Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

William S. Halsted, MD

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles, also known as  "Halsted's Rules of Surgery", set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov


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This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Francesco Todaro (1839 – 1918)
Francesco Todaro

Francesco Todaro (1839 – 1918) Italian physician and anatomist born in Tripi, a village in the province of Messina, Sicily.

While still a medical student at the University of Messina, he joined the Garibaldini as a volunteer and fought at Corriolo and Milazzo during the campaign for Italian unification in 1860. After completing his medical degree, he pursued further anatomical training in Florence, studying under prominent figures including Moritz Schiff and Filippo Pacini (1812 – 1883) focusing his research myocardial and valve anatomy.

In his 1865 publication, "Novelle ricerche sopra la struttura delle orecchiette del cuore umano e sopra la valvola di Eustachio" Todaro described a fibrous extension of the valve of the inferior vena cava (Eustachian valve) starting at the point where the Eustachian valve and the valve of the coronary sinus (Thebesian valve) appear to merge. This structure later became known eponymically as the tendon of Todaro, component of the boundaries of the triangle of Koch, site for the atrioventricular node.

In page 33 of this publication Todaro states: “e perseguitatolo, con ogni accuratezza, in mezzo alle fibre muscolari del sotto, l'accompagnai fino al pilastro posteriore della fossa ovale, da ove mi accertai entrare pel corno posteriore, che qui ha origine, nella valvula di Eustachio, percorrendola in tutto il suo margine libero. Ho confermato dopo, questa osservazione, in molti altri casi ; ed ho trovato sempre costante, il tendine, anco quando la valvula d'Eustachio è quasi manchevole.” “I followed it to the posterior pillar of the oval fossa, from where I confirmed that it entered through the posterior horn, which originates here, into the Eustachian valve, following its entire free margin. I have subsequently confirmed this observation in many other cases, and have always found the tendon to be constant, even when the Eustachian valve is almost missing.”
 Tendon of Todaro

SVC: Superior vena cava, RPA: Right pulmonary artery, RSPV: Right superior pulmonary vein, RIPV: Right inferior pulmonary vein, IVC: Inferior vena cava, RAA: Right atrial appendage, FO: Foramen ovale, TV: Septal leaflet of the tricuspid valve. The yellow line shows the location of the "Tendon of Todaro".  

In 1867 he was appointed Professor of Human Anatomy at the University of Messina, and in 1871 he accepted the chair of anatomy at the University of Rome “La Sapienza”, where he remained until his death.

In 1874, Todaro became a member of the Accademia Nazionale dei Lincei, Italy’s foremost scientific academy. He also served as a Senator of the Kingdom of Italy.

Personal note: There are some publications that assert that the tendon of Todaro is rarely seen. That has not been my experience.

Sources:
1. Sopra la struttura delle orecchiette del cuore umano. Todaro F. Stabilimento Civelli Pub. Florence, Italy: 1865. (Italian)
2. TODARO, Francesco. Dorello P. Enciclopedia Italiana. 1937 (Italian)
3. Todaro, Francesco. Treccani Enciclopedia on line.(Italian) 

4. TODARO, Francesco. Ottaviani A. Dizionario Biografico degli Italiani. Vol. 95. (Italian)
5. Cardiac anatomy primer. McMullen, HL. Am Assoc Thorac Surg.