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 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
Original image courtesy of "Images from the History of Medicine" at www.nih.gov
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UPDATED: The word [pylorus] is Greek. It arises from the word [πύλη] (p?li)meaning [gate]. In ancient Greek [πυλωρός] (pylorus) meant "gatekeeper" or "gate guard", leaving us to assume that Greek physicians had an idea of the function of the pylorus.
The pylorus is a true anatomical sphincter and controls the emptying of the stomach. It is the most distal anatomical component of the stomach and can be see in the image marked with the letter "P". In history, it has been described by other names including "velut portanarium", and "pilorium" this last term was changed to "pylorus" by Andrea Vesalius.
Using surface anatomy the location of the pylorus can be found on or slightly superior to the transpyloric plane and slightly to the right of the midline.
Stenosis of the pylorus can lead to gastric emptying complications. A couple of surgical procedures to alleviate this condition are:
• Pyloromyotomy: From the root terms [pylor], meaning "pylorus", [-my-], meaning "muscle", and the suffix [-otomy], meaning "to open, or to cut"; therefore "opening of cutting the pyloric muscle"
• Pyloroplasty: From the root terms [pylor], meaning "pylorus", and the suffix[-oplasty], meaning "to reshape or reconstruct"; therefore "pyloric reshaping".
The image shows the anterior aspect of the stomach. The liver is retracted. Go= Greater omentum, Lo=Lesser omentum, E= Esophagus, f=Fundus, P= Pylorus.
Images property of:CAA.Inc.Photographer:D.M. Klein
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A fistula is the abnormal communication or passageway between two hollow organs or between a hollow organ and the skin.
The term fistula is also used as a synonym for an anastomosis.
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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.
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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.
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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.
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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
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The terms “anatomy” and “dissection” are synonymous. In the days of Andreas Vesalius, the dissection of a corpse was a public event, where medical students would attend, as well as the paying public.
This event would go on for days as the dissector would explain the anatomy racing against time, as there were no means of body preservation.
Through the centuries after the public anatomies of the 1500’s, the dissection of donated bodies has been continued in the anatomy departments of medical schools helping medical students and surgeons prepare for the challenges of the practice of medicine and surgery.
A public anatomy was one of the events of 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. To my knowledge, a public anatomy has not been done in centuries (I may be wrong).
Some of the objectives were to demonstrate that Andrea Vesalius' description of the anatomy of the brain, its ventricular system, and the cranial nerves was logical, followed a process, and that the Fabrica, in its seventh book can be used as a dissector. The presentation was entitled “A Fabrica-guided Neo-Vesalian Public Dissection of the Brain Ventricular System 500 Years Later at St. Louis University” by Dr. Salomon Segal.
The dissection used excerpts and images from the Fabrica, as well as an advanced HD 3D camera, showing the brain and its structures with amazing clarity. The accompanying photo of the event is not well focused because of the light conditions, but shows the setup for the presentation.
This was an extremely professional presentation and although not completely “public” per se, the variety of attendees had a great feedback on the event. Proper attention to the care and respect towards the specimens and the anonymity of the donors was maintained at all times. I consider myself honored to have been a witness and a participant to this extraordinary event. Dr. Miranda.
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- Written by: Efrain A. Miranda, Ph.D.
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Last week I attended this interdisciplinary symposium hosted by the Saint Louis University and Washington University. This three-day event was inspired by the landmark publication of Andrea Vesalius’s "De humani corporis fabrica, libri septem" (Basel, 1543 and 1555) and the new critical edition and translation of this work, the New Fabrica. Two of the keynote speakers were Daniel Garrison and Malcolm Hast, authors of the new Fabrica by Karger Publishers. Besides them there were several internationally-renowned speakers, art exhibits, presentation of academic papers of leading research, a public anatomy demonstration, rare books workshops, and a publishers’ exhibit hall.
Because the Fabrica represented a collaborative project involving a scientist (Vesalius), a humanist (Johannes Oporinus, the printer), and an artist (Jan van Kalkar), the goal of the conference was to encourage a network of scholars working in disparate fields to explore the potential for future interdisciplinary research. This objective was clearly attained, as I was able to speak and share with rare books curators, university librarians, artists, anatomist, physicians, poets, historians, etc., all of them brought together by the shared admiration for Andreas Vesalius, his work, his publications, and his legacy.
There were many highlights in this symposium and I will try to cover some of them in a series of articles. The first one was a presentation by Dr. Stephen N. Joffe, where he described the number of Vesalius' books still in existence in the US and estimates around the world. It was interesting to me that and estimated 600 first edition Fabricas were ever published, and that of those only a fraction exist today, most in university libraries!
Another highlight was the presentation by Pascale Pollier, a Belgian artist, of the Vesalius Continuum project, part of which are the Fabrica Vitae art exhibit that was available to the attendees and the public for the duration of the symposium. Another part of Vesalius Continuum was the meeting in Zakynthos, Greece in 2014. Pascale also presented the process of creation of a bust of Dr. Gunther Von Hagens, the inventor of the system of plastination.
Probably the most rewarding segments of this symposium were the question and answer sessions after each presentation.
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Image courtesy of Dr. Randall Wolf
UPDATED: This Latin aphorism is at the core of Medicine and Surgery. It means "Above all, do no harm". Another translation would be "First, do no harm". The works of Hippocrates mentions the concept in his book Epidemics , and it has been presented in one way or another trough the ages. Thomas Sydenham (1624 - 1689), an English physician, is probably the first one to use it in an English publication, although his Latin phrase was "Primum est ut, non nocere". The first use of the modern phrasing "Primum Non Nocere" was by Lewis Atterbury Stimson (1844 - 1917), an American surgeon in 1879.
It seems almost counterintuitive that surgery would attempt to do no harm, but this is what moves innovation. From sharper needles that require less force to penetrate, and sharper scalpels that cause less trauma to tissues, to surgical staplers and minimally invasive techniques that attempt to reduce the size of the incision and the overall damage to the tissues.
The design of new surgical devices and new surgical techniques should always attempt to answer to this most important rule of surgery: "Primum Non Nocere".
As a point of interest, the Latin term [nocere] is the basis for the medical term [noxa] means "injury", "harm", or damage", this being the root for the term [noxious]
Sources
1. "Origin and Uses of Primum Non Nocere — Above All, Do No Harm!" Smith, CM J Clin Pharmacol 2005 45 (4): 371–377
2. "On abdominal drainage of adherent portions of ovarian cysts as a substitute for completed ovariotomy" Stimson LA Am J Med Sci 1879;78:88-100.