Medical Terminology Daily - Est. 2012

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

William S. Halsted, MD

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov


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Abdominal regions - Modified from the original Davis, 1910 
Abdominal regions


UPDATED
: In surface anatomy the abdomen can be divided into nine regions by named lines (or planes): transpyloric, transtubercular, and midclavicular. These regions have specific visceral content.

• Hypochondriac regions (right and left): [Hypo]="below"; [chondr]="cartilage"; [iac]=”pertaining to”. In this context, the term means “below or deep to the cartilage (of the ribs)". The right hypochondriac region contains the liver, gallbladder, portal vein, and the right colic flexure. The left hypochondriac region contains the stomach, spleen, tail of the pancreas, and left colic flexure. For a detail on how the name of this region relates to a mental disorder, click here.

• Epigastric region: [Epi]="above"; [gastr]="stomach”; [ic]=”pertaining to". The term means “above the stomach”. This region contains mostly stomach and abdominal esophagus

• Lumbar regions (right and left): Right and left lumbar regions. The term [lumbar] refers to the area of the loins. The right lumbar region contains the ascending colon and part of the right kidney. The left lumbar region contains the descending colon and part of the left kidney

• Umbilical region: Centered around the umbilicus, this region contains mostly small intestine, abdominal aorta, and greater omentum

• Inguinal regions (right and left): From the Latin [inguen]=”groin". Gaius Plinius Secundus aka “Pliny” (23-79 AD) first used this term naming after a plant (inguinalis) which he used to treat hernias of the groin. The right inguinal region contains the cecum and small intestine. The left inguinal region contains the sigmoid colon. In older days, as shown in the sketch, these regions were called the "iliac regions".

• Hypogastric region: [Hypo]="below"; [gastr]="stomach”; “ic”=”pertaining to. The term means “below the stomach”. The hypogastric region contains mostly small intestine and greater omentum. This region used to be called the "pubic region"

A clinical importance of these abdominal regions is that a ventral hernia is usually named by the anatomical region where it protrudes. Based on the image, you will see then why a hernia can be umbilical, inguinal, lumbar, epigastric, or hypogastric.

Sources:
1. "Clinical Anatomy" Brantigan, OC 1963 McGraw Hill
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. Davis, Gwilym G. "Applied Anatomy: The Construction of the Human Body Considered in Relation to Its Functions, Diseases, and Injuries"; Philadelphia: J.B. Lippincott Co., 1910
Image modified from the original Davis, 1910