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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 

Title page of Anathomia Corporis Humanis by Mondino de Luzzi. Image courtesy of the National Library of Medicine
Title page of "Anathomia Corporis Humanis" by Mondino de Luzzi

Alessandra Giliani

 
(1307 – 1326

Italian prosector and anatomist. Alessandra Giliani is the first woman to be on record as being an anatomist and prossector. She was born on 1307 in the town of Persiceto in northern Italy.

She was admitted to the University of Bologna circa 1323. Most probably she studied philosophy and the foundations of anatomy and medicine. She studied under Mondino de Luzzi (c.1270 – 1326), one of the most famous teachers at Bologna.

Giliani was the prosector for the dissections performed at the Bolognese “studium” in the Bologna School of Anatomy. She developed a technique (now lost to history) to highlight the vascular tree in a cadaver using fluid dyes which would harden without destroying them. Giliani would later paint these structures using a small brush. This technique allowed the students to see even small veins.

Giliani died at the age of 19 on March 26, 1326, the same year that her teacher Mondino de Luzzi died.  It is said that she was buried in front of the Madonna delle Lettere in the church of San Pietro e Marcellino at the Hospital of Santa Maria del Mareto in Florence by Otto Agenius Lustrulanus, another assistant to Modino de Luzzi.

Some ascribe to Agenius a love interest in Giliani because of the wording of the plaque that is translated as follows:

"In this urn enclosed are the ashes of the body of 
Alessandra Giliani, a maiden of Persiceto. 
Skillful with her brush in anatomical demonstrations 
And a disciple equaled by few, 
Of the most noted physician, Mondino de Luzzi, 
She awaits the resurrection. 
She lived 19 years: She died consumed by her labors 
March 26, in the year of grace 1326. 
Otto Agenius Lustrulanus, by her taking away 
Deprived of his better part, inconsolable for his companion, 
Choice and deservinging of the best from himself, 
Has erected this plaque"

Sir William Osler says of Alessandra Giliani “She died, consumed by her labors, at the early age of nineteen, and her monument is still to be seen”

The teaching of anatomy in the times of Mondino de Luzzi and Alessandra Giliani required the professor to be seated on a high chair or “cathedra” from whence he would read an anatomy book by Galen or another respected author while a prosector or “ostensor” would demonstrate the structures to the student. The professor would not consider coming down from the cathedra to discuss the anatomy shown. This was changed by Andreas Vesalius.

The image in this article is a close up of the title page of Mondino’s “Anothomia Corporis Humani” written in 1316, but published in 1478. Click on the image for a complete depiction of this title page. I would like to think that the individual doing the dissection looking up to the cathedra and Mondino de Luzzi is Alessandra Giliani… we will never know.

The life and death of Alessandra Giliani has been novelized in the fiction book “A Golden Web” by Barbara Quick.

Sources 
1. “Books of the Body: Anatomical Ritual and Renaissance Learning” Carlino, A. U Chicago Press, 1999 
2. “Encyclopedia of World Scientists” Oakes, EH. Infobase Publishing, 2002 
3. “The Biographical Dictionary of Women in Science”Harvey, J; Ogilvie, M. Vol1. Routledge 2000 
4. “The Evolution of Modern Medicine” Osler, W. Yale U Press 1921 
5. “The Mondino Myth” Pilcher, LS. 1906 
Original image courtesy of NLM
 


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Pelvic diaphragm

The pelvic diaphragm is one of the four diaphragms in the human body (do you know the other three?) and it represents the lower boundary of the abdominopelvic cavity. This thin and  transversely oriented structure is formed from anterior to posterior by the puboccygeus, the iliococcygeus, and the coccygeus muscles.

The first two anterior muscles overlap, the pubococcygeus muscle being superior to the iliococcygeus muscle. Both of them attach laterally to a thickening of the obturator internus fascia that covers the obturator internus muscle. This thickening is known as the arcus tendineus levator ani (ATLA in the image). Because of the relation of the medial fibers of the puboccygeus muscle to the anal canal (puborectalis muscle), and what happens when these muscles contract, these two anterior muscles are known by one common name, the "levator ani" muscle. Click on the picture for a larger image.

Pelvic diaphragm, superior view
The posterior component of the pelvic diaphragm is the coccygeus muscle, which is found lying on the internal aspect of the sacrospinous ligament.
Image property of: CAA.Inc.Artist: D.M. Klein
Word suggested and edited by: Dr. Sanford S. Osher, MTD Contributor
 

Gynecology

The root word [-gyne-] is Greek, from [gynaik] meaning "woman" or "female". The suffix [-ology] is also Greek,  derived from [logos] meaning "study of". [Gynecology] is then "study of a woman or a female". The term refers to the medical specialty that studies and treats the female reproductive system. A separate specialty, obstetrics, deals with the care of the pregnant patient and delivery of the fetus.

Originally, both specialties were the domain of midwives. It was not until the 1600's that male physicians were allowed to treat gynecological problems and attend  births. As the image shows, man-widwifes in Europe were allowed access to the patient only with the use of a "modesty blanket". This is plate XV from the 1681 book "Korte en Bondige Van Der Voortteeling en Kinderbaren" by Samuel Janson.

A man-midwife and a 'modesty blanket' c.1681
As an interesting side note in history, the first male physician to work as a man-midwife was Dr. Wertt from Hamburg. Dr Wertt decided to disguise himself as a woman to attend patients. When he was discovered, the punishment was "swift and salutary": He was burned at the stake.
 
Source:
"The Story of Surgery" by H. Graham, 1939
Word suggested and edited by: Dr. Sanford S. Osher , MTD Contributor
 

-ostomy

From the Greek word [stoma] meaning "mouth or opening", and the suffix [-y] meaning "process or condition". The suffix [-(o)stomy] refers to the "process of creating an opening". This process can be physiological, without intervention, as in the creation of a spontaneous fistula, or it can be a surgical procedure.

As a working explanation of [-ostomy] in surgery, we like to use the term "drainage". Therefore, an [ileostomy] would be the procedure by means of which a drainage opening is creating an anastomosis between the ileum and the abdominal wall.

The accompanying image shows an early 1900's procedure to create a gastrostomy (Wietzel's gastrostomy). The root term [gastr-] means "stomach".

Gastrostomy

Surgery

From the Greek [kheirurgia], a compound word meaning "a work done by hand". The Greek word [kheir/cheir] means "hand", and [ergon] means "work". The intent of the word is that of a medical treatment that is realized by the use of the hands and/or hand instrumentation.

Technology has advanced the evolution of surgery. Today minimally invasive surgical procedures, videoscopic procedures,  and robotic-enhanced surgery are commonplace

Images and links courtesy of: www.wikipedia.com

Cardiovascular bypass surgery (www.wikipedia.com)


Arcuate line

The arcuate line is the arch-shaped (hence the name) inferior border of the posterior sheath of the rectus abdominis muscle. This structure is seen in a laparoscopic (posterior) view (see image, label "B") and represents the transition from a superior area with well-formed aponeurotic posterior rectus sheath to an area devoid of the posterior rectus sheath.

At this point, the inferior (deep) epigastric vessels (see image, label "C") pass from deep to superficial, under the arcuate line and continue superiorly providing blood to the rectus abdominis muscle.

The arcuate line also represents a transition from a well-formed and stronger wall posterior to the rectus abdominis muscle to a weaker region, covered only by deep muscle fascia and transversalis fascia. This allows a surgeon to enter the preperitoneal region using a Totally Extraperitoneal (TEP) approach for a laparoscopic herniorrhaphy.

Label "A" shows the "corona mortis" anatomical variation 

Image property of: CAA.Inc.Artist: M. Zuptich

Arcuate line (B)

Inguinal ligament

The inguinal (Poupart's) ligament has always been described as a separate, discrete,  distinctive ligamentous structure. This is not so. The inguinal ligament is the thickened, incurved, lower free border of the external oblique aponeurosis. This structure extends between the anterior superior iliac spine (ASIS) superolaterally, and the pubic tubercle inferomedially. The inferomedial portion of the inguinal ligament send fibers towars the pectineal ligament (Cooper's ligament) and forms the lacunar (Gimbernat's) ligament.

Inferior to the inguinal ligament is an open region (subinguinal space) that allows passage of structures between the abdominopelvic region and the femoral region. Some of these structures are: Iliacus muscle, psoas major muscle, femoral nerve, lateral femoral cutaneous nerve, femoral artery, femoral vein, etc.

Inguinal ligament
Although described by Vesalius, Fallopius, and others it was the French anatomist and surgeon Francois Poupart (1661-1708) who described this structure in relation to hernia in his book "Chirurgie Complete" published in 1695.

Image property of: CAA.Inc.. Artist: D.M. Klein