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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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Book: The Iconography of Andreas Vesalius (1925)

Vesalius Fabrica Portrait
Figure 1: Vesalius Fabrica Portrait

Recently I acquired the 1925 book “The Iconography of Andreas Vesalius” by Marion Harry Spielmann (1858-1948).  M.H. Spielmann was a well-published Victorian art scholar and critic. At the end of this article you can find the bibliographical information on this book.

The book is a serious detailed research of the known paintings, lithographies, sculptures, and medals that show the likeness of Andreas Vesalius, the date of publication and the author’s commentary on each one.

Andreas Vesalius is known as the “Father of Modern Anatomy”. He pushed for a description of the structure of the human body as seen in a dissection, going against the trend at the time where the anatomy was that described by Galen of Pergamon in his books. Galen’s anatomy was based on animal dissection and not a lot of human dissection. Furthermore, the lecturer would read from the book and the demonstrator pointing at the structures ignoring the discrepancies between the book and the body. For additional information and images click here.

Vesalius opus magnum (great work) was the publication in May 1543 of one of the most famous books in medical history. The title of the book is “De Humani Corporis Fabrica, Libri Septem” (Seven Books on the Structure of the Human Body). The book is now known as the “Fabrica”. This has led numerous artists to paint his likeness, many times based on past images or sometimes from pure imagination. The latest modern edition of the Fabrica was published in 2014.

We do know of only one portrait that depicts Vesalius’ likeness at the time of printing (1542)  and that is the second image in the Fabrica of 1543 (figure 1) This image was carved in a pear wood block later used for printing. The woodblock indicates the date of carving (1542) and the age of the great anatomist that year (28). The sketch from which the block of wood was carved is most surely made by Jan Stephan Van Calcar (1449-1546). There is only supposition as to who was the artist that carved the woodblock, and there are several research papers on the subject. The best suggestion is that the woodcarvers were Francesco Marcolini (1505-1560) and Domenico Campagnola (1500-1564), both mentioned in a paper by Jaffe and Buchanan (2016). Campagnola is actually thought to be the woodcarver for the title page of the 1543 Fabrica.

The Iconography book goes into great detail on this image of the great anatomist, and dedicates a detailed description of the title page of the 1543 and the 1555 editions of the Fabrica, descriptions that I can only encourage to be read by researchers interested in the life and works of Andreas Vesalius. The book can be read online the Internet Archive here. The book is written mostly in English, but has an introduction in French.

1555 Fabrica Title Page
Figure 2: 1555 Fabrica Title Page

 “The  Iconography of Andreas Vesalius” is a rare book, it is not easy to find, and probably the most important characteristic of the book is not mentioned in the many descriptions of the book found on the Internet, medical libraries, and antiquarian booksellers websites: The book originally included a separate, folded-in-four, high-quality linen paper print of the title page of the 1555 Fabrica. Most of the books found today have lost this print. Figure 2 shows a scan of the print found in the book I acquired. A 4.5 Mb watermarked actual size of this print can be seen here. If you want to download it, you can right click on the image and then click on "Save As".

This reprint of the Fabrica’s title page was done using the 1555 original woodblock, which makes it priceless. As shown in the accompanying image, the page leaves blank the two places where the title of the book and the dedication to the king and printer markings where placed. These would have been prepared in separate type and rearranged for a different use after printing. The print measures 16 7/8 by 12 1/4 inches (31.1 by 42.9 cms) The woodblock of the title page of the 1555 Fabrica was last used in 1934 when it was used to print the 1934 edition of the Icones Anatomicae, and then returned to the Louvain University in Belgium where it was destroyed by the German army in 1940. The Icones Anatomicae was the last print using the original woodblocks.  

The rest of the original woodblocks was burned during a WWII bomb raid on July 16, 1944.

The following information is from the Stanford Library and it is one of the few that indicate the existence of the reprint of the 1555 Fabrica title page in an envelope pasted on the book cover reverse.

Author/Creator: Spielmann, M. H. (Marion Harry), 1858-1948.
Subject:    Vesalius, Andreas, 1514-1564. History of Medicine. Physicians. 1500s
Genre: Biographical Information. Historical Works. Portraits

Bibliographic information:
Date: 1925
Series: Research studies in medical history ; no. 3, 1925
Note: Includes index. Title-page of De humani corporis fabrica libri septum by Andreas Vesalius, Second edition, 1555 printed direct from the original wood block in the pocket on verso of cover.

Personal Note: I am working on updating my library catalog to reflect the latest book acquisitions and gifts received. Dr. Miranda.

Sources:
1. “The Iconography of Andreas Vesalius” M.H. Spielmann. The Wellcome Historical Medical Museum London. John Bale, Sons & Danielson Ltd.

2. “The Andreas Vesalius Woodblocks: A Four Hundred Year Journey from Creation to Destruction” Acta Med Hist Adriat 2016; 14(2);347-372
3. "The identity of the artists involved in Vesalius Fabrica 1543” Guerra, F. (1969)  Medical History, 13(1), 37.


Coumadin ridge

Coumadin ridge
Coumadin ridge
Click on the image for a larger version

UPDATED: The [Coumadin ridge], also known as the [Warfarin ridge], or a [left atrial pseudotumor]. is an excessive elevation or protrusion of a normal ridge found between the left superior pulmonary vein and the internal ostium of the left atrial appendage. Usually this ridge will extend inferiorly towards and anterior to the ostium of the left inferior pulmonary vein. The Coumadin ridge is considered an anatomical variation of the otherwise small ridge, known as the left lateral ridge.

Because of its location and morphology, some cardiologists and radiologists have mistaken this elevation or fold of the internal anatomy of the left atrium for a thrombus and prescribed anticoagulant therapy (Coumadin or Warfarin) when none was needed, hence its name.

To understand the generation of the Coumadin ridge we must understand the embryology of this area of the heart. The left atrial appendage is the original left atrium in the embryo, which is displaced anteriorly and superolaterally when the veins that enter the atrium start to dilate at their distal end creating the left sinus venarum. After the left atrium proper has formed, the left atrial appendage is left as nothing more than an embryological remnant that can cause problems if the patient has atrial fibrillation (AFib). The ridge forms at the point where the left atrial appendage and the sinus venarum meet.

The Coumadin ridge can vary in morphology, from presenting as an elevated ridge, to a bulbous, pedunculated mass that seems to float within the left atrial appendage and undulate, following the cardiac motion, forcing the cardiologist into believing they are in the presence of a thrombus or a tumor within the heart.

This fold of tissue may contain the ligament of Marshall, autonomic nerves, and a small artery. In rare cases there may be an actual tumor arising from the location of the Coumadin ridge, but this is just a coincidence.

Now that the Coumadin ridge is a better known anatomical variation, cardiologist sometimes refer to their finding as a pseudotumor, a description that may scare the patient, but is only but a fold of tissue inside the heart.

Finding a Coumadin ridge in a patient with atrial fibrillation can be an interesting situation requiring differential diagnosis, as a patient with AFib can present with thrombi in the left atrial appendage. What to do? Is it or is it not a thrombus? Also, a differential diagnosis is needed in the case where the image is actually that of a left atrial tumor or an atrial myxoma.

The accompanying image is own work based on Sra (2004) and McKay (2008), and is a graphite on paper sketch. The image shown an internal view of the left atrium showing the left superior and inferior pulmonary vein, the ostium of the left atrial appendage and a segment of the area of the mitral valve.

We would like to thank Dr. Randall K Wolf, a contributor to Medical Terminology Daily for suggesting this article.

Sources:
1. “Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography” Lohdi,AM, et al. World J Clin Cases. 2015 Sep 16; 3(9): 831–834
2. “Coumadin ridge” Tasco, V. https://radiopaedia.org/articles/coumadin-ridge
3. “Papillary fibroelastoma arising from the coumadin ridge” Malik, M, Shilo, K, Kilic,A. J Cardiovasc Thorac Res. 2017;9(2):118-120.
4. “‘Coumadin ridge’ in the left atrium demonstrated on three dimensional transthoracic echocardiography” McKay,T., Thomas, L. Europ J Echocard (2008) 9, 298–300
5. “Endocardial imaging of the left atrium in patients with atrial fibrillation” Sra J; Krum D; Okerlund D; Thompson H. J Cardiovasc Electrophysiol 2004 Feb; Vol. 15 (2), pp. 247


The presence of Andreas Vesalius in Zakynthos (3)

Continued from "The presence of Andreas Vesalius in Zakynthos (2)"

Bust of Vesalius made by Pascale Pollier
Bust of Vesalius made by Pascale Pollier
Bust of Vesalius made by Pascale Pollier
Bust of Vesalius made by Pascale Pollier

According to Theo Dirix, Belgian Consul to Greece and Vesalius enthusiast, there are other reminders on the island such as a painting in one of the local schools.

On September 3rd, 2014, as part of the Vesalius Continuum meeting on Zakynthos Island, a new bronze statue was unveiled to celebrate the life and works of Andrea Vesalius and remember his death on Zakynthos. This statue is a representation of Vesalius’ style of depicting anatomy in his book “De Humani Corporis Fabrica Libri Septem” and is a “muscle man” mixed with the motif of the famous plate 20 of Book 1 that shows a skeleton musing over a skull. The statue also presents the Vesalius family coat of arms. The statue is the work of Richard Neave and Pascalle Pollier.

Pascale Pollier, a biomedical artist specializes in face reconstructions and made a new bust of Vesalius based on the only known portrait of the great anatomist found on the pages of his immortal book “The Humani Corporis Fabrica Libri Septem”.

The statue was unveiled in front of an international crowd of anatomists, medical historians, biomedical artists, and film makers. Following the ceremony a display of artistic works related to Vesalius was opened in the Zakynthos municipality.

These are today the signs of the presence of Vesalius on Zakynthos. We know today that his body is interred in the cemetery of the church of Santa Maria della Grazie in Zakynthos. Sadly this church was destroyed twice in earthquakes and in 1953 was completely demolished along with 85% of the city. It was not rebuilt and now lies under the new, rebuilt city. One of the research papers presented at the 2014 Vesalius Continuum meeting has rediscovered the location of the church with great accuracy. The account of this paper and how I was able to find this geolocation will be presented in another article.

In 2014 the Vesalius Continuum Meeting with the Zakynthos government helped unveil a bronze statue to honor Andreas Vesalius. The statue reminds us of the "philosopher" of Jan Stephan Van Calcar, but in this case it is a muscle man contemplating a skull. At the base of the statue is the Vesalian coat of arms with the three weasels

New Vesalius Statue in Zakynthos
New bronze statue of Vesalius

New Vesalius Statue in Zakynthos
Close up of the new bronze statue of Vesalius

Sources
1. “Andreas Vesalius of Brussels 1514-1564” O’Malley, CD. Los Angeles 1965
2. "Andreas Vesalius; The Making, the Madman, and the Myth" Joffe, SN. Persona Publishing 2009
3. “In Search of Andreas Vesalius – The Quest for the Lost Grave” Dirix, T. Lanoo Campus Belgium 2014


 

The presence of Andreas Vesalius in Zakynthos (2)

Continued from “The presence of Andreas Vesalius in Zakynthos (1)

The second reminder of the presence of Andreas Vesalius in the Zakynthos Island is a street in the west side of the city of Laganas, “ΟΔΟΣ ΑΝΔΡΕΑ ΒΕΖΑΛ” or” Andrea Vesalius Street”. It is relatively short, narrow and windy, and it has several restaurants and hotels as you get closer to the sea where it ends at the beach. At this point there is a monument that honors Andrea Vesalius. This monument was erected in 1965. It has inscriptions in Greek, and Latin. This is the third memento to Vesalius in Zakynthos.

Vesalius street sign in Laganas
Vesalius street sign in Laganas

Directions to the Vesalius monument in Laganas
Directions to the Vesalius monument in Laganas

Vesalius Monument in Laganas
Vesalius Monument in Laganas
Vesalius Monument in Laganas
Vesalius Monument in Laganas

 This monument was erected in Laganas following a legend that Vesalius had shipwrecked and he was found at the beach. Another legend says that Vesalius was left at the beach at Laganas to die as he was very sick. One of the presentations at the 2014 Vesalius Continuum meeting by Dr. Mauritz Biesbrouck disputed these legends with recently found letters by George Boucher to Johanes Metellus. George Boucher was a German jeweler that traveled with Vesalius back from Jerusalem and paid for Vesalius’ burial and monument at the church of Santa Maria della Grazie. These letters were authenticated and analyzed, bringing light to Vesalius’ place of disembarkment in Zakynthos. The Laganas monument, although correct in content, should be moved to the port of Zakynthos, to the point where the old city walls were found, the place where Vesalius collapsed and died.

The monument has a legend in both Greek and Latin. It reads as follows:

ΕΙΣ ΜΝΗΜΗΝ ΤΟΥ
ΑΝΔΡΕΑ ΒΕΖΑΛ
ΜΕΓΑΛΟΥ ΒΕΛΓΟΥ ΑΝΑΤΟΜΟΥ
ΘΑΝΟΝΤΟΣ ΕΝ ΖΑΚΥΝΘΩ ΤΟ 1564
Η ΕΝΩΣΙΣ ΤΩΝ ΔΙΠΛΜΑΤΟΥΧΩΝ ΤΩΝ
ΠΑΝΕΠΙΣΤΗΜΙΩΝ ΚΑΙ ΑΝΩΤΑΤΩΝ ΣΧΟΛΩΝ
ΤΟΥ ΒΕΛΓΙΟΥ, ΤΗΝ ΣΧΟΛΩΝ
ΑΝΗΓΕΙΡΕΝ ΤΘ 1965

IN MEMORIAM

ANDREAE VESALII BRUXELLENSIS
TUMULUS
QUI OBIIT IDIBUS OCTOBRIS ANNO MDLXIV
AETATIS VERO SUAE L
QUUM HIEROSOLYMIS REDISSET

Vesalii cineres venerandaque gentibus ossa
quisquis remota conteueris insula
qua jacer incultis memorosa Zakynthos arenis
gradum, viator et laborem sistito
naturae genium finemque extre maque rerum
vidisse credens coetera insanus labor

The rest is a poem in Latin that is translated as:

“The ashes and bones of Vesalius, sacred to the world
whoever finds then on this isolated island passing by the wild shores of Zakynthos,
should hold his tired steps, and believe that it is here that Vesalius met the ultimate goal of nature
and understood that striving for anything else is pointless” (Stouffis, Z, 1990)

When I visited this spot it was raining very hard and while I waited to take these pictures I looked out at the dark sea almost believing that maybe this was the spot where Vesalius came to land in Zakynthos. Now we know that it is not, but the moment was poignant and made me feel closer to the great anatomist.

On a more mundane note, in this area of Laganas because of the street name there are several businesses named "Vezal", a hotel, a supermarket and a taverna! I could not bring myself to post images of those places.

Continued in  "The presence of Andreas Vesalius in Zakynthos (3)


 

The presence of Andreas Vesalius in Zakynthos (1)

Bust of Vesalius in Zakynthos
Bust of Vesalius in Zakynthos

The island of Zakynthos is one of the Ionian Islands found 155 miles (250 km) to the West of Athens. It is to the South of Macedonia, the island of Odysseus. It is also known as Zanthe or Zante, both pronunciations of the medieval Italian name for this island.

In October 15, 1564 Andreas Vesalius died suddenly at the gates of the main city of the island, also called Zakynthos, after a long and perilous return voyage from his pilgrimage to Jerusalem. The details of this trip and his potential cause of death will be covered in subsequent articles.

As famous as Vesalius is today, you would think that it would be easy to find information as to his grave and presence in the island. This is not so. Vesalius last trip to Jerusalem, his return, his death has been to date shrouded in mystery and legend. Some of these have been clarified in the 2014 Vesalius Continuum meeting in Zakynthos.

Plaque on the Bust of Vesalius in Zakynthos
Plaque on the Bust of Vesalius in Zakynthos

There are a few reminders of the presence of Vesalius on the island. The first one is a marble bust found in a small triangular plaza found about 100 yards from the building of the Municipality of Zakynthos and the Dionysios Solomos Square(Πλατεία Διονυσίου Σολωμού). The plaza was initially called “Vesal square” and later was renamed after the former major of Zakynthos, Fotis Ladikos.

Described by O’Malley (1965) in his well-known Vesalius’ biography, I had a difficult time finding the bust, although it is on the main street in front of the sea looking at the port, as most locals do not know about it. It was only by chance that one of the attendees to the meeting, Dr. Kenneth Wise found it close to a well-known Greek Restaurant, the Gallo D’Oro (Golden Rooster). It was also by chance that he and I talked about it when discussing Dr. Wise’s book on Vesalius entitled “All Else Is Mortal”.

 

The marble bust has a barely readable marble plaque that reads in Greek:

ΑΝΔΡΕΑΣ ΒΕΖΑΛ
ΕΓΕΝΝΗΘΗ ΕΙΣ ΒΡΥξΕλλΕΣ 1-2-1515
ΑΠΕΘΑΝΕ ΕΝ ΖΑΚΥΝΘΩ 15-10-1564

ANDREAS VESALIUS
BORN IN BRUSSELS 1-2-1515
DIED IN ZAKYNTHOS 15-10-1564

This plaque has the wrong date of birth, as it is well documented that Andreas Vesalius was born on the early morning of December 31st, 1514, , making the year 2014 the 500th anniversary of his birth and the 450th  anniversary of this death. This is the year when I spent a week in Zakynthos.

Continued here.


Prosopagnosia

Fusiform Gyrus
Fusiform gyrus.

Prosopagnosia is a neurological disorder characterized by the inability to recognize faces.  It is also known as face blindness or facial agnosia. There are different degrees of presentation of this pathology and some patients go through life without knowing that they have this problem characterizing it as just “a quirk” or that “they just are not good at remembering faces”.

Advanced forms of prosopagnosia cause some patients not to be able to recognize their own face or their own family members. Prosopagnosia is thought to be the result of abnormalities, damage, or functional impairment in the right fusiform gyrus, located in the inferior occipitotemporal region of the brain. The fusiform gyrus is related to the limbic system and seems to coordinate the systems that control facial perception and memory.  Prosopagnosia can result from stroke, traumatic brain injury, or certain neurodegenerative diseases

Prosopagnosia seems to also be congenital and run in certain families, pointing to a possible genetic disorder in the fusiform gyrus region.

The etymology of the term prosopagnosia is complex. It starts with the Greek word “gnosia”, a derivate of [γνώση] (gnósi)  meaning “cognition”, “awareness”, or "knowledge". Adding the prefix “a-" leads to [agnosia] meaning lack or absence of cognition or awareness. The prefix "prosop-" derives from the Greek term [πρόσωπο] (prósopo) means f"ace". Therefore, prosopagnosia means “absence of facial awareness”.

There are famous people with prosopagnosia including Jane Goodall and Steve Wozniak.

Here is an interesting video from YouTube on the topic.

videocover010 

Image courtesy of https://commons.wikimedia.org/wiki/File:Fusiform_gyrus_animation.gif
Video courtesy of YouTube and Lucy Barnarf
Note: Google Translate includes the symbol (?). Clicking on it will allow you to hear the pronunciation of the word.