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

Jean George Bachman

Jean George Bachmann
(1877 – 1959)

French physician–physiologist whose experimental work in the early twentieth century provided the first clear functional description of a preferential interatrial conduction pathway. This structure, eponymically named “Bachmann’s bundle”, plays a central role in normal atrial activation and in the pathophysiology of interatrial block and atrial arrhythmias.

As a young man, Bachmann served as a merchant sailor, crossing the Atlantic multiple times. He emigrated to the United States in 1902 and earned his medical degree at the top of his class from Jefferson Medical College in Philadelphia in 1907. He stayed at this Medical College as a demonstrator and physiologist. In 1910, he joined Emory University in Atlanta. Between 1917 -1918 he served as a medical officer in the US Army. He retired from Emory in 1947 and continued his private medical practice until his death in 1959.

On the personal side, Bachmann was a man of many talents: a polyglot, he was fluent in German, French, Spanish and English. He was a chef in his own right and occasionally worked as a chef in international hotels. In fact, he paid his tuition at Jefferson Medical College, working both as a chef and as a language tutor.

The intrinsic cardiac conduction system was a major focus of cardiovascular research in the late nineteenth and early twentieth centuries. The atrioventricular (AV) node was discovered and described by Sunao Tawara and Karl Albert Aschoff in 1906, and the sinoatrial node by Arthur Keith and Martin Flack in 1907.

While the connections that distribute the electrical impulse from the AV node to the ventricles were known through the works of Wilhelm His Jr, in 1893 and Jan Evangelista Purkinje in 1839, the mechanism by which electrical impulses spread between the atria remained uncertain.

In 1916 Bachmann published a paper titled “The Inter-Auricular Time Interval” in the American Journal of Physiology. Bachmann measured activation times between the right and left atria and demonstrated that interruption of a distinct anterior interatrial muscular band resulted in delayed left atrial activation. He concluded that this band constituted the principal route for rapid interatrial conduction.

Subsequent anatomical and electrophysiological studies confirmed the importance of the structure described by Bachmann, which came to bear his name. Bachmann’s bundle is now recognized as a key determinant of atrial activation patterns, and its dysfunction is associated with interatrial block, atrial fibrillation, and abnormal P-wave morphology. His work remains foundational in both basic cardiac anatomy and clinical electrophysiology.

Sources and references
1. Bachmann G. “The inter-auricular time interval”. Am J Physiol. 1916;41:309–320.
2. Hurst JW. “Profiles in Cardiology: Jean George Bachmann (1877–1959)”. Clin Cardiol. 1987;10:185–187.
3. Lemery R, Guiraudon G, Veinot JP. “Anatomic description of Bachmann’s bundle and its relation to the atrial septum”. Am J Cardiol. 2003;91:148–152.
4. "Remembering the canonical discoverers of the core components of the mammalian cardiac conduction system: Keith and Flack, Aschoff and Tawara, His, and Purkinje" Icilio Cavero and Henry Holzgrefe Advances in Physiology Education 2022 46:4, 549-579.
5. Knol WG, de Vos CB, Crijns HJGM, et al. “The Bachmann bundle and interatrial conduction” Heart Rhythm. 2019;16:127–133.
6. “Iatrogenic biatrial flutter. The role of the Bachmann’s bundle” Constán E.; García F., Linde, A.. Complejo Hospitalario de Jaén, Jaén. Spain
7. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 172–189, 1907.


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Drs. Hast and Garrison with the two volumes of the new Fabrica
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Andreas Vesalius opus magnus was the creation and the publication of his book “De Humani Corporis Fabrica, Libri Septem" (Seven books on the structure of the human body). This book was published on May 26th, 1543 by the printing press of Johannes Oporinus.

Much has been said and written about this book and the influence of Vesalius’ work on scientific thinking, the scientific method, and the displacement of dogmatic thinking based on the works of the ancient Greeks and Galen of Pergamon (129AD - 200AD) for a different view of the construction of the body based on direct and empirical observation.

Unfortunately, because of Vesalius’ following of Erasmus’ teachings on Latin, the book was written in a very difficult and circumvoluted language which made it difficult to understand. In addition, the book was very expensive for the times, with an estimated maximum printing of 600 copies.

Drs. Hast and Garrison with the two volumes of the new Fabrica
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Were it not for the images and the captions, as well as the many plagiarized versions of the Fabrica in different languages, Vesalius opus magnus would have been lost to history. Harvey Cushing wrote in his Vesalius bio-bibliography of 1943:”As a book, the Fabrica has been probably more admired and less read than any publication of equal significance in the history of science”.

Although several attempts have been done to translate the Fabrica, most of the works have been incomplete, or have tried to paraphrase or correct Vesalius’ words, leaving us with a watered-down image of the author and his intent.

In 1993 Drs. Daniel H Garrison and Malcom H. Hast began a collaboration to translate the Fabrica of Vesalius. The 20- year story of how they obtained federal grants, discussed the translation, found a publisher, scanned and improved on the original images of the Fabrica, and how they even worked with Christian Mengelt to create a new typography for an annotated new Fabrica, was part of their presentation on the interdisciplinary symposium “Vesalius and the Invention of the Modern Body” hosted by the St. Louis University and the Washington University February 26-28, 2015.

Drs. Hast, Miranda, and Garrison with the  new Fabrica
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This annotated new Fabrica is a translation of the 1543 first edition with comments on the 1555 second edition and it also includes passages and comments from a heavily edited 1555 second edition that has side margins comments and corrections now certified to be in Vesalius’ own handwriting. This book has been speculated to have been Vesalius’ personal copy and probably the basis of a potential third edition. This particular book is now known as "Vesalius' Annotated Fabrica"

The "New Fabrica" was published in 2013 by Karger Publishing, a company based in Basel, Switzerland, the same city where the original Fabrica was published in 1543. The ISBN is 978-3-318-02246-9. Only 948 books were published and it has now been sold out. Because of the demand, an original is now considered a rare book.

Daniel H. Garrison received his degrees from Harvard (A.B. Classics, 1959) and Berkeley (PhD Comparative Literature, 1968). He was a member of the Classics Department at Northwestern University from 1966 until his retirement in 2010. 

Title pages of the new Fabrica with the authors' signatures
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Malcolm H. Hast is Professor Emeritus of Otolaryngology – Head and Neck Surgery – and also past Professor of Cell and Molecular Biology (Anatomy) at Feinberg School of Medicine of Northwestern University. He is Fellow of the American Association for the Advancement of Science as well as Fellow of the Anatomical Society (UK) and a Chartered Biologist and Fellow of the Society of Biology (UK). He is also a recipient of The Gould International Award in Laryngology and a NATO Senior Fellowship in Science.

Personal note: I am honored to have met both Drs. Garrison and Hast at the symposium, shared some of the stories behind the new Fabrica and have them sign my own copy of this incredible book. Dr. Miranda

Sources:
1. "A Bio-blibliography of Andreas Vesalius" Cushung, H. 1943 Saunders