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William Stewart Halsted

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][2] His operating room at Johns Hopkins Hospital is in Ward G, and was described as a small room where medical discoveries and miracles took place.[3] According to an intern who once worked in Halsted's operating room, Halsted had unique techniques, operated on the patients with great confidence and often had perfect results which astonished the interns.[3]

William Stewart Halsted
Halsted in 1922
Born(1852-09-23)September 23, 1852
New York City, U.S.
DiedSeptember 7, 1922(1922-09-07) (aged 69)
Baltimore, Maryland, U.S.
Alma materYale University; College of Physicians & Surgeons of Columbia University
Known for
Scientific career
FieldsMedicine
InstitutionsJohns Hopkins Hospital

Throughout his professional life, he was addicted to cocaine and later also to morphine,[4][5] which were not illegal during his time. As revealed by Osler's diary, Halsted developed a high level of drug tolerance for morphine. He was "never able to reduce the amount to less than three grains daily" (approximately 200 mg).[6] Halsted's addictions resulted from experiments on the use of cocaine as an anesthetic agent that he performed on himself.[7]

Early life edit

 
Halsted in 1874

William S. Halsted was born on September 23, 1852, in New York City.[8][9] His mother was Mary Louisa Haines and his father William Mills Halsted, Jr. He was the oldest of four children.[10] His father was a businessman with Halsted, Haines and Company which was an organization that supplied dry goods.[9][10][11] William Halsted, Jr. was very involved in the community.[9] William S. Halsted's family was of English heritage and was very wealthy with two homes in the state of New York.[12] One of their homes was on Fifth Avenue in New York City and the other was an estate in Westchester County, New York.[12] Though raised a Presbyterian, Halsted was an agnostic by adulthood. Halsted was educated at home by tutors until 1862, when he was sent to boarding school in Monson, Massachusetts at age ten.[12][13] 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 after a year of studying at home.[12] At Yale, Halsted was captain of the football team, played baseball and rowed on the crew team, but his academic achievements were below average.[9][12] One of his social setbacks was in his senior year when he wasn't accepted into the prestigious Skull and Bones secret society.[13] At the end of his senior year at Yale, a newfound interest in medicine seemed to arise. Halsted attended medical lectures at Yale Medical School and studied books on the subjects of anatomy and physiology.[9][13]

Medical education edit

Upon graduation from Yale in 1874, Halsted entered Columbia University College of Physicians and Surgeons.[9] Historians are not certain why Halsted attended medical school. Some believe he was inspired by his father's involvement with medical organizations.[12] Others think he couldn't imagine himself in the family business.[14] Once he entered medical school, he left his early academic difficulties behind him.[12] Physicians central to his emergence as a medical scholar include Henry B Sands, a well-known surgeon, who was Halsted's tutor during this time.[9][12] Halsted served as assistant to Professor of Physiology John Call Dalton, another influence.[9][12] During medical school, Halsted worked in a pharmacy in his free time.[12] After two years of medical school, Halsted started to burn out. He complained about his memory not working correctly among other things so during the summer of his second year he went to Block Island in Rhode Island.[12] Here, he studied while participating in activities like fishing and sailing.[12][13] He then took a competitive exam to apply for an internship at Bellevue Hospital in New York even though this program was only open to students with medical degrees.[12] Halsted did very well on the exam and was awarded the internship for House Surgeon at Bellevue where he remained for a year.[9][12][13]

Halsted spent most of his internship in the medical wards but also helped with some surgical operations.[13] The conditions in the hospital were very unsanitary; bleeding patients was a common practice during this time, and surgical tools weren't as well cared for as they are modernly.[14] Interns ran around the hospital with buckets full of pus from the patients.[14] During the internship, Halsted was introduced to the use of antiseptic through physicians using Joseph Lister's technique created in 1867.[12] This sparked an interest in Halsted, and he helped with the issue of infections at Bellevue during the rest of the internship.[12] He ended his academic career in the top ten of his medical school class. He then participated in a competition that placed him at the top of his class.[13] He graduated in 1877 with a Doctor of Medicine degree.[15]

Medical career edit

After graduation, Halsted joined the New York Hospital as house physician in April 1878, where he introduced the hospital chart which tracks the patient's temperature, pulse and respiration. It was at New York Hospital that Halsted met the pathologist William H. Welch, who would become his closest friend. He left New York Hospital in October 1878.[12]

Halsted had exhausted all of the medical training opportunities the United States had to offer in his position, for there was no program to train recent medical school graduates for a career in medicine at this time.[13] 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.[9][10] He became especially close to Anton Woelfler among others which gave him unlimited access to resources.[9] The relationships Halsted forged with these future leaders in their fields would last a lifetime.[9][13] During this time in Europe, cancer was just starting to be studied more widely, making the timing of his arrival ideal.[14] This experience inspired him with multiple new medical ideas and practices that he would contribute to in the United States.[14]

Halsted returned to New York in 1880 and for the next six years led an extraordinarily vigorous and energetic life. Like when Halsted visited Europe, it was an opportune time for Halsted's involvement because surgery was on the brink of various important discoveries.[13] He operated at multiple hospitals including the Chambers Street Hospital, College of Physicians and Surgeons where he was Assistant Demonstrator in Anatomy, Charity Hospital, Bellevue Hospital and Roosevelt Hospital (currently Mount Sinai West) where he was a visiting physician at all three, and Emigrant Hospital where he was Surgeon-in-Chief.[12] At Bellevue Hospital, he convinced the hospital to erect a tent that was used as his surgical area where he could practice the idea of antiseptic surgery. This project cost $10,000 at the time.[12] Halsted also started teaching, but he greatly strayed from classical teaching methods. He reformed the classroom by creating a more hands-on experience coupled with theory for his students who were generally at the top of their classes.[12][13] He was an extremely popular, inspiring and charismatic teacher due to this. 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 in which he removed seven gallstones.[16] His mother completely recovered.[12] Halsted also performed one of the first emergency blood transfusions in the United States.[16] 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.[12][14] Because of these operations, Halsted became known for being bold, and his reputation as a surgeon was gradually increasing.[12][13]

In 1884, Halsted read a report by the Austrian ophthalmologist Karl Koller, describing the anesthetic power of cocaine when instilled on the surface of the eye.[16] Halsted, his students, and fellow physicians experimented on each other, and demonstrated that cocaine could produce safe and effective local anesthesia when applied topically and when injected.[16][17] Halsted would also inject himself with the drug to test it before using it on his patients during surgeries.[9][14] In the process, Halsted and some of his other colleagues became addicted to the drug. Halsted and Dr. Richard Hall were the only colleagues who became addicted that would survive their cocaine problems.[13] Halsted maintained an active career while dealing with his addiction for five years. However, there were some clues to his condition during this time.[14] Halsted published an article in 1885 in the New York Medical Journal, and it was incoherent. This showcased what state Halsted was in with his addiction to cocaine.[13][16] His close friend Harvey Firestone recognized the gravity of the situation, and arranged for Halsted to be abducted and put aboard a steamer headed for Europe. In the two weeks it took to complete the voyage, Halsted underwent an early, crude form of detoxification. Upon his return to the United States he became addicted again, and voluntarily admitted himself to Butler Sanatorium in Providence, Rhode Island, where they attempted to cure his cocaine addiction with morphine. He was there for seven months.[12] Even though he remained dependent upon morphine for the remainder of his life, he continued his career as a pioneering surgeon; many of his innovations remain standard operating room procedures.[18] However, his addiction to cocaine ended his medical career in New York City.[10]

 
The four doctors: Osler, Halsted, Welch, and Kelly

Following his discharge from Butler in 1886, Halsted moved to Baltimore, Maryland, to join his friend William Welch in organizing and launching the new Johns Hopkins Hospital. Halsted began working in Welch's experimental laboratory, and he presented a paper at Harvard Medical School. Soon thereafter, he was readmitted to Butler Hospital and remained there for nine months. He returned to Baltimore thereafter.[12] When Johns Hopkins University Hospital opened in May 1889, he became Head of the Outpatient Department, acting Surgeon to the hospital, and Associate Professor of Surgery after being recommended by Welch when the first choice for the position fell through. These lesser positions alluded to the fact that the administration was still worried about Halsted's past cocaine addiction. In 1890, he was appointed Surgeon-in-Chief of the hospital.[12][13] In 1892, Halsted joined Welch, William Osler, and Howard Kelly in founding the Johns Hopkins School of Medicine, and was appointed its first Professor of Surgery.[19] Compared to his teaching in New York, Halsted's teaching was declining. He would pay attention to specific students and ignore the rest. However, he would also give certain residents that worked under him unprecedented learning experiences because of the amount of responsibility he awarded them.[9][10] During these years at Johns Hopkins, he is credited with multiple achievements in the surgical world.[9]

Achievements edit

Halsted was credited with starting the first formal surgical residency training program in the United States at Johns Hopkins. He based this mainly on the ideas that he obtained in Europe, especially those of the Germans, Austrians, and Swiss. This was the foundation for the residency training programs in place today.[13] The program began with an internship of undefined length (individuals advanced once Halsted believed they were ready for the next level of training), followed by six years as an assistant resident, and then two years as house surgeon. This program was also developed to create role models and teachers for the next generation of surgeons.[13] Halsted trained many of the prominent academic surgeons of the time, including Harvey Williams Cushing and Walter Dandy, founders of the surgical subspecialty of neurosurgery; and Hugh H. Young, a founder of the specialty of urology.[20] His methods of training surgeons spread, first to the rest of Baltimore and then throughout the United States.[9][13] Many prominent figures in medical surgery were affected and influenced by his new system of training, and it has had a profound impact on American medicine.[9][13]

 
Radical mastectomy

Halsted held the belief that cancers spread through the bloodstream, which led him to think that sufficient local removal of the tumor would cure the cancer.[21] This belief led him to perform the first radical mastectomy for breast cancer in the U.S. at Roosevelt Hospital in New York in 1882,[22][23] an operation first performed in France a century earlier by Bernard Peyrilhe (1735-1804).[24] Halsted had observed a German surgeon perform increasingly aggressive surgeries to remove cancerous tumors from the breast, but the patients still relapsed even with this more aggressive surgery.[14] An English surgeon, Charles Moore, believed that even more breast tissue should be removed and doctors who were trying to save women from disfigurement were doing them a disservice.[14] Halsted took this to the next level, eventually resorting to removing the pectoralis major, lymph nodes near the collar bone, and lymph nodes near the armpit.[9][14] Some surgeons in Europe even removed ribs from women with breast cancer. This caused great disfigurement of the women operated on.[14] Halsted presented his findings at the American Surgical Association conference in New Orleans in 1898, concluding that the procedure significantly decreased the percentage of local reoccurrence.[9][14] He also presented more findings in 1907, showing the same results.[14] In the years since Halsted's research, the radical mastectomy has come under fire. It is now known that survival from breast cancer is more closely related to how much the cancer has spread before surgery than how much is removed during surgery.[14]

Halsted created multiple techniques for surgery so damage to tissues and blood supply would be minimized. Some of these new advances included different types of forceps, sutures, and ligatures.[9] Besides working on breast cancer, Halsted also contributed to the surgical treatment for other diseases including vascular aneurysm, inguinal hernia, and a certain kind of primary carcinoma of the ampulla of Vater.[9] In addition, he helped develop anesthesia, an integral part of modern surgery.[9] 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 was also involved in the introduction of rubber gloves into the operating room for surgery in 1889.[25] The main reason for the introduction of rubber gloves was to protect the hands of scrub nurse Caroline Hampton. She suffered from contact dermatitis and painful eczema as a result of the antiseptics used, so Halsted arranged for Goodyear Rubber Company to make "bespoke" rubber gloves for her. Caroline Hampton would later give up her job as a nurse to become Halsted's wife. Although, the use of gloves wasn't originally championed for sanitary reasons, such gloves drastically increased the cleanliness of operations, as was later demonstrated by Joseph Colt Bloodgood.[25][9][11]

Other achievements included advances in thyroid, biliary tract, hernia,[26] 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. Dr. William Mayo, one of the cofounders of the Mayo Clinic, once commented that Dr. Halsted took so long to perform procedures that the patients usually healed before he had a chance to close the incision.[27] 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."[28]

Personal life edit

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.[9][29] He died on September 7, 1922, 16 days short of his 70th birthday, from bronchopneumonia as a complication of surgery for gallstones and cholangitis.[8][9][30]

Eponyms edit

See also edit

References edit

  1. ^ Roberts, CS (2010). "H.L. Mencken and the four doctors: Osler, Halsted, Welch and Kelly". Baylor University Medical Center Proceedings. 23 (4): 377–88. doi:10.1080/08998280.2010.11928657. PMC 2943453. PMID 20944761.
  2. ^ . Archived from the original on March 10, 2015. Retrieved December 2, 2010.
  3. ^ a b Markel, Howard (2012). An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug, Cocaine. New York: Pantheon Books. pp. 188. ISBN 978-1400078790.
  4. ^ Zuger, A (April 26, 2010). "Traveling a Primeval Medical Landscape". The New York Times.
  5. ^ 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 February 2, 2014. {{cite web}}: |last2= has generic name (help)
  6. ^ Markel, Howard (2011). An Anatomy of Addiction. Sigmund Freud, William Halsted, and the Miracle Drug Cocaine. Pantheon Books. p. 211.
  7. ^ 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
  8. ^ 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 March 3, 2010. Dr. William Stuart Halsted, professor of surgery at Johns Hopkins Medical School for many years as one of the foremost leaders in ... died today....
  9. ^ a b c d e f g h i j k l m n o p q r s t u v w x y Ock-Joo, Kim (June 2003). (PDF). 의사학. 대한의사학회. 12 (1): 66–87. ISSN 2093-5609. Archived from the original (PDF) on November 3, 2022. Retrieved November 3, 2022.
  10. ^ a b c d e Olch, Dr. Peter (March 2006). "William Stewart Halsted: A lecture by Dr. Peter D. Olch". Annals of Surgery.
  11. ^ a b Haas, L. F. (1922). "William Stewart Halsted (1852-1922)". Neurology, Neurosurgery, and Psychiatry. 69 (1452): 461–464. Bibcode:1922Sci....56..461C. doi:10.1126/science.56.1452.461. PMID 17774978.
  12. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z Osborne, Michael (2007). "William Stewart Halsted: his life and contributions to surgery". Oncology. 8 (3): 256–265. doi:10.1016/S1470-2045(07)70076-1. PMID 17329196. S2CID 19916657.
  13. ^ a b c d e f g h i j k l m n o p q r s Cameron, J L (May 1997). "William Stewart Halsted. Our surgical heritage". Annals of Surgery. 225 (5): 445–458. doi:10.1097/00000658-199705000-00002. PMC 1190776. PMID 9193173.
  14. ^ a b c d e f g h i j k l m n o Mukherjee, Siddhartha (2011). The Emperor of all Maladies. Scribner. pp. 60–72.
  15. ^ "William Stewart Halsted". Annals of Surgery. PMC 1448951.
  16. ^ a b c d e Gerald, Ember (2011). "Genius on the Edge: The Bizarre Double Life of Dr. William Stewart halsted". Anesthesiology. 114 (6): 1496–1497. doi:10.1097/ALN.0b013e318216e9fa. PMC 2898614.
  17. ^ Halsted, William S. (1885). "Practical comments on the use and abuse of cocaine". The New York Medical Journal. 42: 294–95.
  18. ^ Imber, G. Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted. Kaplan Publishing (2010), pp. 138-43.
  19. ^ Imber (2011), pp. 162-4.
  20. ^ Imber (2011), pp. 183-5.
  21. ^ "Evolution of Cancer Treatments: Surgery". American Cancer Society. June 12, 2014. Retrieved July 13, 2020.
  22. ^ 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
  23. ^ 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.
  24. ^ B. Peyrhile, "Dissertatio academica de cancro," The Lyon Academy, (1773)
  25. ^ a b Kean, Sam (May 5, 2020). "The Nurse Who Introduced Gloves to the Operating Room". Distillations. Science History Institute. Retrieved June 1, 2020.
  26. ^ a b Halsted, WS (1893). "The radical cure of inguinal hernia in the male". Annals of Surgery. 17 (5): 542–56. PMC 1492972. PMID 17859917.
  27. ^ Markel, Howard (July 19, 2011). An Anatomy of Addiction: Sigmond Freud, William Halstead, and the Miracle Drug, Cocaine. New York: Vintage Books. p. 189. ISBN 978-1400078790.
  28. ^ 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.
  29. ^ . Archived from the original on February 3, 2018. Retrieved August 8, 2008.
  30. ^ Imber G: Ref. 5, op cit.

Further reading edit

  • Brecher, Edward M.; and the Editors of Consumer Reports (1972). Licit and Illicit Drugs, Chapter 5, 'Some eminent narcotics addicts'. Retrieved February 2, 2014 – via Schaffer Library of Drug Policy. {{cite book}}: |last2= has generic name (help)
  • Cameron, John. (1997). "Williams Stewart Halsted: Our Surgical Heritage". Annals of Surgery. 225 (5): 445–58. doi:10.1097/00000658-199705000-00002. PMC 1190776. 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 978-0-394-55130-2.
  • "Who named it?". William Stewart Halsted. Retrieved August 3, 2005.
  • . William Stewart Halsted. Archived from the original on March 21, 2005. 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. doi:10.1080/08998280.1999.11930198.
  • 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". Journal of Experimental Medicine. 63 (1): 395–438. doi:10.1084/jem.11.1.175. PMC 2124704. PMID 19867240.
  • Halsted WS (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 2124707. 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.{{cite book}}: CS1 maint: multiple names: authors list (link)
  • 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.

External links edit

  • "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

william, stewart, halsted, september, 1852, september, 1922, american, surgeon, emphasized, strict, aseptic, technique, during, surgical, procedures, early, champion, newly, discovered, anesthetics, introduced, several, operations, including, radical, mastecto. 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 2 His operating room at Johns Hopkins Hospital is in Ward G and was described as a small room where medical discoveries and miracles took place 3 According to an intern who once worked in Halsted s operating room Halsted had unique techniques operated on the patients with great confidence and often had perfect results which astonished the interns 3 William Stewart HalstedHalsted in 1922Born 1852 09 23 September 23 1852New York City U S DiedSeptember 7 1922 1922 09 07 aged 69 Baltimore Maryland U S Alma materYale University College of Physicians amp Surgeons of Columbia UniversityKnown forInventing the residency training system in U S MastectomyIntroduced rubber surgical glovesScientific careerFieldsMedicineInstitutionsJohns Hopkins HospitalThroughout his professional life he was addicted to cocaine and later also to morphine 4 5 which were not illegal during his time As revealed by Osler s diary Halsted developed a high level of drug tolerance for morphine He was never able to reduce the amount to less than three grains daily approximately 200 mg 6 Halsted s addictions resulted from experiments on the use of cocaine as an anesthetic agent that he performed on himself 7 Contents 1 Early life 2 Medical education 3 Medical career 4 Achievements 5 Personal life 6 Eponyms 7 See also 8 References 9 Further reading 10 External linksEarly life edit nbsp Halsted in 1874William S Halsted was born on September 23 1852 in New York City 8 9 His mother was Mary Louisa Haines and his father William Mills Halsted Jr He was the oldest of four children 10 His father was a businessman with Halsted Haines and Company which was an organization that supplied dry goods 9 10 11 William Halsted Jr was very involved in the community 9 William S Halsted s family was of English heritage and was very wealthy with two homes in the state of New York 12 One of their homes was on Fifth Avenue in New York City and the other was an estate in Westchester County New York 12 Though raised a Presbyterian Halsted was an agnostic by adulthood Halsted was educated at home by tutors until 1862 when he was sent to boarding school in Monson Massachusetts at age ten 12 13 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 after a year of studying at home 12 At Yale Halsted was captain of the football team played baseball and rowed on the crew team but his academic achievements were below average 9 12 One of his social setbacks was in his senior year when he wasn t accepted into the prestigious Skull and Bones secret society 13 At the end of his senior year at Yale a newfound interest in medicine seemed to arise Halsted attended medical lectures at Yale Medical School and studied books on the subjects of anatomy and physiology 9 13 Medical education editUpon graduation from Yale in 1874 Halsted entered Columbia University College of Physicians and Surgeons 9 Historians are not certain why Halsted attended medical school Some believe he was inspired by his father s involvement with medical organizations 12 Others think he couldn t imagine himself in the family business 14 Once he entered medical school he left his early academic difficulties behind him 12 Physicians central to his emergence as a medical scholar include Henry B Sands a well known surgeon who was Halsted s tutor during this time 9 12 Halsted served as assistant to Professor of Physiology John Call Dalton another influence 9 12 During medical school Halsted worked in a pharmacy in his free time 12 After two years of medical school Halsted started to burn out He complained about his memory not working correctly among other things so during the summer of his second year he went to Block Island in Rhode Island 12 Here he studied while participating in activities like fishing and sailing 12 13 He then took a competitive exam to apply for an internship at Bellevue Hospital in New York even though this program was only open to students with medical degrees 12 Halsted did very well on the exam and was awarded the internship for House Surgeon at Bellevue where he remained for a year 9 12 13 Halsted spent most of his internship in the medical wards but also helped with some surgical operations 13 The conditions in the hospital were very unsanitary bleeding patients was a common practice during this time and surgical tools weren t as well cared for as they are modernly 14 Interns ran around the hospital with buckets full of pus from the patients 14 During the internship Halsted was introduced to the use of antiseptic through physicians using Joseph Lister s technique created in 1867 12 This sparked an interest in Halsted and he helped with the issue of infections at Bellevue during the rest of the internship 12 He ended his academic career in the top ten of his medical school class He then participated in a competition that placed him at the top of his class 13 He graduated in 1877 with a Doctor of Medicine degree 15 Medical career editAfter graduation Halsted joined the New York Hospital as house physician in April 1878 where he introduced the hospital chart which tracks the patient s temperature pulse and respiration It was at New York Hospital that Halsted met the pathologist William H Welch who would become his closest friend He left New York Hospital in October 1878 12 Halsted had exhausted all of the medical training opportunities the United States had to offer in his position for there was no program to train recent medical school graduates for a career in medicine at this time 13 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 Kolliker Jan Mikulicz Radecki Max Schede Adolph Stohr Richard von Volkmann Anton Wolfler Emil Zuckerkandl 9 10 He became especially close to Anton Woelfler among others which gave him unlimited access to resources 9 The relationships Halsted forged with these future leaders in their fields would last a lifetime 9 13 During this time in Europe cancer was just starting to be studied more widely making the timing of his arrival ideal 14 This experience inspired him with multiple new medical ideas and practices that he would contribute to in the United States 14 Halsted returned to New York in 1880 and for the next six years led an extraordinarily vigorous and energetic life Like when Halsted visited Europe it was an opportune time for Halsted s involvement because surgery was on the brink of various important discoveries 13 He operated at multiple hospitals including the Chambers Street Hospital College of Physicians and Surgeons where he was Assistant Demonstrator in Anatomy Charity Hospital Bellevue Hospital and Roosevelt Hospital currently Mount Sinai West where he was a visiting physician at all three and Emigrant Hospital where he was Surgeon in Chief 12 At Bellevue Hospital he convinced the hospital to erect a tent that was used as his surgical area where he could practice the idea of antiseptic surgery This project cost 10 000 at the time 12 Halsted also started teaching but he greatly strayed from classical teaching methods He reformed the classroom by creating a more hands on experience coupled with theory for his students who were generally at the top of their classes 12 13 He was an extremely popular inspiring and charismatic teacher due to this 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 in which he removed seven gallstones 16 His mother completely recovered 12 Halsted also performed one of the first emergency blood transfusions in the United States 16 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 12 14 Because of these operations Halsted became known for being bold and his reputation as a surgeon was gradually increasing 12 13 In 1884 Halsted read a report by the Austrian ophthalmologist Karl Koller describing the anesthetic power of cocaine when instilled on the surface of the eye 16 Halsted his students and fellow physicians experimented on each other and demonstrated that cocaine could produce safe and effective local anesthesia when applied topically and when injected 16 17 Halsted would also inject himself with the drug to test it before using it on his patients during surgeries 9 14 In the process Halsted and some of his other colleagues became addicted to the drug Halsted and Dr Richard Hall were the only colleagues who became addicted that would survive their cocaine problems 13 Halsted maintained an active career while dealing with his addiction for five years However there were some clues to his condition during this time 14 Halsted published an article in 1885 in the New York Medical Journal and it was incoherent This showcased what state Halsted was in with his addiction to cocaine 13 16 His close friend Harvey Firestone recognized the gravity of the situation and arranged for Halsted to be abducted and put aboard a steamer headed for Europe In the two weeks it took to complete the voyage Halsted underwent an early crude form of detoxification Upon his return to the United States he became addicted again and voluntarily admitted himself to Butler Sanatorium in Providence Rhode Island where they attempted to cure his cocaine addiction with morphine He was there for seven months 12 Even though he remained dependent upon morphine for the remainder of his life he continued his career as a pioneering surgeon many of his innovations remain standard operating room procedures 18 However his addiction to cocaine ended his medical career in New York City 10 nbsp The four doctors Osler Halsted Welch and KellyFollowing his discharge from Butler in 1886 Halsted moved to Baltimore Maryland to join his friend William Welch in organizing and launching the new Johns Hopkins Hospital Halsted began working in Welch s experimental laboratory and he presented a paper at Harvard Medical School Soon thereafter he was readmitted to Butler Hospital and remained there for nine months He returned to Baltimore thereafter 12 When Johns Hopkins University Hospital opened in May 1889 he became Head of the Outpatient Department acting Surgeon to the hospital and Associate Professor of Surgery after being recommended by Welch when the first choice for the position fell through These lesser positions alluded to the fact that the administration was still worried about Halsted s past cocaine addiction In 1890 he was appointed Surgeon in Chief of the hospital 12 13 In 1892 Halsted joined Welch William Osler and Howard Kelly in founding the Johns Hopkins School of Medicine and was appointed its first Professor of Surgery 19 Compared to his teaching in New York Halsted s teaching was declining He would pay attention to specific students and ignore the rest However he would also give certain residents that worked under him unprecedented learning experiences because of the amount of responsibility he awarded them 9 10 During these years at Johns Hopkins he is credited with multiple achievements in the surgical world 9 Achievements editHalsted was credited with starting the first formal surgical residency training program in the United States at Johns Hopkins He based this mainly on the ideas that he obtained in Europe especially those of the Germans Austrians and Swiss This was the foundation for the residency training programs in place today 13 The program began with an internship of undefined length individuals advanced once Halsted believed they were ready for the next level of training followed by six years as an assistant resident and then two years as house surgeon This program was also developed to create role models and teachers for the next generation of surgeons 13 Halsted trained many of the prominent academic surgeons of the time including Harvey Williams Cushing and Walter Dandy founders of the surgical subspecialty of neurosurgery and Hugh H Young a founder of the specialty of urology 20 His methods of training surgeons spread first to the rest of Baltimore and then throughout the United States 9 13 Many prominent figures in medical surgery were affected and influenced by his new system of training and it has had a profound impact on American medicine 9 13 nbsp Radical mastectomyHalsted held the belief that cancers spread through the bloodstream which led him to think that sufficient local removal of the tumor would cure the cancer 21 This belief led him to perform the first radical mastectomy for breast cancer in the U S at Roosevelt Hospital in New York in 1882 22 23 an operation first performed in France a century earlier by Bernard Peyrilhe 1735 1804 24 Halsted had observed a German surgeon perform increasingly aggressive surgeries to remove cancerous tumors from the breast but the patients still relapsed even with this more aggressive surgery 14 An English surgeon Charles Moore believed that even more breast tissue should be removed and doctors who were trying to save women from disfigurement were doing them a disservice 14 Halsted took this to the next level eventually resorting to removing the pectoralis major lymph nodes near the collar bone and lymph nodes near the armpit 9 14 Some surgeons in Europe even removed ribs from women with breast cancer This caused great disfigurement of the women operated on 14 Halsted presented his findings at the American Surgical Association conference in New Orleans in 1898 concluding that the procedure significantly decreased the percentage of local reoccurrence 9 14 He also presented more findings in 1907 showing the same results 14 In the years since Halsted s research the radical mastectomy has come under fire It is now known that survival from breast cancer is more closely related to how much the cancer has spread before surgery than how much is removed during surgery 14 Halsted created multiple techniques for surgery so damage to tissues and blood supply would be minimized Some of these new advances included different types of forceps sutures and ligatures 9 Besides working on breast cancer Halsted also contributed to the surgical treatment for other diseases including vascular aneurysm inguinal hernia and a certain kind of primary carcinoma of the ampulla of Vater 9 In addition he helped develop anesthesia an integral part of modern surgery 9 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 was also involved in the introduction of rubber gloves into the operating room for surgery in 1889 25 The main reason for the introduction of rubber gloves was to protect the hands of scrub nurse Caroline Hampton She suffered from contact dermatitis and painful eczema as a result of the antiseptics used so Halsted arranged for Goodyear Rubber Company to make bespoke rubber gloves for her Caroline Hampton would later give up her job as a nurse to become Halsted s wife Although the use of gloves wasn t originally championed for sanitary reasons such gloves drastically increased the cleanliness of operations as was later demonstrated by Joseph Colt Bloodgood 25 9 11 Other achievements included advances in thyroid biliary tract hernia 26 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 Dr William Mayo one of the cofounders of the Mayo Clinic once commented that Dr Halsted took so long to perform procedures that the patients usually healed before he had a chance to close the incision 27 Though like most men of his craft he had no religion he yet revived and reinforced the ancient saying of Ambroise Pare 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 28 Personal life editIn 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 9 29 He died on September 7 1922 16 days short of his 70th birthday from bronchopneumonia as a complication of surgery for gallstones and cholangitis 8 9 30 Eponyms editHalsted 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 26 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 Halsted ligament Costoclavicular ligament it is formed from dense condensation of clavipectoral fasciaSee also editThe KnickReferences edit Roberts CS 2010 H L Mencken and the four doctors Osler Halsted Welch and Kelly Baylor University Medical Center Proceedings 23 4 377 88 doi 10 1080 08998280 2010 11928657 PMC 2943453 PMID 20944761 Johns Hopkins Medicine The Four Founding Professors Archived from the original on March 10 2015 Retrieved December 2 2010 a b Markel Howard 2012 An Anatomy of Addiction Sigmund Freud William Halsted and the Miracle Drug Cocaine New York Pantheon Books pp 188 ISBN 978 1400078790 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 February 2 2014 a href Template Cite web html title Template Cite web cite web a last2 has generic name help Markel Howard 2011 An Anatomy of Addiction Sigmund Freud William Halsted and the Miracle Drug Cocaine Pantheon Books p 211 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 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 March 3 2010 Dr William Stuart Halsted professor of surgery at Johns Hopkins Medical School for many years as one of the foremost leaders in died today a b c d e f g h i j k l m n o p q r s t u v w x y Ock Joo Kim June 2003 William Stewart Halsted in the History of American Surgery PDF 의사학 대한의사학회 12 1 66 87 ISSN 2093 5609 Archived from the original PDF on November 3 2022 Retrieved November 3 2022 a b c d e Olch Dr Peter March 2006 William Stewart Halsted A lecture by Dr Peter D Olch Annals of Surgery a b Haas L F 1922 William Stewart Halsted 1852 1922 Neurology Neurosurgery and Psychiatry 69 1452 461 464 Bibcode 1922Sci 56 461C doi 10 1126 science 56 1452 461 PMID 17774978 a b c d e f g h i j k l m n o p q r s t u v w x y z Osborne Michael 2007 William Stewart Halsted his life and contributions to surgery Oncology 8 3 256 265 doi 10 1016 S1470 2045 07 70076 1 PMID 17329196 S2CID 19916657 a b c d e f g h i j k l m n o p q r s Cameron J L May 1997 William Stewart Halsted Our surgical heritage Annals of Surgery 225 5 445 458 doi 10 1097 00000658 199705000 00002 PMC 1190776 PMID 9193173 a b c d e f g h i j k l m n o Mukherjee Siddhartha 2011 The Emperor of all Maladies Scribner pp 60 72 William Stewart Halsted Annals of Surgery PMC 1448951 a b c d e Gerald Ember 2011 Genius on the Edge The Bizarre Double Life of Dr William Stewart halsted Anesthesiology 114 6 1496 1497 doi 10 1097 ALN 0b013e318216e9fa PMC 2898614 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 The Bizarre Double Life of Dr William Stewart Halsted Kaplan Publishing 2010 pp 138 43 Imber 2011 pp 162 4 Imber 2011 pp 183 5 Evolution of Cancer Treatments Surgery American Cancer Society June 12 2014 Retrieved July 13 2020 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 a b Kean Sam May 5 2020 The Nurse Who Introduced Gloves to the Operating Room Distillations Science History Institute Retrieved June 1 2020 a b Halsted WS 1893 The radical cure of inguinal hernia in the male Annals of Surgery 17 5 542 56 PMC 1492972 PMID 17859917 Markel Howard July 19 2011 An Anatomy of Addiction Sigmond Freud William Halstead and the Miracle Drug Cocaine New York Vintage Books p 189 ISBN 978 1400078790 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 High Hampton history Archived from the original on February 3 2018 Retrieved August 8 2008 Imber G Ref 5 op cit Further reading editBrecher Edward M and the Editors of Consumer Reports 1972 Licit and Illicit Drugs Chapter 5 Some eminent narcotics addicts Retrieved February 2 2014 via Schaffer Library of Drug Policy a href Template Cite book html title Template Cite book cite book a last2 has generic name help Cameron John 1997 Williams Stewart Halsted Our Surgical Heritage Annals of Surgery 225 5 445 58 doi 10 1097 00000658 199705000 00002 PMC 1190776 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 978 0 394 55130 2 Who named it William Stewart Halsted Retrieved August 3 2005 A Tribute to William Stewart Halsted MD William Stewart Halsted Archived from the original on March 21 2005 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 doi 10 1080 08998280 1999 11930198 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 Journal of Experimental Medicine 63 1 395 438 doi 10 1084 jem 11 1 175 PMC 2124704 PMID 19867240 Halsted WS 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 2124707 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 a href Template Cite book html title Template Cite book cite book a CS1 maint multiple names authors list link 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 External links edit 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 Retrieved from https en wikipedia org w index php title William Stewart Halsted amp oldid 1181035791, wikipedia, wiki, book, books, library,

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