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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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Posterolateral artery

The posterolateral artery, also known as the "retroventricular artery" is one of the two terminal branches of the right coronary artery. The other terminal branch is the posterior interventricular artery or PDA. This artery presents with many variations, from being absent to extremely long arteries with extensive branching that take some of the territory of the circumflex artery. The posterolateral artery extends from the crux cordis to the left side of the heart in the atrioventricular sulcus.

The AV node artery, which provides blood supply to the AV node (a component of the conduction system of the heart) may arise from the posterolateral artery instead of arising from the right coronary artery or the posterior interventricular artery.

When present, the posterolateral artery provides some posterior left ventricular branches and maybe some posterior left atrial branches. See the accompanying image, you may click on the image for more information. The image depicts a posterolateral artery slightly longer than usual.

Posteroinferior view of the heart. IVC=inferior Vena CavaImage property of: CAA.Inc. Photography: Efrain Klein

 

Sir William Osler


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.
Sir William Osler (1849-1919). William Osler was born in Bond Head, Canada, in what today is known as Ontario, of English parents. He started his college studies to become a minister, but realizing his true vocation was in medicine, he entered the Toronto School of Medicine, earning his medical degree in 1872.

Osler completed postgraduate studies in Europe, returning as a Professor at the McGill University. In 1884 he moved to Philadelphia to the University of Pennsylvania. In 1889 he left to become Physician-in-Chief and one of the founders of the newly-built John Hopkins hospital. His contributions to this new hospital and the American medical education are innumerable. Dr. Osler initiated the residency programs used today, as well as the programs of third and fourth year medical students in bedside patient rounds.

A prolific writer, Dr. Osler penned over 1,500 articles, monographs, and books, some of which are famous. His “Principles and Practice of Medicine” was published for a record 17 editions and 76 years (1892 -1968)! One of his most famous addresses is “Aequanimitas”, which he delivered when leaving the University of Pennsylvania.

Sir William Osler
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov
In 1905 Dr. Osler accepted the position of Royal Chair of Medicine at Oxford, in England, and in 1911 he was awarded the title of “Sir William Osler”.

Personal Note: In June 1999, I had the opportunity to visit the collection of the John Martin Rare Book Room at the University of Iowa Medical School. I was allowed to read and handle original copies of the Fabrica and the Epitome by Vesalius as well as other original and rare medical books, including De Muto Cordis, by William Harvey. The books I had the opportunity to review were placed on an antique desk that belonged to Sir William Osler. A moment that has stayed with me, as it was the confluence of great individuals: Andreas Vesalius, the anatomist; William Harvey, the physiologist, and Sir William Osler, the medical educator. Dr. Miranda

Sources:
“Sir William Osler, M.D., C.M.” Sarik, J. Yeo, Ch.Pinckney J. The American Surgeon78.4 (2012): 385-7.
“Sir William Osler and gastroenterology” Chaun H. Can J Gastroenterol (2010) 24:10 615-618
“Sir William Osler (1849-1919)” Haas, LF J Neurol Neurosurg Psychiatry 1999 67: 137
“Sir William Osler (1849-1919)”Christian, HA Proc Amer Acad Arts Sci (1922) 496-499


Coarctation

Of Latin origin, the word [coarctatio] means "to press together", or to confine. It is used as a synonym with "stricture" or "stenosis".

The term [coarctation] is used today used mostly to describe a narrowing, stricture, or stenosis of blood vessels, such as "coarctation of the aorta"


Pisiform

The pisiform bone is one of the four bones that comprise the proximal row of the carpus or carpal bones that form the wrist. It is the smallest of the carpal bones, is spheroidal in shape, and presents with only one articular surface (see image).

Its name originates from the Latin [pisum], meaning "pea". It is also known as "os pisiforme" or "lentiform bone", because some feel it is shaped like a lentil.

The pisiform bone articulates posteriorly with the triquetrum, and has on its anterior (volar) surface attachments to the transverse carpal ligament, and to the Abductor Digiti Quinti, and Flexor Carpi Ulnaris muscles.

The accompanying image shows the anterior (volar) surface of the wrist. Click on the image for a larger picture.

Scaphoid bone - anterior (volar) view of the wrist

Image modified from the original: "3D Human Anatomy: Regional Edition DVD-ROM." Courtesy of Primal Pictures


Fossa

This is a Latin word meaning a trench, a ditch, or an excavation. It arises from the Latine term [fodere] meaning "to dig". The plural form for "fossa" is "fossae".

There are many fossae listed in human anatomy, here are some of them:

fossa scaphoides: found in the pinna
fossa ovalis: found in the wall of the right atrium
fossa triangularis: found in the pinna
ischioanal fossa: a triangular fossa found in the perineum, inferior to the pelvic diaphragm and superior to the urogenital diaphragm, etc.


Pre-

The prefix [pre-] has its origin in the Latin preposition [prae] meaning "anterior", "in front of", or "before". 

Applications of this prefix include:

precordial: anterior to the heart, as in "precordial pain"
preoperative: before the operation
preperitoneal: anterior to the peritoneum, referring to the region found outside and anterior to the peritoneal sac, an area containing fat, and important for preperitoneal laparoscopic surgery
presystolic: before systole
• preaortic: anterior to the aorta