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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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Lapar-

The root term [-lapar-] term is Greex, and although today we use it to mean "abdomen", it actually means "flank" or "loins".

In its pure etymological meaning the root term [lapar], as in "laparotomy" or "laparoscopy" should be used to denote a surgical action in only two of the abdominal regions, the right and left lumbar regions (or flank regions) denoted in the accompanying image.

The first use of the term [-lapar-] referring to the whole of the abdominal region was in January, 1878 by Thomas Bryant, FRCS in his book "A Manual for the Practice of Surgery" using the term [laparotomy] to describe an "incision in the abdomen". Other terms used to denote the abdominal region are "ventral", and of course, "abdominal".

Laparotomy: the suffix [-otomy] means to "open" or "to cut", the term means then " to cut of to open the abdomen"
Laparoscope: an instrument used to view into the abdomen
Laparoscopy: the act of using a laparoscope
Laparostomy: an unusual procedure where the abdomen is not closed, but left partially open (but protected) so that the surgeon can come back periodically to perform an abdominal "lavage" to manage an intractable abdominal sepsis
Laparorrhaphy: the suffix [-orrhaphy] means "to repair". Refers to the repair or closure of a laparotomy

Abdominal regions and their content

Sources:
1. Mughal, M. M., Bancewicz, J. and Irving, M. H. (1986), ‘Laparostomy’: A technique for the management of intractable intra-abdominal sepsis. Br J Surg, 73: 253–259
2. Thomas, B.(1878). "A Manual for the Practice of Surgery" PHiladelphia: Henry C. Lea and Sons

Cribriform

The etymology of this word arises from two Latin words; [cribrum], meaning "a sieve" and [forma], meaning "shape" or "shaped-like". The word [cribriform] means then "sieve-like" or "perforated with a large number or holes".

There are places in the body where the term applies. Examples are the cribriform plate (lamina cribrosa), a sieve-like region found in the superior aspect of the ethmoid bone (see accompanying image) , described in detail by Gabrielle Fallopius.  The olfactory nerves, extensions of the olfactory, bulb pass through the cribriform plate on their way to the olfactory epithelium, an area of the mucosa in the superior aspect of the nose. Another is the cribriform fascia (Hesselbach's fascia) on the anterosuperior aspect of the thigh through which passes the greater saphenous vein and other structures.

Ethmoid bone, superior view, showing the cribriform plate (www.bartleby.com)

Images courtesy of www.bartleby.com
Click on the image for a larger version. For more information on the ethmoid bone click here


Vein

From the Latin [vena], meaning "vein". Some early authors postulated that the term derivates from the Latin word [venio] meaning "to come", because the blood in the veins "comes in" to the heart. There are two root terms meaning "vein", the first is the Latin derivated [-ven-], as in the terms venous and intravenous. The second root term is Greek [-phleb-], as in the terms phlebectomy, phlebotomy, and phlebotomist. Peripheral veins have internal one-way valves, while most of the central veins (in the trunk) do not present with valves. Failure of a peripheral venous valve can lead to dilation of the vein, condition called a varix.

Venous: pertaining to a vein
Intravenous: inside or within a vein
Phlebectomy: removal of a vein
Phlebotomy: to open a vein


Carotid

The term [carotid] is Greek and means "to sleep", "to stupefy", or "to put to sleep". This arises from the observed fact that compression of the large arteries in the neck caused animals to fall asleep (Rufus of Ephesus c.100BC). Andrea Vesalius proposed the name "soporalis arteriae", but the Greek term [carotid] is what we use today. 

The carotid arterial system is bilateral. On the right side, the right common carotid artery arises from the brachiocephalic trunk, while on the left side the left common carotid artery arises from the aortic arch. The common carotid artery divides into an external and an internal carotid artery. The internal carotid artery presents a dilation close to its origin, the carotid sinus, and then heads superiorly to enter the carotid canal of the temporal bone. The internal carotid artery does not give any branches in the neck region and ends providing important branches to the eye and the arterial circle of Willis, which supplies part of the brain.

The external carotid ends giving origin to two arteries, the superficial temporal artery and the maxillary artery. The external carotid artery gives off six named branches:

• Superior thyroid artery
• Lingual artery
Facial  artery
Ascending pharyngeal artery
 Occipital artery
Posterior auricular artery

Sources:
1.
"The ancient Hellenic and Hippocratic origins of head and brain terminology" Panourias IG, el al Clin Anat 2012 Jul;25(5):548-581
2. "The origin of Medical Terms" Skinner, AH, 1970
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

Wilhelm Konrad Roentgen


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.

Wilhelm Konrad Roentgen (1845 - 1923). A German physicist, Professor Roentgen started studying Physics at the University of Ultrech, and receiving his degree from the University of Zurich. Having observed fluorescence on a paper covered with barium platinocyanide close to an active cathode ray. Suspecting the presence of "invisible rays", he devised an experiment to prove this. 

On November 8, 1895 he confirmed his theory and called these invisible-to-the-eye emissions "X"-rays. He also observed the action of these "X"-rays on photographic plates, and that these rays could traverse through the human body, showing the bones. In fact, the first "roentgenogram" was an image of his wife's hand. If you hover over Professor Roentgen's image, you will see an depiction of this historic image. This image marks the beginning of the science of Radiology.

Professor Wilhelm Konrad Roentgen received many awards, medals, and recognitions. In 1901 he was awarded the Physics Nobel Prize.

Sources:
1. http://www.nobelprize.org

2. "The origin of Medical Terms" Skinner, HA; 1970
Thanks to Megan Ohse for suggesting this article

Original imagecourtesy ofImages from the History of Medicine at nih.gov

Sulcus / gyrus

These two different terms must be analyzed together. The Latin term [sulcus] means "groove or fissure". Its plural form is [sulci]. There are many anatomical sulci in the body, one of them being the costal sulcus in the ribs.

The second term [gyrus] is also Latin and means "circle or ring", as used in the words gyroscope or gyrations. In its adjective or descriptive form, [gyrus] is used to denote something "bent, curved, or broad-shouldered"1. The plural form is [gyri]. In the case of the brain a gyrus is formed as a mound or an elevation between the "valleys" of the sulci (see image). If you click on the image a secondary image depicting the lateral aspect of the brain will appear.

In the brain there are many sulci, the secondary image shows the lateral or Sylvian sulcus, and the central sulcus or sulcus of Rolando.

Sulcus / gyrus and Brain, lateral view (www.bartleby.com)
In relation to the central sulcus there are two gyri. The anteriorly situated precentral gyrus is considered the primary motor cortex and associated with voluntary motor activity (colored in green in the secondary image).  The postcentral gyrus (colored in blue) is situated posterior to the central sulcus and is the primary sensory cortex, associated with somatic (bodily) conscious sensation. 

"The origin of Medical Terms" Skinner, AH, 1970
Initial image by: Albert Kok, courtesy of: Wikipedia.org. Secondary image modified from the original. 
Additional information courtesy of Bartleby.com.
Terms suggested by Sara Mueller.