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Meckel's diverticulum
- This is the persistence of the intra-abdominal part of the
vitello-intestinal duct, which normally completely disappears. Vestigial
remnants of the structure can take on a number of forms but the one best
known is that of an out-pouching or diverticulum from the intestine
which is said to be found two feet from the ileo-caecal valve in 2% of
people and to be 2 inches long. It may contain cells similar to that
found in the stomach or pancreas and cause complications such as
perforation, haemorrhage from peptic ulceration, intussusception or
intestinal obstruction.
- J F Meckel (the younger) (1781-1833) came from a distinguished
medical family. His grandfather, J F Meckel (1714-1774), was Professor
of Anatomy, Botany and Obstetrics in Berlin and first described the
spheno-palatine ganglion (Meckel ganglion) and the dural space which
contains the Gasserian ganglion (Meckel cave). His father, P P Meckel
(1756-1803), was Professor of Anatomy and Surgery at Halle, where he was
born. He studied medicine there and at Gottingen, Wiirzburg and Vienna
and graduated at Halle in 1802. He then studied in Holland, France,
Italy and Germany and England, returning home in 1806, succeeding his
father in the Chair of Anatomy and Surgery in 1808. He discovered the
first branchial cartilage, sometimes called Meckel cartilage. He wrote
important books on human anatomy and pathology, and atlases of human
abnormalities.
Murphy's sign
- After deep palpation under the mid point of the right subcostal
margin the patient is asked to inspire with resultant pain in patients
with acute cholecystitis.
- J B Murphy (1857-1916) US surgeon. Born in Appleton, Wisconsin, he
became Professor of Surgery at Northwestern University, Chicago, from
1895-1916. He was protégé of Christian Finger and after interning in
Cook County Hospital and a brief period in practice, he went in 1882 to
Vienna to work with Billroth. Afterwards he visited Berlin
and Heidelberg. He did much pioneering work on intestinal anastomosis
including anastomosis of the gall bladder to the intestine. In 1896 he
was the first person to successfully unite a femoral artery severed by a
gunshot wound. He had previously undertaken much experimentation on
end-to-end resections of arteries and veins. In his technique he invaginated the intima outside the adventitia of the vessel. This
resulted in a narrowing of the lumen and of 13 cases only 4 were
successful. He was a pioneer in the use of bone grafting and made
contributions to the understanding and management of ankylosis. He
independently proposed artificial pneumothorax to manage unilateral lung
disease in tuberculosis. A child he had been treating with tuberculosis
died in a car accident and at autopsy he found that several tubercular
cavities were healing on one side of the lung which was collapsed by the
disease. He had a curiously harsh and strident voice but he nonetheless
could fire the enthusiasm in his audience and was a fine clinical
teacher as well as a painstaking operator. A tall man with a parted red
beard, with outspoken views, his flamboyant character and appearance
made him good copy for the news media which upset the local
conservatives and older surgeons. He was troubled throughout his life
with recurrences of tuberculosis.
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