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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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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!!


Happy New Year 2018!

The staff at Clinical Anatomy Associates, Inc. wishes a Happy and Prosperous New Year 2018 to the readers, subscribers, contributors, and friends of Medical Terminology Daily.

This year we are looking at bringing in new contributors, new articles, and updating our website to help our visitors even more

HAPPY NEW YEAR 2018!!


Andreas Vesalius Bruxellensis

On December 31st, 2017 we celebrate Andreas Vesalius' 503rd birthday...
His teachings and presence inspire us to continue our quest for knowledge, as his motto states:
"Vivitur Ingenio, Cætera Mortis Erunt"


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.

Andreas Vesalius Bruxellensis (1514- 1564). A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

Andreas Vesalius Bruxellensis
The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". For other articles on Andreas Vesalius, click hereDr. Miranda


Snowman sign

The “snowman sign” is a particular image on a chest X-Ray image, which is seen in anomalous pulmonary venous drainage and coarctation of the aorta which causes a Total Anomalous Pulmonary Venous Return (TAPVR).

This abnormality occurs when the pulmonary veins fail to drain into the left atrium and instead form an aberrant connection with some others cardiovascular structures. Such abnormalities account for approximately 2% of cardiac malformations.

There are four types of TAPVR; type 1 is the most common (and the one that creates the snowman sign). In this case the pulmonary veins terminate at the supracardiac level, emptying into the right atrium by way of an anomalous pulmonary venous drainage into the superior vena cava (SVC), and the left brachiocephalic vein (by way of a vertical vein). The confluence of these veins dilates the right brachiocephalic vein, which appears as a dilated vessel on the right of the upper mediastinal edge. When seen in an AP Chest X-Ray, the TAPVAR type 1, resembles a snowman; the dilated vertical vein on the left, the right brachiocephalic vein superiorly, and the SVC on the right form the head of the snowman, the body is formed by the enlarged right atrium.

Article written by: Prof. Claudio R. Molina, MsC

Snowman sign
Snowman sign.
Click on the image for a larger depiction

Sources:
1. Emma C. Ferguson, Rajesh Krishnamurthy, and Sandra A. A. Oldham. (2007) Classic Imaging Signs of Congenital Cardiovascular Abnormalities. RadioGraphics 27:5, 1323-1334.
2. Somerville, J., & Grech, V. (2009). The chest x-ray in congenital heart disease 1. Total anomalous pulmonary venous drainage and coarctation of the aorta. Images in Paediatric Cardiology, 11(1), 7–9.