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

Marcia Crocker Noyes
(1869 – 1946)

Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore... This is certainly an article that can be called "A Moment in History"

Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]

Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.

The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.

Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!

Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.

Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.

Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.

In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.

The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.

Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]

Marcia Noyes handwriting

NOTE: This article has been modified from the original Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.

Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding


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Peripheral nerve injuries can result from trauma, compression, thermal damage or systemic diseases, and their classification is essential for diagnosis, management, and prognosis. Three key terms are used to describe the severity and nature of these injuries: neurapraxia, axonotmesis, and neurotmesis. They describe the structural and functional integrity of nerve fibers after injury. The etymology of these terms derives from the Greek language.

These terms were initially proposed by Sir Herbert John Seddon (1903 – 1977), an English anatomist and orthopedic surgeon who published his initial findings in 1943, followed by Sir Sydney Sunderland (1910 – 1993), an Australian orthopedic surgeon who published a revised classification in 1951. The terms coined by Seddon and Sunderland and their classification system into 5 Grades of Nerve Injury remain central to the treatment of nerve injuries today.

Neurapraxia:

Neurapraxia represents the mildest form of nerve injury. It is characterized by a temporary block of nerve conduction without axonal disruption. Recovery is typically complete and occurs within days to weeks.

• No structural damage to the axon or surrounding connective tissue.
• Localized demyelination may occur, leading to a conduction block.
• Commonly results from compression or mild blunt trauma (e.g., “Saturday night palsy” or a "transient ulnar nerve palsy").

The term is derived from the Greek [νεῦρον] meaning “nerve” and [πρᾶξις] (praxis) meaning “action”. In medical terminology “a” or “an” means “without” or “absence of”. Thus, the word is constructed as [neur]-[a]-[praxia] meaning “absence of nerve function”.

 Sir Herbert John Seddon (1903 – 1977) AI composite image

 Sir Herbert John Seddon (1903 – 1977)

 Sir Sydney Sunderland (1910 – 1993)

 Sir Sydney Sunderland (1910 – 1993)

Axonotmesis

Axonotmesis is a more severe injury in which the axon is damaged, but the surrounding connective tissue structures (endoneurium, perineurium, and epineurium) remain intact. Wallerian degeneration occurs distal to the lesion, and axonal regeneration following the intact connective tissue channels can allow for not only nerve regeneration but regain of function of the damaged nerve. This is the mechanism of action of cryoneurolysis devices used in surgery.

• Axonal continuity is lost, but the scaffolding remains.
• Regeneration can occur at a rate of approximately 1–3 mm/day.
• Often seen in crush injuries or prolonged compression.

The term is derived from the Greek [ἄξων] meaning “axis” and [τμῆσις], meaning “division” or “cut”. Axonotmesis means “division (cutting) of the axon.”

Augustus Volney Waller (1816 – 1870)
Augustus Volney Waller (1816 – 1870)

Neurotmesis

Neurotmesis is the most severe form of nerve injury. It involves complete disruption of the axon and surrounding connective tissue, as would happen when a nerve is transected or avulsed. It results in permanent loss of function, since when the axons start to regrow, there are no connective tissue “tunnels” to guide the growing axon to their terminal connections. One of the problems that may happen is the formation of a neuroma or neurinoma at the site of nerve transection.

The only way to attempt to restore function is with surgical intervention bringing the cut ends of the nerves together, sometimes using microsurgery. The results of surgery are not always optimal

• Wallerian degeneration occurs distal to the injury.
• Regeneration is not possible without surgical repair.
• Typically is the result from lacerations, severe traction injuries, or penetrating trauma.

The term is derived from the Greek [νεῦρον] meaning “nerve” and [τμῆσις] meaning “division” or “cut”. Neurotmesis thus translates to “division of the nerve.”

Accurate classification of nerve injuries can help guide prognosis and treatment:

• Neurapraxia: Managed conservatively with physical therapy and observation.
• Axonotmesis: May require surgical exploration if function does not return within expected time frames.
• Neurotmesis: Early surgical intervention is usually necessary to restore any function. 

Nerve injury comparison table

 

Note: The term “Wallerian degeneration” is associated eponymically with Augustus Volney Waller (1816 – 1870), an English physiologists know for his work on nerve injury and regeneration. 

Personal note: Most people talk about "peripheral nerves", as if "central nerves" existed. This is not so. Within the Central Nervous System (CNS) the bundles of axons have different names such as "fascicles" (fasciculus lenticularis), tracts" (spinothalamic tract), lemniscus (medial lemniscus), etc. These central bundles of axons form structures that themselves have separate names, such as the corpus callosum, internal capsule, external capsule, anterior commissure, etc. All of these structures lack a well formed connective tissue wrap, which is the reason why transection of these structures usually does not allow recovery, such as in the case of spinal cord transection.

Nerves, which are only found in the Peripheral Nervous System (PNS). do have a well-formed connective tissue wrap formed by the endoneurium, perineurium, and epineurium. The presence of these connective tissue structures is what allows for nerve regeneration and recuperation of functionality.

To be precise then, using the term "peripheral nerve" is redundant, as all nerves are peripheral! Dr. Miranda

Sources
1. Seddon H. Three Types of Nerve Injury. Brain. 1943;66(4):237-88. doi:10.1093/brain/66.4.237
2. Seddon H, Medawar P, Smith H. Rate of Regeneration of Peripheral Nerves in Man. J Physiol. 1943;102(2):191-215. doi:10.1113/jphysiol.1943.sp004027
3. Sunderland S. A Classification of Peripheral Nerve Injuries Producing Loss of Function. Brain. 1951;74(4):491-516. doi:10.1093/brain/74.4.491 
4. O'Brien, M. D., & Wade, D. T. (1992). Neurological rehabilitation. Chapman and Hall. 
5. Liddell, H. G., & Scott, R. (1940). A Greek-English Lexicon. Oxford University Press. 
6. "The Origin of Medical Terms" Skinner 1970 
7. "Dorland's Illustrated Medical Dictionary" 28th Ed. W.B. Saunders. 1994 
8. “Stedman’s medical eponyms” Farbis, P; Bartolucci, S. Williams & Wilkins 1998 
9. https://radiopaedia.org/articles/sunderland-classification-of-nerve-injury 
10. " Correlative Neuroanatomy and Functional Neurology" Chusid, Joseph. Lange Medical Publications 
The image of H.J. Seddon is an AI composite of the few images and portraits available. Courtesy OpenAI.