William Stewart Halsted

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The Four Doctors by John Singer Sargent, 1905.
From left to right: Welch, Halsted, Osler, Kelly.
It is said that Halsted's difficult personality prompted Sargent to paint him in colors that would fade in time. Of note:Sargent's careful depiction of Halsted's short, stubby thumb.

William Stewart Halsted (September 23, 1852 – September 7, 1922) is known as the father of American surgery.

Born in New York City, he was the founder of the American residency training system of progressive responsibility.

William S. Halsted was named the first chief of the Department of Surgery at Johns Hopkins Hospital when it initially opened in May 1889. He was named Surgeon-in-chief in 1890 and promoted to Professor of Surgery in 1892. He is accredited with starting the first formal surgical residency training program in the United States.

Halsted’s surgical residency program consisted of an internship period (the length was left undefined and individuals advanced once Halsted believed they were ready for the next level of training). Internship was followed by 6 years as assistant resident and then 2 years as house surgeon. Halsted’s first resident was Frederick J. Brockway who started in May 1889 but dropped out of the program in October 1890 to teach anatomy. Halsted went on to train many of the academic surgeons of the time including Harvey Cushing and Walter Dandy.

He is also well known for his many other medical and surgical achievements. As one of the first proponents of hemostasis and investigators of wound healing, Halsted pioneered the modern surgical fundamental principles of absolute control of bleeding, accurate anatomical dissection, complete sterility, exact approximation of tissue in wound closures without excessive tightness, and gentle handling of tissues. The first radical mastectomy for breast cancer was performed by Halsted. Other achievements include advances in thyroid, biliary tree, hernia, intestinal, and arterial aneurysm surgeries.

[edit] Timeline

Achievements, Personal events, Historical background.

1846

• Use of ether for general anesthesia by William T.G. Morton

1852

• September 23 - Born in New York City

1867

• March 16 - Joseph Lister publishes series of articles in The Lancet on the "Antiseptic Principle of the Practice of Surgery" describing the use of carbolic acid (phenol) on surgical wounds to reduce the incidence of gangrene.

1870

• Graduates from Phillips Academy Andover
• Captain of first American 11-player football team
  • This is played against Eton College, two years prior to the first annual Yale-Harvard football game.
  • Other sports: rowing, gymnastics, baseball (shortstop).

1874

• Graduates Yale University
  • A multi-sport athlete, Halsted is a mediocre student.
  • Does show not any interest in medicine until senior year, when his interest is piqued by Gray's Anatomy and a physiology textbook by John C. Dalton.
• Enrolls in College of Physicians and Surgeons in New York
  • Halsted is assigned to assist John C. Dalton himself and anatomist and surgery professor Henry B. Sands as a mentor.

1876

• October - Begins internship at Bellevue Hospital despite having completed only two years of medical school.

1878

• July to October - Serves as house physician at New York Hospital
• November - Begins training in Vienna under Theodor Billroth

1879

• Studies in Germany

1880

• Returns to New York

1880-1886

• Appointments at several hospitals, including Bellevue and Roosevelt Hospital.

1881

• First emergency blood transfusion, performed on sister
  • Upon discovering his sister nearly dead from a postpartum hemorrhage, Halsted boldly draws his own blood and injects it into his sister, saving her life.
  • Halsted implies knowledge of blood rejection possibility.
• Performs one of first operations for gallstones in U.S., performed on mother
  • Visiting his mother in Albany, he finds her exhibiting Charcot's triad (fever, right upper quadrant pain, jaundice).

1882

• Development of Halsted radical mastectomy as treatment for breast cancer

1883-1886

• Papers describe blood transfusions, autotransfusions, saline infusions
  • Among the first to suggest the replacement of blood during surgery as well as autotransfusion and intravenous saline for use in shock, although these ideas forgotten for dozens of years before becoming the standard of care.

1884

• Use of cocaine for local anesthesia demonstrated by Karl Koller
• Begins cocaine research, developing the nerve block and other local anesthesia techniques.
  • Halsted and colleagues develop severe cocaine addiction.

1885

• • He only publishes one paper on the topic, in the New York Medical Journal
    • Halstead's writing is indubitably stained by the evidence of intoxication.

1886

• Attempts detoxification from cocaine
  • Pupil Harvey Cushing never suspects the cocaine habit.
  • This period between fighting cocaine addiction and beginning Johns Hopkins marks an abrupt personality change for Halsted from bold and vivacious extrovert to diffident, anti-social introvert.
  • In later years, Halsted becomes addicted to morphine, also unsuspected by nearly everyone. This was revealed in a book by William Osler: The Inner History of Johns Hopkins Hospital.

1888

• Moves to Baltimore

1889

• Johns Hopkins Hospital opens
  • Contemporaries here include William H. Welch, William Osler, Howard Kelly, Franklin Mall, William Howell, and John Jacob Abel.
• Invention of surgical gloves
  • Head operating room nurse and wife-to-be Caroline Hampton develops dermatitis from chemicals used to disinfect hands for surgery.
  • This prompts Halsted to hire the Goodyear Rubber Company to manufacture thin gloves that will not interfere with necessary sensitivity.
  • Halsted only later realizes the impact of gloves on antisepsis.
• Publishes inguinal hernia repair method at the same time as Edoardo Bassini.
  • Inguinal hernias had been previously associated with high mortality rates.
  • Although infrequently performed, the Halsted II remains the gold standard today, with post-operative complication rates only slightly improved from Halsted's 7%.

1890

• Is appointed first Chief of Surgery at Johns Hopkins Hospital
• June 4 - Marries Caroline Hampton, niece of General Wade Hampton of South Carolina.
  • The married couple are described as opposites in appearance.
    • A dandy garbed in European tailored suits and Parisian cobbled boots, Halsted is known to dress impeccably, even sending his dress shirts yearly to Paris to be laundered.
    • Mrs. Halsted's style is described as austere.
  • Halsted and wife never had children, but they did have Dachshunds, including Sisley (or Sisly,) Fritz, Nip and Tuck. In 1915, he wrote that Nip had died just a few weeks after Sisly (MacCallum, 1930, p 120).
  • They live separately in a three-story brick home in Baltimore: Halsted on the second floor, Caroline and canines on the third.
  • Each summer they spend one month at High Hampton, Caroline's 2000-acre (8 km²) North Carolina family estate.

1892

• Performs first successful subclavian artery ligation

1893

• *First Johns Hopkins medical students, 15 men and 3 women, begin training
  • This is due to the efforts of four young Baltimoreans--all women--who raised the money needed to open the school only on the condition that women be granted equal opportunity admission .
  • These women were university trustees' daughters: M. Carey Thomas, Mary Elizabeth Garrett, Mary Gwinn, and Elizabeth King.
  • Garrett contributed an additional amount with additional strings: these established pre-requisites for medical school admission.

1896

• Harvey Cushing begins training under Halsted

1898

• American Surgical Association establishes Halsted's mastectomy and inguinal hernia repair as gold standards

1901

• Discovery of blood groups by Karl Landsteiner

1909

• Theodor Kocher becomes first surgeon to win Nobel Prize

1918

• Halsted elected president of the Maryland Medical Chirugical Society.

1919

• Halsted's gall-bladder is removed by former student Richard Follis

1920

• Publishes The Operative Story of Goiter

1922

• Develops choledocholithiasis, has complications post-operatively; dies in Baltimore, Maryland, September 7, 1922.
  • Former students Heuer and Mont Reid perform operation.
  • They use Halsted's own technique in closing the bile duct.
  • Complications include a gastrointestinal hemorrhage and post-operative pneumonia, which was the cause of death.

[edit] Eponyms

• Halsted's law - Transplanted tissue will grow only if there is a lack of that tissue in the host.
• Halsted's operation I - Operation for inguinal hernia.
• Halsted's operation II - Radical mastectomy for cancer of the breast.
• Halsted's sign - A sign for carcinoma of the breast.
• Halsted's suture - A mattress suture for wounds that produced less scarring.

[edit] Trivia

• Halsted published 180 papers in his lifetime.
• Halsted is also known for inventing mosquito clamps.
• Halsted was responsible for the inclusion of temperature charts in medical records.
• Halsted never joined the American College of Surgeons.
• Halsted's Maryland address was 1201 Eutaw Place.
• Halsted's students called him "The Professor."
• Halsted's first resident was Frederick J. Brockway.
• Halsted's secretary's name was Miss Stokes.
• Halsted's gardener's name was Bradley.
• While at Andover, Halsted played the role of Hans in The Office Seekers.
• Halsted attended his 40 year Yale college reunion.
• Halsted proposed Florence Sabin to the National Academy of Science.
• Halsted's hobbies included dahlia raising, astronomy, and collecting antique furniture and rugs.
• Halsted has a street in Chicago named after him, Halsted Street
• Halsted enjoyed bowling at the University Club in New York City.
• Halsted bought eyeglasses, pens, and cigarette holders in huge quantities.
• Halsted smoked Pall Mall cigarettes.
• Halsted shopped for fruit at the Lexington Market.
• Halsted's Yale roommate was Sam Bushnell.
• Halsted's favorite breakfast was coddled guinea hen eggs.

[edit] References

• Sherman, Irwing; et al (Sept 2006). "Personal recollections of Walter E. Dandy and his Brain Team". Journal of Neurosurgery 105: 487. 
• Nuland, Sherwin B. (1988). Doctors: the Biography of Medicine. New York: Knopf. ISBN 0-394-55130-3. 
• Who named it?. William Stewart Halsted. Retrieved on August 3, 2005.
• A Tribute to William Stewart Halsted, MD. William Stewart Halsted. Retrieved on August 18, 2005.
• Bryan, Charles S. (1999). "Caring Carefully: Sir William Osler on the issue of competence vs. compassion in medicine". Baylor University Medical Center Proceedings 12 (4): 277–284. 
• Cameron, John. (1997). "Williams Stewart Halsted: Our Surgical Heritage". Annals of Surgery 225 (5): 445-458. 
• Halsted, William S. (1885). "Practical comments on the use and abuse of cocaine". The New York Medical Journal 42: 294-195. 
• Halsted, William S. (1887). "Practical Circular suture of the intestines; an experimental study". The American Journal of the Medical Sciences 94: 436-461. 
• Halsted, William S. (1889). "Practical The radical cure of hernia". The Johns Hopkins Hospital Bulletin 1: 12-13, 112. 
• Halsted, William S. (1890-1891). "The treatment of wounds with especial reference to the value of the blood clot in the management of dead spaces". The Johns Hopkins Hospital Reports 2: 255-314.  First mention of rubber gloves in the operating room.
• Halsted, William S. (1892). "Ligation of the first portion of the left subclavian artery and excision of a subclavio-axillary aneurism". The Johns Hopkins Hospital Bulletin 3: 93-94. 
• Halsted, William S. (1894-1895). "The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1899, to January, 1894". The Johns Hopkins Hospital Reports 4: 297. 
• Halsted, William S. (1899). "The Contribution to the surgery of the bile passages, especially of the common bile-duct". The Boston Medical and Surgical Journal 141: 645-654. 
• Halsted, William S. (1925). "Auto- and isotransplantation, in dogs, of the parathyroid glandules". The Journal of Biological Chemistry, Baltimore 63: 395-438. 
• Halsted, William S. (1909). "Partial progressive and complete occlusion of the aorta and other large arteries in the dog by means of the metal band". The Journal of Experimental Medicine, New York 11: 373-391. 
• Halsted, William S. (1915). "A diagnostic sign of gelatinous carcinoma of the breast". Journal of the American Medical Association, Chicago, 64: 1653. 
• Burjet, W.C., Ed. (1924). Surgical Papers by William Stewart Halsted. Baltimore: Johns Hopkins Press. 
• MacCallum WG. (1930). William Stewart Halsted, surgeon. Baltimore: Johns Hopkins Press.