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-Louis Petit

Jean Louis Petit
(1674 – 1750)

French surgeon and anatomist, Jean Louis Petit was born in Paris in on March 13, 1674.  His family rented an apartment at his house to Alexis Littre (1658 – 1726), a French anatomist. Petit became an apprentice of Littre at seven years of age, helping him in the dissections for his lectures and at an early age became the assistant in charge of the anatomic amphitheater.

Because of Petit’s dedication to anatomy and medicine, in 1690 at the age of sixteen, became a disciple of a famous Paris surgeon, Castel.

In 1692, Petit entered the French army and performed surgery in two military campaigns. By 1693 he started delivering lectures and was accepted as a great surgeon, being invited to the most difficult operations.  In 1700 he was appointed Chief Surgeon of the Military School in Paris and in the same year he received the degree of Master of Surgery from the Faculty of Paris.

In 1715 he was made a member of the Royal Academy of Sciences and an honorary member of the Royal Society of London. He was appointed by the King as the first Director General of the Royal Academy of Surgery when it was founded in 1731.

Petit’s written works are of historical importance.  “Traite des Maladies des Os” ( A Treatise on Bone Diseases);  “Traite des Maladies Chirurgicales et des Operation” (A Treatise on Surgical Diseases and their Operations” This last book was published posthumously in 1774. He also published a monograph on hemorrhage, another on lachrymal fistula, and others.

He was one of the first to perform choIecystotomy and mastoidotomy. His original tourniquet design for amputations saved many in the battlefield and the design of the same surgical instrument today has not changed much since its invention by him.

His name is remembered in the lumbar triangle, also called the "triangle of Petit", and the abdominal hernia that can ensue through that area of weakness, the lumbar hernia or "Petit's hernia".

Sources:
1. “Jean Louis Petit – A Sketch of his Life, Character, and Writings” Hayne, AP San Fran Western Lancet 1875 4: 446-454
2. “Oeuvres compl?tes de Jean-Louis Petit” 1837 Imprimerie de F. Chapoulaud
3. Extraits de l'eloge de Jean-Louis Petit Ius dans Ia seance publique de I' Academie royale de chirurgie du 26 mai 1750” Louis A. Chirurgie 2001: 126 : 475- 81


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Update to the website and library catalog

Dr. Miranda's Ex-Libris  bookplate

UPDATED: After a long hiatus, I am happy to report that this website has been updated to a newer version of Joomla!, and still hosted by GoDaddy. The "look" of the website has not changed, but the software is faster and with a higher level of security. This work was done by my good friend from Greece, Christopher Mavros, who is an expert at designing web templates, web sites, and Joomla! extensions.  This also meant that my library catalog was left unfinished for a long time and this required lots of additional work.

First, the library needed new and updated bookplates, which were printed by BookplateInk, a USA based company that I strongly recommend. In case anyone wonders, the famous anatomists that are depicted in the bookplate are Harvey, Vesalius, Spigelius, and Albinus. Second, I needed software that could create the code to publish the titles of the library online. This work was done by my daughter Evelyn, to whom I am deeply grateful.

Recataloging the library is an ongoing effort. This will also require repairing and rebinding some of the older and damaged books. Due to this, during the next weeks and months this listing will change, but for a bibliophile this is not work, but pleasure.

As many of you know I am a collector of old and antique medical and anatomy books and I also have several copies of some of these books in different languages.

The oldest book in the library dates from 1696 and is "Opera Chirurgica Anotomica Conformata al Moto Circolare Del Sangue, & Altre Inuenziono De'piu Moderni. Aggivuntovi Un Trattato Della Peste" by Paolo Barbette. I recently acquired the 1713 book by Aulus Cornelius Celsus "De Medicina, Libri Octo".

Another book I am very proud of is not old, but still a rare book. It is "The Fabric of the Human Body, An Annotated Translation of the 1543 and 1555 Editions of “De Humani Corporis Fabrica Libri Septem", by Drs. Garrison and Hast This monumental translation work took twenty years and only 948 copies of this book were published in 2014. Completely sold out, it is today a rare book!

There are many other books that are important to me, either by its rarity (for those who know.... "The Green Book") or its controversy, as are the books by Pernkopf and Stefano Mancini.

You are welcome to peruse my library catalog, but be forewarned; I am not selling any of my books. Should you want to find a copy, you can use Abebooks.com as a great source for old and new books.

Dr. Miranda


Xiphoid appendix

Sternum - Xiphoid appendix
Click on the image for a larger version.

UPDATED: The term [xiphoid] is Greek in origin [ξίφος] and points to the similarity [-oid] of the sternum to a short straight sword used by the Greek. The term xiphoid refers to the lower cartilaginous inferior tip of the sternum. It presents with anatomical variations that include a central opening, or large processes that look like a disc, or even a bifid xiphoid process.

It has been named the xiphisternum, the metasternum, and the ensiform process. It is the last cartilage to ossify in the human, and it is used as a landmark for laparoscopic surgery. i.e. a subxiphoid port is a location for a laparoscopic port in the abdomen.

As a side note, another term used for [sternum] is the Latin word [gladius], referring to the short Roman straight sword of the gladiators. This term is no longer in use, but if it were, the xiphoid appendix would be the tip of the sword.

Think about this: why is a certain plant called a "gladiolus"?

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


Medieval health poem

Cover page of Regimen Sanitatis Salernitatum c. 1480
Cover page of Regimen Sanitatis Salernitatum c. 1480
Click on the image for a larger depiction

 "Thou to health and vigor should attain
Shun mighty cares, all anger deem profane
From heavy suppers and much wine abstain;
Nor trivial count it after pompous fare
To rise from the table and take to the air.
Spurn idle noonday slumbers, nor delay
The urgent call of nature to obey.
These rules if thou wilt follow to the end
Thy life to greater length thou may extend".

The original poem is written in Latin and is part of the book "Regimen Sanitatis Salernitarum" published in 1480. This book contains articles and poems by Afflacius, Bartholomeus, Copho, Ferrarius, Petronius, Johannes Platearius, and Trotula. The editor of the book was Arnold de Villa Nova. It was later translated into English.

It is considered one of the two great publications of the School of Salerno in the Medieval Ages, the other one being the "Compendium Salernitatus"

More on this wonderful book here.

Source:
"Medieval and Renaissance Medicine" B.L. Gordon 1959 Philosophical Library Inc. USA


Andreas Vesalius Bruxellensis

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.

Andreas Vesalius Bruxellensis

Andreas Vesalius Bruxellensis (1514- 1564). A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". For other articles on Andreas Vesalius, click hereDr. Miranda


Triangle of "doom"

Triangle of "doom"

UPDATED: The "triangle of doom" is a name given to a roughly triangular area in the posterior aspect of the anterior wall of the lower abdominopelvic region. It is used by surgeons repairing an inguinofemoral hernia with a mesh and they want to avoid large vascular structures, namely the external iliac artery and vein. The "triangle of doom" will be highlighted when you hover your cursor over the image.

The so-called "triangle of doom" is a misnomer perpetuated by the first laparoscopic surgeons who observed the anatomy of the inguinofemoral region from the posterior aspect. It is neither a triangle (as it only has two boundaries), nor is it an eponym (no such person - that is why is should not use uppercase). It does indicate an area where it is extremely dangerous to place staples or sutures during laparoscopic hernia surgery.

The "triangle of doom" is an inverted "V" shaped area with its apex at the internal (deep) inguinal ring. The "triangle of doom" is bound laterally by the gonadal vessels, and medially by the vas deferens in the male, or the round ligament of the uterus in the female. Within the boundaries of this area you can find the external iliac artery and vein.

It should be pointed out that although the "triangle of doom" landmark does protect the surgeon from damaging the external iliac vessels, a portion of these vessels lie outside of this area. In fact, there are several other areas of concern for neurovascular damage when performing a laparoscopic herniorrhaphy.

The image also depicts other structures of anatomical importance for laparoscopic herniorrhaphy:

Arcuate line (b)
Hesselbach's triangle (in yellow)
Aberrant obturator artery (Corona Mortis) (a)
• Inferior (deep) epigastric artery (c)

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


Clinical anatomy of the inguinofemoral hernias, as well as abdominal and perineal hernias are some of the lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc. For more information Contact Us.


The long road to the book "In the shadow of Vesalius" (3)

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.

If you arrived directly to this article, the first article in this three-page series can be read HERE

Bryan Green reading his poem in the book of Theo Dirix “ In Search of Andreas Vesalius”
Bryan Green reading his poem in Theo Dirix's
book “ In Search of Andreas Vesalius”
Click on the image for a larger version

I would like to shine a light on my husband poet /sculptor Bryan Green , who wrote a poem on Vesalius that is published in Theo’s book; “In Search of Andreas Vesalius: The Quest for the Lost Grave” and gave a performance at the Fabrica Vitae exhibition opening.. Bryan has constantly worked behind the scenes editing many letters, articles, books, and leaflets,  I couldn’t have done it all without his help and advice. He also made the long lorry journey to Zakynthos from Belgium with me and our friend James Gatehouse to deliver the monument.

Vesalius Continuum also marked the start of our touring exhibition “Fabrica Vitae” curated by Eleanor Crook, my sister Chantal Pollier, and myself. The exhibition toured all over Europe and the US with the help and support of Theo Dirix and Belgian Embassies world wide .

The conference and accompanying events could not have happened without financial funds and I hereby would like to thank all our sponsors: Professor Peter Abrahams with his infectious energy and professor Robert Jordan; St Georges University of Grenada, Ruth Richardson and Brian Hurwitz and Mark Gardiner for getting funding from the Wellcome trust, Marie Dauenheimer and the Vesalius Trust, BIOMAB, Ann van the Velde and The University of Antwerp, The AEIMS and MAA, William Nagels, warmly thank the local authorities and the mayor of Zakynthos, ARSIC,  Theo Dirix, and Stephen Joffe, and a special thank you also Stephen for writing a beautiful foreword for our book In the Shadow of Vesalius.

You can imagine after such an exciting and wonderful adventure, which took quite a few years to organize, and a quite a few years to reminisce over, we decided we wanted to keep the momentum going and thus the Vesalius triennial was born.

In 2017 BIOMAB, in collaboration with Vesaliana, organized the first triennial in Zakynthos ‘Uniting Medicine with Poetry, History and Culture’

It seems like another world in which we made our plans for the 2nd edition of the Vesalius Triennial Congress, 4 months before the COVID-19 pandemic lock down. From the vain belief that COVID-19 would not hit most countries, to hopes that everything would have blown over by 13th November 2020 (the day when the next Vesalius Triennial Congress would take place in Antwerp) to realizing that we were going to have to take action, the scientific committee has transformed from one in which everyone knew their time-tried and perfected role, to one requiring invention in uncharted territory.

New Vesalius Statue in Zakynthos

Professor Vivian Nutton and Professor Omer Steeno looking at a first edition of the Fabrica
Professors Vivian Nutton and Omer Steeno
looking at a first edition of the Fabrica

Canceling the 2nd  Vesalius Triennial was not a welcome prospect , since facilitating human communication is the corner stone of a scientific community. So we set sail for the vast virtual-reality realm. To discover just how far we could delve into virtual communication with a dedicated but small organising committee, was an eventful, insightful voyage. Sadly after long and careful consideration and several online meetings we finally decided to postpone all international congress keynote lectures and educational sessions until 2023.

However we would like to invite all the friends of Vesalius for a virtual book launch on Nov 13th we will soon post the event details on how to register for this event on social media, and on Vesalius continuum website

The book "In the shadow of Vesalius" can be ordered here: http://garant.be/shadow-of-vesalius/ 

Finally I would like to thank everyone who has been part of this adventure, special thank you to Professor Dr. Efrain Miranda ( Clinical Anatomy) for his continuous support, EBSA, Prof. Stefanos Geroulos, Vasia Hatzi (MEDinART), Pavlos Plessas, Nicos Varvianis, Maria Sidirokastriti-Kontoni & Fr. Panagiotis Kapodistrias,  the many wonderful speakers, the local organisers, our Keynote speaker Professor Martin Kemp for his wonderful contribution,  Eleni Andrianaki; ibis el greco , the wonderful delegates, the artists of the Fabrica Vitae exhibition, the museum and universities where we took our exhibition, a special thank you to Juris Salaks and Ieva Lebiete for hosting our exhibition at the Stradins museum and for all the help and support, Apostolis Sarris, Nikos Papadopoulos, Sylviane Déderix, Jan Driessen, Theo Dirix, Chr. Merkouri.and to the all the friends of Vesalius who like to keep his spirit alive.

Pascale Pollier-Green
Oct 2020

Personal note: I would like to thank Pascale Pollier-Green for authoring this series of articles and wish Professor Robrecht Van Hee the best success publishing this new book on the history and influence of Andreas Vesalius on anatomy, medicine, science, and the Arts. Dr. Miranda.