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A Moment in History

Self-portrait, Henry Vandyke Carter, MD (Public Domain)
Self-portrait, Henry Vandyke Carter, MD (Public Domain)

Henry Vandyke Carter, MD
(1831 – 1897)

English physician, surgeon, medical artist, and a pioneer in leprosy and mycetoma studies.  HV Carter was born in Yorkshire in 1831. He was the son of Henry Barlow Carter, a well-known artist and it is possible that he honed his natural talents with his father. His mother picked his middle name after a famous painter, Anthony Van Dyck. This is probably why his name is sometimes shown as Henry Van Dyke Carter, although the most common presentation of his middle name is Vandyke.

Having problems to finance his medical studies, HV Carter trained as an apothecary and later as an anatomical demonstrator at St. George’s Hospital in London, where he met Henry Gray (1872-1861), who was at the time the anatomical lecturer. Having seen the quality of HV Carter’s drawings, Henry Gray teamed with him to produce one of the most popular and longer-lived anatomy books in history: “Gray’s Anatomy”, which was first published in late 1857.  The book itself, about which many papers have been written, was immediately accepted and praised because of the clarity of the text as well as the incredible drawings of Henry Vandyke Carter.

While working on the book’s drawings, HV Carter continued his studies and received his MD in 1856.

In spite of initially being offered a co-authorship of the book, Dr. Carter was relegated to the position of illustrator by Henry Gray and never saw the royalties that the book could have generated for him. For all his work and dedication, Dr. Carter only received a one-time payment of 150 pounds. Dr.  Carter never worked again with Gray, who died of smallpox only a few years later.

Frustrated, Dr. Carter took the exams for the India Medical Service.  In 1858 he joined as an Assistant Surgeon and later became a professor of anatomy and physiology. Even later he served as a Civil Surgeon. During his tenure with the India Medical Service he attained the ranks of Surgeon, Surgeon-Major, Surgeon-Lieutenant-Colonel, and Brigade-Surgeon.

Dr. Carter dedicated the rest of his life to the study of leprosy, and other ailments typical of India at that time. He held several important offices, including that of Dean of the Medical School of the University of Bombay. In 1890, after his retirement, he was appointed Honorary Physician to the Queen.

Dr. Henry Vandyke Carter died of tuberculosis in 1897.

Personal note: Had history been different, this famous book would have been called “Gray and Carter’s Anatomy” and Dr. Carter never gone to India. His legacy is still seen in the images of the thousands of copies of “Gray’s Anatomy” throughout the world and the many reproductions of his work available on the Internet. We are proud to use some of his images in this blog. The image accompanying this article is a self-portrait of Dr. Carter. Click on the image for a larger depiction. Dr. Miranda

Sources:
1. “Obituary: Henry Vandyke Carter” Br Med J (1897);1:1256-7
2. “The Anatomist: A True Story of ‘Gray’s Anatomy” Hayes W. (2007) USA: Ballantine
3. “A Glimpse of Our Past: Henry Gray’s Anatomy” Pearce, JMS. J Clin Anat (2009) 22:291–295
4. “Henry Gray and Henry Vandyke Carter: Creators of a famous textbook” Roberts S. J Med Biogr (2000) 8:206–212.
5. “Henry Vandyke Carter and his meritorious works in India” Tappa, DM et al. Indian J Dermatol Venereol Leprol (2011) 77:101-3


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Commotio Cordis

I have received several questions regarding this term and its meaning, because of the cardiac arrest suffered on the field by the Buffalo Bills defensive player Damar Hamlin while playing the Cincinnati Bengals on January 2nd, 2023.

For those who were watching the game, close to the end of the first quarter Hamlin blocked another player in what looked like a normal and standard play. Immediately after, Damar Hamlin stood up and immediately collapsed. The video can be seen here. The player was treated on the field and later reports indicated that he had suffered a cardiac arrest and was treated with CPR (manual cardiopulmonary resuscitation), the use of an AED (Automated External Defibrillator) and oxygen. The player was intubated and was considered to be in critical, but stable condition.

The consensus is that Damar Hamlin suffered a ventricular arrhythmia, which allowed the heart to beat erratically, but not be able to pump blood, which is why he had to be defibrillated using the AED.

The cause for this is an uncommon (30 cases per year in the US) but known situation known as Commotio Cordis, a ventricular dysrhythmia caused by a sudden hit to the sternum in a particular location*. It has been seen in baseball and softball players where the pitcher is hit in the sternum by a fast ball coning from first base. Also seen in lacrosse players. In most cases this happens in younger individuals where the four sternabrae that form the body of the sternum have not yet completely ossified, making the sternum and lower costal cartilages quite flexible, being able to “bend in” when hit directly and compress the heart.

As some of you may know, I am a 7th Degree Black Belt in Goju-Ryu Karate. This type of punch to the sternum is one of the many techniques used in advanced Martial Arts. In most cases this punch will slow down an opponent, but it does not cause Commotio Cordis. It is a technique that should only be practiced under very close supervision. In fact, this technique was thought to be legend and was called “the touch of death” in China.

An example of Commotion Cordis caused by a Karate move can be see in the following video. Look at the hand of the practitioner on the right and the devastating consequence that follows. Please note the similarity of the situation in this video and what happened to Damar Hamlin. There is a lapse of time between the commotio cordis cardiac arrest where the athlete gets up or walks followed fainting and unconsciousness.

The words are Latin. Commotio means “agitation or commotion”. Cordis means heart. The conditions to cause Commotio Cordis need to be exact, as the heart needs to be in ventricular repolarization, when the heart ventricles are starting to refill with blood. The "window" for a sternal hit to cause Commotio Cordis is very small.

For additional information please visit StatPearls at https://www.statpearls.com/ArticleLibrary/viewarticle/19761 


Friggatriskaidekaphobia / paraskevidekatriaphobia

UPDATED: This article was originally titled "[friggatriskaidekaphobia], a word that means "fear of Friday the thirteenth".

It is based on the term [triskaidekaphobia] which means "fear of the number thirteen". Although in modern Greek the number thirteen is pronounced [dekatria] (δεκατρία), the term triskaideka means "three and ten" in older Greek. Add the suffix [phobia] meaning "fear" and you have the word triskaidekaphobia. An alternate spelling is triskadekaphobia

The term [Frigga] refers to a Norse goddess after whom the name for the day Friday originates. Frigga is the wife of Odin and the mother (or stepmother, depending on who interprets old traditions) of Thor.

Reading the book "Complications: Notes from the Life of a Young Surgeon" by Atul Awande. MD (one of the books in my library) I came across a synonym for this concept, the word "paraskevidekatriaphobia" also written as "paraskevideikatriaphobia". The author does not explain the origin or etymology of the term. What he does say is that in the United States, on Friday the 13th, people "perform rituals before leaving the house, call in sick to work, or postpone flights or major purchases, causing businesses to lose $750 million annually". Keep in mind that this book was written in 2002. A simple calculation at https://www.inflationtool.com/ shows that by 2022, this corresponds to 1.2 billion dollars!

The origin of the superstition that Friday the 13th is a bad day started on Friday the 13th, 1307. On this date all the Knights Templar were rounded, arrested, accused, tortured, and executed. It is indeed a bad day, but only if you are a member of the Knights Templar!


Book: Myology before Vesalius – Giovanni Batista Canani –

This is a book published recently by my good friends Francis Van Glabbeek, Maurits Biesbrouck, and Jacqueline Vons.

This group is dedicated to the works of Andreas Vesalius and his influence on Medicine, Surgery and the Arts. As part of the analysis of Vesalius’ works they started research on a far less-known anatomist, Giovanni Battista Canani (1515 - c.1579). Cananis’ last name is sometimes presented as Canano.

The authors researched a book of which there are only 15 known copies in the world, far less than Vesalius’ Fabrica, "Musculorum Humani Corporis Picturata Dissectio". Of these 15 copies, only two are in the USA, one at Yale University, the other at Duke University. The online version of the Duke University can be seen or downloaded here.

Canani was born in Ferrara, Italy and was a remarkable and leading physician-anatomist in the sixteenth century, but he is far less well known today than contemporaries such as Vesalius, Fallopio or Colombo.His only work on the muscular anatomy of the upper limb Musculorum Humani Corporis Picturata Dissectio (Dissection Images of the Muscles of the Human Body) can in fact be considered as a masterpiece of its time, no less innovative than Vesalius’ Fabrica. The book is revolutionary in its content and contains copper etchings of exceptional quality and precision. This is the result of Canani’s extensive dissections of human corpses, performed meticulously and with a determination to discover the tiniest details of the human anatomy.

Book cover - Myology Before Vesalius
Book cover - The Anatomist by Bill Hayes 

In fact, Canani came from a distinguished medical family and developed into an anatomist at an early age. He was trained by Marcantonio della Torre, an associate of Leonardo da Vinci, and was Pope Julius IIIs personal physician until his death in 1555, after which he became chief physician at the University of Ferrara. He discovered the palmaris brevis muscle in the hand and was the first to describe the valves in the veins, a fact which he communicated to his contemporary, Vesalius. Around 1542, he published a small volume of twenty leaves on the muscles of the arm and forearm. This was to be the initial book of may be a larger work he planned to produce; however, it was the only book that was completed. It is thought that he felt his work was so overshadowed by Vesalius' Fabrica that he destroyed as many copies as he could recover. This would explain the scarcity of copies of Canani’s original book.

Thankfully, the book by Van Glabbeek, Maurits Biesbrouck and Jacqueline Vons contains a color facsimile of Cananis’ publication and should be a fantastic addition for any student of Medical History or collector of Vesaliana. You can order your copy by clicking here or use the QR code in this article.

cananiqrcode sm ...... Professor Francis Van Glabbeek , anatomist and surgeon, founding member and member of BIOMAB (Biological and Medical Art in Belgium), is 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.

Maurits Biesbrouck is a well known Vesalius scholar who published a Dutch translation of the first volume of the 1543 Fabrica by Vesalius, as well as a Vesalius bibliography as well as a summary and discussion of the editions of his works.

Jacqueline Vons is Professor Emeritus of classical languages at Université François Rabelais in Tours, France. Together with Prof. Stephane Velut, Professor of Anatomy at the same university, she published the first French translation of Vesalius’s Epitome and is currently working on the French translation of Vesalius’s 1543 Fabrica.

Personal note: This is a book that I personally recommend and proud to add to my personal library. Dr. Miranda.

Sources:
1. “Myology before Vesalius - Giovanni Battista Canani (1515 - 1579 n.s.) and his Musculorum Humani Corporis Picturata Dissectio " Van Glabbeek,F; Biesbrouck, M.; Vons, J. 2022. Garant, Belgium.
2. "Musculorum Humani Corporis Picturata Dissectio" Sigersit, HE. 1925 Lier & Co. Florece, Italy.


"The Anatomist" - A True Story of Gray's Anatomy

As you know, I am interested in the history of Science, Medicine, and specially, Human Anatomy. Because of that and as part of this website we added a series called "A Moment in History". The objective was to create a series of articles to honor those individuals who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research including individuals who have contributed in different ways, but still added their life work to the advancement of medical knowledge.

One of the individuals who piqued my interest was Henry Gray, FRS author of one of the great teaching books on anatomy ever written, “Gray’s Anatomy”. This book was first published in England in 1858, later published in the USA from 1862 to 1990. The English Edition is still published and is now in its 42nd Eddition.

I started to look deeper into his life which, I learned with surprise, was not only very short, but obscure. Researching into Henry Gray’s life, I came about this book: “The Anatomist – A True Story of Gray’s Anatomy” by William (Bill) Hayes.

Bill Hayes started looking into Henry Gray’s life with the intent of writing a biography. He rapidly run into a wall. Besides a well-detailed list of academic titles and positions, degrees awarded, and scientific papers that he published. As the author states “what I had gathered about him would amount to little more than a Curriculum Vitae”. So, he starts a journey to uncover more data about Gray’s life and his well-known book.

Book cover - The Anatomist by Bill Hayes
Book cover - The Anatomist by Bill Hayes 

Bill Hayes started looking into Henry Gray’s life with the intent of writing a biography. He rapidly run into a wall. Besides a well-detailed list of academic titles and positions, degrees awarded, and scientific papers that he published. As the author states “what I had gathered about him would amount to little more than a Curriculum Vitae”. So, he starts a journey to uncover more data about Gray’s life and his well-known book.
Henry Gray, FRS (Public Domain)
Henry Gray, FRS (Public Domain)
...... Henry Vandyke Carter, MD
Henry Vandyke Carter, MD

Part of his journey was to understand the importance of anatomy as a component of the medical curriculum, fueled by one of the few photographs that exists of Henry Gray. In this particular 1870 picture by Joseph Langhorn, Gray is in the anatomy laboratory at St. George’s Hospital with his students. Here is a Pinterest link to that photograph.

Bill Hayes was accepted as a participant in the anatomy laboratory for physical therapy students and later visited medical students in the anatomy lab. Just his observations and comments throughout the book on these activities is worth reading this book.

What is interesting is the lack of personal information on Henry Gray. To this date, we do not have information about his birth, either location or date. There is more information on his family that on the subject. Most agree that Henry Gray was born in 1827, but some propose 1825. Either way, there is no firm data. What we do know is that he died on June 12, 1861, having contracted smallpox most probably from his nephew Charles Gray. Henry Gray was 36 years old.

In his research, the author discovers Henry Gray’s collaborator and illustrator of the book: Henry Vandyke Carter, MD. Where Gray is obscure and with no personal information, Henry Carter writes a diary daily, and for some time he actually writes another diary that he calls “Reflections” on more personal and religious topics. Carter is a troubled, complicated individual blessed with incredible anatomical knowledge and drawing capabilities that can be seen throughout the book.

It is because of these diaries that we know Henry Carter and we can glimpse (almost at a distance) the character of Henry Gray, but it is not enough to elucidate his biography. In some ways it is like looking at an individual through a veil. You see him, but it is nebulous.

Much of the book is concentrated on Henry Carter, his life, his depression bouts, his self doubts and the work that he did illustrating Gray’s book. In some ways he is behind the scenes, and even though he did much of the dissection work and illustration, Henry Carter is mostly unknown to the anatomical world, as in may cases the medical illustrators are, with some notable exceptions.

Henry Carter is paid only 150 pounds for his work and even before getting paid he pays for a ticket to India where he accomplishes his objectives in life and in academia. Henry Carter eventually retires and comes back to England where he dies in 1897.

Bill Hayes and his partner visited rare book libraries at different universities and eventually go to London to visit areas and locations where Henry Gray lived and worked. There is a sense of accomplishment, but also a sense that we can almost touch the life of Henry Gray but fall short of seeing him.

The book ending is poignant, dealing with personal matters and thoughts on life and death. Eventually the author is very clear that the study of anatomy, although on dead subjects who donated their bodies to the universities is actually an activity that helps us understand life.

Bill Hayes is an awarded author of seven books, a frequent contributor to the New York Times and a photographer. More information about him and his activities at https://www.billhayes.com

Personal note: This is a book that I personally recommend and proud to add to my personal library. My one observation is that the author should have probably name the book “The Anatomists - A True Story of Gray’s Anatomy” as it is the story of the life of the two Henrys: Gray and Carter. In fact, I believe that Gray’s Anatomy could have been called “Gray’s and Carter’s Anatomy”, had history been slightly different – Dr. Miranda.

Sources:
1. “Henry Gray and Henry Vandyke Carter: Creators of a Famous Textbook" Roberts, S. J Med Biog 2000 8: 206-212
2. "Henry Gray, Anatomist: An Appreciation" Boland, F Am J Med Sci 1908 1827-1924
3. "The Anatomist: A True Story of Gray’s Anatomy" Hayes, B. Random House PG 2007

Rhomboid major

The rhomboid major muscle is found in the posterior aspect of the thorax between the spine and scapula. This muscle originates from the spinous processes of the thoracic vertebrae T2 to T5 as well as the supraspinous ligament at these levels by way of an aponeurosis that varies in width. It inserts on the medial border of the scapula, from about the level of the scapular spine to the inferior angle of the scapula by way of short tendinous fibers.

It adducts, elevates, and inferiorly rotates the scapula. It also helps to maintain the scapula flush with the posterior aspect of the thoracic cage. It is innervated by the dorsal scapular nerve (C4, C5), a branch of the brachial plexus.

The Terminologia Anatomica name for the muscle is musculus rhomboideus major.

The rhomboid major is one of the 17 muscles that attach to the scapula.  

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Morris' Human Anatomy" Pearce, J. (1942) Blakiston Co. Philadlephia USA
6. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010

Image modified from the original by Henry VanDyke Carter, MD. in the book "Grays's Anatomy" by Henry Gray FRS. Public domain

Rhomboid major muscle. Image modified from the original by Henry VanDyke Carter, MD. Public domain
Rhomboid major muscle
Click on the image for a larger depiction

 

Omohyoid

The omohyoid also known as the musculus omohyoideus is the most lateral of the infrahyoid muscles, the others being the sternohyoid, sternothyroid, and thyroid muscles.The omohyoid is a long muscle formed by two muscular bellies (superior and inferior) and an intermediate tendon.

The inferior belly originates from the superior margin of the scapula, near the superior transverse ligament of the scapula. Sometimes, as a variation, the tendon of the inferior belly originates directly from this ligament. The inferior belly passes medially, posteriorly, and slightly superiorly towards the intermediate tendon. The medial aspect of this belly is deep to the trapezius muscle.

The intermediate tendon is held in place by a strong extension of the middle layer of the cervical fascia. This extension has firm attachments to the first rib and the posterior surface of the clavicle.

Along with the other infrahyoid muscles, the omohyoid muscle depresses the hyoid bone. Each belly receives a separate branch that arises from the ansa cervicalis (C1, C2, and C3).

Note: The image in this article was taken from the book "Tratado de Anatomía Humana" by Testut and Latarjet. The illustration was made by George Devy, a famous French painter who specialized in anatomical illustrations (? -1902) and the engraving was made by a Swiss artist, Edmond Boulenaz (1859-1905). This image is in the Public Domain and has been edited by us.

Omohyoid muscle - Image modified from the original. Public domain
Omohyoid muscle.
Click on the image for a larger depiction

The inferior belly of the omohyoid is one of the 17 muscles that attach to the scapula.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010
6. "Petite histoire de l'iconographie anatomique" Huard, P; Imbalt-Huart, MJ Communication présentée à la Société Française d'Histoire de la Médecine, le30 septembre 1972.
7. https://www.anatomicalterms.info