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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Endoscope
The prefix [endo-] is of Greek origin and means "inner or within". There are many uses of the term as follows:
- Endocardium: the root term [card] means "heart" and the suffix [-ium] refers to a "layer or membrane" - Inner layer of the heart
- Endocrine: the suffix [-crine] means "secretion", the word meaning "inner secretion". Refers to a gland that deposits its secretions within the bloodstream. The products of endocrine glands are known generically as "hormones"
- Endometrium: the root term [-metr-] is Greek, meaning "uterus" . The word endometrium means "inner layer of the uterus"
- Endoscope: the term [-scope] refers to an instrument used for viewing. There is a consensus that a viewing instrument that enters through a natural body cavity will be called an "endoscope" (see image). All others will adopt the name of the cavity that is being viewed, as a laparoscope, a thoracoscope, an arthroscope, etc.
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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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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
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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. 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.
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. "Salomon 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 by Rose Tibayan
3. "Salomon Hakim, alma y vida de cient?fico"Article by Paulina Ortiz
4. "Salomon Hakim: Un milagro de Colombia para el mundo"
Original image courtesy of The Hydrocephalus Association
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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
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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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.
For more information on the ethmoid bone click here
Source:
1. "Anatomy of the Human Body" Henry Gray 1918. Philadelphia: Lea & Febiger
2 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
Original image in the public domain, by Henry VanDyke Carter, MD, courtesy of bartleby.com