William Stewart Halsted
|William Stewart Halsted|
William Stewart Halsted in 1922
|Born||September 23, 1852
New York City
|Died||September 7, 1922 (aged 69)
Johns Hopkins Hospital
|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.
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. Throughout his professional life, he was addicted to cocaine and later also to morphine, which were not illegal during his time. The addictions were a direct result of Halsted's use of himself as an experimental subject, in investigations on the effects of cocaine as an anesthetic agent.
Early life and education
William S. Halsted was born on September 23, 1852 in New York City. 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 on the crew team. 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.
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. 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 morphine for the remainder of his life, but continued as an innovative and pioneering surgeon, with many of his practices still standard operating room procedures. 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. In 1882 Halsted performed the first radical mastectomy for breast cancer in the U.S. at Roosevelt Hospital in New York; an operation first performed in France a century earlier by Bernard Peyrilhe (1735-1804). 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.”
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. He died on September 7, 1922, 16 days short of his 70th birthday, from bronchopneumonia as a complication of surgery for gallstones and cholangitis.
- 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
- Roberts, CS (2010). "H.L. Mencken and the four doctors: Osler, Halsted, Welch and Kelly". Baylor University Medical Center Proceedings. 23 (4): 377–88. PMC . PMID 20944761.
- Johns Hopkins Medicine:The Four Founding Professors
- Zuger, A (April 26, 2010). "Traveling a Primeval Medical Landscape". The New York Times.
- 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.
- Imber G: Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted. New York: Kaplan Publishing. ISBN 978-1-60714-627-8. OCLC 430842094
- "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....
- "William Stewart Halsted". Annals of Surgery. Retrieved 2010-03-03.
- Halsted, William S. (1885). "Practical comments on the use and abuse of cocaine". The New York Medical Journal. 42: 294–95.
- Imber G: Genius on the Edge. Kaplan Publishing, New York, 2011.
- The Breast: Comprehensive Management of Benign and Malignant Diseases, Volume 2 by Kirby I. Bland and Edward M. Copeland III, 4th ed., 2009, pg. 721
- 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.
- B. Peyrhile, "Dissertatio academica de cancro," The Lyon Academy, (1773)
- Halsted, WS (1893). "The radical cure of inguinal hernia in the male" (PDF). Annals of Surgery. 17 (5): 542–56. PMC .
- 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.  Mencken on Halsted.
- High Hampton history
- Imber G: Ref. 5, op cit.
- 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.
- Cameron, John. (1997). "Williams Stewart Halsted: Our Surgical Heritage". Annals of Surgery. 225 (5): 445–58. doi:10.1097/00000658-199705000-00002. PMC . PMID 9193173.
- Garrison, Fielding H. "Halsted," American Mercury, v. 7, no. 28 (April 1926) 396–401.
- Sherman, I; Kretzer, Ryan M.; Tamargo, Rafael J. (September 2006). "Personal recollections of Walter E. Dandy and his Brain Team". Journal of Neurosurgery. 105 (3): 487–93. doi:10.3171/jns.2006.105.3.487. PMID 16961151.
- Nuland, Sherwin B. (1988). Doctors: the Biography of Medicine. New York: Knopf. ISBN 0-394-55130-3.
- "Who named it?". William Stewart Halsted. Retrieved August 3, 2005.
- "A Tribute to William Stewart Halsted, MD". William Stewart Halsted. Retrieved 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): 277–84.
- Halsted, William S. (1885). "Practical comments on the use and abuse of cocaine". The New York Medical Journal. 42: 294–95.
- Halsted, William S. (1887). "Practical Circular suture of the intestines; an experimental study". The American Journal of the Medical Sciences. 94: 436–61. doi:10.1097/00000441-188710000-00010.
- 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: 93–4.
- 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 (26): 645–54. doi:10.1056/nejm189912281412601.
- Halsted, William S. (1925). "Auto- and isotransplantation, in dogs, of the parathyroid glandules". The Journal of Biological Chemistry. 63: 395–438.
- Halsted WStitle=Partial progressive and complete occlusion of the aorta and other large arteries in the dog by means of the metal band (March 1, 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. 11 (2): 373–91. doi:10.1084/jem.11.2.373. PMC . PMID 19867254.
- Halsted WS (1915). "A diagnostic sign of gelatinous carcinoma of the breast". Journal of the American Medical Association. 64 (20): 1653. doi:10.1001/jama.1915.02570460029011.
- 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.
- Imber, G (2010). Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted. New York: Kaplan Publishing. ISBN 978-1-60714-627-8. OCLC 430842094.
- "Re-Examining The Father Of Modern Surgery". Fresh Air. February 22, 2010. An interview with Gerald Imber, author of Genius on the Edge, and an excerpt from the book.
- A documentary on the life of Dr. Halsted recently aired on the public broadcasting station WETA "Halsted The Documentary".
- National Academy of Sciences Biographical Memoir