by Edward Rowe
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EDITORIAL NOTE: Responding to the fact that introducrory biology textbooks introduce more new terms than do first-year language classes, some misguided educators are promoting a drastic reduction in what they call "unnecessary jargon." In this issue, Dr. Rowe elaborates the rich origins and complex meanings that are lost when inaccurate common names are substituted. This language is not just for physicians, but for citizens who will be patients, who will sit on juries judging medical practices, who will vote on health-related laws, and who individually monitor their own health and collectively determine our health insurance rates. Ihe precise use of words is not just a symptom of an educated person, it is part and parcel of operating as a healthy, educated person. Dr. Rowe's enjoyable essay weaves this terminology into everyday life.
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COVER: Vesalius illustrated skeletons in poses to best portray their features. This frontal view is a classic recognized by medical and anatomy students. The shovel handle does not align with the blade and is a stage prop.
by Edward Rowe
The first time we encounter the exotic-sounding technical names for bones, most of us simply accept the standard terms given in our textbooks. We don't mind the extra effort of learning them because it's mildly eiciting to be initiated into the language used by physicians. Only later do we begin to learn the subject of this issue of the Naturalist, the Greek and Latin origins of these terms.
The technical bone terms used here are now standardized internationally, but this obviously was not always the case. Our modern anatomical terminology got its start in the mid-1500s when a few brilliant innovators dared lo defy the authorities who opposed dissection of human bodies and founded modern scientific anatomy. (The very word anatomy refers to the act of dissection; it comes from Greek and Latin roots, tom "to cut" and ana "up".) There was an early, if not very advanced, anatomical tradition in Greek and Roman times. We know about this classical anatomy from its most brilliant contributor, Galen, who lived most of his life in Second Century Rome and wrote 400 treatises on medicine, philosophy and religion. Progress in anatomy was agonizingly slow in Europe as it passed through its dark ages, and even Galen's contributions would probably have been lost if they hadn't been preserved by scholars in Arab lands. By the early 1500s anatomy was being taught in some but by no means all European medical schools. Where anatomy was taught, the professors limited themselves to presenting Galen's surviving book knowledge. Where anatomy classes used dissections (and they did so only to demonstrate Galen's correctness), neither the professor nor the medical students "dirtied their hands" with the actual dissections; that was a lower-class job delegated to uneducated servants. In the raid-1500s a strong personality, Andreas Vesalius, professor of anatomy at Padua, broke this slavish dependence on Galen's conclusions and re-established Galen's method of learning anatomy firsthand.
You've probably seen reproductions of the wood engravings from Vesalius' book,De Humani Carports Fabrica, which was published in 1543 and set in motion our modern anatomical tradition. This book, which was one of the earliest books printed with movable type and one of the very first illustrated printed books, is considered a classic by cultural historians as well as by anatomists.
Vesalius converted anatomy from an uncritical acceptance of ancient texts into a modern observational science, defied the authorities who disapproved of human dissection, engaged the best artists of his day to execute his woodcuts, and worked with printers, who were inventing the most advanced technology of the day. His justifiable pride comes through in the crowded illustrated title-page of the Fabrica. Vesalius is shown doing the dissection himself, and the now deposed dissectors have nothing to do but quarrel among themselves. One of the figures in classical robes probably represents Galen looking on approvingly. The skeleton may represent one of Vesalius' preoccupations, the importance of the skeleton as the framework on which all the other organs are hung. The naked figure probably represents another of his preoccupations, the importance of being able to look at surface anatomy and deduce the state of internal structures. (Current anatomy teachers often make the same point by telling future doctors and nurses that they need to develop a kind of x-ray vision.) The animals in the picture represent the fact that most dissection of the time was on animals, and even Vesalius was permitted only to dissect a few humans, all of them executed criminals. The figure at top right may represent the printer, whose high level of skill was as essential to the success of the Fabrics as Vesalius' anatomical skills or the engraver's artistic skills.
The work of Vesalius and his followers started anatomy on a long line of useful discoveries which continues to the present- Communication of the rich details of internal anatomy required the invention of many new words. It was natural that Vesalius and the other early European anatomists would make use of Latin and Greek words as they began to describe their discoveries. The universities in which they worked typically drew faculty and students from all over Europe. These scholars spoke such a variety of different languages and dialects that they couldn't understand each other in their native languages, but because of church traditions they shared a reading knowledge of classical Greek and a speaking knowledge of Latin. Professors everywhere on the continent routinely lectured in Latin. As Vesalius and his colleagues named their discoveries they converted Greek and Latin names for surface features into names for internal parts and they improvised other terms from sources as diverse as classical mythology and household items.
|Figure 1. Title page from De Humani Corporis Fabrica by Vesalius, 1543.|
Two pairs of bones make up the shoulder girdle, the bones which provide the foundation for the upper arm. The two clavicles are in front and the two scapulas in back. The clavicle is a slightly curved, slender bone. It takes its name from the Latin word clavicula, which is usually translated as "little key". To our eyes it more resembles a gate latch or lever than a modern key. We find the same clav- root in the word clavichord, an early keyboard instrument related to the harpsichord and piano.
The term scapula originally meant not shoulder bone but the whole shoulder region. Here we have a case of our transferring the word for a surface feature to the bone beneath it. On the front surface of a scapula is a projection shaped like a rugged bird's beak. It is known as the comcoid ("crow-shaped") process.
The name humerus for the upper arm bone is spelled differently than the word humorous or amusing. In Latin, humerus was the name for the whole upper arm, muscles and skin as well as the bone. Now, however, it is the official anatomical name for the bone within that arm.
Both the Latin and the Greek words for elbow have been utilized in our present-day terminology. Latin ulna was transferred from the name for the elbow into the name of one of the two forearm bones. Greek olene was combined with kranion ("head") to form olecrancn, our term for the head or tip of the elbow, or what we call the "funny bone". By the way, that jangling feeling we get when we hit the elbow in just the wrong place is due to stimulation of a nerve, not of the bone.The name radius for the other forearm hone reminds us that this is the bone which rotates around the ulna and carries the wrist and hand with it.
There are eight bones in the wrist, collectively called the carpal bones, after the Latin term corpus, which meant wrist.
Beyond the carpals the five metacarpals form the flat web of the hand and provide the bases of the finger bones. Here the root meta- means after or beyond. The subject of metaphysics, one of the most abstract branches of philosophy, got its name simply because Aristotle's book on the subject immediately followed his book on physics.
There are fourteen finger bones, known as phalanges, on each hand. The Greek wore phalanx referred not only to these finger bones but to a formidable battle formation. The front row of a military phalanx consisted of soldiers armed with spears and shields standing shoulder to shoulder. If an enemy beat down the front row, there were seven to fifteen rows of replacements standing behind the front-row troops.
The Latin word pelvis meant "basin", a good description of the ring of bones formed by the right and left hip bones and the sacrum. Rather than refer to a whole hip bone, anatomists usually refer to three regions, the upper flaring ilium, the anterior pubis, and the lower ischium (part you sit on). Separating each hip bone into three regions is not arbitrary; in the skeleton of a young, growing person each hip bone is actually three separate bones joined by thin (cartilage) growth regions. Each of these three bones gets its name from a Greek or Latin term for the hip region.
In each hip bone there is a deep, cup-like socket which holds the rounded head of the thigh bone. The name given to this socket is acetabulum, Latin for vinegar bowl. The root acet- means "vinegar". Acetic acid gets its name from the fact that it is the main constituent of vinegar. The Latin word femur meant the whole thigh, but the meaning shifted and the word now denotes the bone within the thigh.
The patella is the round bone, which lies in front of the knee joint. Patella is Latin for "little plate". It seems a shame to give such a trivial name to a bone which serves at least four important functions: It acts as an energy-absorbing bumper protecting the more tender structures of the knee joint. It lies within the heavy tendon from the large quadriceps group of muscles and gives the added strength of bone tissue to that tendon. Because the patella has low-friction cartilage on the surface which slides in a groove in the femur, contractions of the powerful quadriceps muscles are transmitted to the lower leg with less frictional loss. Finally, the patella improves the tendon's angle of leverage as it pulls on the lower leg bone, so it increases the effective force transmitted to the lower leg.
|Figure 4. The male (top) and female (bottom) pelvis clearly shows differences, including the passage width required to allow childbirth. From Gray, 1858.|
Each lower leg has two bones, the thicker tibia, which bears most of the weight, and the more slender fibula. Tibia was the Latin word for a musical pipe, such as one note on a pan flute. This bone is typical of limb bones in that it has a hollow shaft and two ends of spongy bone. It could easily happen that one end of a buried tibia could decay, leaving a hollow tube open at one end and closed at the other. The dimensions are reasonable; a resonant tube the length of an average human tibia would sound a note close to middle C.
The tibia is parallelled by a thinner bone, the fibula. In classical times fibulae were metal clasps or pins used to hold clothing together. The simpler ones were like our safety pins and the more elaborate ones were like our decorative pins or brooches. (At the end of the Oedipus legend, the protagonist is so remorseful that he uses a fibula - a pin, not a bone - to shred his eyes.)
At the lower ends of the tibia and fibula are rounded projections known as malleoli. We sometimes inaccurately call these our "ankle bones". The mall- root means "hammer", related to the English word mallet, and the -olus is a diminutive ending. The two malleoli act to "hold in" the talus, the top bone of the tarsal group.
There are seven bones of the tarsal (ankle) group. Tarsus was the Greek word for ankle, and it also meant flat. There is a flat region of the inside of the ankle, just below the malleoli. There is another more or less flat structure in the body called a tarsus, the fibrous connective tissue stiffener of the upper eyelid. The uppermost of these seven ankle bones is the talus, whose joint with the tibia and fibula allows the hinge-like movement between leg and foot. The calcaneus (heel bone) acts like a short lever on the back of the foot; when the calf muscles contract, they pull on this bone through the Achilles tendon and cause the foot to point. Talus was the Latin word for the whole ankle and calcaneus meant the whole heel. Another three tarsal bones are known as the cuneiform ("wedge-shaped") bones. (One of the earliest forms of writing was known was cuneiform, made by pushing wedge-shaped sticks into clay. It started out as simple record keeping of commercial transactions and ended as literature.)
Vesalius' illustration of the backbone can be compared to a more modern illustration. What we call the "backbone" is of course not one bone but a column made up of about 33 individual bones known as vertebrae. These vertebrae, plus the discs connecting them, provide a strong yet flexible "reinforcing rod" for the upper body. Though most of us would be unaware of this, the term vertebra itself implies the flexibility and mobility of the column; the word vertebra comes from the Latin verb vertere, which means "to turn" (Many English words are built on the same root, including revert, to turn back; invert, to turn over; and divert, to turn aside).
The topmost bone in the vertebral column is known as the atlas bone. The atlas supports the skull, and whenever we nod our head to signal "yes", our skull rocks forward and backward on the atlas.
The atlas bone was named for Atlas the Greek titan who, in the original myth, held up the sky. Atlas apparently became a figure of speech for just about any support structure. If you look up Atlas in several dictionaries you will find pictures of Atlas-shaped columns holding up temple roofs, Atlas-shaped supports on metal bowls, etc. (We often see him represented as a muscular figure straining to support the spherical planet Earth on his shoulders but this is undoubtedly a more recent variation on the old myth.)
The bone just under the atlas is the axis, appropriately named because the atlas (and the skull) rotate around it when we signal "no". The upward projection on the axis, the structure which allows this bone to function as an axis, is called the dens (Latin for tooth) or odontoid process (Greek odont = tooth, -oid = shape).
At the lower end of the vertebral column, literally at the tail end, are several small vertebrae known collectively as the coccyx. This word is Greek for cuckoo, and the name refers to the forward-curvature of this group of bones, which resembles the downward-curving beak of the European cuckoo bird.
Just above the coccyx is the largest single bone of the vertebral column, the sacrum. It is formed from the fusion of five embryonic vertebrae and joins with the right and left hip bones. Most dictionaries state that the word sacrum was Latin for "sacred", but they fail to clear up the mystery of why this bone might be sacred. Galen referred to this bone by a Greek word which can be translated as sacred, but none of the explanations is entirely satisfactory. Was Galen making a sinister reference to animal or human sacrifice? One tradition has it that this bone was considered sacred by the early Christians; because of its large size it would be one of the last bones to decay, so on Resurrection Day the rest of the body could be reconstituted from this remnant. The least colorful explanation is that non-Christian Galen was just mis-translated; the Greek word Galen used could mean "important" as well as sacred, and all he meant was that the sacrum is the most important bone of the vertebral column in the sense that it is the largest.
Most adult humans have 22 skull bones, ten cranial bones (those enclosing the brain) and twelve facial bones. The frontal bone lies under the forehead. The right and left parietal bones lie posterior to the frontal bone and form the right and left side walls of the cranium. The name parietal comes from the Latin word paries, wall. The well-known temporal bones lie just below the parietals. A structure on the temporal bone, the mastoid (Greek, breast-shaped) process, is a rounded protuberance which serves as a point of attachment for a muscle which moves the head forward. Another structure on the temporal bone, the styloid process resembles a pointed stylus, a needle-shaped marking instrument.
|Figure 7. View of the inner surface of the base of the skull. Near the top is the sieve-like ethmoid bone. Near the bottom is the opening called the foramen magnum where the spinal cord enters the skull. After McMurrich.|
The zygomatic bone takes its name from the zygoma, an arch of bone extending from the cheek to the temporal bone. Zygoma meant to yoke or connect, and strong jaw-closer muscles run from the zgomatic arch to the lower jaw. (A term which goes back to the same root, zygote, refers to another kind of "connection", the single cell resulting from the fusion of an egg and a sperm cell.) Foramen magnum translates literally from Latin as "large opening", and that is what it is, the opening in the occipital bone through which the spinal cord enters the skull. Occiput (Latin for base of the skull) came from two simpler roots, oc or ob, opposite or other end, and caput (head).
The sphenoid bone resembles an upside-down keystone in the sense that it lies at the base of the brain and all the other cranial bones join it. The word sphenoid, Greek for "wedge-shape", is a reference to this arrangement. In the middle of the sphenoid is a rounded depression, the sella turcica, Latin for 'Turkish saddle". In life, this depression contains the body's master gland, the pituitary. The Latin word sella is retained as the word for saddle or chair in Spanish as silla.
The vomer bone provides a midline partition separating the airway into the right and left nasal passageways. The name meant plow in Latin and the bone certainly does look like a plowshare.
The ethmoid bone lies above the vomer and between the two orbits (eye sockets). The top of the ethmoid makes up part of the floor under the brain and has many small openings through which olfactory nerves reach the upper the nasal passages.
The name ethmoid means "sieve-like". The ethmoid has several delicate snail shell-like bony parts known as conchae ("snails") that project into the airway and help tumble the inhaled air. The conchae are covered with blood-rich, mucus-secreting tissues, which trap dust and warm and moisten the inhaled air. A vertical partition arises from the top of the ethmoid bone and looks very much like its Latin name, crista galli, which means "rooster's comb".
A small bone, the lacrimal, provides another part of the lining of the orbit. The root lacrim- means "tears" and refers to the fact that this bone partially surrounds a duct which collects tear fluid after it has flowed over the front of the eye and carries it to the nasal passages. (Tears not only keep the surface of the eye moist but they also help moisten the inhaled air as it passes over the conchae.)
|soft, pliable "gristle" lacking blood vessels in the adult skeleton; the embryonic "skeleton" is mostly cartilage and is slowly replaced by more active bone tissue.|
|a broken bone; compound fractures extend through an open wound; complicated fractures cause damage to organs, nerves, etc.|
|soft core of most bones; red marrow harbors stem cells that produce red and white blood cells, yellow marrow is mostly fat.|
|inflamation of bone.|
|cells that form bone.|
|bone-absorbing cells, now known to be a type of macrophage (a "white blood cell"); bone grows through a combined action of osteoblasts|
|bone infection; may lead to abcesses in bone and require surgery.|
|a thinning of bone tissue from lack of calcium; a common process with aging.|
|a bone tumor.|
|outer coating of a bone, a layer of blood vessels and nerves necessary for bone growth and repair; bone pain is from the
|Figure 8. Front and side views of the human skull, provided here for use by teachers in coursework. Drawn by Mark Buehler, Emporia State Univeisity.|
Ayers, Donald. 1972. Bioscientific Terminology: Words from Latin and Greek Stems. University of Arizona Press: Tucson.
Borror, Donald J. 1960. Dictionary of Word Roots and Combining Forms. Mayfield Publishing Company: Palo Alto: CA.
Clemente, Carmine D. (ed.) 39S4. Gray's Anatomy of the. Human Body, 30th Edition. Lea and Febiger: Philadelphia.
Dorland, W.A. Newman. 1988. Dorland's Illustrated Medical Dictionary 27th Edition. W.B. Saunders Co., Philadelphia.
Hole, John W. Hole, Jr. 1990. Human Anatomy and Physiology, 5th Edition. Wm. C. Brown, Publ.: Dubuque, IA.
Matt, M. and J. Ziemian. Human Anatomy Coloring Book. Order 24138-6 from Dover Publ., Inc., 31 East Mincoia, NY 11501 for $2.95.
McMinn, R.M.H. and R.T. Hutchins. 1977. Color Atlas of Human Anatomy. Yearbook Medical Publ.: Chicago.
Nettcr, Frank H. 1953. The CIBA Collection of Medical Illustrations. CIBA Pharmaceutical Products: Summit, NJ.
Netter, Frank H. 1989. Atlas of Human Anatomy. Pharmaceutical Division, CIBA-Geigy Corporation: West Caldwell, NJ.
Partridge, Eric. 1983. Origins: A Short Etymological Dictionary of Modem English. Greenwich House/Crown Publishers: New York.
Rowe, Edward. 1982. "I Didn't Know that! (Humans" Kansas School Naturalist Vol. 29, No. 1. Photocopies available for $1.00.
Saunders, J.B. and CO. O'Malley (ed.) The Illustrations of Andreas Vesalius. Order 20968-7 from Dover Publications, Ind. for $10.95.
Simpson, J.A. and E.S.C. Weiner. 1989. The Oxford English Dictionary, 2nd Edition. Clarendon Press: Oxford.
Skinner, Henry A. 1961. The Origin of Medical Terms, 2nd Edition. Williams and Wilkins Co.: Baltimore.
Tortora, Gerard J. and N.P. Anognostakos. 1990. Principles of Anatomy and Physiology, 6th Edition. Harper and Row: New York.
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