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Marcia Crocker Noyes
(1869 – 1946)
Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore... This is certainly an article that can be called "A Moment in History"
Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]
Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.
The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.
Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!
Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.
Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.
Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.
In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.
The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.
Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]
NOTE: This article has been modified from the original Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.
Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding
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- Written by: Efrain A. Miranda, Ph.D.
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Original Facebook image
For those who follow this blog or my articles on LinkedIn you know that I have several pet peeves regarding the misuse of medical and anatomical terminology. You can read some of these articles in the following links:
- One of my pet peeves... pronouncing the word “dissection” wrong
- 11+ medical words that are used incorrectly
- Ramus intermedius, a cardiac anatomical variation
- Using vernacular terms as medical terms
- GIGO: The use of artificial intelligence in social media and education. “It looks good, so let’s use it (but it’s wrong)”
Recently, reading an article on Facebook, I realized that there are many people, some of them health care professionals, who use (and teach) anatomical directional terminology incorrectly. The post itself shows an image depicting directional terminology in humans.
The original image is shown here and if you hover your mouse on it you will see my concerns. If you click on it, you will see a larger depiction of these concerns.
1. Dorsal and Ventral and… 2. Caudal and Cranial
These four terms are used by many, referring to the human body in the anatomical position. The fact is that in the human anatomy, the proper terms to use are as follows:
1. Instead of ventral, the proper term to use is anterior.
2. Instead of dorsal, the proper term to use is posterior.
3. Instead of cranial, the proper term to use is superior.
4. Instead of caudal, the proper term to use is inferior.
Let’s look at the etymology behind the terms.
Ventral arises from the Latin [ventrum] and [venter] which means “abdomen” or “belly”. Some contend that the term means “towards the abdomen” and even say that the term is correct because the abdomen is the largest part of the anterior aspect of the body. In any case, never use the term “stomach” to mean abdomen (another pet peeve).
The term dorsal arises from the Latin [dorsum] which means “back”.
Click for a larger image
The term cranial arises from the Latin [cranium] meaning “skull”. Not mentioned in the image is the term “cephalad” which is Greek [κεφάλι] meaning “head”. The suffix [ad] means “toward”, so cephalad means “towards the head”.
Additional controversy is found with the term “caudal” or “caudad”. It originates from the Latin [cauda] which means “tail”. How can anyone say that the feet are “caudal” when the tail is the coccyx? Despite this, there are many who teach the term caudal and define it as “towards the feet”, even knowing the origin of the term.
The reason for these terms is that they are used in veterinary medicine and embryology. You see, in a quadruped, these four terms apply perfectly as you can see in this image.
The terms “cranial” and “caudal” are also used in embryology. Since the embryo is curved, we need terms that reflect this curvature, and since the upper and lower extremities have not yet developed, the tail is the “end” of the embryo! As for the terms “ventral” and “dorsal”, the image the follows is self-explanatory… the back of the embryo is almost all of it! See the following image:
Controversy also arises from the use of the term “dorsal” to refer to the superior aspect of the foot. It is just a consensus. The inferior aspect of the foot is referred a “plantar”, and “dorsal” was adopted to reflect this opposition.
Click for a larger image
In the comments to this Facebook article, C. Hartig mentioned “rostral”. The term [rostrum] is Latin and means “beak”. In Roman times the term was used to denote a speaker’s platform, as the dais was usually adorned with eagles that had a pointed beak. Through use, the term “rostrum” was used as “face” (some people have a very pointed nose).
In anatomy we use the term rostral as “face”. The term is used in neuroanatomy and refers to a plane that is transverse to the axis of the Central Nervous System. See the accompanying image. In the spinal cord, the terms “rostral” and “caudal” follows the transverse plane of the body. In the head, the axis of the brainstem changes and now an axial image of the brainstem is angled. In the cerebrum this changes again and now points anteriorly towards the face (or frontal lobe).
This leads to the misuse of the term “axial”. Yes, it can be used as “transverse plane, but only when referring to the body as a whole. This changes when we use the term “axial” referring to an organ or structure. An “axial” image of the heart is different from a “transverse image of the heart.
A word of caution. Because of the importance of embryology in neurogenesis of the nervous system, these embryological terms are used in adult neuroanatomy, Hence the terms "dorsal root ganglion", "ventral horn", ventral root", etc.
3. Sagittal Plane
The term “Axes of the CNS (Dr. Miranda, 1977)” arises from the Latin [sagitta], meaning “arrow”. An arrow would transfix someone from front to back. A sagittal plane is a vertical plane that divides the body into right and left portions. Since a plane has no width (geometrical definition) there are infinite sagittal planes. Only one divides the body into equal right and left portions. This is the midsagittal plane or median plane.
The image is correct in the sense that the median plane is one of many sagittal planes, but this representation forces many students to misuse the terms. If it is a median or midsagittal image, say so.
Disclaimer: I do not know the origin of the original image in the Facebook post, whether it is copyright-free or not. I used it because it has been posted publicly. All other images in this article are personal, copyright-free, or proper attribution have been posted as required by copyright law.
Sources:
1. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. “The Origin of Medical Terms” Skinner HA 1970 Hafner Publishing Co.
3. "Medical Meanings, A Glossary of Word Origins" Haubrich, W.S. 1997. American College of Physicians, Philadelphia, PA.
4. "Elementos de Neuroanatomía" Fernandez, J.; Miranda, EA.
5. "Dorland's Illustrated Medical Dictionary" 28th Ed. W.B. Saunders. 1994
6. "Medical Terminology; Exercises in Etymology" Dunmore CW, Fleischer RM 2nd Ed. 1985
7. "Medical Meanings; A Glossary of Word Origins" Haubrich, WS. Am Coll Phys 1997
8. "Lexicon of Orthopædic Terminology" M. Diab. 1999. Amsterdam Hardwood Academic Publishers.
9. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
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- Written by: Efrain A. Miranda, Ph.D.
Peripheral nerve injuries can result from trauma, compression, thermal damage or systemic diseases, and their classification is essential for diagnosis, management, and prognosis. Three key terms are used to describe the severity and nature of these injuries: neurapraxia, axonotmesis, and neurotmesis. They describe the structural and functional integrity of nerve fibers after injury. The etymology of these terms derives from the Greek language.
These terms were initially proposed by Sir Herbert John Seddon (1903 – 1977), an English anatomist and orthopedic surgeon who published his initial findings in 1943, followed by Sir Sydney Sunderland (1910 – 1993), an Australian orthopedic surgeon who published a revised classification in 1951. The terms coined by Seddon and Sunderland and their classification system into 5 Grades of Nerve Injury remain central to the treatment of nerve injuries today.
Neurapraxia:
Neurapraxia represents the mildest form of nerve injury. It is characterized by a temporary block of nerve conduction without axonal disruption. Recovery is typically complete and occurs within days to weeks.
• No structural damage to the axon or surrounding connective tissue.
• Localized demyelination may occur, leading to a conduction block.
• Commonly results from compression or mild blunt trauma (e.g., “Saturday night palsy” or a "transient ulnar nerve palsy").
The term is derived from the Greek [νεῦρον] meaning “nerve” and [πρᾶξις] (praxis) meaning “action”. In medical terminology “a” or “an” means “without” or “absence of”. Thus, the word is constructed as [neur]-[a]-[praxia] meaning “absence of nerve function”.
Sir Herbert John Seddon (1903 – 1977)
Sir Sydney Sunderland (1910 – 1993)
Axonotmesis
Axonotmesis is a more severe injury in which the axon is damaged, but the surrounding connective tissue structures (endoneurium, perineurium, and epineurium) remain intact. Wallerian degeneration occurs distal to the lesion, and axonal regeneration following the intact connective tissue channels can allow for not only nerve regeneration but regain of function of the damaged nerve. This is the mechanism of action of cryoneurolysis devices used in surgery.
• Axonal continuity is lost, but the scaffolding remains.
• Regeneration can occur at a rate of approximately 1–3 mm/day.
• Often seen in crush injuries or prolonged compression.
The term is derived from the Greek [ἄξων] meaning “axis” and [τμῆσις], meaning “division” or “cut”. Axonotmesis means “division (cutting) of the axon.”
Augustus Volney Waller (1816 – 1870)
Neurotmesis
Neurotmesis is the most severe form of nerve injury. It involves complete disruption of the axon and surrounding connective tissue, as would happen when a nerve is transected or avulsed. It results in permanent loss of function, since when the axons start to regrow, there are no connective tissue “tunnels” to guide the growing axon to their terminal connections. One of the problems that may happen is the formation of a neuroma or neurinoma at the site of nerve transection.
The only way to attempt to restore function is with surgical intervention bringing the cut ends of the nerves together, sometimes using microsurgery. The results of surgery are not always optimal
• Wallerian degeneration occurs distal to the injury.
• Regeneration is not possible without surgical repair.
• Typically is the result from lacerations, severe traction injuries, or penetrating trauma.
The term is derived from the Greek [νεῦρον] meaning “nerve” and [τμῆσις] meaning “division” or “cut”. Neurotmesis thus translates to “division of the nerve.”
Accurate classification of nerve injuries can help guide prognosis and treatment:
• Neurapraxia: Managed conservatively with physical therapy and observation.
• Axonotmesis: May require surgical exploration if function does not return within expected time frames.
• Neurotmesis: Early surgical intervention is usually necessary to restore any function.
Note: The term “Wallerian degeneration” is associated eponymically with Augustus Volney Waller (1816 – 1870), an English physiologists know for his work on nerve injury and regeneration.
Personal note: Most people talk about "peripheral nerves", as if "central nerves" existed. This is not so. Within the Central Nervous System (CNS) the bundles of axons have different names such as "fascicles" (fasciculus lenticularis), tracts" (spinothalamic tract), lemniscus (medial lemniscus), etc. These central bundles of axons form structures that themselves have separate names, such as the corpus callosum, internal capsule, external capsule, anterior commissure, etc. All of these structures lack a well formed connective tissue wrap, which is the reason why transection of these structures usually does not allow recovery, such as in the case of spinal cord transection.
Nerves, which are only found in the Peripheral Nervous System (PNS). do have a well-formed connective tissue wrap formed by the endoneurium, perineurium, and epineurium. The presence of these connective tissue structures is what allows for nerve regeneration and recuperation of functionality.
To be precise then, using the term "peripheral nerve" is redundant, as all nerves are peripheral! Dr. Miranda
Sources
1. Seddon H. Three Types of Nerve Injury. Brain. 1943;66(4):237-88. doi:10.1093/brain/66.4.237
2. Seddon H, Medawar P, Smith H. Rate of Regeneration of Peripheral Nerves in Man. J Physiol. 1943;102(2):191-215. doi:10.1113/jphysiol.1943.sp004027
3. Sunderland S. A Classification of Peripheral Nerve Injuries Producing Loss of Function. Brain. 1951;74(4):491-516. doi:10.1093/brain/74.4.491
4. O'Brien, M. D., & Wade, D. T. (1992). Neurological rehabilitation. Chapman and Hall.
5. Liddell, H. G., & Scott, R. (1940). A Greek-English Lexicon. Oxford University Press.
6. "The Origin of Medical Terms" Skinner 1970
7. "Dorland's Illustrated Medical Dictionary" 28th Ed. W.B. Saunders. 1994
8. “Stedman’s medical eponyms” Farbis, P; Bartolucci, S. Williams & Wilkins 1998
9. https://radiopaedia.org/articles/sunderland-classification-of-nerve-injury
10. " Correlative Neuroanatomy and Functional Neurology" Chusid, Joseph. Lange Medical Publications
The image of H.J. Seddon is an AI composite of the few images and portraits available. Courtesy OpenAI.
- Details
- Written by: Efrain A. Miranda, Ph.D.
G.E. Rindfleisch (1836 – 1908)
This article is an anatomical, physiological, and terminological discussion for two related cardiac structures: The Vincula Aortæ and the cardiac folds of Rindfleisch.
The topic of this article was triggered by a LinkedIn post by Dr. Guillermo Stöger, an Argentinian cardiac surgeon who works in the Cardiac Department of the Heart Center in Leipzig, Germany.
In his post, Dr. Stöger describes the Vincula Aortæ as “communication or adhesions” between the intrapericardial portion of the ascending aorta and the intrapericardial portion of the pulmonary trunk. In this segment these two vessels share their adventitia layer as well as a rich vascular supply. Dr. Stöger also describes the presence of small vessels in the area, which can cause a hematoma when a dissection or trauma of one of this vessels happens.
So, what is the Vincula Aortæ? It was first described by Georg Eduard Von Rindfleisch (1836-1902), a German pathologist and histologist in an article in German published in 1884 titled “Ligament-like connections between the aorta and pulmonary artery (vincula aortae)” [1]. In this article Rindfleisch describes the movement of the pulmonary trunk and ascending aorta caused by the pressure fluctuations between systole and diastole, forcing these two structures to twist and separate in opposite directions. While the ascending aorta tends to move towards the right sternoclavicular joint, the pulmonary trunk tends to move towards the left third intercostal space. Rindfleisch states that the presence of the intervascular “ligaments” reduces the mobility of these structures.
Click for a larger image
Being a histologist, Rindfleisch describes the structure of this intervascular structure (the Vincula Aortæ) as containing connective and fibrofatty tissue with vascular structures, encased in adventitia, and all of them covered by the visceral pericardium (endocardium). The accompanying image, modified from the original by WC Roberts [12], shows how the ascending aorta and pulmonary trunk share their adventitia; the arrows point to the area where there is connective tissue. Rindfleisch posits that the constant movement of the vessels and pericardium slowly causes the pericardium to wrinkle and fill with fat causing a semilunar elevation 2 -3 cm superior to the root of the aorta. He says that these fatty pads are more evident in people over 40 years of age.
It should be pointed out that Rindfleisch described the intervascular communication between the ascending aorta and pulmonary trunk, as a “clamp”, and also as “adhesions” or “ligaments”, and he named them “Vincula Aortæ”; but although he described the pericardial fatty fold caused by the movement of these structures, he did not name it. Later they were eponymically referred to as the “folds of Rindfleisch”. According to Netter [2] when more than one is present only the larger and usually most superior of these folds is so called.
The following mage is from Rindfleisch’s 1884 article and shows a tear in the ascending aorta with an aortic dissection. Interestingly, he says that the tears in the aorta (or pulmonary trunk) happen higher in these vessels, distal to the Vincula Aortae, which gives the lower segments additional strength.
In 2003 Morrison et al [3] published a description of the Fold of Rindfleisch stating that they were “unaware of a formal description of this structure”, naming it “crista aortæ ascendentis”. They described neurovascular bundles, fat and connective tissue in this structure, ending with a recommendation to do careful hemostasis to avoid hemorrhage intra and postoperatively, just as Dr. Stöger suggested recently.
Modified from Parke (1966)
In a “Letter to the Editor” following Morrison’s publication, Dr. Wesley Parke refuted it stating that the structure in question had already been described 40 years earlier in 1966 by himself [4], followed by a detailed study of the vessels in the region in 1970 [5]. Parke references brief statements on these folds by Davis in 1927 [6] and Hans Smetana in 1930 [7]. Parke calls this fold the “aortic ridge” and ascribes to it a cushioning function between the aorta and the right atrial appendage. No mention of Rindfleisch.
The image (modified from Parke's 1966 original) shows two specimens of the ascending aorta. The arrows point to the folds of Rindfleisch. Note that specimen 3 has a double semilunar fold.
The importance of the work of Dr. Wesley Parke is the detailed description of the “vasa vasorum” that provide blood supply to the aorta and pulmonary trunk creating a plexus of vessels. Careful hemostasis is needed to prevent bleeding when working at the root of the pulmonary trunk and aorta.
Parke mentions Hans Smetana (1894 - 1977). His paper "Vasa Nutritia der Aorta" describes the many vasa vasorum of the aorta and his work was followed by W. Parke who described the complex blood supply to the ascending aorta and pulmonary trunk. Following are two images modified from the original works by these authors. Again, it is critical to point out the importance of these vessels found in the area of the Vincula Aortae when performing surgery.
Smetana, 1929
Parke, 1970
There are research articles on the fatty ridges found in the proximal ascending aorta, but many have forgotten the contributions of Rindfleisch. In 1999 F. Unger named it the “plica transversa aortæ” [8]. This letter was criticized, by Falkowski et al [8] reminding that the structure was first named “Plica semilunaris nach Rindfleisch” by Julius Tanders (1869 – 1936) in his book “Anatomie des Herzens” [10]. Falkowski says “it is not the first time we have encountered self-given names to structures that have been previously studied and named a century, and sometimes centuries ago”.
Rindfleisch was the first to describe and name the common connective tissue and adventitia between the intrapericardial ascending aorta and pulmonary trunks (vincula aortae) and the fold of pericardial tissue that should bear his name: the aortic semilunar fold (plica semilunaris aortæ) of Rindfleisch.
Sources:
1. “Uber Klammeratigae Verbindungen zwischen Aorta und Pulmonal arterie (Vincula aortae)”. Rindfleisch E Von. 1884. Virch Arch Pathol Anat Physiol Klin Med 96: 302–306.
2. “CIBA collection of medical illustrations” Netter F. 1971; vol 5, The Heart. section 1, plate 5.
3. “Surgically Relevant Structure on the Ascending Aorta” Morrison, JJ; Codispoti, M; Campanella, C. 2003 J Clin Anat 16:253-255
4. “The human aortic ridge and cushion” Parke, WW; Michels, NA 1966 Anat Rec, 154: 185-193.
5. “The vasa vasorum of the ascending aorta and pulmonary trunk and their coronary and extracardiac relationships” Parke WW. 1970 Am Heart J 80:802– 810
6. “The periaortic fat bodies” Davis DJ. Arch Path and Lab Med 1927 4:937-942
7. “Vasa Nutritia der Aorta: Smetana, H. 1929 Virchows Archiv für pathologische Anatomie und Physiologie und für klinische Medizin. 274: 170-187
8. “The Plica Transversa Aortae: An Addendum to the Anatomic Nomenclature of the Heart” Unger, F. 1999 Ann Thorac Surg 68:2383-91
9. “Plica transversae aortae—fold of Rindfleisch” Falkowski, G; Dzigivker, I; Bitran, D. 2001 Ann Thorac Surg 7:1-761-762
10. “Anatomie Des Herznes” Tandler, J et al. 1913. Publisher Gustav Fischer
11. “"Tratado De Anatomía Humana” Testut, L.; Latarjet, A. Barcelona, Spain: Salvat Editores, 1943.
12. “Aortic dissections: Anatomy, consequences, and causes” Roberts WC (1981). Am Heart J 101:195-214.
13 “The Fatty Ridge and Fatty Cushion of the Human Pulmonary Trunk” Nadkarni, SD, et al. Anatomical Record 1976 187: 107-112
14."Stedmans Medical Eponyms" Forbis, P.; Bartolucci, SL; 1998 Williams and Wilkins
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- Written by: Prof. C. Uribe
The anatomical framework of the seven books
that comprise Vesalius' Fabrica
As an educator with over 20 years teaching Human Anatomy, I have witnessed how accurate and up-to-date language can transform teaching and learning in health sciences.
The recent publication of Anatomical Terminology 2 (TA2), made freely available by the International Federation of Anatomists' Associations (IFAA), represents a significant advance that all professionals in the field should adopt as soon as possible.
Anatomical terminology is not simply a list of terms, but the basis for clear, effective and universal communication. The TA2 update addresses not only necessary changes resulting from new anatomical research and discoveries, but also substantial improvements in consistency and accuracy. This is especially relevant today, when globalization and digitalization demand accurate communication between professionals from different countries and specialties.
Using TA2 involves:
- Unifying anatomical criteria globally.
- Facilitating the teaching of anatomy with clear and precise terms.
- Improving the quality and safety of healthcare by reducing misunderstandings.
- Empowering scientific research by ensuring consistency in academic publications.
I invite fellow teachers, students and health professionals to familiarize themselves with TA2 and actively apply it in their academic and clinical practices. Let us take advantage of this tool to continue raising the standard of our work and the quality of anatomy education.
You can consult TA2 directly at this link: https://libraries.dal.ca/Fipat/ta2.html
What has been your experience with the update of anatomical terminologies?... Are you ready to integrate TA2 into your teaching and professional practice?
- Details
- Written by: Efrain A. Miranda, Ph.D.
Recientemente recibí un libro de Chile. Este libro está en Francés y se titula “Traité D’Accouchements” (Tratado sobre el Parto) o “Tratado de Obstetricia”, y se publicó en 1898 en París. El autor es el Dr. Pierre-Victor Alfred Auvard (1844 - 1940), un Ginecólogo-obstetra Francés,
El libro pertenecía a la biblioteca del Hospital San José. El Antiguo Hospital San José es un exhospital ubicado en la calle San José, a un costado del Cementerio General de Santiago, en la comuna de Independencia, ciudad de Santiago, Chile. Construido entre los años 1841 y 1872 funcionó como hospital hasta 1999, cuando se construyó el nuevo Hospital San José.Este hospital ahora está siendo demolido y se construirá uno nuevo en su lugar, pero los libros viejos de la biblioteca fueron desechados sin contemplaciones.Un ingeniero a cargo de las nuevas obras logró rescatar algunos de estos libros y uno de ellos fue traído de Chile a Estados Unidos por otro amigo mío, Carlos Verdugo, compañero de colegio.
El libro estaba en pésimas condiciones, con un título apenas legible, el lomo roto y los folletos internos separados porque los hilos que lo sujetaban estaban rotos. Como la encuadernación y la reparación de libros son otra de mis aficiones, me encargué de la tarea y ahora se añadirá a mi colección. Aquí hay algunas fotos del proceso. Haga clic en la imagen para verla más grande.
En una de sus páginas, el libro tiene un sello antiguo y apenas legible que dice "Manuel Casanueva del C". Una breve búsqueda indicó que se trataba del sello Ex-Libris del cirujano chileno Dr. Manuel Casanueva del Canto. Por supuesto, tuve que investigar un poco sobre el antiguo propietario de este libro.
Manuel Casanueva del Canto nació en la ciudad de Linares, Chile, el 5 de julio de 1908. De 1925 a 1931 cursó del primero al sexto año de medicina en la Facultad de Medicina de la Universidad de Chile (donde yo estudié). En ese entonces, la Facultad de Medicina estaba en el barrio Independencia de Santiago. En 1930 obtuvo su licenciatura en medicina.
El libro reparado en mi biblioteca
Entre 1930 y 1931 fue residente de cirugía en el Hospital San Francisco de Borja (donde fue paciente de niño), pasando por Medicina Interna, Medicina de Urgencias y Cirugía y Obstetricia, obteniendo su título de cirujano en mayo de 1932. Su tesis de grado se tituló “Anatomía Patológica: Alteraciones inflamatorias de la vesícula biliar”.
Como cirujano, trabajó en el Hospital Militar de Santiago, el Servicio Central de Urgencias y el Hospital Central de Traumatología. En 1952, volviendo a sus orígenes, se trasladó al Departamento de Cirugía de la Universidad de Chile, en el Hospital José Joaquín Aguirre. Este hospital se encuentra en el mismo campus que la Facultad de Medicina donde estudió.
En 1955 postuló (y obtuvo) el puesto de Profesor Extraordinario de Cirugía Patológica en la Facultad de Medicina de la Universidad de Chile. Para entonces, ya contaba con una destacada trayectoria docente, varios premios médicos, y fue autor del libro "Transfusión Sanguínea Práctica" en 1939, además de ser coautor de varios libros médicos y más de 81 artículos.
Se convirtió en Jefe de Cirugía del Hospital José Joaquín Aguirre y en 1961 invitó a Pablo Neruda, chileno ganador del Premio Nobel de Literatura, a impartir una conferencia en el hospital.
En 1975, la Editorial Andrés Bello publicó su libro "Cirugía", en dos volúmenes en español. No he podido encontrar este libro. No se sabe mucho de él después de esta fecha. No se ha encontrado ninguna fotografía ni retrato.
Se casó con María Yolanda Carrasco Coral (fecha desconocida) y tuvieron tres hijos: María Cristina, Isabel y Manuel Luis.
Falleció el 13 de febrero de 1981 en Viña del Mar y está enterrado en Santiago de Chile. Investigaciones posteriores indicaron que este libro que recibí de regalo fue donado a la biblioteca del Hospital San José por el Dr. Casanueva, donde finalmente fue desechado, rescatado, transportado a Estados Unidos y reparado.
Cubierta final hecha en cuero y lino
Cubierta interna con papel marmolizado
Espero que este artículo llegue a la los descendientes de la familia Casanueva del Canto en Linares (hoy son Casanueva Carrasco y/o Casanueva Iommi) y que me ayuden a actualizar esta investigación y tal vez obtener una foto del Dr. Casanueva del Canto. El artículo original en Inglés puede leerse aquí.
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Anterior view of the heart
Personal Note: A few weeks ago, I came across a very interesting article in Spanish by Dr. Jose Manuel Revuelta from the University of Cantabria, Spain. The article (in Spanish) talked about the “small brain inside the heart”. One of my interests in the anatomy of the heart is the intrinsic system called the cardiac “ganglionated plexuses”, “ganglionated plexi”, or “GPs”.
It is our proposal that this nervous system inside the heart, which works autonomously (if needed to or forced to) and also dependent, of the autonomic nervous system, is responsible for the intrinsic working of the heart and its dysfunction is probably the root of cardiac dysrhythmias. We have several seminars on this topic here.
In a recent publication with Dr. Randall K. Wolf, we explained both the Wolf Procedure and the anatomical basis that underline atrial fibrillation.
The concept of the "small brain of the heart" is not new. It has been mentioned by Woolard (1926), Armour (1997), Pauza (2000), and others. These authors and others are referenced in this publication. Unfortunately, the diffusion of the concept of an intrinsic, interconnected mesh of clusters of neurons within the heart and other organs that have rhythmic activity, has many names used by the media. That is why you can find articles on the "little brain of the gut", the "gut brain", the "enteric nervous system", the "little brain of the heart", etc.
Dr. Revuelta's article shows that the interest on the GPs continues on, and more research is being done on this topic. He has graciously granted us permission to translate and publish his article in “Medical Terminology Daily”. He has also expressed interest in publishing some of his articles in this blog. Dr. Miranda
The “Little Brain” Inside the Heart
Dr. José Manuel Revuelta Soba
Professor of Surgery. Professor Emeritus, University of Cantabria, Spain
Dr. José Manuel Revuelta
In December 2024, the prestigious journal Nature Communications published that a group of researchers from the Karolinska Institute (Sweden) and Columbia University (United States) have discovered that the heart contains a small autonomous brain.
In general, scientific knowledge has been relating cardiac activity to the brain, as the only organ that regulates its functioning. This intimate bidirectional relationship regulates the adaptation of its rhythm and contractile force to changing energy demands, through impulses and signals transmitted by the autonomic nervous system. However, the heart surprises us again with new properties that go beyond what is known.
Autonomic nervous system
The neurovegetative nervous system of the human being is involuntary, comprising the sympathetic and parasympathetic nervous systems, essential for the functioning of the organism. They act in conjunction with the enteric nervous system, which also has involuntary action and regulates the activity of the gastrointestinal tract. The complex interactions between these autonomous systems, which have opposing actions, maintain cardiovascular homeostasis, that is, they provide the appropriate amount of oxygenated blood to the organs and tissues according to their demands.
The sympathetic nervous system regulates, among other functions, the body's response to any danger perceived as a threat to physical or mental health, known as the "fight or flight" reaction, described in 1915 by the physiologist Walter B. Cannon in the United States. This instinctive reaction leads to the immediate release of certain chemical substances into the blood, such as adrenaline and noradrenaline. These hormones act as neurotransmitters that produce an increase in the contractile force of the heart, tachycardia, contraction of blood vessels, hypertension and dilation of the airways. These neurotransmitters are released in the brain, facilitating the diffusion of their messages through the extensive network that forms this autonomous nervous system, increasing the state of alertness and eliminating any feeling of drowsiness. By producing an immediate tachycardia, it improves the supply of oxygen to the organs and tissues, enlarges the pupils and reduces the digestion of food to save energy and make it available for this reaction to an unexpected danger.
The parasympathetic nervous system controls the relaxation of the body at the end of the stress caused by the sudden “fight or flight” reaction, once the threat has passed, restoring the normal functioning of the organism. Its main function is the conservation and storage of energy through the release of acetylcholine, a powerful neurotransmitter, discovered by the English physiologist Henry H. Dale, for which he was awarded the Nobel Prize in Medicine in 1936. This substance produces vasodilation, reduction of blood pressure, decreased heart rate and increased intestinal motility.
The enteric nervous system has the exclusive mission of regulating the functioning of the gastrointestinal tract, which is completely covered by hundreds of millions of nerve fibers that transmit brain messages for digestive mobility and function, modifying the volume of blood flow via vasoconstriction or vasodilation.
The small brain of the heart
The innervation of the heart is more complex than previously thought, conditioned by messages from the autonomic nervous system and others from the organ itself. In the early 1990s, scientists described that the heart contained some neurons similar to those in the human brain, which led to speculation about the possible existence of independent neuronal activity within the heart that mediated its functioning and rhythm. This fascinating discovery soon became a priority objective of scientific research.
In 2021, James S. Schwaber and R. Vadigepalli, researchers at Thomas Jefferson University in Philadelphia, performed a three-dimensional mapping of the heart's neural center. They found that the heart receives constant information from the brain about the internal and external state of its environment, adjusting heart rate, blood pressure, and cardiac output. However, these messages also came from the heart's own neural system, called the "little brain," behaving as if there were an internal loop, something similar to what systems engineers call a programmable logic controller or PLC. Most of these neurons are located near the aortic and pulmonary valves, with their largest neuronal cluster (74 percent) located in the area of the sinoatrial plexus, on the upper lateral wall of the right atrium, in immediate relation to the mouth of the superior vena cava.
Using mathematical models, they observed that when this peculiar neural programmable logic controller was activated, it perfectly adjusted the heart's response to the various impulses and signals from the brain to improve cardiac performance, making its work more efficient. Without the presence of this "little brain" it would be impossible to eliminate or correct the possible errors and damage contained in some brain messages, so the heart could become erratic, causing irregular heartbeats or arrhythmias, as well as defects in its contractility.
As these scientists analyze their 3D heart models, obtained from various mammals, new questions arise about the actions of this "brain of the heart", its internal organization, its influence on the contractile force and rhythm of the heart, as well as its coordination and responses to the constant messages from the brain. Currently, these three-dimensional maps are being used to better understand how the vagus nerve connects with cardiac neurons, opening new opportunities for the greater integration of systems engineering into the field of cardiology.
Recent findings from the Karolinska Institutet and Columbia University have revealed that the heart does indeed have its own “mini-brain,” containing a nervous system that self-regulates its rhythm and function according to demand. This complex neurological center is made up of various types of neurons with different functions, some of which function as cardiac pacemakers.
This important research project was carried out in the zebrafish, an animal model that has great similarities with the human heart, both in terms of its heart rate and its general functioning. These scientists mapped the composition, organization and functions of neurons within this small intracardiac brain, using a combination of anatomical methods, electrophysiological techniques and neuronal RNA sequencing. They carried out a complete molecular and functional classification of intracardiac neurons, revealing a complex neuronal diversity within the heart itself.
This intracardiac neurological center is not part of the autonomic nervous system governed by the brain, contrary to what was believed. The data obtained in this interesting scientific investigation show that this “small brain” is made up of several types of independent sensory neurons with clear neurochemical and functional diversity. This population of neuronal cells allows the expression of various genes that encode various neurotransmitter receptors (glycine, glutamate, adrenergic, inotropic, GABA, muscarinic, serotonergic receptors, etc.), suggesting a complex network of neurotransmission specific to the heart, which ignores its total dependence on central orders from the brain.
“We were surprised to see the complexity of this small brain inside the heart, which has a key role in maintaining and controlling the heartbeat, similar to how the brain regulates other rhythmic functions such as locomotion and breathing. Better understanding this nervous system could lead to new insights into heart disease and help develop new treatments, such as for arrhythmias. We will continue to investigate how the heart’s brain interacts with the real brain to regulate cardiac functions under different conditions, such as exercise, stress or disease”, explains Konstantinos Ampatzis, a senior researcher at the Department of Neuroscience at Karolinska Institutet, Sweden, who led the study.
Future electrophysiological, pharmacological and molecular research will be critical to better understand the tangled interactions and complex regulatory mechanisms of the internal neurotransmission of this autonomous “small brain” and thus understand its overall regulation of cardiac rhythm, contraction and output in the face of the multiple physical and mental changes to which we are exposed throughout life.
“There is a wisdom of the head and a wisdom of the heart"
Charles Dickens (1812-1870), English writer
“Facts do not cease to exist because they are ignored”
Aldous Huxley (1894-1963), English writer and philosopher.
Sources:
1. “Decoding the molecular, cellular, and functional heterogeneity of zebrafish intracardiac nervous system”. Pedroni, A; Yilmaz, E; Del Vecchio,L; et al. Nature Communications, 2024; 15 (1) DOI: 10.1038/s41467-024-54830-w
2. Bodily changes in pain, hunger, fear, and rage; an account of recent researches into the function of emotional excitement” Cannon, W. 1915. D. Appleton and Co. USA.
3. “Mapping the little brain at the heart by an interdisciplinary systems biology team” Vadigepalli, Rajanikanth et al. iScience, Volume 24, Issue 5, 102433. https://doi.org/10.1016/j.isci.2021.102433
4. A comprehensive integrated anatomical and molecular atlas of rat intrinsic cardiac nervous system. Achanta S. et al. iScience 2020 Jun 26;23(6):101140 doi: 10.1016/j.isci.2020.101140
5. "Minimally Invasive Surgical Treatment of Atrial Fibrillation: A New Look at an Old Problem" Randall K. Wolf, Efrain A. Miranda, Operative Techniques in Thoracic and Cardiovascular Surgery, 2024, doi.org/10.1053/j.optechstcvs.2024.10.003
6 Valenza, G., Matić, Z. & Catrambone, V. The brain–heart axis: integrative cooperation of neural, mechanical and biochemical pathways. Nat Rev Cardiol 22, 537–550 (2025).