Thursday, September 27, 2007
Names and Places, Pouches and Spaces
It's always with wonderment that I consider the pioneers of medicine, of surgery, of anatomy. To conceive of a time when every thought was a new one, when discoveries abounded for those with imagination, boldness, and curiosity, is to be thrilled, jealous, and.... bemused. What could it have been like, opening the body and its mysteries to the world, engraving your name on the way out? As I let my mind jazz, thoughts fizz like a Sapphire tonic.
When it takes some effort -- maybe a microscope or some really careful dissection -- to discover something, it seems reasonable that your name gets attached. Islets of Langerhans. Ampulla of Vater. Sphincter of Oddi. Valves of Heister. Crypts of Morgani (he got "columns," too.) But where's the cutoff? I don't get why Gabriele Falloppio got to name something as obvious and macroscopic as an oviduct. That's not discovering. That's noticing. We don't have the Colon of Powell, or the Heart of Palm. (I don't know who March was, or why he got to name the Eyes.) The white line of Toldt is sort of macro-observational and a name seems an extravagance. On the other hand, if Toldt was the guy who figured out that it was really a dotted line on which a surgeon cuts to unveil the colon -- a move that thrilled me the first time I did it and still does, for its anatomic simplicity, for its sweet entry into secret space, for the way it translates embryology into practicality -- then he deserves the kudos.
"Foramen" (for-AY-men) and its pleasant plural, "foramena" are among those cool words we learn in med school. It means "opening." A hole, is what it is. There are many anatomic openings deserving of the name: foramen ovale (oh-VAL-ee) looks good and sounds good; works good in a fetus. Lots of bony holes, especially ones through which nerves or vessels pass, are called foramena -- the obturator foramen, optical foramen, yada yada... But Jean-Jacques Winslow (shouldn't that be "Winsleau?") discovered he could stick his finger in a place, and stuck his name on it, too. Borderline. I don't want to get into the Zen of what constitutes a hole, but his "discovery" is only about some things that are near each other. Inlet, maybe. We've got islets, why not inlets? Then it starts to sound nautical, which makes me think not of Winslow, but of Winslow Homer. That's it: it's the "Oddity of Homer."
Consider Morrison and his pouch. And Douglas's. They're just places, areas. To me, it's not earthshaking. On the other hand, Broca claimed his area with some effort.
I'm ambivalent about the Space of Retzius. As an anatomical concept, "space" doesn't have a lot of panache. On the other hand, the surgical dissection of it, developing it into a tissue plane, is cool: another of many places that spread themselves open for and yield to the surgeon, when their secrets are out.
Clearly the Greek and the Latin have fought for dominance of the nomenclature. It's a puzzle to me that they made a truce of sorts in the kidney. We speak "nephric" and we talk "renal" interchangeably. Even to the point of naming things twice: that little yellow top-hat to the kidney, the ad-renal or the epi-nephron, as of juice it makes, two names for the same thing: adrenaline, epinephrine. What gives? (Let me re-emphasize and diverge: like the robin's-egg blue of the gallbladder, the bold yellow of the adrenal is a starting splash of exuberant color among the otherwise earthy tones of the belly.) (Well, yeah, there's lemony lipid all over in there. But as organs go, the color of the adrenal is a surprise.)
Those solid surgical soldiers of old deservedly got operations named after them; and instruments, and procedures. Because there's no end to invention, it still happens, and will. Lots of the living have their names (and lucrative patents) on devices; techniques and new operations keep unfolding. I've mentioned in the past, I think, having a position named after oneself: Trendelenberg, Fowler (and his brother, Semi) managed to do it. If I had a position named after me (as I might have said already), I'd rather...
Nearly unique, though, among the namings, is to be remembered for a maneuver. Something about that is, well, transcendent. So I'll give it a separate post...