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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

Dr. Thomas Dent Mütter
Dr. Thomas Dent Mütter (1811-1859)

Dr. Thomas Dent Mütter

(1811-1859)

Thomas Dent Mutter was born on March 9, 1811, in Richmond, VA. His mother died in 1813, and his father died of tuberculosis in 1817. Thomas was orphaned when he was barely 8 years old. His father left him a somewhat meager inheritance and in his early life had to do with less that others with his objectives in life. He was well educated under the tutelage of Robert Carter, his guardian, and in 1824 he started his studies at the Hampden Sidney College of Virginia. He continued with a medical apprenticeship with a Dr. Simms in VA. He was well respected and even at his early age he would do home visits for his medical benefactor with great results. He started medical studies at the University of Pennsylvania, where he earned his MD in 1831. The new young doctor, Thomas Dent Mutter, MD was only 20 years of age.

At the time, Europe was the place to go to if you wanted advanced medical studies. Dr. Mutter had no money, so he applied as a ship surgeon to be able to cross the Atlantic. Once in Europe, he spent time in Paris, where he studied under the tutelage of Dr. Guillaume Dupuytren. He later studied for a short time in England where he met Dr. Robert Liston. Following Dupuytren's teachings, Mutter was fascinated by plastic surgery.

A chance encounter with what was to become his first well-known acquisition of a medical curiosity, Mutter started thinking on how to help those people that were known at that time as “monsters”, patients who the general public did not see, because they did not appear in public. The curiosity in question was a wax reproduction of the face of a French woman who had a “horn” arising from her forehead. This piece is on exhibit at the Mütter Museum.

Back in the United States in 1832, Thomas Dent Mutter changed his last name to give it a more “European” sound and added an “umlaut”, so now he was Thomas D. Mütter, MD. It may also be that he wanted to pay homage to his Scottish-German heritage, who knows? He opened his medical office in Philadelphia and although it took time, eventually he had a thriving practice. One of his specialties was the work on “deformities” so common at the time because of facial scars born out of the use of open fires in houses, and deformities caused by burns and loss of tissue due to chemicals used in local industry. Dr. Mütter is the pioneer of what we call today “Reconstructive Surgery”.

In 1835 he was asked to join the Medical Institute of Philadelphia as an assistant professor of Surgery. He was an instant success. Dr. Mütter was adored by his students because, he would question the students and guide them to discovery instead of just lecturing and leaving. In his Discourse eulogy of Dr. Mütter by Joseph Pancoast he writes:” The power of attracting students near him by his mingled gentleness, energy, and enthusiasm; of fixing their attention by the lucid and methodical arrangements of his Subject, by his clear demonstrations, and sprightly oral elucidations, came so readily to him, and was so early displayed) as to seem almost intuitive.” In 1841 Dr Mütter was appointed Professor of Surgery at the Jefferson Medical College in Philadelphia.

Dr. Mütter had always had poor health, even in childhood, and his dedication to his passion, long hours, took its toll on his body. In 1956 he set sail for Europe and resigned his teaching duties. He was named Emeritus Professor of Surgery. Unfortunately, the trip did not help, and he returned to the US in early 1958. Fearful of another winter in cold Philadelphia, he moved to Charleston, SC, where he died on March 19, 1859.

Dr. Mütter’s story does not end here. He was an avid collector and throughout his short life he had pulled together an impressive collection of medical oddities, samples, and curiosities. Knowing that his life was at an end, he negotiated with the Philadelphia College of Physicians to have them host his collection in perpetuity as well as the creation of a trust fund that would ensure that the public and medical students would have access to this incredible collection. Through the years this collection has increased and is known today as the Mütter Museum of the Philadelphia College of Physicians. I strongly urge our readers to visit this incredible museum. For more information, click here.

Personal notes: In the late 90’s, I attended a meeting of the American Association of Clinical Anatomists.  During the meeting I met Gretchen Worden, who at the time was the Curator of the Mütter museum. Gretchen was inspirational, fun, and a great conversationalist! I had the opportunity to visit Gretchen at the Mütter museum and had the luck to be treated to a “behind the scenes” tour. What an experience! I was saddened to hear that Gretchen Worden passed on August 2, 2004. Still, in my recent visit to the Mütter Museum, I was glad to see a new section at the museum that remembers Gretchen. Her biography can be read here.

I would like to thank Dr. Leslie Wolf for lending me the book by O’Keefe that lead to me writing this article. Dr. Miranda

Sources:
1. “Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine” O’Keefe, C. 2015 Penguin Random House, LLC
2. “A Discourse Commemorative of the Late Professor T.D. Mütter” Pancoast, J. 1859 J Wilson Publisher
3. “Thomas Dent Mütter: the humble narrative of a surgeon, teacher, and curious collector” Baker, J, et al. The American Surgeon, Atlanta 77:iss5 662-14
4. “Thomas Dent Mutter, MD: early reparative surgeon” Harris, ES; Morgan, RF. Ann Plast Surg 1994 33(3):333-8
5. “5 Things I Learned from Thomas Dent Mütter” O’Keefe C.


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Kernicterus

Kernicterus is a disorder where excess bilirubin accumulates in the deep neural tissues of the brain and can cause brain damage in the newborn.

It is characterized by jaundice and a limpness of the newborn, devoid of energy. Can present with seizures, convulsions, and muscle spasms.

This condition is treatable and requires awareness from the parents if yellowness of the skin (jaundice) is detected along with the above-mentioned signs in the early days post-partum. There are other signs not mentioned in this article

The word [kernicterus] comes from the German word [kern], meaning “nucleus” or “core”. In this particular word the term kern refers to the fact that one of the most importantly affected brain structures in kernicterus are the basal ganglia of the brain (also known as the "central nuclei", found at the "core" of the brain. It also includes the word [icterus] from the Greek word [ικτερός] pronounced (ikterós). The word [icterus] in Greek was originally used to denote a yellow bird, and is now used to denote the yellow color of jaundice.

 Newborn with kernicterus jaundice
Click on the image for a larger version. 

We would like to thank diseasepictures.com for the image in this article. For additional information on neonatal jaundice, click here.

Sources:
1. Clayman, L. "The AMA Encyclopedia of Medicine" 1989. Random House, NY
2. “The Origin of Medical Terms” Skinner HA 1970 Hafner Publishing Co.

Thanks to Jackie Miranda-Klein for her contribution suggesting this word. Please consider contributing to Jackie's medical mission to Belize by "clicking here".


Parenchyma

The term [parenchyma] is a Greek term (παράένχέω). Its origin and meaning have little relation to the medical use of the term. The word means "that what is poured" or to "pour in". The actual definition of the term is "the proper mass of a solid organ". If someone refers to the "liver parenchyma", they are referring to the hepatic tissue, so it is with any other solid organ.

The etymology of the word is obscure and reflects ancient physiological theories and history. Vesalius mentions that the word was introduced by Erasistratus circa 300BC. He thought that the blood was "poured" into the organ and then this poured fluid would congeal to form the organ's proper mass. With time this concept was abandoned, but the word persisted to its modern meaning.

Interesting, there are many which accentuate the word wrongly. The accent or stress should be on the letter "e" and not on the letter 'y", so it should be pronounced "parénchyma"


Layers of the GI tract

The gastrointestinal (GI) tract is formed, with a few exceptions, by four concentric layers of tissue. These are, from deep to superficial, the mucosa, submucosa, muscular (or muscularis) and the serosa layers. This is the simplified version. The fact is that there are more sublayers.

The mucosa layer is characterized by the presence of intestinal villi, which in the stomach and small intestine contribute to absorption of the digested food. The mucosa has a thin layer of connective called the "lamina propia" and external to it a thin layer of smooth muscle, the muscularis mucosae.

Layers of the gastrointestinal tract
Images property of:CAA.Inc.Artist:Dr. E. Miranda
The submucosa layer is formed by irregular connective tissue and contains on its most external region a plexus of nerves and neurons, the "submucosal plexus of Meissner", which provides parasympathetic innervation to glands and the muscularis mucosae.

The muscular layer, also known as the "muscularis" is composed of two sublayers of smooth muscle. The deep layer contains circular fibers and is known either as the "circular muscle layer" or the "muscularis interna", the superficial layer contains longitudinal smooth muscle fibers and is known as the "longitudinal muscle layer" or the muscularis externa. Between both muscle layers lies the "myenteric plexus of Auerbach", a layer of sympathetic and parasympathetic nerves and neurons that provides nerve supply to the muscular layer. The combined action of this plexus on the muscular layer is responsible for peristalsis.

The serosa layer is the outer or external layer and is formed by a layer of peritoneum. As such, this layer can also be called "visceral peritoneum".

There are variations from GI organ to GI organ in the arrangement, content, glands, thickness of the layers, etc. The most important differences can be found in the thoracic esophagus and most of the rectum which are devoid of a serosa layer, and in the stomach, where there is a third muscular layer, deep to the circular layer, called the "oblique layer" that contributes fibers to the lower esophageal sphincter found at the esophagogastric junction.


Manubrium

UPDATED: The word [manubrium] is Latin and mean "handle", referring to the area where a person holds an instrument or device. To exemplify this, in Spanish the vernacular use of the word [manubrio] refers to the handles of bicycle or even the steering wheel of a car. 

In anatomy, the term is used with the same meaning. In the malleus, a hammer-like ossicle of the middle ear, the manubrium is the handle-like extension of the bone that attaches to the tympanic membrane.

In the case of the sternum, the [manubrium sterni] is the superior portion bound by the sternal angle (of Louis) inferiorly.  The use of the word manubrium can be explained because in early anatomy, the sternum was known by the Latin term [gladius] referring to the similarity of the sternum to the short sword of the gladiators. The area where you hold the sword is the handle, ergo, manubrium.

The manubrium has a superior and median notch called the "suprasternal notch" or the "jugular notch". It is important because in the case of a mediastinoscopy, the incision is made just superior to this landmark. The manubrium articulates superolaterally with the clavicle and inferolaterally with the superior aspect of the cartilage of the second rib. The rest of the rib cartilage articulates with the body of the sternum.

Image property of:CAA.Inc.. Artist: Mark J. Zuptich

Sternal angle - Angle of Luis
Click on the image for a larger version.

Induration

The word [induration] arises from the Latin words induratio, meaning "thick or hard" and indurare, meaning "hardening".

It refers to a pathological hardening of tissues caused by tumoration or edema, increase of fibrous or connective tissue, or other causes. It is a good, descriptive term when stating a patient's symptoms. The term has been in use in English since the 14th century.

Note: The links to Google Translate include an icon that will allow you to hear the pronunciation of the word.


It's our 20th year anniversary!!!

20 year Anniversary

At the beginning of 1998, Clinical Anatomy Associates, Inc. was formed as an Ohio Corporation. Our mission is to deliver industry relevant, cutting-edge Training, Marketing, and R&D services that will enable our clients to gain a competitive advantage. Over the past two decades, Clinical Anatomy Associates, Inc. has become the go-to R&D resource for feasibility studies that require cadaver studies and anatomical research. We are also a preferred training solution for Sales Representatives, Distributors, Engineers, Clinicians, and Marketing Managers in the areas of Medical Terminology, Clinical Anatomy, and Surgical Procedures. Our expertise allows us to deliver training in a variety of medical and anatomical topics.

In 2012 Dr. Efrain A. Miranda, CEO of Clinical Anatomy Associates started "Medical Terminology Daily" (MTD), a website/blog as a service to the medical community, medical students, and the medical industry. MTD posts medical or surgical terms, its meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. These posts are also shared on Facebook to a group of followers.

20 year anniversary for Clinical Anatomy Associates, Inc. and 6 years for Medical Terminology Daily! Help us congratulate our staff and specially the contributors and friends of Medical Terminology Daily.

Our thanks to all our customers, friends, and contributors for an amazing 20 years!!! Looking forward to more!!