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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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Galen of Pergamon


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.

Galen of Pergamon (129AD - 200AD). A Roman physician of Greek origin, Galen is a seminal character in Medicine and Physiology for the ages. He has been known as Galen, Galenus, Aelius Galenus, Claudius Galenus, Claudius Clarissimus Galen, and Galen of Pergamus. He was born in 129 A.D. in a Roman-Greek community in Pergamum (today's Turkey). As a very young man, he studied Medicine at the Pergamum  temple of Asclepius.  After traveling for additional studies, Galen obtained the appointment of "physician to the gladiators" back at this hometown of Pergamum.

The post required of him to study and develop hygiene, preventive medicine, as well as dealing with the gladiator's injuries. The horrible wounds allowed him to observe and study human anatomy and develop incredible skills at treating battle wounds. Galen traveled to Rome, where he was appointed Physician to the Emperor Marcus Aurelius.

Galen performed human and animal anatomical dissections, writing over 300 medical, pharmaceutical, and philosophical treatises in Greek, many of which were translated into other languages, especially Latin and Arabic.

Galen of Pergamum
Even though most of the original books were lost, the translations and interpretations of Galen's work have survived until today. His teachings and dictums were considered undisputable for over 1,500 years. In fact, in Medieval times and early Renaissance doubting Galen's teachings was considered heresy!

Galen's name is preserved in the eponymical "Vein of Galen", the great central cerebral vein.

Sources:
1. "Claudius Galenus of Pergamum: Surgeon of Gladiators. Father of Experimental Physiology" Toledo-Pereyra, LH; Journal of Investigative Surgery, 15:299-301, 2002
2. "Galen: history’s most enduring medic" Tan, SY; Singapore Med J 2002:3 (43):116 –117
3. "Galen and His Anatomic Eponym: Vein of Galen" Ustun, C.; Clinical Anatomy 17:454–457 (2004)
Original image courtesy of Images from the History of Medicine at nih.gov


Temporal bone

The temporal bone is a complex bone composed of several regions. The image shows an anterior view of the right temporal bone. To see the location of the bone, look at the inset that shows by transparency the location of the bone. Click on the image for a larger picture.

A. Squamous portion: From the Latin [squama], and meaning "scale-like", this portion of the bone is very thin, articulating with the parietal and sphenoid bones.

B. Zygomatic process: an anterior extension that articulates with the corresponding temporal process of the zygomatic bone.

C. Mastoid process: A Greek term from [-mast-] meaning breast, and the suffix [-oid] meaning "similar to".

D. Styloid process: Another Greek term from [stylos] meaning a "pillar", but also a "pen", therefore "shaped or similar to a pen". This is a slender and long inferior bony process. Close to the syloid process there are other processes, the pterygoid processes.

E.Petrous process: From the Latin [petrus] meaning "rock". The petrous process contains the components of the external auditory canal, the middle and inner ear, and a large canal through which passes the internal carotid artery

Temporal bone (anterior view)

 

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

Ectopic

This term has combined Greek components. The prefix [ect-] comes from [ectos], meaning "outside", and the root term [-top-] from [topos], meaning "place or location". The suffix [-ic] of course means "pertaining to". The word [ectopic] then means "outside its (normal) place or location".

The words has several uses. As an example, in atrial fibrillation, the atria of the heart will depolarize in abnormal or ectopic locations, causing a dysrhythmia. Another common use is in endometriosis, where there are abnormal or ectopic implantation sites of endometrium.


Oliver W. Holmes Sr.


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.

Oliver W. Holmes Sr. (1809-1894). American physician, writer, and poet, Oliver Wendell Holmes Sr. was born in 1809 in Cambridge, MA. He started his studies in law, but soon turned to Medicine, studying part of his time in Paris. In 1843 he joined the fight against "puerperal fever", for which he was mocked, but he stood his ground on principle. A gifted writer, he published several books on essays, biography, and poetry. He was Dean of the Harvard Medical School.  He received several honorary doctorates in Law and letters from Harvard and Cambridge. Little known is his contribution to Medicine by  the coining of the terms "anesthesia" and "anesthetic", and that he was the father of a Supreme Court Judge, Justice Oliver Wendell Homes Jr.

The Journal of Clinical Anatomy published an article on Oliver W. Holmes Sr. profiling his many accomplishments.

Original image courtesy of www.nndb.com.
Sources:
1. "The Origin of Medical Terms" Skinner, H.A.(1970)
2. "Oliver Wendell Holmes, Sr. (1809–1894): Physician, jurist, poet, inventor, pioneer, and anatomist" Tubbs, RS et al, Clin Anat 25:8; 992-997 (2012)

Omentum

The origin or etymology of the word [omentum] is not clear. The plural form is [omenta] and it refers to membranes associated with the stomach. The term was first used by Galen and later by Celsus. It was Andrea Vesalius who gave us the first clear anatomical description of the omenta.

The omenta are double-layered peritoneal membranes. There are two omenta. The lesser omentum ("Lo" in the image) extends between the liver and stomach, and liver and the first part of the duodenum. The greater omentum ("Go" in the image) projects off the stomach, reaches as low as the lower abdominal cavity and reflects superiorly to connect with the transverse colon. The greater omentum contains a larger amount of fat than the lesser omentum.

Both omenta contain a number of arteries, veins, and other structures between their layers. In the case of the greater omentum, we find the right and left gastroepiploic arteries as well as the greater curvature vascular arcade.

Images property of: CAA.Inc.Photographer: D.M. Klein

Abdominal dissection
Go= Greateromentum, Lo=Lesseromentum, 
E=Esophagus, f=fundus, P= Pylorus.

Theodor Billroth


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.

Christian Albert Theodor Billroth (1829-1894) was born in Prussia, in the city of Bergen. After being considered a slow learner requiring tutoring at home, Billroth studied Medicine in Berlin. In 1860 he was appointed as Professor of Clinical Surgery.

He is well-know by the partial or subtotal gastric resection surgeries he pioneered. In 1881 he performed the first of what is now known as a "Billroth I" procedure. He was the first to perform a partial resection and anastomosis of the esophagus, as well as the first surgeon to excise a rectal cancer. He is considered one of the Masters of Surgery.

Billroth was also a gifted musician playing the violin and viola. Good friend with Johannes Bramhs, he was sometimes invited to conduct the Zurich Symphonic Orchestra.

The first Billroth I procedure was performed in 1881 in a 43 year old female. Besides the well-known Billroth I and Billroth II subtotal gastrectomies, there are several eponyms that carry Billroth's name. Billroth's concepts on gastrointestinal anastomoses paved the way for the invention of surgical staplers.

Source: "Christian Albert Theodor Billroth: Master of surgery" Kazi, RA; Peter, RE, J Postgrad Med March 2004 50:1, 82-83
Original image courtesy of Images from the History of Medicine at nih.gov