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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William S. Halsted, MD
(1852 – 1922)
American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.
As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.
Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.
Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.
He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.
As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.
Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at www.nih.gov
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The suffix [-(o)penia] arises from the Greek [πενία] or [penia], meaning "poverty" or "to lack". In medical terminology this suffix is used to mean "a deficiency", or "lack of". Examples of its use are:
- Leukopenia or leukocytopenia: A combination of root terms; [leuk], means "white", and [-cyt-] means "cell". A white cell deficiency
- Pancytopenia: The prefix [pan] means "wide" or "many". The term refers to the deficiency of a wide variety of cells, in this case, blood cells
- Neutropenia or neutrocytopenia: Refers to the deficiency of neutrophil cells or polymorphonuclear leukocytes, The most common type of white blood cells
- Osteopenia: The root term [-oste] means "bone". A bone deficiency, not low enough to be classified as osteoporosis
- Erythropenia: The root term [-erythr-] means "red". A deficiency of red blood cells
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The right coronary artery (RCA) is one of the two branches that arises from the ascending aorta and provide blood supply to the heart. The RCA begins at the coronary ostium, situated usually within the right sinus of Valsalva found in the aortic valve, one of the semilunar valves of the heart.
The RCA gives off in its initial course two arteries: the conus artery, which gives blood to the conus arteriosus, the outflow tract of the right ventricle, and the artery to the sinoatrial (SA) node, a component of the conduction system of the heart.
The RCA descends in the atrioventricular sulcus, giving off a series of small right ventricular branches and a couple of small right atrial branches, it then bends around the acute margin (margo acutus) and passes to the posterior surface of the heart. Just before the RCA bends posteriorly, it will give off the acute marginal artery, usually a thin, longer branch that extends towards the cardiac apex.
In its posterior trajectory the RCA gives off a couple of small posterior right ventricular arteries and then ends at the crux cordis, where the RCA gives off the posterior interventricular artery, commonly known as the posterior descending artery (PDA). The RCA will also give off the posterolateral artery, which, situated in the atrioventricular sulcus, extends the vascular territory of the RCA into the region of the left ventricle. This origin of the PDA from the RCA is subject to anatomical variation, which gives origin to the concept of coronary dominance.
Arising from the terminal portion of the RCA (sometimes from the posterolateral artery) is the artery to the atrioventricular (AV) node, another component of the conduction system of the heart. It is easily understood that stricture or stenosis of the RCA (depending on location) can then lead to damage of the conduction system of the heart.
Human heart and coronary artery anatomy and pathology are some of the many lecture topics developed and presented by Clinical Anatomy Associates, Inc.
Image property of: CAA.Inc.Artist: Victoria G. Ratcliffe
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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.
Sir Percival Pott
Sir Percival Pott (1714 – 1788)
English surgeon and anatomist, Percival Pott was born in London on January 6, 1714. His name has the alternate spelling Percivall. In 1729 Pott started his apprenticeship with a surgeon, William Nourse. At age 22 he received the diploma from the Company of Barber Surgeons, and by age 34 he became a full independent surgeon at St. Bartholomew’s Hospital in London. In 1753 Percival Pott was elected, with William Hunter, as Master of Anatomy at Surgeon’s Hall
His name is eponymically remembered in “Pott’s fracture”, a condition that apparently he himself suffered and that kept him in bed writing several of his most important works. This historical account is refuted by many and could be legend. The fact is that Percival Pott did write about what today is known as “Pott’s fracture”.
Percival Pott was elected to the Fellowship of the Royal Society in 1764 and became Governor of the Company of Barber Surgeons in 1765.
Pott was one of the first to recognize a condition caused by industrial working conditions when he diagnosed “Chimney Sweeper’s Cancer” a scrotal cancer caused by the exposure to soot and poor working and personal hygienic conditions.
Some of Pott’s eponyms:
- Pott’s fracture: Fracture of the fibula superior to the lateral with rupture of the medial ligament and outward displacement of the foot
- Pott’s disease: Spinal tuberculosis with hyperkyphosis
- Pott’s puffy tumor: Edema of the scalp due to underlying osteomyelitis and suppuration
Sources:
1. "Sir Percival Pott" Ann R Coll Surg Engl (Suppl) 2011; 93:66–67
2. “Percivall Pott (1714–1788) and chimney sweepers’ cancer of the scrotum” Brown JR, Thornton JL. Br J Ind Med 1957; 14: 68–70
3. "Percival Pott; Pott's fracture, Pott's disease of the spine, Pott's paraplegia". Harold, E. J Periop Pract, 22 (11), 366
4. “The Origin of Medical Terms” Skinner, HA 1970
5. “Dictionary of Medical Eponyms” Firkin, BG; Whitworth JA 1987
6. “Invective in surgery: William Hunter versus Monro Primus, Monro Secundus, and Percival Pott” Ravitch. MM, Bull N Y Acad Med. 1974; 50(7): 797–816
7. “Percivall Pott” Dobson, J. Ann Roy Coll Surg Eng 1972: 50; 50-65
Original image courtesy of "Images from the History of Medicine" at www.nih.gov
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The [iliococcygeus muscle] is one of the muscles that forms the pelvic diaphragm. It is the more superficial and one of the two muscular components of the levator ani muscle, the other one being the pubococcygeus muscle.
The iliococcygeus muscle attaches anterolaterally to a thickening of the deep fascia of the obturator internus muscle called the Arcus Tendineous Levator Ani (ATLA).
It attaches posteriorly to the sacrococcygeal region and posteromedially it attaches to a medial ligamentous structure that stretches between the anal canal and the coccyx, the anococcygeal ligament or anococcygeal raphe.
Some fibers of both the iliococcygeus and the pubococcygeus muscles continue inferiorly between the external and internal anal sphincters. This is known as the "conjoined longitudinal muscle of the anal canal" and it is one of the few areas in the human body where there is a mixing of both smooth (involuntary) muscle and striated (voluntary) muscle.
Image property of: Photographer: David M. Klein
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The [pubococcygeus muscle] is one of the muscles that forms the pelvic diaphragm. It is the deepest and one of the two muscular components of the levator ani muscle, the other one being the iliococcygeus muscle.
The pubococcygeus muscle attaches anteriorly to the posterior aspect of the body of the os pubis or pubic bone, leaving a gap or hiatus anteriorly which allows passageway of the deep dorsal vein of the penis in the male or the deep dorsal vein of the clitoris in the female.
Anterolaterally, the pubococcygeus muscle attaches to a thickening of the deep fascia of the obturator internus muscle called the Arcus Tendineous Levator Ani (ATLA).
As its name implies, the pubococcygeus attaches posteriorly to the sacrococcygeal region and posteromedially it attaches to a medial ligamentous structure that stretches between the anal canal and the coccyx, the anococcygeal ligament or anococcygeal raphe.
Several subcomponents are described in the pubococcygeus muscle, one of them being the puborectalis muscle. This muscle is the medial component of the pubococcygeus, it attaches anteriorly to the pubic bone and arches posterior to the anal canal, kinking it and being one of the components of fecal continence.
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Dura Mater: Latin terms meaning [tough mother]. The dura mater is the outermost of the three meninges. It is quite tough, forming a sac containing the spinal cord and brain, known as the dural sac or thecal sac. The image, from a book by Andreas Vesalius, shows a head with the dura mater in situ (label "A").
For more information on the meninges, click here.
Original images from Andreas Vesalius '"De Humani Corporis Fabrica; Libri Septem" (1543)