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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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Adam Christian Thebesius


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.

Adam Christian Thebesius (1686- 1732). German physician and anatomist, Thebesius studied in the University of Leiden, Netherlands, where he received his doctorate in 1708 with the thesis "De circulo sanguinis in corde" (on the circulation of the blood in the heart). In 1713 he became a member of the Royal Academy of Natural Scientists (Kaiserliche Akademie der Naturforscher), where he adopted the Latin name "Eyryphon". Besides his natural sciences and medical research, Thebesius developed an interest in astrophysics.

Extremely interested in coronary circulation, Thebesius injected dyes and fluids in the coronary arteries, veins, and coronary sinus. Along with Raymond Vieussens (1635-1713) , Thebesius described all these structures. Today his name is attached to the eponymic Thebesian veins (venae cordi minima), and the Thebesian valve guarding the exit of the coronary sinus into the right atrium of the heart. Both these structures were mentioned in his 1708 doctoral thesis

Sources:
1. “The Role of the Thebesian Vessels in the Circulation of the Heart” Wearn, J.T. J Exp Med. 1928 January 31; 47(2): 293–315
2. The Story Behind the Word. Some Interesting Origins of Medical Terms. Wain,H. 1958. 
3. The Origin of Medical Terms. Skinner, H.A. 1970

Adam Christian Thebesius

Original image courtesy of Images from the History of Medicine at nih.gov


Ventricular system of the brain

The ventricular system of the brain is an interconnected system of cavities and ducts within the brain through which cerebrospinal fluid (CSF) circulates. The CSF is produced in the choroid plexuses located within the ventricles.

There are two large curved lateral ventricles, each found within a cerebral hemisphere. They connect with the third ventricle via an opening called the "foramen of Monro". The third ventricle connects with the fourth ventricle by way of a slender canal called the "cerebral aqueduct" or the "aqueduct of Sylvius".

The third ventricle is found deep within the brain between the right and left diencephalic portion of the cerebrum.

The fourth ventricle is located between the pons of the brain stem anteriorly and the cerebellum posteriorly. This ventricle has a rhomboidal shape and it connects with the external aspect of the brain and the subarachnoid space. Failure of this CSF drainage from the ventricles to the subarachnoid space can lead to pathological accumulation of CSF within the ventricles and hydrocephalus.

The superior image shows a lateral view of the brain with a superimposed image of the ventricular system. If you click on this image, you will see a superior view of a cast of the ventricular system (by Retzius). More information on these images at www.bartleby.com.

The inferior image shows a posterior view of the brain stem and the cerebellum which has been opened in the median plane to expose the 4th ventricle. Click on the image to see a larger version.

Ventricular system of the brain (www.bartleby.com)
Superior image courtesy of: www.bartleby.com
4th ventricle - Human brain dissectionInferior image property of: CAA.Inc.
Photographer: Efrain Klein


Cerebrospinal fluid

The cerebrospinal fluid (CSF) is a colorless, transparent fluid produced from the arterial flow of blood by the choroid plexuses found within the ventricular system of the brain. The CSF exits the ventricular system and enters the subarachnoid space and its cisterns. It is then absorbed at the level of the arachnoid granulations into the venous component of the cardiovascular system.

The CSF has many functions, some of them being protection, the creation of a fluid environment where the brain 'floats", cleansing, and others. For a more detailed description of the CSF, click here.

The CSF is produced at an average rate of 550-700ml/day. It is absorbed at the same rate. An imbalance between production and absorption of CSF (as well as a blockage within the ventricular system) can lead to an accumulation of CSF within the brain, causing hydrocephalus.


Hippocrates of Cos


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.

Hippocrates of Cos (460 BC - 370 BC). A Greek physician, Hippocrates was born on the Greek island of Cos (Kos) c. 460BC. Considered the "Father of Medicine" he removed Medicine from the realms of superstition and magic. He was the first to record medical writings and is considered the first one to use and maintain proper medical terminology. There are many writing attributed to Hippocrates, but there is no assurance that these were actually written by Hippocrates himself. Hippocrates changed the art of medical diagnosis by replacing supernatural precepts with observation-based methodology. Natural, rather than supernatural causes, would from here on explain all disease processes, what was known as Rational Medicine.

He is known for having set the oath that governs medical principles, the Hippocratic Oath, although there are many authors that contend that this oath was written long time after he died.

Sources:
1. "Hippocrates himself" JAMA. 1968;204(12):1138-1139

2. "Hippocrates: father of medicine" Tan, S Y (01/01/2002). Singapore medical journal(0037-5675), 43(1), p.5.

Original image courtesy of  www.nih.gov

Atrioventricular sulcus

This is a combined word arising from terms [atrium], [ventricle], and [sulcus]. For the etymology of each word, click on the corresponding link.

The atrioventricular sulcus, also know as the "coronary groove" or "coronary sulcus" is an evident incomplete groove between the atria and ventricles of the heart. It is complete posteriorly and is separated anterosuperiorly by the roots of the aorta and the pulmonary trunk.  It contains the right coronary artery on the right side, and the circumflex artery on the left side, hence the name "coronary groove". These coronary arteries are not visible as they are usually covered by subepicardial fat.

The atrioventricular sulcus (and the corresponding coronaries) are also in relation to the deeper situated atrioventricular (AV) valves, the tricuspid valve on the right; and the mitral or bicuspid valve on the left side. The accompanying image depicts the location of the AV valves, and therefore the location of the AV sulcus.

Source: "Gray's Anatomy"38th British Ed. Churchill Livingstone 1995

Anterior view of the thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). P. Pulmonary valve. A. Aortic valve. B. Bicuspid valve. T. Tricuspid valve (www.bartleby.com)

Images courtesy of www.bartleby.com 
Click on the image for a larger version.
Anterior view of the thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). P. Pulmonary valve. A. Aortic valve. B. Bicuspid valve. T. Tricuspid valve


Plexus

The term [plexus] comes from the Latin term [plectere] meaning " to twine, or to braid". In anatomy, the term [plexus] refers to a group of structures that are intertwined or form a meshwork.  The plural form is [plexuses]. Gabrielle Fallopius used the term to denote "a tangle of nerves"

There are many plexuses described in the human body. Most are formed by nerves, but there are many that are lymphatic or vascular. The best known are the plexuses of nerves formed by the ventral rami of the spinal nerves. These are the cervical plexus, the brachial plexus, the lumbar plexus, and the sacral plexus. The image depicts the brachial plexus. For a larger version, click on the image, and for further information on the cervical and brachial plexuses, click here

Images and links courtesy of: www.bartleby.com

Brachial plexus (www.bartleby.com)