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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Statue of St. Peter (St. Peter´s Basilica), it is possible to observe the pope blessing sing in his right hand
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Also referred to as “benediction hand”, “Preacher`s hand”, “Papal Hand”, “Pope Blessing hand”, etc. This sign is linked to an ulnar nerve neuropathy, and there is a long time controversy about the name of this sign as well as its etiology, where some authors contend that there may be involvement of the median nerve.

Scholars, books and Internet sites are not clear about it. If there is an ulnar nerve neuropathy the person attempting to open his hand would be left with the second and third digits in extension, while the fourth and fifth digits would be flexed at the interphalangeal joints but extended at the metacarpophalangeal joints due the loss of the function of the interossei muscles and lumbrical muscles of the fourth and fifth digits. 

The key for this sign is based in on the blessing act which is performed with an open hand and not with a fist. This is the reason why an ulnar neuropathy and not a median nerve neuropathy is the undelaying cause of the Papal Benediction Sign.

Presumably this term was the result of an injury of Saint Peter’s (the first Pope) ulnar nerve which caused him to bless using the “Preacher’s hand”. It stands to reason that everyone copied him as we can see in the lustrations and the art of the Catholic Church.

Article written by: Prof. Claudio R. Molina, MsC

Sources:
1. Futterman, B. (2015). Analysis of the Papal Benediction Sign: The ulnar neuropathy of St. Peter. Clinical Anatomy (New York, N.Y.), 28(6), 696–701. Click here for the article
2. "From Vulcan Salute To Papal Blessing, Ulnar Nerve Damage Caused Original Benediction Sign | Box | NYIT". Nyit.edu. N.p., 2017. Web. 14 Jan. 2017
Image by By Mattana [Public domain], via Wikimedia Common: Click here for the link to the original image