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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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Charles H. McBurney, 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.

Charles H. McBurney, MD (1845- 1913). British surgeon and anatomist, Dr. McBurney studied at Harvard University, and received his MD from the Colombia University in New York. At the forefront of the aseptic technique revolution, Dr. MacBurney, following Halsted's example, required the use of surgical gloves and strict aseptic technique in his operating room, considered the "first modern operating room in America"

His studies focused on appendicitis, and demonstrated a point of maximum tenderness at a point "exactly between an inch and a half and two inches from the anterior spinous process of the ileum on a straight line drawn between that process and the umbilicus". This point has become known as the eponymic "McBurney's point". There is a discrepancy between the original description of this point by McBurney and some medical publications. Continuing his research on the surgical approach to the inflamed vermiform appendix, in 1894 Dr. MacBurney presented an approach that used a small incision for appendectomy. This incision is know today as "McBurney's incision."

Sources:
1. "Charles Heber McBurney (1845 – 1913)" Yale,SH and Musana, KA Clin Med Res. 2005 August; 3(3): 187–189.
2. "Charles McBurney (1845–1913)—point, sign, and incision"  JAMA 1966;197:1098–1099
3. "The first modern operating room in America"  Clemons BJ AORN J. 2000 Jan;71(1):164-8, 170

Original imagecourtesy of National Institutes of Health.

Cardiac apex

The word [apex] is Latin and means "the top". It refers to the highest point in a mountain or in a pyramid; the point furthest from the base. The plural form is [apices].  There are several anatomical apices in the human body.

The cardiac apex (also known by the Latin term apex cordis) is a misunderstood term. It refers to the "top" of the heart, but this is clear only when you place the heart in such a way that the apex is actually pointing "up" (see image). In this position the heart is like a pyramid and the base will be the surface opposite the apex. The anatomical location of the apex of the heart is posterior to the left 5th intercostal space in adults, just medial to the left midclavicular line.

Click on the image for a larger picture.

Human heart - Cardiac apex

Endo-

The prefix [endo-] is of Greek origin and means "inner or within". There are many uses of the term as follows:

Endocardium: the root term [card] means "heart" and the suffix    [-ium] refers to a "layer or membrane" - Inner layer of the heart
Endocrine: the suffix [-crine] means "secretion", the word meaning "inner secretion". Refers to a gland that deposits its secretions within the bloodstream. The products of endocrine glands are known generically as "hormones"
Endometrium: the root term [-metr-] is Greek, meaning "uterus" . The word endometrium means "inner layer of the uterus"
Endoscope: the term [-scope] refers to an instrument used for viewing. There is a consensus that a viewing instrument that enters through a natural body cavity will be called an "endoscope" (see image). All others will adopt the name of the cavity that is being viewed, as a laparoscope, a thoracoscope, an arthroscope, etc.

Original image courtesy of  Wikipedia.

   

Benign / Malignant

These two opposing terms are used to describe key characteristics of a tumor. [Benign] derives from the Latin term [benignus], meaning "good" and "gentle". The medical application of the word denotes a condition (or tumor) that is not bad (malignant), and that it is favorable for treatment and recovery.

The term [malignant] derives from the Latin word [malus], meaning "ill-disposed, malicious, or bad". The medical application is to a condition or tumor that is unfavorable to treatment and recovery. Over time the term malignant has become synonymous with "cancer".


Anterior - Posterior

These two opposite terms must be studied together. Both words are used as directional anatomical and surgical terms, and most importantly, they are relationship terms, that is, they express the spatial location of one structure in reference to another.

The term [anterior] is Latin and means "in front of". It is related to the prefix [ante-] which means "before", or "anterior" and the Latin [anticus], which means "in the very front".

The term [posterior] is more complex. Although it is based on a Latin term meaning "after", the prefix [poster-] is used as a comparative to mean "behind (a structure of reference)". Following are some examples of the proper use of these terms:

- The aorta is anterior to the spine
- The sternum is anterior to the heart
- The occipital bone is the most posterior bone of the cranium
- The trachea is anterior to the esophagus 

Because a human body is always studied in the anatomical position, in the hand, the anterior aspect is the palm and in this case a synonym for anterior is [volar].  

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

Anterior - Posterior

Salomon Hakim, 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. Salomón Hakim (1922 - 2011). Dr. Hakim was born in the city of Barranquilla, Colombia. He started medical school in 1944 and elected neurosurgery as his specialty. He had special interest in electricity and physics, which he used extensively in his research.

In 1957 Dr. Hakim was exposed to a strange case of a young man with what was known then as "symptomatic occult hydrocephalus". Until that time the accepted knowledge was that hydrocephalus was due to an increase in intracranial pressure of different etiology. The problem was that the young man had normal pressure, yet had a hydrocephalus and enlarged ventricles. Dr. Hakim applied his knowledge of physics and laid the conceptual basis for what became known as "Normal Pressure Hydrocephalus" a condition until then unrecognized and that is found in aging patients with dementia, Alzheimer's, and other pathologies.

Working at home, Dr. Hakim developed a pressure-regulating shunt  to drain the excess cerebrospinal fluid (CSF) from the ventricular system of the brain. These valves were later produced by medical industry. His son Carlos has continued his legacy and now the Hakim programmable valve is one of the best CSF shunt systems in the world.

Original image courtesy of The Hydrocephalus Association

I had the pleasure of meeting Dr. Hakim in 1993 in Santiago, Chile, and again later in the US, as he presented his valve system to a group of neurosurgeons.  This short article does not do justice to the physician, researcher, and family man. I encourage you to read more in the following links. Dr. Miranda

Sources:
1. "Salom?n Hakim and the Discovery of Normal-Pressure Hydrocephalus" Wallenstein, MB; McKhann, GM. Neurosurgery (2010) 67;1:155-159
2. "The Reprieve: Reversing Dementia" online article byRose Tibayan
3. "Salom?n Hakim, alma y vida de cient?fico"Article by Paulina Ortiz
4. 
"Salom?n Hakim: Un milagro de Colombia para el mundo"