UPDATED: The term [xiphoid] is Greek in origin [ξίφος] and points to the similarity [-oid] of the sternum to a short straight sword used by the Greek. The term xiphoid refers to the lower cartilaginous inferior tip of the sternum. It presents with anatomical variations that include a central opening, or large processes that look like a disc, or even a bifid xiphoid process.

It has been named the xiphisternum, the metasternum, and the ensiform process. It is the last cartilage to ossify in the human, and it is used as a landmark for laparoscopic surgery. i.e. a subxiphoid port is a location for a laparoscopic port in the abdomen.

As a side note, another term used for [sternum] is the Latin word [gladius], referring to the short Roman straight sword of the gladiators. This term is no longer in use, but if it were, the xiphoid appendix would be the tip of the sword.

Think about this: why is a certain plant called a "gladiolus"?

Image property of:CAA.Inc.. Artist:David M. Klein

Click on the image for a larger version.

 "Thou to health and vigor should attain
Shun mighty cares, all anger deem profane
From heavy suppers and much wine abstain;
Nor trivial count it after pompous fare
To rise from the table and take to the air.
Spurn idle noonday slumbers, nor delay
The urgent call of nature to obey.
These rules if thou wilt follow to the end
Thy life to greater length thou may extend".

The original poem is written in Latin and is part of the book "Regimen Sanitatis Salernitarum" published in 1480. This book contains articles and poems by Afflacius, Bartholomeus, Copho, Ferrarius, Petronius, Johannes Platearius, and Trotula. The editor of the book was Arnold de Villa Nova. It was later translated into English.

It is considered one of the two great publications of the School of Salerno in the Medieval Ages, the other one being the "Compendium Salernitatus"

More on this wonderful book here.

Cover page of Regimen Sanitatis Salernitatum c. 1480
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"Medieval and Renaissance Medicine" B.L. Gordon 1959 Philosophical Library Inc. USA

Andreas Vesalius Bruxellensis (1514- 1564). A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". For other articles on Andreas Vesalius, click here. Dr. Miranda

UPDATED: The "triangle of doom" is a name given to a roughly triangular area in the posterior aspect of the anterior wall of the lower abdominopelvic region. It is used by surgeons repairing an inguinofemoral hernia with a mesh and they want to avoid large vascular structures, namely the external iliac artery and vein. The "triangle of doom" will be highlighted when you hover your cursor over the image.

The so-called "triangle of doom" is a misnomer perpetuated by the first laparoscopic surgeons who observed the anatomy of the inguinofemoral region from the posterior aspect. It is neither a triangle (as it only has two boundaries), nor is it an eponym (no such person - that is why is should not use uppercase). It does indicate an area where it is extremely dangerous to place staples or sutures during laparoscopic hernia surgery.

The "triangle of doom" is an inverted "V" shaped area with its apex at the internal (deep) inguinal ring. The "triangle of doom" is bound laterally by the gonadal vessels, and medially by the vas deferens in the male, or the round ligament of the uterus in the female. Within the boundaries of this area you can find the external iliac artery and vein.

The image also depicts other structures of anatomical importance for laparoscopic herniorrhaphy:

• Arcuate line (b)
• Hesselbach's triangle (in yellow)
• Aberrant obturator artery (Corona Mortis) (a)
• Inferior (deep) epigastric artery (c)

Image property of:CAA.Inc.. Artist:M. Zuptich.

Clinical anatomy of the inguinofemoral hernias, as well as abdominal and perineal hernias are some of the lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc.

If you arrived directly to this article, the first article in this three-page series can be read HERE

I would like to shine a light on my husband poet /sculptor Bryan Green , who wrote a poem on Vesalius that is published in Theo’s book; “In Search of Andreas Vesalius: The Quest for the Lost Grave” and gave a performance at the Fabrica Vitae exhibition opening.. Bryan has constantly worked behind the scenes editing many letters, articles, books, and leaflets,  I couldn’t have done it all without his help and advice. He also made the long lorry journey to Zakynthos from Belgium with me and our friend James Gatehouse to deliver the monument.

Vesalius Continuum also marked the start of our touring exhibition “Fabrica Vitae” curated by Eleanor Crook, my sister Chantal Pollier, and myself. The exhibition toured all over Europe and the US with the help and support of Theo Dirix and Belgian Embassies world wide .

The conference and accompanying events could not have happened without financial funds and I hereby would like to thank all our sponsors: Professor Peter Abrahams with his infectious energy and professor Robert Jordan; St Georges University of Grenada, Ruth Richardson and Brian Hurwitz and Mark Gardiner for getting funding from the Wellcome trust, Marie Dauenheimer and the Vesalius Trust, BIOMAB, Ann van the Velde and The University of Antwerp, The AEIMS and MAA, William Nagels, warmly thank the local authorities and the mayor of Zakynthos, ARSIC,  Theo Dirix, and Stephen Joffe, and a special thank you also Stephen for writing a beautiful foreword for our book In the Shadow of Vesalius.

Bryan Green reading his poem in the book of Theo Dirix “ In Search of Andreas Vesalius”
Click on the image for a larger version

In 2017 BIOMAB, in collaboration with Vesaliana, organized the first triennial in Zakynthos ‘Uniting Medicine with Poetry, History and Culture’

It seems like another world in which we made our plans for the 2nd edition of the Vesalius Triennial Congress, 4 months before the COVID-19 pandemic lock down. From the vain belief that COVID-19 would not hit most countries, to hopes that everything would have blown over by 13th November 2020 (the day when the next Vesalius Triennial Congress would take place in Antwerp) to realizing that we were going to have to take action, the scientific committee has transformed from one in which everyone knew their time-tried and perfected role, to one requiring invention in uncharted territory.

Canceling the 2nd  Vesalius Triennial was not a welcome prospect , since facilitating human communication is the corner stone of a scientific community. So we set sail for the vast virtual-reality realm. To discover just how far we could delve into virtual communication with a dedicated but small organising committee, was an eventful, insightful voyage. Sadly after long and careful consideration and several online meetings we finally decided to postpone all international congress keynote lectures and educational sessions until 2023.

However we would like to invite all the friends of Vesalius for a virtual book launch on Nov 13th we will soon post the event details on how to register for this event on social media, and on Vesalius continuum website

The book "In the shadow of Vesalius" can be ordered here: http://garant.be/shadow-of-vesalius/ 

Professors Vivian Nutton and Omer Steeno looking at a first edition of the Fabrica
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Pascale Pollier-Green
Oct 2020

Personal note: I would like to thank Pascale Pollier-Green for authoring this series of articles and wish Professor Robrecht Van Hee the best success publishing this new book on the history and influence of Andreas Vesalius on anatomy, medicine, science, and the Arts. Dr. Miranda.

If you arrived directly to this article, the first article in this three-page series can be read HERE

Without the organizing skills and drive and energy of Dr. Mark Gardiner and the countless meetings and emails with Theo Dirix, the conference Vesalius Continuum would not have been the huge world class event it became.

In 2013 Dr. Mark Gardiner and I first introduced ourselves to Professor Vivian Nutton who was giving a lecture at Warwick University about the incredible find of a hand written (by Vesalius himself !) edited version of the Fabrica’s second edition, which would have become the third edition, …had Vesalius not met his untimely death. Mark and I were blown away by this wonderfully exciting lecture and we asked Professor Nutton to be a speaker at our conference in 2014, which he accepted gladly. He was invited again in 2017 for the triennial and has now especially for this publication written an exciting account of Vesalius in England, 1544 to 1547.

Sculpting the monument in Richard Neave’s studio

My colleague and dear friend forensic medical artist Richard Neave and I sculpted a bronze monument to commemorate Vesalius’s death on the Island of Zakynthos on 15th Oct 1564. This monument might never have been erected if it were not for the wonderful idea of  Antwerp GP and president of Vesaliana Dr Marc de Roeck together with William Nagels, who devised a way of self-funding this large undertaking. We had countless meetings discussing the monument and agreed with Dr. de Roeck that by making a bronze facial reconstruction portrait (made by Richard Neave and myself) and selling 12 copies we would gather enough money together to make the monument, pay to have it cast in Bronze and drive the sculpture from Belgium to Zakynthos ready to have its grand inauguration at the start of the conference. This was all achieved successfully and the sculpture now stands on the Island of Zakynthos’s Vesalius square, facing the Ionian sea.

After our first visit to “what we thought then was the grave site“ at Laganas, I wrote a letter to the Belgian embassy in Greece, asking for help with our quest,  a year later when Theo Dirix took office as Consul he wrote back to me, my letter had ignited a flame in the heart of taphophile Theo Dirix.

Sculpting the monument in Richard Neave’s studio
Click on the image for a larger version

Theo Dirix wrote 2 books on the quest of the grave and now will reveal some new insights with his article  in the book “In the Shadow of Vesalius”.

This article continues HERE