William Stewart Halsted

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William Stewart Halsted
William Stewart Halsted.jpg
William Stewart Halsted in 1922
Born September 23, 1852
New York City
Died September 7, 1922 (aged 69)
Johns Hopkins Hospital
Nationality United States
Fields Medicine
Institutions Johns Hopkins Hospital
Alma mater Yale University; College of Physicians & Surgeons of Columbia University
Known for inventing the residency training system in U.S.
Mastectomy
Influences Theodor Billroth

William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922) was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer. Along with William Osler (Professor of Medicine), Howard Atwood Kelly (Professor of Gynecology) and William H. Welch (Professor of Pathology), Halsted was one of the "Big Four" founding professors at the Johns Hopkins Hospital.[1] Throughout his professional life, he was addicted to cocaine and later also to morphine,[2][3] which were not illegal during his time.

Early life and education[edit]

Halsted in 1874

William S. Halsted was born on September 23, 1852 in New York City.[4] His mother was Mary Louisa Haines and his father William Mills Halsted, Jr. His father was a businessman with Halsted, Haines and Company. Halsted was educated at home by tutors until 1862, when he was sent to boarding school in Monson, Massachusetts. He didn't like his new school and even ran away at one point. He was later enrolled at Phillips Academy in Andover, Massachusetts, where he graduated in 1869. Halsted entered Yale College the following year. At Yale, Halsted was captain of the football team, played baseball and rowed crew. Upon graduation from Yale in 1874, Halsted entered Columbia University College of Physicians and Surgeons. He graduated in 1877 with a Doctor of Medicine degree. Though raised a Presbyterian, Halsted was an agnostic by adulthood.[5]

Medical career[edit]

After graduation, Halsted joined the New York Hospital as house physician, where he introduced the hospital chart which tracks the patient's temperature, pulse and respiration. It was at New York Hospital that Halsted met William H. Welch, who would become his closest friend.

Halsted then went to Europe to study under the tutelage of several prominent surgeons and scientists, including Edoardo Bassini, Ernst von Bergmann, Theodor Billroth, Heinrich Braun, Hans Chiari, Friedrich von Esmarch, Albert von Kölliker, Jan Mikulicz-Radecki, Max Schede, Adolph Stöhr, Richard von Volkmann, Anton Wölfler, Emil Zuckerkandl.

Halsted returned to New York in 1880 and for the next six years led an extraordinarily vigorous and energetic life. He operated at multiple hospitals, including Roosevelt Hospital, the College of Physicians and Surgeons, Charity Hospital, Emigrant Hospital, Bellevue Hospital and Chambers Street Hospital. He was an extremely popular, inspiring and charismatic teacher. In 1882 he performed one of the first gallbladder operations in the United States (a cholecystotomy performed on his mother on the kitchen table at 2 am). Halsted also performed one of the first blood transfusions in the United States. He had been called to see his sister after she had given birth. He found her moribund from blood loss, and in a bold move withdrew his own blood, transfused his blood into his sister, and then operated on her to save her life.

In 1884, Halsted read a report from Karl Koller, describing the anesthetic power of cocaine when it is instilled into the eye. Halsted realized that cocaine might be an excellent local anesthetic. Having learned the scientific method when he was in Europe, Halsted, together with his students and fellow physicians, began to experiment with cocaine. They injected each other's nerves and showed that cocaine when injected into a nerve can produce safe and effective local anesthesia.[6] Halsted became addicted, and was eventually sent to Butler Sanatorium in Providence, Rhode Island. There they attempted to cure him by converting his addiction from cocaine to morphine; he remained dependent upon both drugs for the remainder of his life,[7] but continued to function competently as a physician and surgeon. After being discharged from Butler in 1886, Halsted moved to Baltimore, Maryland to join his friend William Welch at the soon-to-be-opened Johns Hopkins Hospital.

Halsted was the first chief of the Department of Surgery at Johns Hopkins Hospital when it opened in May 1889. He was appointed surgeon-in-chief in 1890 and became Professor of Surgery in 1892 with the opening of Johns Hopkins University School of Medicine. At Johns Hopkins, Halsted was credited with starting the first formal surgical residency training program in the United States.

Halsted’s surgical residency program consisted of an internship (the length was left undefined and individuals advanced once Halsted believed they were ready for the next level of training). Internship was followed by six years as an assistant resident and then two 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 Williams Cushing, Walter Dandy and Hugh Hampton Young, founders of neurosurgery and urology respectively.

He is also known for many other medical and surgical achievements. As one of the first proponents of hemostasis and investigators of wound healing, Halsted pioneered Halsted's principles, modern surgical principles of control of bleeding, accurate anatomical dissection, complete sterility, exact approximation of tissue in wound closures without excessive tightness, and gentle handling of tissues. Halsted performed the first radical mastectomy for breast cancer in the US;[8] an operation first performed in France a century earlier by Bernard Peyrilhe (1735-1804).[9] Other achievements included the introduction of the latex surgical glove and advances in thyroid, biliary tract, hernia, intestinal and arterial aneurysm surgery.

H.L. Mencken considered Halsted the greatest physician of the whole Johns Hopkins group, and Mencken’s praise of his achievements when he reviewed Dr. MacCallum's 1930 biography is a memorable tribute. “His contributions to surgery were numerous and various. He introduced the use of local anesthetics, he was the first to put on rubber gloves, and he devised many new and ingenious operations. But his chief service was rather more general, and hard to describe. It was to bring in a new and better way of regarding the patient. Antisepsis and asepsis, coming in when he was young, had turned the attention of surgeons to external and often extraneous things. Fighting germs, they tended to forget the concrete sick man on the table. Dr. Halsted changed all that. He showed that manhandled tissues, though they could not yell, could yet suffer and die. He studied the natural recuperative powers of the body, and showed how they could be made to help the patient. He stood against reckless slashing, and taught that a surgeon must walk very warily. Though, like most men of his craft, he had no religion, he yet revived and reinforced the ancient saying of Ambroise Paré: ‘God cured him; I assisted.’ Above all, he was a superb teacher, though he never formally taught. The young men who went out from his operating room were magnificently trained, and are among the great ornaments of American surgery today.”[10]

In 1890, Halsted married Caroline Hampton, the niece of Wade Hampton III, a former general in the Confederate States Army and also a former Governor of South Carolina. They purchased the High Hampton mountain retreat in North Carolina from Caroline's three aunts. There, Halsted raised dahlias and pursued his hobby of astronomy; he and his wife had no children.[11] He died on September 7, 1922, 16 days short of his 70th birthday, from bronchopneumonia, as a complication of Gallstone and cholangitis.[4][12]

Eponyms[edit]

  • 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 breast cancer
  • Halsted's sign: a medical sign for breast cancer
  • Halsted's suture: a mattress suture for wounds that produced less scarring
  • Halsted mosquito forceps: a type of hemostat

References[edit]

  1. ^ Johns Hopkins Medicine:The Four Founding Professors
  2. ^ Zuger, A (April 26, 2010). "Traveling a Primeval Medical Landscape". The New York Times. 
  3. ^ Brecher, Edward M.; and the Editors of Consumer Reports (1972). "Licit and Illicit Drugs, Chapter 5, 'Some eminent narcotics addicts'". Schaffer Library of Drug Policy. Retrieved 2 February 2014. 
  4. ^ a b "Dr. Wm. S. Halsted Dies At Johns Hopkins. Professor of Surgery There for 33 Years Was One of the Foremost Leaders in Medical Science.". New York Times. September 8, 1922. Retrieved 2010-03-03. "Dr. William Stuart Halsted, professor of surgery at Johns Hopkins Medical School for many years as one of the foremost leaders in ... died today...." 
  5. ^ "William Stewart Halsted". Annals of Surgery. Retrieved 2010-03-03. 
  6. ^ Halsted, William S. (1885). "Practical comments on the use and abuse of cocaine". The New York Medical Journal 42: 294–95. 
  7. ^ Imber G: Genius on the Edge. Kaplan Publishing, New York, 2011.
  8. ^ Mukherjee, Siddhartha (November 16, 2010). The Emperor of All Maladies: A Biography of Cancer. Simon and Schuster. p. 23. ISBN 978-1-4391-0795-9. Retrieved September 6, 2011. 
  9. ^ B. Peyrhile, "Dissertatio academica de cancro," The Lyon Academy, (1773)
  10. ^ H.L. Mencken, "A Great American Surgeon," American Mercury, v. 22, no. 87 (March 1931) 383. Review of William Stewart Halsted, Surgeon, by W.G. MacCallum. [1] Mencken on Halsted.
  11. ^ High Hampton history
  12. ^ Imber G: Ref. 5, op cit.

Further reading[edit]

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