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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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Francois Poupart


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.

François Poupart (1661-1709). Physician, zoologist, entomologist, and anatomist, Francois Poupart was born in Le Mans, France. His origins were very humble and he studied Medicine in Paris as a very poor student.  He had great interest in entomology, studying the anatomy of insects. Poupart obtained his MD a the University of Reims and was a surgeon at the H?tel (hospital) Dieu. A naturalist, Poupart is known for having written a monograph on the anatomy of the leech.

His life is mostly unknown. Poupart died at the age of 48. His name is eponymically associated with the inguinal ligament, which he described in detail in 1705. Although this structure was originally described by Gabrielle Fallopius, it was Poupart who stated the function of the inguinal ligament as an attachment for the three lateral muscles of the abdominal wall.

 

Sources:
1. "Two eponymous surgeons: Cowper and Poupart" Ellis, H. Brit J Hosp Med 2009 701:4 225
2. "The Anatomical History of the Leech" Poupart, F. Phil Transact 1697 19:722-726

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*: There is no known image of Francois Poupart that we could find. If you have any source, please let us know through our "Contact Us" form.

Pinna

The word [pinna] is Latin and means "feather". It also means "wing". The variation [penna] as in the case of [pennate], means "winged". It refer to the external ear, or auricle. It appears that the use of the term [pinna] for ear arises from the ear-like or winged extensions of viking and medieval helmets.

The ear has three components, the internal, middle, and external ear. The external ear is composed of the external acoustic canal and the pinna. The pinna is composed of fibrocartilage covered with skin, and has several ligaments and small muscles related to it. These muscles are  extrinsic (between the pinna and the skull) and intrinsic (within the pinna) All these muscles have limited capabilities in the human.

The pinna receives blood supply from the anterior and posterior auricular arteries, and a small branch of the occipital artery. The nerve supply is by way of the great auricular nerve, the auricular branch of the vagus nerve, the auriculotemporal branch of the mandibular nerve, and the lesser occipital nerve.

Lateral view of the pinnaImages property of: CAA.Inc. Artist: Dr. E. Miranda

The external (lateral) anatomy of the pinna is complicated and very detailed, with potential anatomical variations. Click on the image for a higher detail. The medial aspect of the pinna presents elevations which correspond to the depressions (fossae) on its lateral surface and they are named, eminentia conch?, eminentia triangularis, eminentia scaphoides, etc.

Circum-

The prefix [circum-] is Latin and means "around" or "about". It is used in medical terms such as:                            

Circumcision: the root term [-cis-] meaning to "cut". To cut around
Circumflex: the root term [flex] for [flexion] meaning to "bend". Bends around
Circumambulation: a patient that walks in circles

Also in everyday terms such as:

Circumlocution: to talk around a subject
Circumnavigation: To sail or navigate around
Circumscribe: to write in circles or around a subject

Flexion / extension

The word [flexion] comes from the Latin [flexere] meaning "to bend". In anatomy, flexion is the reduction in the angle between two bodily components that are communicated by a type of joint.

By contrast, [extension] refers to the opposite action, that is, the increase in the angle between two bodily components that are communicated by a type of joint.

The image shows flexion of the head, the upper extremity, and the lower extremity. Hover over the image to see extension of the same structures. 

Excessive flexion (hyperflexion) or extension (hyperextension) of a joint can lead to potential pathology as would be the case of hyperextension of the neck as a result of a car crash (whiplash injury)

Note that in a human in the anatomical position, flexion of the upper extremity is an anterior movement, while flexion of the lower extremity is a posterior movement. You could make a case that in these image the upper extremity is performing an anteflexion (anterior flexion) while the lower extremity is performing a retroflexion (posterior flexion). 

In the upper and lower extremities there are whole groups of muscles that, because of their action, are called flexors or extensors.


Vermiform appendix

The word [vermis] is Latin and means "worm". The term [vermiform appendix] means "the worm-shaped appendage", and refers to a worm-like appendage that is related to the cecum, a segment of the right colon.

This structure was first described by Jacobo Berengario da Carpi in 1524, and it was Andreas Vesalius who first described it as an appendix, and suggested it looked like a worm. It has been called the [vermix] and the [cecal appendix]

The vermiform appendix1 has the same four layers found in most of the abdominal digestive tract and is attached to the cecum at the point where the three tenia coli (libera, mesenterica, and omentalis) meet. The length of the vermiform appendix is variable. On average about 2.5 to 3 inches, it can be as long as 10 inches in length, with one recorded case of a 13 inch appendix!2

Terminal ileum, cecum, and vermiform appendix (www.bartleby.com)Original image courtesy of www.Bartleby.com

The location of the vermiform appendix is also subject to anatomical variation, being found in a retrocecal position in 65% of the cases. For more information on this organ's anatomical variations, click here.

The vermiform appendix is an intraperitoneal structure, as it has a peritoneal extension called the mesoappendix. Within the mesoappendix are the appendiceal arteries and veins. The appendiceal artery is usually a branch of the ileocolic artery.

1. It is not proper to call this structure the "appendix", as there are many appendices in the human body.
2. Personal note: The longest vermiform appendix I have personally seen was 8 inches (20.3 cm) in length, retrocolic, and the tip of the organ was actually retrohepatic!.  Dr. Miranda.


Dr. Willem Einthoven


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.
Dr. Willem Einthoven (1860 - 1927). Einthoven was Dutch, born on 1860 in the city of Semarang in the island of Java. His father was a physician working for the Dutch military. He started his medical studies at the University of Utrecht, Holland. Having developed an interest in ophthalmology and physiology, he developed his medicine doctorate thesis on stereoscopic color vision.

In 1885 Einthoven became a Professor of Physiology at the University of Leiden. Having seen a demonstration of Augustus Waller’s “electrogram” (a device that recorded minute deviations on a mercury column when electrically stimulated) in 1887, he improved it by creating the “string galvanometer”. In 1901 Einthoven published his first recordings of what he called “elektrokardiogramm” (EKG).

The initial device was bulky, heavy, and required the patient to sit with both arms and the left leg in separate buckers of salt water, but it did record the electrical activity of the heart (Click here for an image of one of the first electrocardiographs). Eventually the device was commercialized and history was made. It was Einthoven who used the letter P,Q,R,S, and T in electrocardiography.

In 1924, Willem Einthoven was awarded the Nobel Prize in Physiology.

Dr. Willem EinthovenOriginal imagecourtesy of "Images from the History of Medicine" at www.nih.gov.
Sources:

1. "Willem Einthoven (1860-1927): father of electrocardiography". Merritt, C. Tan. SY. Singapore Med J 53:(1) 17
2. "Willem Einthoven (1860-1927)" Davies, M; Hollman, A. Heart. 1997 October; 78(4): 324
3. "Willem Einthoven: The development of the human electrocardiogram" Cajavilcaa, C.,Varonb, J.Resuscitation 76:3 2008; 325–328