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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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Medial / lateral

The terms [medial] and [lateral] are opposing anatomical relationship terms that indicate the location of a structure or structures in relation to the midline or median plane. The accompanying image depicts the median plane.

The term "midline" is a bit of a misnomer, as this is a plane and not a line, although if you look at the median plane from the anterior or posterior aspect of an individual in the anatomical position, you would have a line, ergo, midline! Look at this article on the anatomical position to see an explanation and image of this concept.

The term [medial] means "closer to the midline". An example of the use of this term is: "the head of the clavicle is medial to the shoulder joint", that is, the head of the clavicle is closer to the midline than the shoulder joint.

The term [lateral] means "further from the midline". An example of the use of this term is: "the wrist joint is lateral to the elbow joint", that is, the wrist joint is further away from the midline than the elbow joint.

Click on the image for a visual explanation of the concepts of "medial" and "lateral".

 

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

Medial / Lateral

Inion

The term [inion] is Greek and originally referred to the posterior aspect of the neck, as mentioned in the Iliad.

The term fell in disuse for hundreds of years, until it was resurrected by Peter Paul Broca (1824-1880) as a craniometric point. The inion is the midline protuberance in the posteroinferior aspect of the external surface of the occipital bone. Today, in most anatomy texts the inion is referred to as the "external occipital protuberance"

The inion is found at the intersection of three bony lines that are easily palpable, the bilaterally situated superior nuchal line, and the median nuchal line (see accompanying image). There is a corresponding internal occipital protuberance in the internal aspect of the occipital bone.

Original image courtesy of Bartleby.com. Click on the image for a larger version. 

External view of the occipital bone. (www.bartleby.com)

Sesamoid

The word [sesamoid] means "similar to a sesame". First used by Galen c.180AD, he describes small ovoid bones that are "similar to a sesame seed", referencing the seed of the plant sesamum indicum, the oil of which was used as a laxative at that time. 

Sesamoid bones are found in the tendons of some muscles and are mostly inconstant. Largey and Bonnet proposed a classification for these bones as: accessory, capsuloligamentous, intratendineous, and mixed.

Of special interest to this article are the sesamoid bones found within the two tendons of the flexor hallucis brevis muscle in the base of the foot (see accompanying X-ray image). These bones, especially the medial sesamoid bone, was attributed religious, mystical, and magical powers since ancient times. This is due to the fact that this small bone is highly resistant to natural decomposition. A Hebrew medical text dated 210 BC, attributed to Ushaia presented a small bone he called "luz" as the "depository of the soul". Many other authors, including Vesalius (who called it Albadaran), believed that upon resurrection, the whole body could reform from this "seed" bone.

This belief was later reinforced by religious texts into the early Renaissance which stated that this bone was indestructible and its presence was enough to guarantee resurrection for believers. 

Sources:
1. "Les os se?samo?¨des de l’hallux : du mythe a` la fonction" Largely,A; Bonnel, BE Med Chir Pied 2008 24: 28–38
2. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
3. "De Humani Corporis Fabrica" Vesalius, Andrea. 1543 Oporinus
Thanks to the first year medical students at the University of Cincinnati who inspired this article. Dr. Miranda
 

Foot X-ray

Original image courtesy of
Wesley Norman, Ph.D.


Ignaz Semmelweis


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.

Ignaz Semmelweis, MD (1818- 1865). Born in Budapest as Ign?c F?l?p Semmelweis, he started his university studies as a lawyer, but changed to Medicine and in 1844, at the age of 26, attained his MD degree. in 1847 he was appointed as an assistant in Obstetrics, almost at the same time of the death of a friend (Kolletschka, a pathologist) who died of what appeared to be "puerperal fever", also known as "childbed fever" after being accidentally stabbed by a knife during the autopsy of a female who had died of that disease. Semmelweis reasoned that the disease somehow was transmitted via the wound and started a crusade to have surgeons and students clean their hands with a carbolized solution before examining a healthy pregnant woman.

Although the obstetric wards under his care reduced the rate of this disease to almost nothing, Semmelweis endured criticism from his teachers, colleagues, and peers, and he did not make any friends by calling "murderers" those who did not follow his ideas.  murderers".  An excerpt of a letter to one of this detractors reads: "I denounce you before God and the world as a murderer and the history of puerperal fever will not do you an injustice when for the service of having been the first to oppose my life-saving technique it perpetuates your name as a medical Nero". He did not publish his findings until later in life, and then received even more criticism.

In 1865 was committed to an mental asylum only to die a few days later. He was only 47 years old. The same year he died Joseph Lister performed the first operations using antiseptic technique.


Original image courtesy of
Images from the History of Medicine.

Sources:
1. NEWSOM S." PIONEERS IN INFECTION CONTROL - SEMMELWEIS,IGNAZ,PHILIPP". The Journal of hospital infection. 1993-03-01;23:175-187.
2. Ellis, H. (2008). Ignaz Semmelweis: tragic pioneer in the prevention of puerperal sepsis. British Journal Of Hospital Medicine (London, England: 2005), 69(6), 358 
3
. " A Corner of History: Ignaz Philipp Semmelweis" Wynder, EL  Prev Med 3" (4) Dec 1974, 574-580
4. "Ignaz Semmeweis; a hand-washing pioneer" P. Rangapa JAPI May 2010 58:328

Muscle

The term [muscle] arises from the Latin word [musculus] which derives from the Latin term [mus] meaning "mouse". We can only guess that, just as today, Roman fathers would show their biceps and forearm muscles to their children and tried to make them believe a mouse had gotten under their skin!. The root term for muscle is [-my-]. The corresponding combining form is [-myo-]. 

There are three types of muscle in the human body:

• Skeletal muscle: it is typical of muscles related to bones (skeletal) and they are voluntary.
Smooth muscle: found in organs that act without volition (involuntary), such as the digestive system and glands.
Cardiac muscle: found exclusively in the heart.

Skeletal (striated) muscle structure
Skeletal and cardiac muscles have distinct striations visible under a microscope. 

Muscles are formed by subunits, each one surrounded by a named membrane. One of the suffixes that means layer or membrane is [-sium]:

Epimysium: Epi=outer; my=muscle; sium=membrane. The outer or external membrane (layer) of a muscle
 Perimysium: Peri=around; my=muscle; sium=membrane. A membrane around a muscle
 Endomysium: Endo= inner or internal; my=muscle; sium=membrane. The inner or internal membrane of a muscle

Original image courtesy of Wikipedia. Click on the image for a larger version. 

 

Trabeculae carnae

The trabeculae carnae is a meshwork of fleshy cords found in the inner aspect of the right and left ventricles of the heart.

The Latin term [trab] means "beam", and [trabeculum] refers to the group of beams that supports a roof, like an intertwined network.  The plural for of [trabeculum] is [trabeculae].

The second term [carnae] is Latin for "meaty". The meaning of [trabeculae carnae] is the "meaty meshwork".

The trabeculae carnae are more evident and larger in the left ventricle than in the right ventricle, and larger and more complex towards the cardiac apex.  The accompanying image shows the dissection of a human heart exposing the trabeculae carnaes in the right ventricle.

Click on the image for a larger version

Image property of: CAA.Inc.

Interior of the right ventricle - Human heart