a workweek daily medical or surgical term, its 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

Antoine Louis
(1723–1792)

French surgeon, anatomist, and physiologist. Following his medical studies and a long career as a physiologist, Antoine Louis was named Permanent Secretary of the Royal French Academy of Surgery. His other titles were those of Professor of the Royal Academy, Consultant Surgeon of the Armies of the King, member of the Royal Society of Sciences of Montpellier, Inspector of the Royal Military Hospitals, and Doctor in Law of the University of Paris. As a member of these academies Louis was instrumental in the design and construction of the guillotine. Initially called the "Louisette", this device was later named after another French physician in the same committee, Dr. Joseph-Ignace Guillotin.

Antoine Louis' name is better know to history as the eponymic origin of the "sternal angle" also know as the "Angle of Louis" and synonymously (probably by misspelling or translation) the "angle of Lewis", and "angle of Ludwig". This anatomical landmark is extremely important as it serves as a superficial landmark for important anatomical occurrences (click here).

As a point of controversy, there are some that contest the history of this eponym adjudicating it to Pierre Charles Alexander Louis (1787-1872), another French physician dedicated to the study of tuberculosis.

Sources:
1. Srickland, N; Strickland A Angle of Louis, More Than Meets the Eye. MedTalks:
2. Ramana, R. K., Sanagala, T. and Lichtenberg, R. (2006), A New Angle on the Angle of Louis. Congestive Heart Failure, 12: 197–199
3
. "The origin of Medical Terms" Skinner, HA; 1970


 "Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.

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Medieval health poem

 "Thou to health and vigor should attain
Shun mighty cares, all anger deem profane
From heavy suppers and much wine abstain;
Nor trivial count it after pompous fare
To rise from the table and take to the air.
Spurn idle noonday slumbers, nor delay
The urgent call of nature to obey.
These rules if thou wilt follow to the end
Thy life to greater length thou may extend".

The original poem is written in Latin and is part of the book "Regimen Sanitatis Salernitarum" published in 1480. This book contains articles and poems by Afflacius, Bartholomeus, Copho, Ferrarius, Petronius, Johannes Platearius, and Trotula. The editor of the book was Arnold de Villa Nova. It was later translated into English.

It is considered one of the two great publications of the School of Salerno in the Medieval Ages, the other one being the "Compendium Salernitatus"

More on this wonderful book here.

Cover page of Regimen Sanitatis Salernitatum c. 1480
Cover page of Regimen Sanitatis Salernitatum c. 1480
Click on the image for a larger depiction

Source:

"Medieval and Renaissance Medicine" B.L. Gordon 1959 Philosophical Library Inc. USA


Andreas Vesalius Bruxellensis

On December 31st, 2020 we celebrate Andreas Vesalius' 506rd birthday...
His teachings and presence inspire us to continue our quest for knowledge, as his motto states:
"Vivitur Ingenio, Cætera Mortis Erunt"


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.

Andreas Vesalius Bruxellensis (1514- 1564). A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

Andreas Vesalius Bruxellensis
The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". For other articles on Andreas Vesalius, click hereDr. Miranda


Triangle of "doom"

UPDATED: The "triangle of doom" is a name given to a roughly triangular area in the posterior aspect of the anterior wall of the lower abdominopelvic region. It is used by surgeons repairing an inguinofemoral hernia with a mesh and they want to avoid large vascular structures, namely the external iliac artery and vein. The "triangle of doom" will be highlighted when you hover your cursor over the image.

The so-called "triangle of doom" is a misnomer perpetuated by the first laparoscopic surgeons who observed the anatomy of the inguinofemoral region from the posterior aspect. It is neither a triangle (as it only has two boundaries), nor is it an eponym (no such person - that is why is should not use uppercase). It does indicate an area where it is extremely dangerous to place staples or sutures during laparoscopic hernia surgery.

The "triangle of doom" is an inverted "V" shaped area with its apex at the internal (deep) inguinal ring. The "triangle of doom" is bound laterally by the gonadal vessels, and medially by the vas deferens in the male, or the round ligament of the uterus in the female. Within the boundaries of this area you can find the external iliac artery and vein.

It should be pointed out that although the "triangle of doom" landmark does protect the surgeon from damaging the external iliac vessels, a portion of these vessels lie outside of this area. In fact, there are several other areas of concern for neurovascular damage when performing a laparoscopic herniorrhaphy.

The image also depicts other structures of anatomical importance for laparoscopic herniorrhaphy:

Arcuate line (b)
Hesselbach's triangle (in yellow)
Aberrant obturator artery (Corona Mortis) (a)
• Inferior (deep) epigastric artery (c)

Image property of:CAA.Inc.Artist:M. Zuptich.


Clinical anatomy of the inguinofemoral hernias, as well as abdominal and perineal hernias are some of the lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc.



The long road to the book "In the shadow of Vesalius" (3)

If you arrived directly to this article, the first article in this three-page series can be read HERE

I would like to shine a light on my husband poet /sculptor Bryan Green , who wrote a poem on Vesalius that is published in Theo’s book; “In Search of Andreas Vesalius: The Quest for the Lost Grave” and gave a performance at the Fabrica Vitae exhibition opening.. Bryan has constantly worked behind the scenes editing many letters, articles, books, and leaflets,  I couldn’t have done it all without his help and advice. He also made the long lorry journey to Zakynthos from Belgium with me and our friend James Gatehouse to deliver the monument.

Vesalius Continuum also marked the start of our touring exhibition “Fabrica Vitae” curated by Eleanor Crook, my sister Chantal Pollier, and myself. The exhibition toured all over Europe and the US with the help and support of Theo Dirix and Belgian Embassies world wide .

The conference and accompanying events could not have happened without financial funds and I hereby would like to thank all our sponsors: Professor Peter Abrahams with his infectious energy and professor Robert Jordan; St Georges University of Grenada, Ruth Richardson and Brian Hurwitz and Mark Gardiner for getting funding from the Wellcome trust, Marie Dauenheimer and the Vesalius Trust, BIOMAB, Ann van the Velde and The University of Antwerp, The AEIMS and MAA, William Nagels, warmly thank the local authorities and the mayor of Zakynthos, ARSIC,  Theo Dirix, and Stephen Joffe, and a special thank you also Stephen for writing a beautiful foreword for our book In the Shadow of Vesalius.

Bryan Green reading his poem in the book of Theo Dirix “ In Search of Andreas Vesalius”
Bryan Green reading his poem in the book of Theo Dirix “ In Search of Andreas Vesalius”
Click on the image for a larger version


You can imagine after such an exciting and wonderful adventure, which took quite a few years to organize, and a quite a few years to reminisce over, we decided we wanted to keep the momentum going and thus the Vesalius triennial was born.

In 2017 BIOMAB, in collaboration with Vesaliana, organized the first triennial in Zakynthos ‘Uniting Medicine with Poetry, History and Culture’

It seems like another world in which we made our plans for the 2nd edition of the Vesalius Triennial Congress, 4 months before the COVID-19 pandemic lock down. From the vain belief that COVID-19 would not hit most countries, to hopes that everything would have blown over by 13th November 2020 (the day when the next Vesalius Triennial Congress would take place in Antwerp) to realizing that we were going to have to take action, the scientific committee has transformed from one in which everyone knew their time-tried and perfected role, to one requiring invention in uncharted territory.

 New Vesalius Statue in Zakynthos

Canceling the 2nd  Vesalius Triennial was not a welcome prospect , since facilitating human communication is the corner stone of a scientific community. So we set sail for the vast virtual-reality realm. To discover just how far we could delve into virtual communication with a dedicated but small organising committee, was an eventful, insightful voyage. Sadly after long and careful consideration and several online meetings we finally decided to postpone all international congress keynote lectures and educational sessions until 2023.

However we would like to invite all the friends of Vesalius for a virtual book launch on Nov 13th we will soon post the event details on how to register for this event on social media, and on Vesalius continuum website

The book "In the shadow of Vesalius" can be ordered here: http://garant.be/shadow-of-vesalius/ 

 

Professor Vivian Nutton and Professor Omer Steeno looking at a first edition of the Fabrica
Professors Vivian Nutton and Omer Steeno looking at a first edition of the Fabrica
Click on the image for a larger version

 

Finally I would like to thank everyone who has been part of this adventure, special thank you to Professor Dr. Efrain Miranda ( Clinical Anatomy) for his continuous support, EBSA, Prof. Stefanos Geroulos, Vasia Hatzi (MEDinART), Pavlos Plessas, Nicos Varvianis, Maria Sidirokastriti-Kontoni & Fr. Panagiotis Kapodistrias,  the many wonderful speakers, the local organisers, our Keynote speaker Professor Martin Kemp for his wonderful contribution,  Eleni Andrianaki; ibis el greco , the wonderful delegates, the artists of the Fabrica Vitae exhibition, the museum and universities where we took our exhibition, a special thank you to Juris Salaks and Ieva Lebiete for hosting our exhibition at the Stradins museum and for all the help and support, Apostolis Sarris, Nikos Papadopoulos, Sylviane Déderix, Jan Driessen, Theo Dirix, Chr. Merkouri.and to the all the friends of Vesalius who like to keep his spirit alive.

Pascale Pollier-Green
Oct 2020

Personal note: I would like to thank Pascale Pollier-Green for authoring this series of articles and wish Professor Robrecht Van Hee the best success publishing this new book on the history and influence of Andreas Vesalius on anatomy, medicine, science, and the Arts. Dr. Miranda.


 

 

 

The long road to the book "In the shadow of Vesalius" (2)

If you arrived directly to this article, the first article in this three-page series can be read HERE

One of the most important conferences that BIOMAB initiated and co-organized was without  doubt “Vesalius Continuum” which took place in 2014 on the island of Zakynthos  . This joint AEIMS conference was organized in collaboration with Dr Mark Gardiner and the then Consul at the Belgian Embassy in Greece - Theo Dirix, and brought together many prominent scholars and Vesalius experts who presented papers on the life, work and death of Vesalius, and the influence of the Fabrica on modern anatomy, and on medical art and contemporary art (pdf file).

Without the organizing skills and drive and energy of Dr. Mark Gardiner and the countless meetings and emails with Theo Dirix, the conference Vesalius Continuum would not have been the huge world class event it became.

In 2013 Dr. Mark Gardiner and I first introduced ourselves to Professor Vivian Nutton who was giving a lecture at Warwick University about the incredible find of a hand written (by Vesalius himself !) edited version of the Fabrica’s second edition, which would have become the third edition, …had Vesalius not met his untimely death. Mark and I were blown away by this wonderfully exciting lecture and we asked Professor Nutton to be a speaker at our conference in 2014, which he accepted gladly. He was invited again in 2017 for the triennial and has now especially for this publication written an exciting account of Vesalius in England, 1544 to 1547.

Sculpting the monument in Richard Neave’s studio
Sculpting the monument in Richard Neave’s studio

Vesalius’s 500 th anniversary celebrations did not end with the organization of the conference, but became a collection of several events.

My colleague and dear friend forensic medical artist Richard Neave and I sculpted a bronze monument to commemorate Vesalius’s death on the Island of Zakynthos on 15th Oct 1564. This monument might never have been erected if it were not for the wonderful idea of  Antwerp GP and president of Vesaliana Dr Marc de Roeck together with William Nagels, who devised a way of self-funding this large undertaking. We had countless meetings discussing the monument and agreed with Dr. de Roeck that by making a bronze facial reconstruction portrait (made by Richard Neave and myself) and selling 12 copies we would gather enough money together to make the monument, pay to have it cast in Bronze and drive the sculpture from Belgium to Zakynthos ready to have its grand inauguration at the start of the conference. This was all achieved successfully and the sculpture now stands on the Island of Zakynthos’s Vesalius square, facing the Ionian sea.

In 2009 I had completed a facial reconstruction course at the academy of fine arts in Maastricht , the Netherlands, and as Vesalius had always been my big inspiration and the reason why I chose to become a medical artist,  it was my dream to make a facial reconstruction of Vesalius. The dream soon turned into a passion, and the passion into an obsession to go in search of the grave of Vesalius and find his skull.
Ann suggested to Marc we sailed to Zakynthos with the MYC-Medical Yachting Club to start the quest for the grave. I will never forget the day that Marc gave me the ships wheel as we got closer to the island and I sailed into the harbor of Zakynthos! An amazing feeling!

After our first visit to “what we thought then was the grave site“ at Laganas, I wrote a letter to the Belgian embassy in Greece, asking for help with our quest,  a year later when Theo Dirix took office as Consul he wrote back to me, my letter had ignited a flame in the heart of taphophile Theo Dirix.

 

Dr. Marc De Roeck and Pascale Pollier sailing to Zakynthos
Sculpting the monument in Richard Neave’s studio
Click on the image for a larger version

 

Soon the quest became an official scientific research collaborative project between the Belgian School of Athens (Jan Driessen, Apostolis Sarris, Sylviane Déderix) and the Greek authorities, together with the invaluable research of Omer Steeno, Maurits Biesbrouk and Theodoor Godeeris, who all share their latest findings in this book. With this wonderful collaborative effort, even though we have not yet found the actual grave, we can truly claim that we have made some history.

Theo Dirix wrote 2 books on the quest of the grave and now will reveal some new insights with his article  in the book “In the Shadow of Vesalius”.

This article continues HERE


The long road to the book "In the shadow of Vesalius"

The following article was written by my good friend Pascale Pollier-Green and it recounts the long road that has taken her and other Vesaliana followers all over the world, and has resulted in the publication of the book "In the Shadow of Vesalius". Dr. Miranda

The concept behind the book “In the shadow of Vesalius” is probably best described by the opening address of the editor and one of the authors, Professor Robrecht Van Hee. Following here are a few excerpts from his transcript:

“The quincentenary of Vesalius’s birthday in 2014 has been characterized by a flow of colloquia and publications on the Flemish anatomist, often presenting new insights concerning his life and death, as well as concerning his works and iconography.

This revival of interest has subsisted and induced new symposia and initiatives, resulting in new congress proceedings and publications, reflecting the search of an increasing number of scholars into the anatomical, social, and artistic influences of Vesalius and his  opus magnum book "De Humani Corporis Fabrica Libri Septem" on 16th century and later scientific evolution.”

Pascale Pollier
Pascale Pollier-Green, author of this article

This book focuses on some of these anatomists, artists, publishers and other personalities, who in different ways remained in the shadow’ of Vesalius.

This is most pertinent in the case of Vesalius’s collaborator and artist Jan Steven van Calcar, whom Vesalius only mentioned as ‘his friend’, but was probably responsible for at least an important number of the plates and figures in the famous Fabrica and Epitome.  This gradually gains momentum enhanced by a recently found drawing (figure 1) which is commented on in the book by Caiati and co-workers, and is believed to be a preliminary sketch  by Jan Steven van Calcar of one of the most iconic drawings in the Fabrica, namely the so-called ‘Philosopher’. (see image)

It is in this light that I would like to take a few people out of the shadows and bring them into the spotlight, and by this, explaining how this book came about.

I first was introduced to Bob Van Hee in 2006 by Ann Van de Velde. Professor Robrecht H. Van Hee who is a surgeon and medical historian, with over 160 publications to his name, has always had a special interest in Andreas Vesalius.  In 2005 he promoted Vesalius for a television contest programme about “Who’s the most famous Belgian in history”.  

In 2007 Ann and I were organizing the AEIMS conference Confronting Mortality with Art and Science”. This conference brought together a group of artists, scientists and medical illustrators.

Bob van Hee and anatomist Francis Van Glabbeek both gave excellent lectures on Vesalius, Triverius and Philip Verheyen during a nocturnal visit to the Plantin Moretus museum in Antwerp.

It was also at this conference I invited Joanna Ebenstein to give a talk on her then new project” The morbid anatomy library blog” which has grown into the amazing art /science platform it is today.

The conference was such a success that we decided to set up BIOMAB, Biological and Medical Art in Belgium,  with a teaching programme ARSIC ( art researches science international collaborations) .

BIOMAB would never have seen the light of day if it wasn’t for the energy, and drive and fearless enterprising spirit of hematologist and medical artist; Dr. Ann Van de Velde. Over the years we have organized many dissection drawing workshops, exhibitions, conferences, made films and books and have written many articles and given many lectures. Our article in the book  “Anatomical Drawing From Cadavers – Limb by Limb Removed -- Brought Us Together” elucidates our collaborations and our intension and achievements.

 Image attributed to Jan Stephan Van Calcar
Click on the image for a larger version
Anatomist and surgeon Professor Francis Van Glabbeek, founding member and currently President of BIOMAB, and a passionate collector of antiquarian medical books, has been a driving force in continuing Vesalius’s legacy by bringing artists together with scientists, and, in the spirit of Vesalius, teaching anatomy from direct observation. I remember the first meeting with Francis with much fondness. He lovingly showed me a first edition of the Fabrica and spoke with so much passion and knowledge about the work and influence that Vesalius and the Fabrica still have on anatomy today.

This article continues HERE