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Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. 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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A Moment in History

Self-portrait, Henry Vandyke Carter, MD (Public Domain)
Self-portrait, Henry Vandyke Carter, MD (Public Domain)

Henry Vandyke Carter, MD
(1831 – 1897)

English physician, surgeon, medical artist, and a pioneer in leprosy and mycetoma studies.  HV Carter was born in Yorkshire in 1831. He was the son of Henry Barlow Carter, a well-known artist and it is possible that he honed his natural talents with his father. His mother picked his middle name after a famous painter, Anthony Van Dyck. This is probably why his name is sometimes shown as Henry Van Dyke Carter, although the most common presentation of his middle name is Vandyke.

Having problems to finance his medical studies, HV Carter trained as an apothecary and later as an anatomical demonstrator at St. George’s Hospital in London, where he met Henry Gray (1872-1861), who was at the time the anatomical lecturer. Having seen the quality of HV Carter’s drawings, Henry Gray teamed with him to produce one of the most popular and longer-lived anatomy books in history: “Gray’s Anatomy”, which was first published in late 1857.  The book itself, about which many papers have been written, was immediately accepted and praised because of the clarity of the text as well as the incredible drawings of Henry Vandyke Carter.

While working on the book’s drawings, HV Carter continued his studies and received his MD in 1856.

In spite of initially being offered a co-authorship of the book, Dr. Carter was relegated to the position of illustrator by Henry Gray and never saw the royalties that the book could have generated for him. For all his work and dedication, Dr. Carter only received a one-time payment of 150 pounds. Dr.  Carter never worked again with Gray, who died of smallpox only a few years later.

Frustrated, Dr. Carter took the exams for the India Medical Service.  In 1858 he joined as an Assistant Surgeon and later became a professor of anatomy and physiology. Even later he served as a Civil Surgeon. During his tenure with the India Medical Service he attained the ranks of Surgeon, Surgeon-Major, Surgeon-Lieutenant-Colonel, and Brigade-Surgeon.

Dr. Carter dedicated the rest of his life to the study of leprosy, and other ailments typical of India at that time. He held several important offices, including that of Dean of the Medical School of the University of Bombay. In 1890, after his retirement, he was appointed Honorary Physician to the Queen.

Dr. Henry Vandyke Carter died of tuberculosis in 1897.

Personal note: Had history been different, this famous book would have been called “Gray and Carter’s Anatomy” and Dr. Carter never gone to India. His legacy is still seen in the images of the thousands of copies of “Gray’s Anatomy” throughout the world and the many reproductions of his work available on the Internet. We are proud to use some of his images in this blog. The image accompanying this article is a self-portrait of Dr. Carter. Click on the image for a larger depiction. Dr. Miranda

Sources:
1. “Obituary: Henry Vandyke Carter” Br Med J (1897);1:1256-7
2. “The Anatomist: A True Story of ‘Gray’s Anatomy” Hayes W. (2007) USA: Ballantine
3. “A Glimpse of Our Past: Henry Gray’s Anatomy” Pearce, JMS. J Clin Anat (2009) 22:291–295
4. “Henry Gray and Henry Vandyke Carter: Creators of a famous textbook” Roberts S. J Med Biogr (2000) 8:206–212.
5. “Henry Vandyke Carter and his meritorious works in India” Tappa, DM et al. Indian J Dermatol Venereol Leprol (2011) 77:101-3


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Benign / Malignant

These two opposing terms are used to describe key characteristics of a tumor. [Benign] derives from the Latin term [benignus], meaning "good" and "gentle". The medical application of the word denotes a condition (or tumor) that is not bad (malignant), and that it is favorable for treatment and recovery.

The term [malignant] derives from the Latin word [malus], meaning "ill-disposed, malicious, or bad". The medical application is to a condition or tumor that is unfavorable to treatment and recovery. Over time the term malignant has become synonymous with "cancer".

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Anterior - Posterior

These two opposite terms must be studied together. Both words are used as directional anatomical and surgical terms, and most importantly, they are relationship terms, that is, they express the spatial location of one structure in reference to another.

The term [anterior] is Latin and means "in front of". It is related to the prefix [ante-] which means "before", or "anterior" and the Latin [anticus], which means "in the very front".

The term [posterior] is more complex. Although it is based on a Latin term meaning "after", the prefix [poster-] is used as a comparative to mean "behind (a structure of reference)". Following are some examples of the proper use of these terms:

- The aorta is anterior to the spine
- The sternum is anterior to the heart
- The occipital bone is the most posterior bone of the cranium
- The trachea is anterior to the esophagus 

Because a human body is always studied in the anatomical position, in the hand, the anterior aspect is the palm and in this case a synonym for anterior is [volar].  

Image property of: CAA.Inc. Artist: Victoria G. Ratcliffe

Anterior - Posterior
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Salomon Hakim, MD


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.To search all the articles in this series, click here.

Dr. Salomón Hakim (1922 - 2011). Dr. Hakim was born in the city of Barranquilla, Colombia. He started medical school in 1944 and elected neurosurgery as his specialty. He had special interest in electricity and physics, which he used extensively in his research.

In 1957 Dr. Hakim was exposed to a strange case of a young man with what was known then as "symptomatic occult hydrocephalus". Until that time the accepted knowledge was that hydrocephalus was due to an increase in intracranial pressure of different etiology. The problem was that the young man had normal pressure, yet had a hydrocephalus and enlarged ventricles. Dr. Hakim applied his knowledge of physics and laid the conceptual basis for what became known as "Normal Pressure Hydrocephalus" a condition until then unrecognized and that is found in aging patients with dementia, Alzheimer's, and other pathologies.

Working at home, Dr. Hakim developed a pressure-regulating shunt  to drain the excess cerebrospinal fluid (CSF) from the ventricular system of the brain. These valves were later produced by medical industry. His son Carlos has continued his legacy and now the Hakim programmable valve is one of the best CSF shunt systems in the world.

Original image courtesy of The Hydrocephalus Association

I had the pleasure of meeting Dr. Hakim in 1993 in Santiago, Chile, and again later in the US, as he presented his valve system to a group of neurosurgeons.  This short article does not do justice to the physician, researcher, and family man. I encourage you to read more in the following links. Dr. Miranda

Sources:
1. "Salom?n Hakim and the Discovery of Normal-Pressure Hydrocephalus" Wallenstein, MB; McKhann, GM. Neurosurgery (2010) 67;1:155-159
2. "The Reprieve: Reversing Dementia" online article byRose Tibayan
3. "Salom?n Hakim, alma y vida de cient?fico"Article by Paulina Ortiz
4. 
"Salom?n Hakim: Un milagro de Colombia para el mundo"

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Lapar-

The root term [-lapar-] term is Greex, and although today we use it to mean "abdomen", it actually means "flank" or "loins".

In its pure etymological meaning the root term [lapar], as in "laparotomy" or "laparoscopy" should be used to denote a surgical action in only two of the abdominal regions, the right and left lumbar regions (or flank regions) denoted in the accompanying image.

The first use of the term [-lapar-] referring to the whole of the abdominal region was in January, 1878 by Thomas Bryant, FRCS in his book "A Manual for the Practice of Surgery" using the term [laparotomy] to describe an "incision in the abdomen". Other terms used to denote the abdominal region are "ventral", and of course, "abdominal".

Laparotomy: the suffix [-otomy] means to "open" or "to cut", the term means then " to cut of to open the abdomen"
Laparoscope: an instrument used to view into the abdomen
Laparoscopy: the act of using a laparoscope
Laparostomy: an unusual procedure where the abdomen is not closed, but left partially open (but protected) so that the surgeon can come back periodically to perform an abdominal "lavage" to manage an intractable abdominal sepsis
Laparorrhaphy: the suffix [-orrhaphy] means "to repair". Refers to the repair or closure of a laparotomy

Abdominal regions and their content

Sources:
1. Mughal, M. M., Bancewicz, J. and Irving, M. H. (1986), ‘Laparostomy’: A technique for the management of intractable intra-abdominal sepsis. Br J Surg, 73: 253–259
2. Thomas, B.(1878). "A Manual for the Practice of Surgery" PHiladelphia: Henry C. Lea and Sons
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Cribriform

The etymology of this word arises from two Latin words; [cribrum], meaning "a sieve" and [forma], meaning "shape" or "shaped-like". The word [cribriform] means then "sieve-like" or "perforated with a large number or holes".

There are places in the body where the term applies. Examples are the cribriform plate (lamina cribrosa), a sieve-like region found in the superior aspect of the ethmoid bone (see accompanying image) , described in detail by Gabrielle Fallopius.  The olfactory nerves, extensions of the olfactory, bulb pass through the cribriform plate on their way to the olfactory epithelium, an area of the mucosa in the superior aspect of the nose. Another is the cribriform fascia (Hesselbach's fascia) on the anterosuperior aspect of the thigh through which passes the greater saphenous vein and other structures.

Ethmoid bone, superior view, showing the cribriform plate (www.bartleby.com)

Images courtesy of www.bartleby.com
Click on the image for a larger version. For more information on the ethmoid bone click here

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Vein

From the Latin [vena], meaning "vein". Some early authors postulated that the term derivates from the Latin word [venio] meaning "to come", because the blood in the veins "comes in" to the heart. There are two root terms meaning "vein", the first is the Latin derivated [-ven-], as in the terms venous and intravenous. The second root term is Greek [-phleb-], as in the terms phlebectomy, phlebotomy, and phlebotomist. Peripheral veins have internal one-way valves, while most of the central veins (in the trunk) do not present with valves. Failure of a peripheral venous valve can lead to dilation of the vein, condition called a varix.

Venous: pertaining to a vein
Intravenous: inside or within a vein
Phlebectomy: removal of a vein
Phlebotomy: to open a vein

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