MTD

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

Marcia Crocker Noyes
(1869 – 1946)

Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore... This is certainly an article that can be called "A Moment in History"

Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]

Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.

The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.

Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!

Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.

Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.

Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.

In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.

The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.

Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]

NOTE: This article has been modified from the original Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.

Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding

"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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Details: Written by: Efrain A. Miranda, Ph.D.; Published: October 31, 2024

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.

Ether Dome Skylight

During one of many trips this year, I found myself with a free day in Boston, Massachusetts. Had a recommendation to try and visit the Ether Dome, which I did, and it was an interesting, although short, experience.

The Ether Dome is the name given by the Massachusetts General Hospital (MGH) to the first operating room of the MGH and it is located under the dome at the top of the Bullfinch Building, named after its architect Charles Bullfinch (who later became one of the architects for the USA Capitol). The reason for the location of the operating room is that there is a large skylight that provided the light for the operations.

The operating room was in service between 1821 and 1867 and over 8,000 operations were performed here. It was later used as a storage are, a nurse’s dormitory, a dining room, and today as a teaching auditorium. It still has the arrangement of a semicircular staired pavilion, as in the early days of the operating room. The Ether Dome was designated a National Historic Site in 1965.

The reason for the name Ether Dome is that in this location, on October 16, 1846, anesthesia was used successfully for the first time. The surgeon was John C. Warren, one of the MGH’s founders. The anesthesiologist was William T. G. Morton, a dentist. The patient was Gilbert Abbott. The operation was the excision of a neck tumor. Upon waking up, the patient said that he had felt no pain.

This event was so revolutionary that painting and images have bee created all over to remember the occasion. One of most creative was the work done for a mural called “Ether Day, 1846” The artists were Warren and Lucia Prosperi, who in 2000-2001 took photographs of surgeons and administrators at MGH in period clothing in different poses to recreate the event of the first use of anesthesia. An oil painting of the mural can be seen at the Ether Dome. If you are interested in visiting the MGH, I recommend planning your visit with the Paul S. Russel Museum of Medical History and Innovation. The museum itself is worth visiting. If you want, the Russel Museum has a virtual tour of the Ether Dome and the Hospital, click here.

Since the Ether Dome is an active teaching auditorium, it is not always available for visitors, to it is good to call ahead, I did not, and was lucky to enter the auditorium prior to a welcome meeting for first year medical students. What an historical location to begin your medical career!

The Ether Dome houses a plaster cast of a Roman statue, the Apollo Belvedere, an Egyptian mummy, and an old human skeleton used for teaching.

A large plaque on the wall reads: ” On October 16, 1846 in this room, then the operating theatre of the Hospital, was given the first public demonstration of Anæsthesia to the extent of producing insensibility to pain during a serious surgical operation. Sulphuric ether was administered by William Thomas Green Morton, a Boston dentist. The patient was Gilbert Abbott. The operation was the removal of a tumor under the jaw. The surgeon was John Collins Warren.
The patient declared that he had felt no pain during the operation and was discharged well, December 7. Knowledge of this discovery spread from this room throughout the civilized world and a new era for surgery began.”

Here is a photograph of a later operation in 1847 where Morton and Warren can be seen.

I have written several articles about this topic, the event, and its protagonists. Here are some of the links:

Anesthesia
The first use of anesthesia in surgery
William T.G. Morton
Oliver W. Holmes Sr. (who coined the term “anesthesia”)

Note: Ether Dome Skylight image. Ravi Poorun [oddityinabox] CC BY-SA 3.0, via Wikimedia Commons. Public Domain

Details: Published: October 22, 2024

John Marshall (1818 – 1891)

The ligament of Marshall (LOM) is the embryological remnant of the sinus venosus and left cardinal vein. It contains fat, fibrocellular tissues, blood vessels, muscle bundles (bundles of Marshall), autonomic nerve fibers, and some ganglia corresponding to the ganglionated plexuses (plexi) of the heart.

It was first described by John Marshall (1818-1891) in an 1850 paper titled “On the Development of the Great Anterior Veins Man and Mammalia; including an Account of certain remnants of Fœtal Structure found in the Adult, a Comparative View of these Great Veins the different and an Analysis of their occasional peculiarities in the Human Subject”. In this paper, Marshall makes a detailed embryological description of the structures that derive from the left cardinal vein in the human and adds comparative anatomy with other mammalian species.

The left cardinal vein, which originally enters the left side of the sinus venosus, regresses and modifies leaving the following structures in the adult: From superior to inferior they are the brachiocephalic vein, the obliterated duct of Cuvier, the oblique vein of the left ventricle, and the coronary sinus.

The embryological remnant of the left cardinal vein closes and forms a fibrous cord known as the “duct of Cuvier” (named a after French anatomist and naturalist, Baron de la Cuvier (1769 – 1832)). As this fibrous cord crosses the gap between the left pulmonary vein and the left superior pulmonary vein, the visceral pericardium creates a fold over it; that fold is the ligament of Marshall.

In his paper John Marshall calls it the “vestigial fold of the pericardium”. He describes in this fold “a duplicature of the serous layer of the pericardium, including cellular and fatty tissue, the vestigial fold contains some fibrous bands, small blood-vessels and nervous filaments” …” in the interval between the pulmonary artery and vein”.

The image shows the ligament of Marshall (yellow arrow), the left pulmonary artery (LPA), and the left superior pulmonary vein (LSPV). Click on the image for a larger depiction.

Marshall continues his description as the LOM descends toward the heart and states that there is a portion of the left cardinal vein that is total obliterated and sometimes “wanting”. This is the obliterated portion of the duct of Cuvier, which he does not specifically describes in the LOM. In some cases, Marshall says that the duct is absent and replaced by some whitish fibrous streaks crossing the base of the left pulmonary veins. Today we call this the “obliterated portion of the vein of Marshall”.

He then continues describing a small vein that continues towards and opens in the superior aspect of the coronary sinus. This is the patent portion of the duct of Cuvier, and he calls this structure the “small oblique auricular vein”. Today we call this the “oblique vein of the left atrium” or eponymically, the “vein of Marshall”. The coronary sinus is the end portion of the left cardinal vein.

Contemporary studies on the structure of the LOM have described autonomic nerve fibers and aggregations of neuronal bodies (ganglia) on and around the LOM. Also, cardiac musculature extending from the left atrium, and the coronary sinus over the root of the vein of Marshall have been described (bundles of Marshall).

In some cases, the left cardinal vein does not regress and presents in the adult as a “persistent left superior vena cava”. In this case there is no obliterated duct of Cuvier, the oblique vein of the left atrium and coronary sinus are enlarged, and the venous blood from the head and the left upper extremity drains through the coronary sinus into the right atrium. The following image shows a persistent left superior vena cava (yellow arrow), the left atrial appendage (LAA), the left pulmonary artery (LPA), and the left superior pulmonary vein (LSPV). Click on the image for a larger depiction.

Because of the autonomic nerve fibers and ganglia involved, the LOM (and coronary sinus) have been described as being one of the potential foci for atrial fibrillation (AFib) and has become a target for ablation in AFib surgical procedures.

Personal note: My personal thanks to my good friend and contributor to "Medical Terminology Daily", Dr. Randall K. Wolf for the surgical images.

Sources:
1. “On the Development of the Great Anterior Veins Man and Mammalia; including an Account of certain remnants of Fœtal Structure found Adult, a Comparative View of these Great Veins the different and an Analysis of their occasional peculiarities in the Human Subject” Marshall, J. 1850 Phil Trans R Soc 140:133 – 170
2. “The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias” Kim, D, Lai, A, Hwang, C. et al. JACC. 2000 Oct, 36 (4) 1324–1327.
3. “Myocardium of the Superior Vena Cava, Coronary Sinus, Vein of Marshall, and the Pulmonary Vein Ostia: Gross Anatomic Studies in 620 Hearts” DeSimone CV, Noheria A, Lachman N, Edwards WD, et al. J Cardiovasc Electrophysiol. 2012 Dec; 23(12)
4. “Correlative Anatomy for the Electrophysiologist: Ablation for Atrial Fibrillation. Part I: Pulmonary Vein Ostia, Superior Vena Cava, Vein of Marshall” Macedo PG, Kapa S, Mears JA, Fratianni A, Asirvatham SJ. J Cardiovasc Electrophysiol. 2010 Jun 1;21(6):721-30.
5. “"Human Embryology" WLJ Larsen 1993 Churchill Livingstone
6. “Langman's Medical Embryology" Sadler, T.W. 7ed. Baltimore: Williams & Wilkins, 1995.
7. "Vascular Surgery: A Comprehensive Review" Moore, Wesley S. USA: W.B. Saunders, 1998.
8. Portrait of J. Marshall by Alphonse Legros, Courtesy of Wikipedia. Public Domain.

Details: Published: October 09, 2024

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.

John Marshall (1818 – 1891)

John Marshall (1818 – 1891) British anatomist and surgeon. Initially, he apprenticed with Dr. Wales in Wisbech. In 1838 he entered the University College, London, where he studied with William Sharpey (1802 – 1880), who was then teaching physiology. In 1849 Marshall became a Fellow of the Royal College of Surgeons of England.

In 1845 he became a demonstrator of anatomy at University College, London and in 1847 with the help of Jones Quain (1796 – 1865) and William Sharpey he was appointed as assistant surgeon.

Marshall was appointed professor of surgery at University College in 1866, and in 1884 he was appointed consulting surgeon to University College Hospital.

He was known as a great artist and used his abilities to teach anatomy with the help of blackboards. He lectured on anatomy to art students, and one of his books is titled “Anatomy for Artists” (London, 1878), which was received with great enthusiasm by his art students.

John Marshall wrote several books and works, mentioned in the “Sources” section of this article, but he is probably better known for his association with the eponymic “Ligament of Marshall”. In 1850, he published a detailed description (36 pages) of the embryology of the cardinal veins, the superior vena cava, and the presence of a persistent “left superior vena cava” with a description of the oblique vein of the left atrium, the obliterated Duct of Cuvier, and the fold of pericardium over this duct that today carries his name.

The paper was published in the journal “Philosophical Transactions of the Royal Society”, and the title was “On the Development of the Great Anterior Veins Man and Mammalia; including an Account of certain remnants of Fœtal Structure found in the Adult, a Comparative View of these Great Veins the different and an Analysis of their occasional peculiarities in the Human Subject”. The sketches that accompany this seminal paper were drawn by him.

If you are interested in reading this paper, it is available online at the Royal Society website. For the actual publication in PDF format, click here.

Marshall also is recognized for being one of the first to use electrocautery in surgery, as well as being a pioneer in the removal of lower extremity varicose veins. He was the first to demonstrate that cholera can be spread through contaminated drinking water.

The image shows the ligament of Marshall (yellow arrow), the left pulmonary artery (LPA), and the left superior pulmonary vein (LSPV).

Personal note: My thanks to an attendee to one of my cardiovascular lectures. He asked who was Marshall of the "ligament of Marshall:... Here is the answer. Dr. Miranda.

Sources and publications:
1. “A Description of the Human Body, its Structure and Functions” London, 1860, 4to, with folio plates; 4th ed. 1883.
2. “Anatomy for Artists” London, 1878, royal 8vo; 2nd ed. 1883; 3rd edit. 1890.
3. “A Rule of Proportion for the Human Figure” 1878, fol.
4 “A Series of Life-size Anatomical Diagrams” seven sheets.
5. “Physiological Diagrams” life size, eleven sheets.
6. “On the Relations between the Weight of the Brain and its Parts, and the Stature and Mass of the Body” 1892, J Anat Physiol
7. “The Brain of the late George Grote” 1892, J Anat Phys
8. “On the Development of the Great Anterior Veins Man and Mammalia; including an Account of certain remnants of Fœtal Structure found in the Adult, a Comparative View of these Great Veins the different and an Analysis of their occasional peculiarities in the Human Subject” 1850 Phil Trans R Soc 140:133 - 170
9. Portrait of J. Marshall by Alphonse Legros, Courtesy of Wikipedia. Public Domain.

Details: Published: June 27, 2024

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.

Georg Eduard von Rindfleisch
G.E. Rindfleisch (1836 – 1908)

Georg Eduard Von Rindfleisch (1836 – 1908), German pathologist and histologist of Bavarian nobility ancestry. Rindfleisch studied medicine in Würzburg, Berlin, and Heidelberg, earning his MD in 1859 with the thesis “De Vasorum Genesi” (on the generation of vessels) under the tutelage of Rudolf Virchow (1821 - 1902). He then continued as a assistant to Virchow in a newly founded institute in Berlin. He then moved to Breslau in 1861 as an assistant to Rudolf Heidenhain (1834–1897), becoming a professor of pathological anatomy. In 1865 he became full professor in Bonn and in 1874 in Würzburg, where a new pathological institute was built according to his design (completed in 1878), where he worked until his retirement in 1906.

He was the first to describe the inflammatory background of multiple sclerosis in 1863, when he noted that demyelinated lesions have in their center small vessels that are surrounded by a leukocyte inflammatory infiltrate.

After extensive investigations, he suspected an infectious origin of tuberculosis - even before Robert Koch's detection of the tuberculosis bacillus in 1892. Rindfleisch 's special achievement is the description of the morphologically conspicuous macrophages in typhoid inflammation. His distinction between myocardial infarction and myocarditis in 1890 is also of lasting importance.

Associated eponyms

"Rindfleisch's folds": Usually a single semilunar fold of the serous surface of the pericardium around the origin of the aorta. Also known as the plica semilunaris aortæ.

"Rindfleisch's cells": Historical (and obsolete) name for eosinophilic leukocytes.

Personal note: G. Rindfleisch’s book “Traité D' Histologie Pathologique” 2nd edition (1873) is now part of my library. This book was translated from German to French by Dr. Frédéric Gross (1844-1927) , Associate Professor of the Medicine Faculty in Nancy, France. The book is dedicated to Dr. Theodore Billroth (1829-1894), an important surgeon whose pioneering work on subtotal gastrectomies paved the way for today’s robotic bariatric surgery. Dr. Miranda.

Sources:
1. "Stedmans Medical Eponyms" Forbis, P.; Bartolucci, SL; 1998 Williams and Wilkins
2. "Rindfleisch, Georg Eduard von (bayerischer Adel?)" Deutsche Biographie
3. "The pathology of multiple sclerosis and its evolution" Lassmann H. (1999) Philos Trans R Soc Lond B Biol Sci. 354 (1390): 1635–40.
4. “Traité D' Histologie Pathologique” G.E.
Rindfleisch 2nd Ed (1873) Ballieres et Fils. Paris, Translated by F Gross.

Details: Published: May 10, 2024

"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"

Cover page of Regimen Sanitatis Salernitatum c. 1480

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.

The author of the book was Constantinus Africanus of Carthage (1020-1087). His birth and original religion is in question, some stating that he was a Sarracen, and therefore born as a Muslim. He traveled extensively in Egypt, Greece, Italy, and India. His ability to read and speak Arabic, Latin, Greek, and other languages, helped him later to be considered one of the important translators of medical books bringing lost Latin and Greek knowledge in books from Arab countries into Europe.

After arriving in Salerno, Constantinus became a monk and dedicated his life to the publication of medical translation, not hesitating to call other's works as his own.

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"