Excellent Enteric Explorers
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EDUCatION IN GASTROENTEROLOGY Excellent Enteric Explorers Matthijs P Somford, Geertruid MH Marres, George P van der Schelling Amphia Hospital, Breda, The Netherlands Abstract Heinrich Wilhelm Gottfried von Waldeyer-Hartz (1837–1921) was born in Hehlen, Braunschweig, Germany. As if following the natural course of an ingested particle, He was a pupil of Friedrich Gustav Joseph Henle. He became several structures in the gastrointestinal tract which were Professor of Anatomy at the University of Strasbourg, which named after their discoverers are presented including concise at that time also employed great teachers such as Friedrich backgrounds of these pioneers of the human intestines. Daniel von Recklinghausen and Adolph Kussmaul. It was here that Von Waldeyer described and named the plasma Keywords cell in 1875. From 1867 until 1872, Waldeyer studied the development of cancer. In 1883, he went to Berlin as a Eponyms – gastro-intestinal tract. Professor of Anatomy. In 1884, Von Waldeyer described the lymphatic ring in the oropharynx and in 1888 he named Introduction the chromosome. Johannes Sobotta, whose atlases are still widely used, was one of Von Waldeyer’s students. Von For centuries, scientists have studied the anatomy of the Waldeyer is considered to be the founder of the neuron human gastrointestinal tract. This has resulted in a number theory of the nervous system. He coined the term ‘neuron’ of eponyms in this part of the human body, which honour to describe the basic structural unit of the nervous system the discoveries of these early pioneers. in 1891. Knowing more about the historical background of these Passing from the mouth to the stomach, we travel down individuals and their work makes medical science more the esophagus. ‘Oesophagus’ is not an eponym, but is derived dynamic. from the Greek word ‘οισοφάγος’ [oi-so-pha-goss], meaning By analogy with Isaac Asimov’s Fantastic Voyage, we ‘what carries and eats’. At the end of this gullet, we reach would like to take you on a journey through the human the stomach. In the lower half of this reservoir, we encounter body. In Asimov’s story, a team of people is miniaturized to the pylorus. The word ‘pylorus’ is not an eponym either, microscopic size and injected into a scientist’s bloodstream but is derived from the Greek word ‘πυλωρος’ [puu-low- so they can dissolve a blood clot in the man’s brain. Our ross], which means ‘gate guard’. We enter the duodenum journey, however, has no other mission than to marvel at after being permitted by this “guard”. ‘Duodenum’ is an the background of the anatomical eponyms. Additionally, abbreviation of the Latin ‘duodenum digitorum’ – meaning our exit will not be quite the same as in Asimov’s story, in ‘twelve fingers’ – which is the approximate length of this part which the team leaves the body in a teardrop: instead we of the small intestine. The duodenal wall contains Brunner’s shall travel the route of an ingested particle. glands, which excrete mucus to protect and lubricate the Embarking on our voyage, we must first pass through duodenum and activate enzymes. Waldeyer’s ring. This ring consists of the lingual, pharyngeal and the palatine tonsils. Johann Conrad Brunner (1653–1727) was a Swiss anatomist. His father-in-law, J.J. Wepfer, was the actual discoverer of the duodenal glands. Brunner was a pioneer Received: 30.08.2009 Accepted: 17.09.2009 of experimental physiology. He discovered that excising J Gastrointestin Liver Dis the pancreas in dogs caused polydipsia and polyuria. His December 2009 Vol.18 No 4, 469-472 findings became the basis of further research into the etiology Address for correspondence: Matthijs Somford Amphia Hospital Breda of diabetes. Brunner’s glands are located mainly before the Amsterdam, The Netherlands ampulla of Vater, through which bile salts and pancreatic Email: [email protected] fluids enter the intestine. 470 Somford et al Abraham Vater (1684–1751) was born in Wittenberg, of Anatomy and Pathology in Kraków. He returned to Prague Germany. At the University of Wittenberg he studied in 1855 to become Professor and Director of the Pathological both philosophy and medicine. Vater became a Doctor of Anatomy Institute. Other discoveries which are attributed Philosophy in 1706 and received his medical degree in to Treitz include the angle of Treitz (the sharp curve at the 1710. duodenal–jejunal junction) and Treitz’s fossa (a depression In 1719, Vater became Professor Extraordinaire of Botany in the peritoneum extending posterior to the caecum). He and Anatomy. Following his appointment, he founded an died in 1872 after ingesting potassium cyanide. anatomical museum. Vater is thought to be the first professor After the ligament of Treitz, the jejunum starts. The term to teach anatomy to women. Most of his published work ‘jejunum’ is derived from the Latin adjective jejunus, which deals with anatomy, but he also wrote about botany, surgery, means “fasting” or “barren”, referring to the fact that this gynaecology, pathology, pharmacology and chemistry. part of the intestine is found empty after death. Surrounding the ampulla of Vater and regulating the Approximately five centimeters behind the pylorus, we secretion of bile salts and pancreatic fluids is the sphincter find the plicae circulares, or circular folds of Kerckring. of Oddi. These mucosal folds are most pronounced in the jejunum Ruggero Ferdinando Antonio Giuseppe Vincenzo and disappear in the first half of the ileum. Their function Oddi (1864–1913) was born in Perugia, Italy. While studying is to enlarge the surface of the intestine and to slow down medicine at the universities of Perugia, Bologna and Florence, the progress of food. he discovered the sphincter and described its physiological Theodor Kerckring or Dirk Kerckring (1638–1693) properties. As an assistant at the Physiological Institute of was born in Amsterdam, The Netherlands. After studying Florence, Oddi reintroduced bedside teaching. In January Latin, he went on to study medicine at Leiden University. 1894, Oddi was named Head of the Physiology Institute He spent most of his career in Amsterdam, but started of Genoa. He was relieved of his duties in 1900 however, travelling Europe in 1675. He eventually settled in Hamburg. due to flirtations with drugs and fiscal improprieties. Oddi Kerckring is best known for his Spicilegium Anatomicum, in then sought employment in the Belgian colonial medical which he describes medical curiosities, autopsy discoveries, service. He spent some time in Congo, but his continued and clinical observations, and provides general anatomical use of narcotics eventually caused him to become mentally information. To investigate the folds in the small intestine, unstable. He died in Tunis, Tunisia. Kerckring used a microscope made by Baruch Spinoza. After this smooth journey downward, we have to make The folds in the small intestine are covered with villi. a short climb because the duodenum is suspended by the At the root of the villi are little trap holes that excrete ligament of Treitz, bending it slightly upward. enzymes. These glands or crypts of Lieberkühn can be found throughout the small and large intestine. Václav Treitz or Wenzel Treitz (1819–1872) was born in Hovernic, Bohemia (then part of Habsburg Austria). He Johann Nathanael Lieberkühn (1711-1756) was studied medicine in Prague. In 1852, he was made Professor born in Berlin. Although his father wanted him to study Excellent enteric explorers 471 theology, his talent for science was recognized by Johann outside, Peyer’s patches are best avoided, as they perform Gustav Reinbech, a Protestant theologian. He introduced the immune surveillance of the intestinal lumen and facilitate Lieberkühn to the Prussian king Friedrich Wilhelm I, who the immune response in the mucosa. made it possible for Lieberkühn to devote himself to science Johann Conrad Peyer (1653–1712) was born in and medicine. Schaffhausen, Switzerland. After studying medicine in In 1739, Lieberkühn received his doctorate from the Paris and Montpellier, he received his doctorate in Basel, University of Leiden, where he had studied under Gerard in 1681. When working in Schaffhaussen, Peyer did a lot van Swieten and Herman Boerhaave. of research with Johann Jakob Wepfer and his son-in-law In 1745, Lieberkühn published Dissertatio anatomico- Johann Conrad Brunner. In 1677, Peyer published Exercitatio physiologica de fabrica et actione villorum intestinorum anatomico-medica de glandulis intestinorum earumque usu tenuium hominis, in which he describes the structure and et affectionibus, which describes the patches that have been function of the intestinal villi and glands which were to named after him. bear his name. At the terminal ileum, a final obstacle on our way to the Lieberkühn spent a lot of time exposing, exhibiting and colon is Bauhin’s valve. preserving the vascular tissues of various animals. After his death, his collection of anatomical preparations was Gaspard Bauhin (1560–1624) was born in Basel, dissolved and sold to several museums. Switzerland. He was the son of Jean Bauhin, a French The jejunum changes into the ileum about halfway physician who had been forced to flee the country after through the small intestine. The term ‘ileum’ is most likely converting to protestantism. Bauhin studied medicine in derived from the Latin word for ‘flank’. Padua, Montpellier and Tübingen. He received his doctor’s Approximately 60 to 100 centimeters before the degree when he returned to Basel in 1580. Besides anatomy, ileocoecal valve, we may encounter a small ‘alley’ that he also excelled in the subject of botany. Over the course is present in only 2% of all people. This true congenital of his career, Bauhin was named city physician, Dean of diverticulum, a vestigial remnant of the omphalomesenteric his faculty and Rector of the university. He published his duct, is called Meckel’s diverticulum. principal work on anatomy, Theatrum Anatomicum infinitis locis auctum, in 1592.