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, also known as "Halsted's Rules of Surgery", 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
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This is a word of Greek origin. The prefix [a-) means "absence of", or "without". The root term [-phon-] means "sound" or "voice". Aphonia is a pathological absence of voice, and was used by both Hippocrates and Galen.
Do not confuse [aphonia] with [dysphonia], where the prefix [dys-] means "abnormal". In aphonia there is total absence of voice, whereas in dysphonia there is an abnormal voice or "hoarseness"
As a side note, the word [phonograph] arises from the combination of the root terms [-phon-] and [-graph-], which means "to write". The word [phonograph] does not relate to the playing of a record, but rather to the process of creating one, transforming sound into a wavy line etched on a rotating wax model that is later cast into records. The modern production of sound CD's is similar, where the sound waves are act upon a laser that "burns" the track into a master CD. It is a similar process, but I guess calling creating a CD a type of "phonography" is too old fashion for modern marketing!
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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.
Jan Evangelista Purkinje
Jan Evangelista Purkinje (1787 - 1869). Known by his German name Purkinje, or his Czech name, Purkyn?, as well as his church-given name Salverius. Purkinje was born in the city of Libochovice, Bohemia, (now Czechoslovakia). He started his early studies in the church with Piarist monks. He took the name of Brother Salverius and served as a teacher in the Piarist schools. He dedicated himself to the study of natural sciences. Purkinje left the monastery before taking his final vows. Purkinje continued his studies and graduated in medicine in Prague. Even as a student Purkinje started research on the physics of sound and the physiology of vision, which he continued after his graduation. Purkinje was one of the first to understand the vision of motion, thus creating the first animated cartoons!
In 1823 Purkinje was appointed Professor of Physiology at the University of Wroclaw (Breslau), later taking the same chair in Prague. Besides being one of the first to propose experimental physiology as basis for research, Purkinje was one of the first to use the microscope to study the cells of the body, proposing the "cell theory", and introducing the word "protoplasm".
He made a number of discoveries, and his name is eponymically tied to many structures and processes, such as:
- Purkinje's cell of the cerebellum: Piriform cells found in Purkinje's layer
- Purkinje's fibers of the heart: These are not "fibers" as the name implies, but fast-conducting myocardial cells found as the most distal components of the conduction system of the heart
- Purkinje's law of vertigo: An observation that the apparent motion perceived when stopping the head after rotation changes from horizontal to vertical if the head is inclined laterally. This is important to pilots, as they are trained to understand that in conditions without external reference, moving the head down or laterally can induce uncontrollable vertigo.
Sources:
1. "Purkinje JE (1845) Mikroskopisch-neurologische Beobachturgen" Arch Anat Physiol Wiss Med II/III:281-295
2. "Jan Evangelista Purkinje (1787-1869)" J Neurol Neurosurg Psychiatry. 1994 July; 57(7): 777
3. "Jan Evangelista Purkinje (1787-1869)" Davies, MK; Hollman A. Heart (1996) 76(4): 311
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The root term [-angi-] has Greek origins and means "vessel", as in a "container". The suffix [(o)gram] means "examination of", or a "record". An angiogram is the examination of a vessels using some type of viewing or recording device.
In an angiogram the physician will inject radiopaque contrast to make the vessels discernible in an X-ray machine.
The accompanying image is an angiogram of the right coronary artery. It can also be called a "coronariogram".
The image shows the right coronary artery and three key branches: the acute marginal artery, the posterolateral artery, and the posterior interventricular artery (PDA).
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The "acute margin" refers to the anteroinferior border of the heart. It is also known by its Latin name [margo acutus].
The name of this border or margin of the heart is quite descriptive. If you observe the angle formed between the anterior or sternocostal surface of the heart with the posterior or diaphragmatic surface of the heart, you can see that the angle between these two surfaces is less than 90 degrees, therefore an "acute" angle. The corresponding border between these two surfaces has to be called the "acute margin"!
In relation to the acute margin of the heart there is usually found one of the longest branches of the right coronary artery. This artery that runs alongside the acute margin, is the "acute marginal artery", In an angiogram, this artery clearly depicts the anteroinferior border of the heart.
Here is a link to the article on the "obtuse margin" of the heart.
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The posterolateral artery, also known as the "retroventricular artery" is one of the two terminal branches of the right coronary artery. The other terminal branch is the posterior interventricular artery or PDA. This artery presents with many variations, from being absent to extremely long arteries with extensive branching that take some of the territory of the circumflex artery. The posterolateral artery extends from the crux cordis to the left side of the heart in the atrioventricular sulcus.
The AV node artery, which provides blood supply to the atrioventricular node (a component of the conduction system of the heart) may arise from the posterolateral artery instead of arising from the right coronary artery or the posterior interventricular artery.
When present, the posterolateral artery provides some posterior left ventricular branches and maybe some posterior left atrial branches. See the accompanying image, you may click on the image for more information. The image depicts a posterolateral artery slightly longer than usual.
Image property of: CAA, Inc. Photographer: E. Klein
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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 William Osler
Sir William Osler (1849-1919). William Osler was born in Bond Head, Canada, in what today is known as Ontario, of English parents. He started his college studies to become a minister, but realizing his true vocation was in medicine, he entered the Toronto School of Medicine, earning his medical degree in 1872.
Osler completed postgraduate studies in Europe, returning as a Professor at the McGill University. In 1884 he moved to Philadelphia to the University of Pennsylvania. In 1889 he left to become Physician-in-Chief and one of the founders of the newly-built John Hopkins hospital. His contributions to this new hospital and the American medical education are innumerable. Dr. Osler initiated the residency programs used today, as well as the programs of third and fourth year medical students in bedside patient rounds.
A prolific writer, Dr. Osler penned over 1,500 articles, monographs, and books, some of which are famous. His “Principles and Practice of Medicine” was published for a record 17 editions and 76 years (1892 -1968)! One of his most famous addresses is “Aequanimitas”, which he delivered when leaving the University of Pennsylvania. The book by the same name is a collection of some of his speeches and is part of my personal library.
His book collection grew over the years and he had a full-time librarian in charge of curating it. Her name was Marcia Crocker Noyes (1869 - 1946) and she had an interesting history, including the creation of the Osler Library bookplate.
In 1905 Dr. Osler accepted the position of Royal Chair of Medicine at Oxford, in England, and in 1911 he was awarded the title of “Sir William Osler”.
Personal Note: In June 1999, I had the opportunity to visit the collection of the John Martin Rare Book Room at the University of Iowa Medical School. I was allowed to read and handle original copies of the Fabrica and the Epitome by Vesalius as well as other original and rare medical books, including De Muto Cordis, by William Harvey. The books I had the opportunity to review were placed on an antique desk that belonged to Sir William Osler. A moment that has stayed with me, as it was the confluence of great individuals: Andreas Vesalius, the anatomist; William Harvey, the physiologist, and Sir William Osler, the medical educator. Dr. Miranda
Sources:
“Sir William Osler, M.D., C.M.” Sarik, J. Yeo, Ch.Pinckney J. The American Surgeon78.4 (2012): 385-7.
“Sir William Osler and gastroenterology” Chaun H. Can J Gastroenterol (2010) 24:10 615-618
“Sir William Osler (1849-1919)” Haas, LF J Neurol Neurosurg Psychiatry 1999 67: 137
“Sir William Osler (1849-1919)”Christian, HA Proc Amer Acad Arts Sci (1922) 496-499