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Georg Eduard Von Rindfleisch
(1836 – 1908)
German pathologist and histologist of Bavarian nobility ancestry. Rindfleisch studied medicine in Würzburg, Berlin, and Heidelberg, earning his MD in 1859 with the thesis “De Vasorum Genesi” (on the generation of vessels) under the tutelage of Rudolf Virchow (1821 - 1902). He then continued as a assistant to Virchow in a newly founded institute in Berlin. He then moved to Breslau in 1861 as an assistant to Rudolf Heidenhain (1834–1897), becoming a professor of pathological anatomy. In 1865 he became full professor in Bonn and in 1874 in Würzburg, where a new pathological institute was built according to his design (completed in 1878), where he worked until his retirement in 1906.
He was the first to describe the inflammatory background of multiple sclerosis in 1863, when he noted that demyelinated lesions have in their center small vessels that are surrounded by a leukocyte inflammatory infiltrate.
After extensive investigations, he suspected an infectious origin of tuberculosis - even before Robert Koch's detection of the tuberculosis bacillus in 1892. Rindfleisch 's special achievement is the description of the morphologically conspicuous macrophages in typhoid inflammation. His distinction between myocardial infarction and myocarditis in 1890 is also of lasting importance.
Associated eponyms
"Rindfleisch's folds": Usually a single semilunar fold of the serous surface of the pericardium around the origin of the aorta. Also known as the plica semilunaris aortæ.
"Rindfleisch's cells": Historical (and obsolete) name for eosinophilic leukocytes.
Personal note: G. Rindfleisch’s book “Traité D' Histologie Pathologique” 2nd edition (1873) is now part of my library. This book was translated from German to French by Dr. Frédéric Gross (1844-1927) , Associate Professor of the Medicine Faculty in Nancy, France. The book is dedicated to Dr. Theodore Billroth (1829-1894), an important surgeon whose pioneering work on subtotal gastrectomies paved the way for today’s robotic bariatric surgery. Dr. Miranda.
Sources:
1. "Stedmans Medical Eponyms" Forbis, P.; Bartolucci, SL; 1998 Williams and Wilkins
2. "Rindfleisch, Georg Eduard von (bayerischer Adel?)" Deutsche Biographie
3. "The pathology of multiple sclerosis and its evolution" Lassmann H. (1999) Philos Trans R Soc Lond B Biol Sci. 354 (1390): 1635–40.
4. “Traité D' Histologie Pathologique” G.E.
Rindfleisch 2nd Ed (1873) Ballieres et Fils. Paris, Translated by F Gross
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This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.
Philippo Verheyen
Philippo Verheyen (1648 – 1710). Flemish physician and anatomist, Philipo (Philip) Verheyen was born in the city of Verrebroek in Belgium, worked as a farmer in his early years and was probably expected to be a farmer for the rest of his life. The local Catholic parish pastor Johannes Jaspars, recognizing his intelligence, started teaching him Latin and letters with the intention of having Philip become a priest.
In 1672, he was sent to the Trinity College in Leuven where he started his studies in arts and later in theology. He continued his studies in Theology at the Collegium Sancti Spiritus (College of the Holy Spirit). During the latter part of his studies Verhayen was already wearing a priest’s collar. In 1675 Verheyen suffered an injury that lead to gangrene and eventual amputation of his left leg. This injury prevented him from taking his final vows as a priest.
Verheyen enrolled at the University of Leuven College Of Medicine where after 3 years he became a physician. Unhappy with his mostly theoretical medical knowledge Verhayen moved to Leyden to continue his studies with Frederick Ryus and others.
In 1683 Verheyen returns to Leuven where he presents his doctoral thesis which is accepted. In August 1669 elected Rector Magnificus at the University of Leyden, one of the highest honors ever bestowed on him. This is why Verheyen's statue is among the personalities honored at the town hall in Leuven, Belgium.
Verheyen was a prolific writer including several books and manuscripts. His main work “Corporis Humani Anatomiae”, a two book work, had twelve editions, some in other languages besides Latin. This book became one of the most used anatomy books until the middle of the 18th century. Interestingly, Verheyen relates his life and studies at the beginning of his book in a chapter call Compendium Vitae (CV). Only the first edition was published while Verheyen was alive.
The following excerpt of his book "Corporis Humani Anatomiae Liber Primus" reads : " ... QuintusAuricularis, quia cum minimum sit, auribus expurgandis est aptissimus" translates as"..the fifth (finger, called) Auricularis, because how small it is, is most suitable to clean the ears". Incredibly, anatomists at that time called the fifth digit "digitus auricularis".
Verheyen is credited with the creation of the eponym the “Achilles tendon” which denominates the common tendon for the gastrocnemius and soleus muscle, although at the time he called it the “Chorda Achillis”. He also described the kidneys in detail, especially the arterial “stars” found on the surface of the kidney, which are today known as the “Stars of Verheyen”.
In 2005 an article appeared on the World Wide Web with a painting showing Verhayen dissecting his own amputated leg. This initially “anonymous” oil pintingis actually a Photoshop-edited image which incorporates parts of the painting “The Anatomy Lesson of Dr. Nicolaes Tulp” by Rembrandt. This work was made by ShrestaRit Premnath. This is a conceptual artwork depicting the concept of amputation, but not an actual oil painting, as shown by the image analysis depicted at the bottom of this article.
The story of Verheyen keeping and dissecting his own leg is most probably a myth for several reasons. Verhayen was poor and did not have enough money to go to Leyden to have his leg amputated there as the myth suggests. Preservation techniques were not too good at the time and when Verheyen had his leg amputated he had yet to enter medical school and be introduced to the art of human anatomy. Granted, he had dissected animals before in the farm, but it is doubtful that this myth is true.
"Verheyen dissecting his own leg"
Verheyen's stars on the surface of a human kidney.
Verheyen's statue at Louven's Town Hall.
Title page of Verheyen's Corporis Humani Anatomiae.
Click on the image for a larger version.
The image above shows a comparison between Rembrandt's painting “The Anatomy Lesson of Dr. Nicolaes Tulp” and an "anonymous" oil painting that appeared on the Internet circa 2005.
This oil painting include elements from Rembrandt's work. First, the head of "Verheyen" has been copied and flipped horizontally, This causes "Verheyen's" neck position to be awkward for the job of dissection. Second, the right hand holding the dissector and Achilles' tendon is Dr. Tulp's hand that has been slightly rotated, including the instrument anf the cuff. Third, the left hand is also that of Dr. Tulp, but not the cuff. If you look closely you will notice that both cuffs are different!
I have not been able to find the original painting on which these elements were added. My guess is that the left leg depicted on the table is also added. Interestingly, the table shows perspective problems.
In 2023 I had the honor of being invited by the University of Antwerp in Belgium to speak at the 2023 Vesalius Triennial Meeting in the city of Antwerp, Belgium. While there I visited Verrebroek, the city where Verheyen was born.
Personal note: I am proud to have in my library catalog a copy of the second edition of Philippo Verheyen's “Corporis Humani Anatomiae, Liber Primus”, published in 1710 in Brussels by the printer house of Fraters Serstevens. The book is signed by an Ex-Libris by "Hanolet". I have not been able to find more information on this prior owner of this book. An image of the title page is depicted in this article. Dr. Miranda
Sources
1. “Philip Verheyen (1648-1710) and his Corporis Humani Anatomiae” Suy R. Acta chir belg, 2007, 107, 343-354
2. “Achilles tendon: the 305th anniversary of the French priority on the introduction of the famous anatomical eponym” Musil, V. et al Surg Radiol Anat (2011) 33:421–427
3. "Philip Verheyen" Research and movie by digitalstories.be by Hedwige Daenens
Original image courtesy of the National Library of Medicine
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Image property of: CAA.Inc.. Artist: M. Zuptich.
The so-called "triangle of pain" is a misnomer coined by laparoscopic hernia surgeons who observed the anatomy of the inguinofemoral region from the posterior aspect and refers to an inverted "V" shaped area which should be avoided because of the potential to damage nerves when placing staples, tacks, or sutures to anchor a mesh during a laparoscopic herniorrhaphy.
An example of a similar situation with terminology is the so-called "triangle of doom". It is also not a triangle, as it only has two boundaries. similarly, it does indicate an area where it is dangerous to place staples or sutures during laparoscopic hernia surgery.
The "triangle of pain" is an inverted "V" shaped area with its apex at the internal (deep) inguinal ring. It is bound anteriorly by the iliopubic tract / inguinal ligament and by the testicular (spermatic) vessels posteromedially. This "triangle" has no defined posterolateral boundary. although you can see it in drawings by some authors.
The reason why this area should be avoided and not place staples or sutures to anchor a hernia mesh is that there are several nerves which usually cannot be seen as they run just deep to the endoabdominopelvic fascia.These nerves can suffer damage or entrapment when performing a laparoscopic herniorrhaphy and cause pain (hence the name of the area) as well as motor and sensory disorders.
The nerves are:
• Lateral femoral cutaneous nerve: arising from the ventral rami of L2 and L3, this nerve provides sensory innervation to the anterior skin of the thigh
• Femoral nerve: arising from the ventral rami of L2, L3, and L4, this nerves provides motor and sensory innervation to the anterior compartment of the thigh as well as sensory branches to the hip joint
• Genitofemoral nerve: arising from the ventral rami of L1 and L2, this nerve divides anterior to the psoas major muscle into two branches. The genital branch of the genitofemoral nerve enters the inguinal canal and provides sensory and motor innervation to the scrotum and cremaster muscle, as well as the labia majora and mons pubis. The femoral branch of the genitofemoral nerve enters the "triangle of pain" region and passes inferior to the inguinal ligament to provide sensory cutaneous innervation to the superior aspect of the thigh.
The image shows a posterior view of the inguinal region. The "triangle of pain" is depicted in yellow. The iliopubic tract / inguinal ligament is shown by a blue dotted line while the testicular vessels boundary is shown by a red dotted line. The blue arrow points to the aberrant obturator artery (Corona Mortis).
Thanks to Steve Pearson for suggesting this term. Medical illustration by Mark J. 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. For more information Contact Us.
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The noun word [porta] is Latin and means "gate" or "door". The adjectival form [portal] means “pertaining to a door”. These terms are used in anatomy and pathology to denote the entrance to an organ.
• porta hepatis: The entrance or "door" to the liver
• portal vein: The vein that enters through the porta hepatis
• portal system: A system of veins that collects the venous return from the digestive system and derives it through the portal vein into the liver
• portal hypertension: A pathological condition of higher blood pressure in the portal vein system.
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The lumbar region of the spine is composed by five lumbar vertebrae. Although sharing characteristics common to all vertebrae, a lumbar vertebra can be differentiated by the following:
• The vertebral body is large, tall, and when viewed from superior, the vertebral body has a longer transverse diameter and a shorter anteroposterior diameter. Most anatomists describe the vertebral body as being “kidney-shaped”. The massiveness of the vertebral body is due to the larger weight that each consecutive vertebra has to bear in the lumbar region. Because of this, lumbar vertebrae have larger anular epiphyses, and the vertebral body is hourglass-shaped with a “waist”. As with other vertebrae, the body of a lumbar vertebra has vertebral endplates, nutritional foramina, and in its posterior aspect they present with basivertebral foramina.
• The pedicles in the lumbar vertebrae are larger, course in a mostly anteroposterior direction, and have a oval cross-section where the superoinferior diameter is longer and the transverse diameter is shorter. This is important for transpedicular procedures for vertebroplasty or kyphoplasty.
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• The transverse processes are also larger than other vertebrae. Of interest are the facts that the transverse process of the third lumbar vertebra is the longest of all lumbar vertebrae and that the transverse process of the fifth lumbar vertebra courses superolaterally at an angle of almost 45 degrees because of the presence of the strong iliolumbar ligament. The lumbar transverse processes have a small tubercle called the mammillary process.
• The lumbar spinous processes are large and have a square shape.
Again, because of the larger weight bearing capacity of the lumbar vertebrae, they have strong ligaments and their zygapophyseal joints and articular facets tend to be oriented with their surfaces in a transverse plane. This has two consequences: The rotational mobility of the whole lumbovertebral region is limited and they tend not to have anteroposterior displacement.
Image property of CAA.Inc. Photographer: D.M. Klein.
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UPDATED: The term [ischemia] arises from the Greek word [ισχαιμία], meaning "to slow down the flow of blood". The root portion arises from the Greek [σφίγγω] meaning "to constrict" or "to stop". The uffix is [-emia] from the Greek [αίμα] (ema) meaning blood. Another potential origin is the Greek word [ischanein], meaning " to keep at bay" or 'to hold in check". It was Rudolf Virchow (1821-1902) who first used the term [ischemia] to denote a local reduction in the flow of blood.
Today the term ischemia means "localized reduction in the flow of blood to an organ or region of an organ". Ischemia occurs when there is a stenosis or stricture of an artery.
Note: The links to Google Translate include an icon that will allow you to hear the Greek or Latin pronunciation of the word.
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The bifurcation of the aorta is the point at which the abdominal aorta ends distally. At this point the aorta bifurcates giving origin to the right and left common iliac arteries. These arteries trend anterolaterally towards the pelvic brim.
The aortic bifurcation is usually found anterior to the inferior border of the 4th lumbar vertebra vertebra, slightly to the left of the midline. In surface anatomy, the bifurcation corresponds to a point slightly left to the midline and just about two fingerbreadths (two centimeters) inferior to the umbilicus.
This is an important landmark in surface anatomy in laparoscopic surgery. When placing the first periumbilical trocar the surgeon must angle the trocar posteroinferiorly towards the pelvic basin as to avoid perforating or lacerating the abdominal aorta. This situation has been studied in many journal articles.
Inferior to the aortic bifurcation is the confluence of both common iliac veins which give origin to the inferior vena cava.
The middle sacral artery arises from the lower portion of the abdominal aorta and appears inferior to the aortic bifurcation in the midline an continuing on its way to the anterior aspect of the sacrum.
The fact that the aorta bifurcates in front of the 4th lumbar vertebra leaves the L5-S1 intervertebral disc free of major arteries (with the exception of the middle sacral artery) allowing surgeons access to the intervertebral disc to perform laparoscopic removal of the disc with implantation of a device to allow intervertebral fusion in the case of intervertebral disc disease.
Sources:
1. “Major vascular injuries during laparoscopic procedures” Nordestgaard, AG et al Am J Surg (1995) 169,5: 543–545
2. “Evaluation of the direct trocar insertion technique at laparoscopy” Byron. JW et al Obst Gyn (1989) 74:3, 423-425
3. “Open versus closed establishment of pneumoperitoneum in laparoscopic surgery” Bonjer, HJ et al Br J Surg, 84: 599–602
4. “Serious Trocar Accidents in Laparoscopic Surgery: A French Survey of 103,852 Operations” Champault G et al Surg Lap Endosc (1996) 6(5):367-70
5. “Major vascular injuries during gynecologic laparoscopy” Chapron CM et al J Am Coll Surg (1997) 185:5 461-465
Image property of:CAA.Inc.Artist: Victoria G. Ratcliffe