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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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Rectum

The rectum is the most distal segment of the large intestine. 

The word [rectum] arises from the Latin [rectus] and means "straight", such as its use in the name "rectus abdominis" for the "straight muscle of the abdomen".

It seems a misnomer, as the rectum of the human species is actually "S" shaped, as seen in the accompanying image. The reason for this discrepancy is that the rectum was named by Galen of Pergamon (129AD - 200 AD) who himself studied this structure in animals such as sheep and goats. In these animals the rectum is indeed straight, and since contradicting Galen was not acceptable (see Michael Servetus), the name has survived until this day. Even Andreas Vesalius has in his 1953 "Fabrica" a depiction of a straight rectum in the human! Click on the bar beneath the image to see Vesalius' image of the rectum.

The proximal end of the rectum is not clearly discernible from the sigmoidorectal region, from here the rectum has an "S" shape, measures approximately six to seven inches in length (15 - 17 cm), and it ends distally at the junction of the rectum with the  pelvic diaphragm. It is at this point that the anal canal begins.

1. Sigmoid colon 2. Rectum 3. Anus 4. Inferior rectal valve 5. Middle rectal valve 6. Superior rectal valveLarge Intestine - Vesalius 1543
The rectum is characterized by three transverse rectal folds, one on the right side, and two on the left side. These folds are know as the "rectal valves" or the "valves of Houston". The middle rectal fold is known to European anatomists as the "valve of  Kohlrausch" Their function in maintaining fecal material in place as well as their function in defecation is still under study. The rectal valves also have a high level of anatomical variation and may not be present at all.

Image source: "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
Recommended reading: "Transverse Folds of Rectum: Anatomic Study and Clinical Implications" Shafik, A, et al. Clin Anat 14: 196-203 (2001).


-card- / -cordi-

These two root terms mean "heart".

The first one, [-card-] arises from the Greek [kardium]  and can be seen in medical words such as: cardiac, echocardiogram, cineangiocardiogram, cardioplegia, myocardial infarction, etc.

The second one [-cordi-] arises from the Latin [cordis] and can be seen in words such as: precordial pain, cordial, commotio cordis, etc. 

As a point of interest, the original Greek spelling of [kardium]  was used by Nobel prize winner Dr. Willem Einthoven (1860 - 1927) when he invented the electrocardiograph and the electrocardiogram. The German term is [elektrokardiogramm] and the German abbreviation for the procedure is EKG. Since we use the term in Engish, [electrocardiogram] we use the abbreviation ECG. Both are correct, although if you are speaking English, ECG should be used.

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

Collateral circulation

The term "collateral circulation" is generally used to denote a situation where small blood channels dilate and provide blood supply when a pathology creates a stricture and diminishes blood flow (ischemia).

Although the above is correct, the term is also applicable to a normal, non-pathological situation most common in the human body. Please refer to the accompanying image for the following explanation. If needed, click on the image for a larger depiction. In the image, the arrows represent direction of flow.

Most organs or organ segments receive blood supply from more than one source of blood supply. In some cases, like the stomach, there are up to four arteries that provide blood supply to the organ: the right and left gastric arteries, and the right and left gastroepiploic arteries.

Collateral circulation. The arrows indicate direction of arterial blood flow. The dashed lines delimitate vascular territoriesImages property of:CAA.Inc. Artist: Dr. E. Miranda
In other cases, like the small intestine shown in the image, blood arrives to the organ arising from several arteries (A, B, and C) that themselves arise from a parent structure. Because of hydrodynamics, the vascular territories of each artery (represented by dashed lines) tend not to overlap. If for any reason there is stenosisor blockage in any of these arteries (A,B, or C) blood will flow immediately through an alternate route and the organ will not suffer ischemia or necrosis

This is extremely important, as these collateral channels maintain blood supply to areas that may be affected by bending, such as the elbow and knee, which have a rich collateral network. Most of the organs in the body, with some exceptions (brain, heart), have collateral circulation.

Collateral circulation is extremely important for surgery, as surgeons can safely remove parts of organs without affecting the blood supply to the organ. This is also true for all gastrointestinal anastomoses.


Histology

Histology is the scientific branch that studies tissues.

The root term [-hist-] is used to mean "tissues", but how the term came to be used is somewhat convoluted. It arises from the Greek [histos], which indicates the mast of a ship, it then was used to denote a Greek weaver's loom central mast (where the fabric is woven horizontally), and then it was used to indicate that which was woven [histios], the fabric, or the "tissues".  The suffix [-ology] also has Greek origin from [logos] meaning a "book", a "treatise" or "to study". 

The concept of the body being formed by different tissues was pioneered by Marie-Francois Xavier Bichat (1771-1802) who called them "membranes" Bichat is considered to be the "father of Histology". The image shows a histological slide of cardiac muscle. Click on the image for a larger depiction.

Cardiac muscle (Dr. S. Girod, A. Becker)Original image by S. Girod and A. Becker, courtesy of Wikipedia. 

Spondylosis

The root term [-spondyl-] arises from the Greek [spondylos] meaning "vertebra", and the suffix [-osis] means "condition", but with the connotation of "many". The word [spondylosis] means " condition of many vertebrae". This does not add much to the use of this word as an indicator of a pathology, but it does indicate that there is excess bone in a vertebral pathology.

Spondylosis is an osteoarthritic degeneration of the vertebrae and the spine characterized by abnormal bony growths  on the vertebrae that can impinge on nerves and other structures causing pain and mobility problems. The definition of spondylosis also includes degenerative changes in the intervertebral discs.

The abnormal growth of portions of the vertebral body, usually forms "bone spurs", also referred to as "spondylophytes". The accompanying image shows a lumbar vertebra with spondylophytes. Click on the image for a larger depiction.

Spondylophytes on a lumbar vertebraImage property of: CAA.Inc. Photographer: David M. Klein

Rudolf Nissen, MD


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. Rudolf Nissen (1896 - 1981).  Dr Nissen’s life is extraordinary. Born in the city of Neisse, Germany in 1896, he was the son of a local surgeon. He studied medicine in the Universities of Munich, Marburg, and Breslau. He was the pupil of the famous pathologist Albert Aschoff (discoverer of the heart’s AV node, along with Sunao Tawara).

Nissen became a professor of surgery in Berlin, and in 1933 moved to Turkey where he was placed in charge of the Department of Surgery of the University of Istanbul. In 1939 he moved to the US, first to the Massachusetts General Hospital and later to the Jewish Hospital in Brooklyn, New York. After becoming a US citizen, he moved again in 1952 to Basel, Switzerland as Chief of the Department of Surgery, where he retired in 1967. He died in 1981.

His contributions to surgery are innumerable. He wrote over 30 books and 450 journal articles. Known for the development in 1956 of what is today known as the “Nissen fundoplication” for esophageal hiatus hernia surgery, Nissen also worked with his assistant, Dr. Mario Rossetti to develop the “floppy Nissen fundoplication”, also known as the “Nissen-Rossetti procedure”. This would be enough to honor this man, still, he (with Sauerbruch) performed the first lung lobectomy and the first pneumonectomy (called then a total pneumonectomy). In 1949 he performed the first esophagectomy with a gastroesophagostomy for lower esophageal cancer.

Dr. Rudolph NissenOriginal imagecourtesy of Universit?t Basel.
His personal life is even more interesting. Drafted at 20, he fought in WWI and was wounded several times. In 1933, under the Nazi regime, he was ordered to fire all the Jewish-German assistants under his care. Being Jewish himself, he was told that he would keep his job, Nissen could not take this. He resigned his position and moved out of Germany.

Another little known fact is that he operated on Albert Einstein in 1948. He operated on Einstein because of intestinal cysts. Having found a developing abdominal aortic aneurysm, he reinforced it with cellophane, undoubtedly giving his patient a few extra years to live. Einstein died in 1955.

As a personal side note, our good friend Dr. Aaron Ruhalter scrubbed in with Dr. Nissen while serving as a surgical resident at the Brooklyn Jewish Hospital!

Sources:
1. “Rudolf Nissen: The man behind the fundoplication” Schein et al. Surgery 1999;125:347-53
2. “Rudolf Nissen (1896–1981)-Perspective” Liebermann-Meffert, D. J Gastrointest Surg (2010) 14 (Suppl 1):S58–S61
3. “The Life of Rudolf Nissen: Advancing Surgery Through Science and Principle” Fults, DW; Taussky, P. World J Surg (2011) 35:1402–1408
4. “Total Pneumonectomy” Nissen, R. Ann Thorac Surg 1980; 29:390-394
5. “Historical Development of Pulmonary Surgery” Nissen, R. Am J Surg 80: Jan 1955 9- 15