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, also known as "Halsted's Rules of Surgery", 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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The middle cerebral arteries are paired terminal branches of the internal carotid artery. Each middle cerebral artery supplies arterial blood to the brain beyond the arterial circle of Willis. The vascular territory of the middle cerebral artery supplies the lateral surfaces of the frontal, parietal, and temporal cerebral lobes as well as the deeply situated insular lobe.
There are many anatomical variations of the middle cerebral artery, as described here.
Clinical anatomy, pathology, and surgery of the brain and spinal cord are some of the lecture topics developed and delivered by Clinical Anatomy Associates, Inc.
Image modified from the original (in the public domain) by Sobotta (1945)
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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.
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Dr. Húmer Hültl (1868 – 1940) Hungarian surgeon, Húmer Hültl was born in 1868 in Felsobanya. Hültl studied in Budapest, earning his medical degree in 1891, and after surgical training he started to work as a surgeon in 1893.
By 1900, Dr. Hültl was the chief surgeon at the St. Stephen’s Hospital and later at the Sr. Rokus Hospital, and during WWI he was a commander of a Hungarian military hospital. Dr. Hültl’s attention to detail, careful asepsis (after Ignaz Semmelweis) and superb surgical technique earned him the moniker “The Paganini of the Knife”. Hültl was the first in his country to introduce the use of face masks, gloves, sterile cotton, and rubber gloves.
Dr. Hültl was very concerned about the consequences of spillage of gastrointestinal contents in the peritoneal cavity during surgery, covering all the walls of the cavity with sterile towels. At that time some surgical instruments had been invented to keep the edges of the intestines together while suturing. In 1907 Dr. Hültl envisioned a mechanical instrument that could place rows of staples transversely in the intestines thus avoiding spillage. With the aid of Victor Fisher, a German mechanical engineer, the first surgical stapler was constructed.
This original instrument was very bulky and heavy, weighing close to 11 pounds, and used a “bicycle-chain” type of mechanism to push a crankshaft that would push the staples into the anvil to form “B” shaped staples. It placed four rows or staggered staples. This device was first used in surgery on May 9th, 1908. A later, lighter variation of the instrument was later created, with a different crankshaft and weighing 8 pounds. Images of these instruments are available here.
Not many of these instruments were sold, but Dr. Hültl had set the stage for the development of the modern surgical stapler. Even today we still use the basic principles of his surgical stapler: “B" shaped staples, staggered rows of staples, and attention to the avoidance of leakage through the staple line. All of this makes Dr. Hültl an integral part of the history of surgical stapling.
Sources:
1. "Húmer Hültl: The Father of the Surgical Stapler" Robicsek, F.& Konstantinov, I. J Med Biogr February 2001 9: 16-19
2. “Current Practice of Surgical Stapling" Ravitch, MM; Steichen, FM, 1991.
Original image courtesy of "Surgical Stapler Museum" at www.surgicalstaplermuseum.com
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The root term [-mur-] has its origin in the Latin word [murus] and means "wall". In medical terminology it is used mostly as [-mural] meaning "pertaining to a wall". It can be used in the following terms:
• Transmural: Through a wall
• Extramural: Outside a wall
• Intramural: Within a wall
Another term meaning "wall" is [parietal] from the Greek word [paries].
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In medical terms a [sign] is an objective, observable, measurable expression of a pathology. To a physician, the combination of a patient's clinical and familial history (anamnesis), combined with the patient's symptoms and signs allows for a proper diagnosis. Some signs are so subtle and specific that they can only be observed and understood by a trained health care professional. Furthermore, some signs are pathognomonic, that is, by their presence they define a pathology. Furthermore
Contrary to symptoms (which are subjective), signs are not only objective, but comparable between individuals of the same species. Therefore we can compare the heart rate bmp (beats per minute) between normal and sick individuals allowing us to chart a range from normal to abnormal. The same is true for most signs such as body temperature, respiratory capacity, breathing rate, weight, height, etc.
Some signs are particular to a pathology, although they may not be pathognomonic. These specific signs are usually eponymic, such as:
• McMurray's sign: A click caused by the meniscus during manipulation of the knee; indicative of meniscal injury.
• Blumberg's sign: Sharp piercing pain on the abrupt release of steady pressure over the site of a suspected abdominal lesion, indicative of peritonitis. When used to diagnose appendicitis over McBurney's point it may be called Aaron's sign.
• Musset's sign: Rhythmical jerking of the head following the heart pulsations in aortic aneurysm and aortic insufficiency.
• Cardarelli's sign: An abnormal pulsation of the trachea that may be found in patients with an aneurysm of the aortic arch that causes left tracheal displacement.
• Caput medusae: A ring of dilated varicose veins radiating from the umbilicus, usually indicative of portal hypertension.
• Papal Benediction Sign: A contraction of the fourth and fifth digits, as in benediction (see image).
There are many more medical signs, this list is only an illustration of the concept
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The medical term [symptom] has many definitions, as shown in this article. A good definition follows: A symptom is that what a patient refers, it is subjective, and cannot be measured or standardized (between patients). Examples of symptoms are thermal sensation ("I feel hot or feverish"), visceral sensations ("I feel a lump on my throat"), etc. In all cases the main characteristic of a symptom is that is subjective and patient-dependent. It is only relevant to a particular patient and cannot be compared from one patient to another.
Symptoms are part of the clinical study or history of a patient that help lead to a diagnosis.
• Merrian-Webster: "subjective evidence of disease or physical disturbance", "something that indicates the existence of something else"
• Memidex: "any sensation or change in bodily function that is experienced by a patient and is associated with a particular disease"
• Pandora World: "Feelings and perceptions reported by a patient indicative or that can be correlated with a disease process"
• Oxford Dictionaries: "A physical or mental feature that is regarded as indicating a condition of disease, particularly such a feature that is apparent to the patient"
Pain is a subjective entity, as it is characteristic to an individual. We all feel and respond to pain differently, as there are people with higher and lower thresholds to pain. Although I understand the need to have some type of standard, I dread the question posed by many..."From one to ten, can you tell me what your pain level is?. If the answer allows the physician or nurse to compare levels of pain within the same patient and see the evolution of a pathology, I am OK with that. But you cannot use that measurement to compare pain levels between patients!
The latest advances test for nerve activity following a noxa, but this just indicates that pain is being detected. Some say that the higher the recording the higher the pain. Possibly; but since pain is subjective we cannot use that measurement to compare pain levels between patients... at least that is my opinion. Dr. Miranda
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The medical term [tenesmus] originates from the Greek [τεινεσμός], itself derivation from [τέντωμα] meaning "stretch", "distend", or to "strain". It refers to a symptom where the patient refers a constant urge to evacuate, with no or ineffective results. There are two types of tenesmus: rectal tenesmus and vesical tenesmus.
Because of the constant straining, tenesmus patients can have pain and cramping. Tenesmus can be one of the symptoms associated with the distal empty segment of colon or rectum found in a temporary or permanent diverting colostomy.
Note: The links to Google Translate in these articles include an icon that will allow you to hear the Greek or Latin pronunciation of the word.