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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 post anatomical, medical or surgical terms, their 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. Click on the link below to subscribe to the MTD newsletter. If you think an article could be interesting to somebody else, feel free to forward the link of the article. Should you want to use the information on the article, please follow the CAA, Inc Privacy and Security Statement found at the bottom of this page. You are welcome to submit questions and suggestions using our "Contact Us" form. The information on this blog follows the terms on our "Privacy and Security Statement" and cannot be construed as medical guidance or instructions for treatment. |
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Self-portrait, Henry Vandyke Carter, MD (Public Domain)
Henry Vandyke Carter, MD
(1831 – 1897)
English physician, surgeon, medical artist, and a pioneer in leprosy and mycetoma studies. HV Carter was born in Yorkshire in 1831. He was the son of Henry Barlow Carter, a well-known artist and it is possible that he honed his natural talents with his father. His mother picked his middle name after a famous painter, Anthony Van Dyck. This is probably why his name is sometimes shown as Henry Van Dyke Carter, although the most common presentation of his middle name is Vandyke.
Having problems to finance his medical studies, HV Carter trained as an apothecary and later as an anatomical demonstrator at St. George’s Hospital in London, where he met Henry Gray (1872-1861), who was at the time the anatomical lecturer. Having seen the quality of HV Carter’s drawings, Henry Gray teamed with him to produce one of the most popular and longer-lived anatomy books in history: “Gray’s Anatomy”, which was first published in late 1857. The book itself, about which many papers have been written, was immediately accepted and praised because of the clarity of the text as well as the incredible drawings of Henry Vandyke Carter.
While working on the book’s drawings, HV Carter continued his studies and received his MD in 1856.
In spite of initially being offered a co-authorship of the book, Dr. Carter was relegated to the position of illustrator by Henry Gray and never saw the royalties that the book could have generated for him. For all his work and dedication, Dr. Carter only received a one-time payment of 150 pounds. Dr. Carter never worked again with Gray, who died of smallpox only a few years later.
Frustrated, Dr. Carter took the exams for the India Medical Service. In 1858 he joined as an Assistant Surgeon and later became a professor of anatomy and physiology. Even later he served as a Civil Surgeon. During his tenure with the India Medical Service he attained the ranks of Surgeon, Surgeon-Major, Surgeon-Lieutenant-Colonel, and Brigade-Surgeon.
Dr. Carter dedicated the rest of his life to the study of leprosy, and other ailments typical of India at that time. He held several important offices, including that of Dean of the Medical School of the University of Bombay. In 1890, after his retirement, he was appointed Honorary Physician to the Queen.
Dr. Henry Vandyke Carter died of tuberculosis in 1897.
Personal note: Had history been different, this famous book would have been called “Gray and Carter’s Anatomy” and Dr. Carter never gone to India. His legacy is still seen in the images of the thousands of copies of “Gray’s Anatomy” throughout the world and the many reproductions of his work available on the Internet. We are proud to use some of his images in this blog. The image accompanying this article is a self-portrait of Dr. Carter. Click on the image for a larger depiction. Dr. Miranda
Sources:
1. “Obituary: Henry Vandyke Carter” Br Med J (1897);1:1256-7
2. “The Anatomist: A True Story of ‘Gray’s Anatomy” Hayes W. (2007) USA: Ballantine
3. “A Glimpse of Our Past: Henry Gray’s Anatomy” Pearce, JMS. J Clin Anat (2009) 22:291–295
4. “Henry Gray and Henry Vandyke Carter: Creators of a famous textbook” Roberts S. J Med Biogr (2000) 8:206–212.
5. “Henry Vandyke Carter and his meritorious works in India” Tappa, DM et al. Indian J Dermatol Venereol Leprol (2011) 77:101-3
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Acetabulum
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The word acetabulum is formed by the combination of the Latin root [acetum], meaning "vinegar", and the Latin suffix [-abulum] a diminutive of [abrum], meaning a "cup", "holder", or "receptacle". Thus formed, the word acetabulum means "a small vinegar cup". Roman soldiers liked to drink their water mixed with a small quantity of vinegar, so as to reduce the sensation of thirst. This mix was called "Posca". An acetabulum was used to add specific quantities of vinegar to the water, so over time the acetabula (plural form of acetabulum) were considered measuring devices. It is said that they measured one cup, or 2 1/2 oz. of wine. The anatomical acetabula are bilateral cup-like depressions in the os coxae which serve as a component of the coxofemoral joint (hip joint). They are found at the intersection of the three bony components of the os coxae, the ilium, ischium, and pubic bone and look anteroinferiorly. |
 Image property of: CAA.Inc. Photographer: David M. Klein |
| The acetabulum has several components:
• Acetabular margin: An incomplete circular bony edge or border that marks the edge of the acetabulum • Acetabular notch: The area where the acetabular margin is incomplete • Acetabular labrum: Labrum (Lat. :lip). The acetabular labrum is a complete circular ring of fibrocartilage found on the acetabular margin that helps maintain the head of the femur in place. It is not shown in the accompanying image • Lunate surface: A smooth, half-moon shaped area on the floor of the acetabulum. It is covered with hyaline cartilage and allows for articulation with the head of the femur • Acetabular fossa: The non-articular region of the floor of the acetabulum. It contains fat, vessels, and the ligament of the head of the femur Interesting fact: You may find that in older English anatomy books the acetabulum is referred to as the cotyloid cavity. The word cotyloid arises from the Greek [κοτυλοειδές] and means "similar to a cup". This separation in terms still exists when studying anatomy in other languages. For example, in Spanish the acetabulum is called "cavidad cotiloídea" or "cotilo", and in French it is called "cavité cotyloïde" or "cotyle". I guess the Greek soldiers did not drink vinegar with their water... |
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Sternal angle (of Louis)
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UPDATED:The sternal angle is the term used to denote the angulation at the joint between the manubrium and the body of the sternum. This transverse joint is called the "manubriosternal joint" and is a secondary cartilaginous joint of a type known as a symphysis. The angle varies between 160 and 169 degrees. It is know eponymously as the "angle of Louis" named after Antoine Louis1 (1723-1792), a French physician. The importance of the sternal angle is that of an anatomical superficial landmark, which forms a horizontal plane which indicates a series of anatomical occurrences, as follows: • Location of the cartilages of the second rib |
Click on the image for a larger version. |
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Thoracic anatomy, pathology and surgery, are some of the many lecture topics developed and presented by Clinical Anatomy Associates, Inc. |
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In Search of Andreas Vesalius The Quest for the Grave, Lost and not yet found
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My partner in crime and fellow traveler, Theo Dirix, has just published a new account of our common quest for the lost grave of Andreas Vesalius. Until the scientific results of our latest mission in Zakynthos in September 2017, will become public, this collection of articles published since 2014 represents a detailed and complete status quaestionis of a search that will never be the same anymore.
Following is a remarkable quote from the book: "The beast you have in your hands may appear as aged and stubborn: indeed, the texts collected here are not new and they regularly echo each other. The beast barks and growls: these words do not intend to examine or research but were meant to sell a project to potential sponsors. I feel the taste of the creature’s spit in my face, but pleading not guilty to any accusation of self-glorification, I do hope I managed to teach it a few tricks you will enjoy. While continuing to write about Vesalius’s death and his grave, black dogs may still be scratching at my hermitage. When I will finally throw open the doors to the beauty beyond, here’s hoping the encounter with the female spider will taste as fresh as a first kiss and be the beginning of something else." No surprise some have described the book as: "a truly captivating story (a Live Adventure!) written in a fascinating, passionate and inspiring way. Theo Dirix, with his unique style is describing facts from his adventure to locate the grave of Vesalius and he is mentioning with great respect all his collaborators, the friends of Vesalius and those who share the same passion for Anatomy and Art." (Vasia Hatzi on Med in Art). |
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The book can be ordered here: https://www.shopmybooks.com/US/en/book/theo-dirix-32/in-search-of-andreas-vesalius. (English version of the website). More information about the author on his website www.theodirix.com. or here. Personal note: Thanks to Pascale Pollier, a contributor to this website, for allowing us to publish this article, originally published on Vesalius Continuum. I received a personalized copy from the author, Theo Dirix; Thank you very much for the recognition and the use of this website as reference in some of your comments. It is a great read for anyone even mildly interested in the life and specially the death and disappearance of the grave of Andreas Vesalius. There are several passages in the book that I will have to research and transform in articles for this blog. For those who collaborated in the GoFundMe campaign because or our article entitled Do you want your name in a book? The Quest for the Lost Grave.... this is the book and the name of all the contributors are listed in it! The quest continues... Dr. Miranda |
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HOUSTON AFib PATIENT EXPERIENCE SEMINAR
If you arrived to this article looking for information on Atrial Fibrillation, you will find some in this article. If you need to contact Dr. Wolf, please click here.
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HOUSTON AFib PATIENT EXPERIENCE SEMINAR Saturday, April 21st, 2018 9am – 4pm This seminar is free and open to the public. To attend, please call the telephone number to register. WELCOME MESSAGE FROM DR. RANDALL WOLF In my experience over the last 18 years as a physician who specializes in the treatment of Atrial fibrillation (AFib), I have learned AFib sufferers want two things: Hope and a chance to feel better. The first step to hope and to feeling better is to self educate. Learn about the latest medications, techniques and devices to treat AFib. Ask questions. Get a second opinion. Take charge of your health. The purpose of the Houston AFib Patient Experience Seminar is to help AFib sufferers like you take charge of your health. |
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| About 30 million people worldwide carry an AFib diagnosis. Today seems everyone either has AFib or knows someone that has AFib. When I first held an Afib seminar in Beijing, China, over 1200 people with AFib signed up for the seminar. It was standing room only!
Despite the common occurrence of AFib around the world, a recent study found that in patients who were diagnosed with AFib, 40-50% of patients with an elevated risk of stroke were not treated with the best therapy, and the rate of stroke over the next five years was 10%. Here in Houston, we can do better! Learn more about AFib right here today, and I guarantee you will have hope and be more likely to reach your goal of feeling better. Towards an AFib free healthy life, Randall K. Wolf, MD. SEMINAR AGENDA 9:00 am Introductions - Randall Wolf, MD, FACS, FACC, Professor at McGovern Medical School, Cardiothoracic Surgery, Course Director for the AFib Patient Experience Seminar 9:15 am The cost of AFib 9:30 am Mechanisms 9:45 am Blood Thinners – W. Ross Brown, MD, FACC, Comprehensive Heart Care, PA 10:15 am Medications – Sunil Reddy, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine 10:30 am BREAK 10:45 am Diet – Baxter Montgomery, MD, FACC, Clinical Assistant Professor of Medicine, McGovern Medical School, Department of Cardiology 11:00 am Sleep Apnea – Murtuza Ahmed, MD, FAASM, Razzack and Associates, Houston 11:15 am AF Monitoring – Sunil Reddy, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine 11:30 am Questions with panel 12 noon LUNCH Testimonials: Donna Roth, Houston, TX Gary Wight, Houston, TX Mac Peirson, Houston, TX Ross Wroblewski, Lompac, CA Michaela Senk-Eustace, Hartford, CT 1:00 pm Catheter Ablation – Siddharth S. Mukerji, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine 1:30 pm Surgery – Randall Wolf, MD, FACS, FACC 2:00 pm Stop AFib.org – Mellanie True Hills, President 2:30 pm Panel Discussion 2:45 pm Stroke – Ritvij Bowry, MD, Assistant Professor at McGovern Medical School, Vivian L. Smith Department of Neurosurgery 3:00 pm LAA Closure – Siddharth S. Mukerji, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine & Randall Wolf, MD, FACS, FACC 3:30 pm Panel Discussion 4:00 pm Adjourn – Meet with Faculty ABOUT THE HOUSTON AFIB PATIENT EXPERIENCE SEMINAR The University of Texas McGovern Medical School, Cardiothoracic and Vascular Surgery Department in Houston, is proud to host the inaugural Houston AFIB Patient Experience Seminar. The purpose is to educate the public in an interactive format allowing the audience to engage in conversation in a question/answer format with leading medical professionals. Our list of panel members and guest presentations include surgeons, cardiologists, neurologists, pulmonologists as well as testimonials from AFib patients. We are honored to be able to bring awareness to the resources and options available to patients suffering from AFIB. NOTE: If you cannot attend the seminar, there is more information on Atrial Fibrillation at this website; click here. |
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Atrial fibrillation
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What is atrial fibrillation? Atrial fibrillation (AFib) is one of the most common heart conditions, affecting 4% of the adult population. Characterized by a rapid, irregular heartbeat, AFib is largely due to abnormal electrical impulses that cause the atria of the heart to quiver when it should be beating steadily. Blood flow is reduced and is not completely pumped out of the two small upper chambers of the heart, the atria. This negatively impacts cardiac performance and also allows the blood to pool and potentially clot. At rest, a normal heart rate is approximately 60 – 100 beats per minute. In a person with AFib, that heart rate can skyrocket to 180 bpm or even higher. Thorough testing by your health care provider can spot abnormalities in the heart's rhythm before any obvious symptoms are noticed. |
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| Whether it is caused by stress, exercise, or too much caffeine, most people experience a racing heart from time to time. Most cases are harmless, but AFib is a serious medical condition that may often be long lasting. Some people with AFib experience no symptoms at all. But for others, AFib may cause:
• Exercise intolerance What causes atrial fibrillation? Your heart is divided into four chambers: the two upper chambers called atria, and two lower chambers called ventricles. In order for blood to be pumped through your body, a group of specialized cardiac cells, the conduction system of the heart, sends electrical impulses to the atria that tells your heart to contract. Contractions of the heart send approximately five quarts of blood through your body every minute. In people with AFib, however, the impulses are sent chaotically. The atria quiver instead of beat; the blood isn't completely pumped out and may pool and potentially clot. Are you at risk? Your chances of developing AFib increase with age. AFib occurs more commonly in women than in men. According to the Framingham Heart Study (http://circ.ahajournals.org/cgi/content/full/110/9/1042), AFib is associated with a higher risk of death for women than for men. You are also at greater risk of developing AFib if you suffer from an overactive thyroid, high blood pressure, a prior heart attack, congestive heart failure, valve disease or congenital disorders. Diagnosis AFib can sometimes be diagnosed with a stethoscope during an exam by a doctor or other health care provider and is confirmed or diagnosed with an electrocardiogram (EKG). There are several types of EKG’s. They are: • Resting EKG – Electrical activity in the heart is monitored when a person is at rest. The image on this article is a typical EKG AFib recording showing the flutter of the atria followed by the ventricular contraction. In the larger image (click on the image of the article) you can see how this fluttering of the atria causes an abnormal spacing of the ventricular contractions which some patients feel in their chest. PERSONAL NOTE:Dr. Wolf will lecture on a seminar on this topic on April 21st, 2018 in Houston, TX. For more information on this event and on AFib, click here. Thanks to Dr. Randall Wolf for the image and links |
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An analysis of a letter from Dr. Ephraim McDowell (1829)
This article continues the musings of "Interesting discoveries in a medical book". In this book I found a copy of a letter written by Ephraim McDowell, MD; who on December 25, 1809 performed the first recorded ovariotomy in the world. The patient was Mrs. Jane Todd Crawford, who has also been the subject of several articles in this website, including a homage to the "unknown patient/donor". The book seems to have belonged to Cecil Striker, MD, who practiced in Cincinnati. Dr. Striker was a faculty at the University of Cincinnati and one of the founders of the American Diabetes Association (ADA). He also was one of the first physicians to work in 1923 with a "newly discovered" drug by the Eli Lilly Company (Indianapolis) this drug was named Insulin. The medical application of Insulin had only just been discovered about a year earlier. |
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| Inside the book there is a copy of a letter by Dr. Ephraim McDowell to Dr. Robert Thompson dated January 2nd, 1829, a year before Dr. McDowell's death. At the time (1829) Dr. Thompson (Sr.) was a medical student in Philadelphia. According to the note Dr. Thompson lived in Woodford County, KY, had three children and died in 1887. One of his children was also a doctor, but I have not been able to ascertain if this book was given to him by Dr. Striker.
The letter is shown in the image attached. In this letter Dr. McDowell describes in his own words the ovariotomy he performed on Jane Todd. He also describes other ovariotomies he performed and his opinion on "peritoneal inflammation". Note how the letter has no paragraph separation. Apparently, at the time writing paper was expensive and the less pages used, the better! The text of the letter is as follows: Danville, January 2, 1829 Mr. Robert Thompson Sir, |
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| At the request of your father I take the liberty of addressing you a letter giving you a short account of the circumstances which lead to the first operation for diseased ovaria. I was sent in 1809 to deliver a Mrs. Crawford near Greentown of twins; as the two attending physicians supposed. Upon examination per vaginam I soon ascertained that she was not pregnant; but had a large tumor in the abdomen which moved easily from side to side. I told the lady that I could do her no good and carefully stated to her, her deplorable situation. Informed her that John Bell, Hunter, Hay, and A. Wood four of the first and most eminent surgeons in England and Scotland had uniformly declared in their lectures that such was the danger of peritoneal inflammation, that opening the abdomen to extract the tumor was inevitable death. But not standing with this, if she thought herself prepared to die, I would take the lump from her if she would come to Danville. She came in a few days after my return home and in six days I opened her side and extracted one of the ovaria which from its diseased and enlarged state weighed upwards of twenty pounds. The intestines as soon as an opening was made run out upon the table, remained out about twenty minutes and being upon Christmas Day they became so cold that I thought proper to bathe them in tepid water previous to my replacing them; I then returned them, stitched up the wound and she was perfectly well in 25 days. Since that time I have operated eleven times and have lost but one. I now can tell at once when relief can be obtained by an examination of the tumor if it floats freely from side to side or appears free from attachments except of the lower part of the abdomen. I advise the operation, having no fear from the inflammation that may ensue. I last spring operated upon a Mrs. Bryant from the mouth of the Elkhorn from below Frankfort. I opened the abdomen from the umbilicus to the pubis and extracted sixteen pounds. The said contained the most offensive water I ever smelt, and the attendants puked or discharged except myself. She is now living; from being successful in the above operation. Several young gentlemen with ruptures have come to me. I have uniformly cut the ring open, put the intestines up if down the cut the ring all around, every quarter of an inch then pushed the parts closely together and in every case the cure has been perfect. Therefore it appears to me a mere humbug about the danger of the peritoneal inflammation. Much talked about by most surgeons. After wishing you Health and Happiness,
I am yours sincerely P.S. Your father looks better than I have ever seen. Your sister is also in health The most important point of this letter is how easily and publicly they name patients and their home addresses. Today this would be a violation of the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPPA, a legislation that provides data privacy and security provisions to safeguard patient medical information. It is also interesting to see how Dr. McDowell explained to Mrs. Crawford how difficult and dangerous the procedure would be. He stated how four renown surgeons in England and Scotland said that opening the abdomen was "inevitable death". Another point was how long the intestines were outside the body ... twenty minutes, and the maneuver Dr. McDowell used to bring them back to normal temperature. Late December in Kentucky is quite cold, even with wooden stoves and such. I wonder how much the lower temperature helped the patient. The last point refers to his success in hernia procedures in young males. In the 1800's the word "rupture" was the standard to name abdominal hernias. Without explaining the procedure in detail, Dr. McDowell says that "every cure has been perfect". At the time, this was unprecedented, as the recurrence of inguinal hernia procedures, when attempted, was close to 25%. The house where Dr. McDowell lived and practiced is today a museum in Danville, KY. In February, 2017 I visited this museum and wrote an extensive article on it. I encourage those interested in the History of Medicine to visit the place. |
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