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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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Clavicle

The clavicle is part of the anterior portion of the shoulder girdle. It is an elongated bone with an "italic S" curvature. The Latin term for clavicle is [clavicula], and it has two root terms: [-clavic-] and [-clav-]. This is why we have the terms [subclavicular], and [subclavian] both meaning the same: "inferior to the clavicle".

The clavicle articulates medially with the manubrium of the sternum (see image on this article) by way of the sternoclavicular joint. This joint contains a meniscus. Laterally, the clavicle articulates with the acromial process or acromium of the scapula.

The clavicle has the muscular insertions of several muscles: sternocleidomastoid, trapezius, pectoralis major, deltoid, subclavius, and sternohyoid.

Images and links courtesy of Bartleby.com

Left clavicle, superior surfaceLeft clavicle, superior surfaceLeft clavicle, inferior surfaceLeft clavicle, inferior surface

 


Foramen transversarium

The term [foramen transversarium] is Latin for "transverse foramen". It refers to bilateral foramina (openings) found lateral to the vertebral body in the cervical vertebrae. These foramina are found only in cervical vertebrae and serve as a good way to identify them.

Through the foramina transversaria (plural form) pass the vertebral artery and vertebral vein. The vertebral artery is one of the first branches to arise off the subclavian arteries. While the vertebral vein passes through all seven foramina transversaria, the vertebral artery does not pass through the foramen transversarium of the seventh cervical vertebra (vertebra prominens).

Image property of: CAA.Inc. Photographer: David M. Klein

Vertebra

Carl Wernicke


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.

Carl Wernicke (1848-1905). German psychiatrist, neurologist, and neurosurgeon, Carl Wernicke was born in 1848 in the town of Tarnowitz, in what was then Prussia. He studied medicine in Breslau, Poland. In 1817 he became an assistant psychiatrist at a Breslau hospital. Fascinated with the discoveries and publications of Paul Broca on localized brain damage and aphasia, Wernicke left his post for a time to work with Theodor Meynert in Vienna. At that time Meynert was considered an authority in neuropsychiatry. In 1874, soon after his return to Breslau, Wernicke published his ideas and findings in aphasia in a revolutionary  publication "The Aphasia Symptom Complex". Wernicke was only 26.

At the time, the general outlook on brain activity was that the brain worked in localized areas. Carl Wernicke's ideas were that although this was true, the functionality of the brain resided in the connections between the different areas of the brain. His ideas were right. Wernicke described what later would be known as "sensory aphasia" or the eponymic "Wernicke's aphasia".

Wernicke was a pioneer in the surgical treatment of hydrocephalus, as well as the surgical treatment of brain abcesses. He published several books, including a brain atlas. Carl Wernicke died as the consequence of a bycicle accident in 1905.

Sources:
1. "Pioneers in Neurology: Carl Wernicke (1848–1905)" Pillmann, F. J Neurol (2003) 250 : 1390–1391
2. "The scientific history of hydrocephalus and its treatment" Aschoff, A.; Ashemi, P.; Kunze, S.Neurosurg Rev (1999) 22:67–93
3. "Aphasia" Marshall,RS; Lazar, RM;PhD, Mohr,JP. Medical Update for Psychiatrists. Elsevier (1998)3;5:132–138


Original image courtesy of
Images from the History of Medicine.


Lunate

The lunate bone is one of the proximal carpal bones that form the wrist. The name arises from the Latin [luna], meaning "moon". The lunate bone has a deep concavity and crescent-like shape, resembling a crescent moon. This bone is also known as the "semilunar bone" or the os lunatum.

The lunate bone has six surfaces (as a die). It articulates with the scaphoid bone by way of a strong ligament, the scapholunate interosseous ligament. This ligament has several components. Besides the scaphoid bone, the lunate bone articulates with the radius, capitate, hamate, and the triquetrum.

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

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

Scaphoid bone - anterior (volar) view of the wrist


Endarterectomy

The term [endarterectomy] is composed by the prefix [end-] (sometimes used as [endo]), meaning "inner" or "internal"; the root term [-arter-], meaning "artery", and the suffix [-ectomy] meaning "removal" or "excision".

An endarterectomy is performed to remove atheromatous plaque that is causing arterial stenosis. Although every artery is a candidate for this procedure, carotid endarterectomy is one of the most frequently peripheral vascular procedures performed.

The plaque causing arterial stricture can be the origin of thrombi (in situ blood clots), or emboli (loose blood clots that travel with the flood of blood). These emboli can be the cause of cerebral transient ischemic attacks (TIA's).

In an endarterectomy the objective is to remove the inner layer of the vessel containing the atheroma. This layer is the tunica intima of the vessel. The problem when performing the procedure is to maintain perfusion of the brain which receives much of its blood supply trough the internal carotid artery. The brain also receives blood through the vertebral arteries and the contralateral internal carotid artery. All these vessels are interconnected at the base of the brain by the arterial circle of Willis, named after Thomas Willis (1621 - 1675)

For a YouTube video of the procedure: CLICK HERE (9 minutes)
For an image of the carotid plaque in situ: CLICK HERE 

 

Images property of: CAA.Inc. Artist: Dr. E. Miranda

Right carotid artery system - anterior view
Right carotid artery system - anterior view
Click on the image for a larger version

Hordeolum

A [hordeolum] is an inflamed Meibomian gland (also known as a tarsal gland). These glands are found at the edge of the eyelids and their lipid product (meibum) helps seal the eyes and prevent tear evaporation. The vernacular term for an hordeolum is "stye" or "sty".

The term arises from the Latin [hordeum] meaning "barley". It refers to the appearance of the inflamed gland to a barleycorn. The eponymic term "Meibomiam gland" honors Heinrich Meibom (1638-1700), a German anatomist who first described the tarsal glands of the eye.

The removal of a hordeolum is called a "hordeolectomy"

Image courtesy of Wikipedia

HordeolumFive-day old hordeolum