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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.



Last updated: 03 January 2011

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