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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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Coronary dominance

The term [coronary dominance] is the answer to the following question: From which coronary artery does the posterior interventriclular artery (PDA) arise?

In most of the human species the PDA arises from the right coronary artery, (see acompanying image), therefore most humans (70%) are right dominant. The rest are either left dominant (10%) or have balanced dominance (20%). These statistics have significant variation in different studies.

In the case of balanced dominance, there is either a double posterior interventricular artery, where one is a branch of the right coronary artery and the other a branch of the left coronary artery, or a single PDA receiving blood supply from both coranary arteries.

Coronary Arteries. The [*] indicates the left coronary artery
Coronary dominance is important because the interventricular septum receives blood supply from the PDA in its posterior 1/3rd. If the heart is left dominant, all the blood supply of the interventricular septum is dependant on the left coronary artery. In this case, blockage of the left coronary artery can be catastrophic!

There can be interesting anatomical variations in the coronary arteries of the heart. For a detail on these anatomical variations, click here. Heart and coronary artery anatomy is one of the many lecture topics presented by CAA, Inc

Image property of: CAA.Inc.Artist: Victoria G. Ratcliffe


Aphonia

This is a word of Greek origin. The prefix [a-) means "absence of", or "without". The root term [-phon-] means "sound" or "voice". Aphonia is a pathological absence of voice, and was used by both Hippocrates and Galen.

Do not confuse [aphonia] with [dysphonia], where the prefix [dys-] means "abnormal". In aphonia there is total absence of voice, whereas in dysphonia there is an abnormal voice or "hoarseness" 

As a side note, the word [phonograph] arises from the combination of the root terms [-phon-] and [-graph-], which means "to write". The word [phonograph] does not relate to the playing of a record, but rather to the process of creating one, transforming sound into a wavy line etched on a rotating wax model that is later cast into records. The modern production of sound CD's is similar, where the sound waves are act upon a laser that "burns" the track into a master CD. It is a similar process, but I guess calling creating a CD a type of "phonography" is too old fashion for modern marketing!


Ventral

(UPDATED) The term [ventral] arises from the Latin word [venter] and the root term [ventr-] meaning "belly" or "sac". The adjective [ventral] means "towards the front" , or "towards the belly side of the body". The term ventral therefore means "abdomen".

Many use the term [ventral] synonymously with "anterior"; although this is technically correct, the proper term to use when referring to the patient in the anatomical position should be "anterior". In embryology, since the embryo is curved, most of the anterior aspect of the embryo looks towards the abdomen, ergo ventral.

A ventral hernia is any herniation that occurs in the anterior aspect of the abdomen, including Spigelian hernias, omphaloceles, etc.

Other terms that arise from the same root term are [ventricle], meaning "little belly", or "little sac", and [ventricular], meaning "pertaining to a ventricle".

Lateral view - Human fetus 60 days (www.bartleby.com)
Note: A comment from my friend Dr. Elizabeth Murray

"My understanding of "anterior" means "in the direction of movement" for any given organism (and "posterior" means opposite the direction of movement for an organism). Thus, ventral does not ever change for any creature (vertebrate or even invertebrate), as it refers to a body part/surface.  But when considering two-legged and four-legged (or finned) creatures, you see the differences:  Ventral = anterior in us, but in a dog or fish ventral = inferior.

Ventral/dorsal refer to belly/back in any organism, and cranial/caudal refer to head-end and tail-end in any organism -- those four terms refer to body parts.  However, anterior/posterior refer to the way an organism moves in space, and superior/inferior refer to an organism's relationship to the earth/pull of gravity."

An interesting side note: The word [ventriloquist] arises from the root term [-ventri-] from the Latin [venter] and the suffix [-loquist], from the Latin [loquos] and [locutus], meaning "to speak", or "someone who speaks". The term [ventriloquist] means then "someone who speaks from the abdomen (or stomach)". We now know that this is not so, but that is what most people thought a ventriloquist does!

Images courtesy of www.bartleby.comClick on the image for a larger version. 

For more information on this image click here


Jan Evangelista Purkinje


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.

Jan Evangelista Purkinje (1787 - 1869). Known by his German name Purkinje, or his Czech name, Purkyn?, as well as his church-given name Salverius. Purkinje was born in the city of Libochovice, Bohemia, (now Czechoslovakia). He started his early studies in the church with Piarist monks. He took the name of Brother Salverius and served as a teacher in the Piarist schools. He dedicated himself to the study of natural sciences. Purkinje left the monastery before taking his final vows.   Purkinje continued his studies and graduated in medicine in Prague. Even as a student Purkinje started research on the physics of sound and the physiology of vision, which he continued after his graduation. Purkinje was one of the first to understand the vision of motion, thus creating the first animated cartoons!

In 1823 Purkinje was appointed Professor of Physiology at the University of Wroclaw (Breslau), later taking the same chair in Prague. Besides being one of the first to propose experimental physiology as basis for research, Purkinje was one of the first to use the microscope to study the cells of the body, proposing the "cell theory", and introducing the word "protoplasm".

Jan Evangelista PurkinjeOriginal imagecourtesy of Wikipedia.
He made a number of discoveries, and his name is eponymically tied to many structures and processes, such as:

• Purkinje's cell of the cerebellum: Piriform cells found in Purkinje's layer
• Purkinje's fibers of the heart: These are not "fibers" as the name implies, but fast-conducting myocardial cells found as the most distal components of the conduction system of the heart
• Purkinje's law of vertigo: An observation that the apparent motion perceived when stopping the head after rotation changes from horizontal to vertical if the head is inclined laterally. This is important to pilots, as they are trained to understand that in conditions without external reference, moving the head down or laterally can induce uncontrollable vertigo.

Sources:
1. "Purkinje JE (1845) Mikroskopisch-neurologische Beobachturgen" Arch Anat Physiol Wiss Med II/III:281-295

2. "Jan Evangelista Purkinje (1787-1869)" J Neurol Neurosurg Psychiatry. 1994 July; 57(7): 777 
3. "Jan Evangelista Purkinje (1787-1869)" Davies, MK; Hollman A. Heart (1996) 76(4): 311


Angiogram

The root term [-angi-] has Greek origins and means "vessel", as in a "container". The suffix [(o)gram] means "examination of", or a "record". An angiogram is the examination of a vessels using some type of viewing or recording device.

In an angiogram the physician will inject radiopaque contrast to make the vessels discernible in an X-ray machine.

The accompanying image is an angiogram of the right coronary artery. It can also be called a "coronariogram".

Right coronary artery angiogram
The image shows the right coronary artery and three key branches: the acute marginal artery, the posterolateral artery, and the posterior interventricular artery (PDA). Click on the image for a larger depiction. 

Acute margin

The "acute margin" refers to the anteroinferior border of the heart. It is also known by its Latin name [margo acutus].

The name of this border or margin of the heart is quite descriptive. If you observe the angle formed between the anterior or sternocostal surface of the heart with the posterior or diaphragmatic surface of the heart, you can see that the angle between these two surfaces is less than 90 degrees, therefore an "acute" angle. The corresponding border between these two surfaces has to be called the "acute margin"!

In relation to the acute margin of the heart there is usually found one of the longest branches of the right coronary artery. This artery that runs alongside the acute margin, is the "acute marginal artery", In an angiogram, this artery clearly depicts the anteroinferior border of the heart.

Click on the image for a larger depiction. Here is a link to the article on the "obtuse margin" of the heart.

Acute margin of the heart. SVC= Superior vena cavaImage property of: CAA.Inc.Artist: Victoria G. Ratcliffe