Sir Astley Paston Cooper

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A Moment in History

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
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Details: Published: July 14, 2014

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.

Sir Astley Paston Cooper

Sir Astley Paston Cooper (1768 - 1841). An English anatomist and surgeon, Astley Cooper started his medical studies when he was only 16, at the St. Thomas hospital in London. He studied under Henry Cline, and later under John Hunter. Astley Cooper was a well-known anatomist, lecturer, and surgeon in his time. He is known for his many studies in abdominal hernia, otology, aneurysms, and the anatomy and diseases of the breast. In 1804 he described the abdominal transversalis fascia and the internal inguinal ring.

Born in the village of Brooke, Norfolk. At 16 years of age he was placed under the tutelage of Henry Cline (1750 - 1827), senior surgeon at the St. Thomas hospital in London for a seven-year apprenticeship. In 1789 he was appointed as an anatomy lecturer at the same hospital. In 1800 Cooper was appointed Surgeon to the Guy's Hospital in London.

He was the first to attempt the ligation of the abdominal aorta in a patient that had suffered an aortic abdominal aneurysm rupture. The patient survived for one additional day. "Astley Cooper introduced no new philosophy, policy or practice into surgery but was the perfect exponent of the scientific approach to surgery combined with skillful and successful practical ability" Brock (1969)

Cooper’s name survives in several eponymous anatomical structures and diseases he described, following are two of them:

• Cooper's ligaments of the breast: Connective tissue ligamentous strands between the pectoral fascia and the skin overlying the breast. (although it was first described by Andrea Vesalius).
• Cooper's pectineal ligament: A thickening of the periosteum on the superior aspect of the pubic bone, lateral to the pubic tubercle. This structure is a preferred site for staple positioning during a laparoscopic herniorrhaphy. When placing the staples, consideration should be placed on the potential presence of an anatomical vascular variation named the "Corona Mortis".

Although Cooper published a number of books and research papers, his seminal contribution to surgery was his two-volume "Treatise on Hernia". The first volume was published in 1795 and the second volume in 1807, with a revised second edition published in 1827.

Personal note: Although Sir Astley Cooper has been credited with the first description of the complex mammary suspensory ligaments (Cooper's ligaments), a 2016 paper by Brinkman and Hage (see Sources) contests this and gives Andreas Vesalius the honor of describing these structures nearly 300 years before Cooper! Dr. Miranda.

Sources:
1. "Sir Astley Paston Cooper." Singal, R. et al. Indian J Surg 73:1 (2011): 82-84.
2. "Sir Astley Paston Cooper, 1768-1841:the prince of surgery"Rawling, EG. Can Med Assoc J 99.5 (1968): 221.
3. "The life and work of Sir Astley Cooper" Brock, RC. Ann Royal Coll Surg England 44.1 (1969): 1-18
4. "Andreas Vesalius’ 500th Anniversary: First Description of the Mammary Suspensory Ligaments" Brinkman, RJ; Hage JJ. World J Surg (2016) 40:2144–2148

Sir Astley Paston Cooper

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