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

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.

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
. "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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The Balmis expedition

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.

The Balmis Expedition (1803 -1806)  The “Royal Philanthropic Vaccine Expedition”, otherwise known as the "Balmis expedition" is a little known chapter in the history of the eradication of smallpox from this world.

One of the unintended consequences of the Spanish invasion of the New World and the work of the “Conquistadores” was the introduction of smallpox to a virgin population. Other viruses were also introduced, so that between smallpox, measles, rubella, etc. it is said that in 1520 almost 50% of the population of Mexico died because of a biological infection.

Edward Jenner (1749 – 1823) discovered in 1796 that someone infected with cowpox would be protected against smallpox. The vaccine and the expansion of its use brought some relief to Europe, but the damage caused by smallpox in the Spanish colonies was catastrophic. Smallpox in its more virulent variety carried at the time a mortality rate close to 30%, leaving those who survived the virus with skin pockmarks or blinded for life. It is estimated that towards the end of the 18th century, 400,000 people died in Europe because of smallpox, and one third of the survivors were left blind.

 Don Francisco Javier de Balmis y Berenguer

A solution was needed, so in 1803 the Spanish king Carlos IV commissioned Don Francisco Javier de Balmis i Berenguer (1753 – 1819), a Spanish phyisician, to find a solution to the smallpox problem. While planning what was later to be known as the “Royal Philanthropic Vaccine Expedition” Balmis received critical contributions from Don Antonio de Gimbernat y Arb?s (of Gimbernat’s ligament).

The main problem to this expedition was that there was no refrigeration, and the vaccine production and storage as we know it today had not been invented. The procedure was simple: Inoculate the live virus of cowpox from someone who was infected with cowpox. The solution was brilliant. A group of 10 physicians and 25 orphaned children were recruited along with nurses, and having at least one infected child on board each ship, the expedition sailed on November 30, 1803. During the long voyage, child after child were sequentially infected with the smallpox virus so that four months later, on March 19, 1804, the expedition landed in Venezuela with a child with the virus.

From here, the same method was used to distribute the vaccine North and South, to cover all of the Spanish territories until 1810. The original expedition is known as the “Balmis expedition”, and Balmis returned to Spain in 1806. Other expeditions were named after other leaders (Salvany, Justiniano, Grajales y Bola?os, etc.) but all carried the original strain brought to the Americas by Balmis. Although the original 25 children were granted the title of “special children of the Spanish nation”, no one knows how many children were used in the end, or what was their eventual fate transplanted away from their homes.

The image in this article, courtesy of Wikipedia, is a bust found at the Medical College of the Miguel Hernandez University in San Juan de Alicante, Spain

1. “La viruela, aliado oculto en la conquista espa?ola” Sanchez-Silva, DJ. INFORMED 2007; 9 (12) 581-587
2. “La expedici?n de Balmis” Laval ER Rev Chil Infect 2003; 107-108
3. “Antonio de Gimbernat, 1734-1816” Matheson NM. Proc R Soc Med 1949; 42: 407-10.
4. “La vuelta al mundo de la expedici?n de la vacuna (1803-1810)” Diaz de Yraola, G. (2003)
5. “La segunda expedicion de Balmis” Tuells, J.; Duro-Torrijos, JL G Med Mex 2013 (149) 377-84

Original image courtesy of Wikipedia