Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their 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

Jean George Bachman

Jean George Bachmann
(1877 – 1959)

French physician–physiologist whose experimental work in the early twentieth century provided the first clear functional description of a preferential interatrial conduction pathway. This structure, eponymically named “Bachmann’s bundle”, plays a central role in normal atrial activation and in the pathophysiology of interatrial block and atrial arrhythmias.

As a young man, Bachmann served as a merchant sailor, crossing the Atlantic multiple times. He emigrated to the United States in 1902 and earned his medical degree at the top of his class from Jefferson Medical College in Philadelphia in 1907. He stayed at this Medical College as a demonstrator and physiologist. In 1910, he joined Emory University in Atlanta. Between 1917 -1918 he served as a medical officer in the US Army. He retired from Emory in 1947 and continued his private medical practice until his death in 1959.

On the personal side, Bachmann was a man of many talents: a polyglot, he was fluent in German, French, Spanish and English. He was a chef in his own right and occasionally worked as a chef in international hotels. In fact, he paid his tuition at Jefferson Medical College, working both as a chef and as a language tutor.

The intrinsic cardiac conduction system was a major focus of cardiovascular research in the late nineteenth and early twentieth centuries. The atrioventricular (AV) node was discovered and described by Sunao Tawara and Karl Albert Aschoff in 1906, and the sinoatrial node by Arthur Keith and Martin Flack in 1907.

While the connections that distribute the electrical impulse from the AV node to the ventricles were known through the works of Wilhelm His Jr, in 1893 and Jan Evangelista Purkinje in 1839, the mechanism by which electrical impulses spread between the atria remained uncertain.

In 1916 Bachmann published a paper titled “The Inter-Auricular Time Interval” in the American Journal of Physiology. Bachmann measured activation times between the right and left atria and demonstrated that interruption of a distinct anterior interatrial muscular band resulted in delayed left atrial activation. He concluded that this band constituted the principal route for rapid interatrial conduction.

Subsequent anatomical and electrophysiological studies confirmed the importance of the structure described by Bachmann, which came to bear his name. Bachmann’s bundle is now recognized as a key determinant of atrial activation patterns, and its dysfunction is associated with interatrial block, atrial fibrillation, and abnormal P-wave morphology. His work remains foundational in both basic cardiac anatomy and clinical electrophysiology.

Sources and references
1. Bachmann G. “The inter-auricular time interval”. Am J Physiol. 1916;41:309–320.
2. Hurst JW. “Profiles in Cardiology: Jean George Bachmann (1877–1959)”. Clin Cardiol. 1987;10:185–187.
3. Lemery R, Guiraudon G, Veinot JP. “Anatomic description of Bachmann’s bundle and its relation to the atrial septum”. Am J Cardiol. 2003;91:148–152.
4. "Remembering the canonical discoverers of the core components of the mammalian cardiac conduction system: Keith and Flack, Aschoff and Tawara, His, and Purkinje" Icilio Cavero and Henry Holzgrefe Advances in Physiology Education 2022 46:4, 549-579.
5. Knol WG, de Vos CB, Crijns HJGM, et al. “The Bachmann bundle and interatrial conduction” Heart Rhythm. 2019;16:127–133.
6. “Iatrogenic biatrial flutter. The role of the Bachmann’s bundle” Constán E.; García F., Linde, A.. Complejo Hospitalario de Jaén, Jaén. Spain
7. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 172–189, 1907.


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Galen of Pergamum
Galen of Pergamon 
(129AD - 200AD

 
The word sympathetic is the adjectival form of sympathy. This word arises from the Greek [συμπάθεια]and is composed of [syn/sym] meaning “together” and [pathos], a word which has been used to mean “disease”. In reality “pathos” has to do more with the “feeling of self”. Based on this, the word sympathy means “together in feeling”, which is what we use today.

How the term got to be used to denote a component of the so-called autonomic nervous system is part of the history of Medicine and Anatomy.

Galen of Pergamon (129AD-200AD), whose teachings on Medicine and Anatomy lasted as indisputable for almost 1,500 years, postulated that nerves were hollow and allowed for “animal spirits” to travel between organs and allowed the coordinated action of one with the other, in “sympathy” with one another. As the knowledge of the components of the nervous system grew, this concept of “sympathy” stayed, becoming a staple of early physiological theories on the action of the nervous system.

Jacobus Benignus Winslow (1669-1760) named three “sympathetic nerves” one of them was the facial nerve (the small sympathetic), the other the vagus nerve, which he called the “middle sympathetic”, and the last was what was known then as the “intercostalis nerve of Willis” or “large sympathetic", today’s sympathetic chain. Other nerves that worked coordinated with this “sympathetics” were considered to work in parallel with it. It is from this concept that the term “parasympathetic” arises.

Interestingly, the ganglia on the sympathetic chain were for years known as “small brains” and it was postulated that there was a separate multi-brain system coordinating the action of the thoracic and abdominopelvic viscera. The coordination between this “autonomous nervous system” and the rest of the body was made by way of the white and gray rami communicantes.

Today we know that there is only one brain and only one nervous system with an autonomic component which has a “sympathetic” component that is mostly in charge of the “fight or flight” reaction and a “parasympathetic” component that has a “slow down” or “depressor” function. Both work coordinated, so I guess Galen was not "off the mark" after all.

So, we still use the terms “sympathetic” and “parasympathetic”, but the origin of these terms has been blurred by history.

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. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
3. "Medical Meanings:A Glossary of Word Origins" Haubrish, WS American College of Physicians Philadelphia, 1997
4. "The History of the Discovery of the Vegetative (Autonomic) Nervous System" Ackerknecht, EH Medical History, 1974 Vol 18. 
Original image courtesy of Images from the History of Medicine at nih.gov

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