Mediastinum

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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: October 14, 2015

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UPDATED: The mediastinum is the median region of the thorax, usually described as the "space"¹ between the lungs. This region is divided into a superior and inferior mediastinum by a plane that pases through the sternal angle or Angle of Louis.

The inferior mediastinum is itself divided into three separate regions by the pericardial sac. The region anterior to the pericardial sac is the "anterior mediastinum", the region posterior to the pericardial sac is the "posterior mediastinum", and the region containing and including the pericardial sac is the "middle mediastinum". Thus described the mediastinum comprises four regions as follows:

• Superior mediastinum: It contains the aortic arch, the brachiocephalic trunk, the thoracic segments of the left common carotid and the left subclavian arteries, the brachiocephalic veins, a portion of the superior vena cava, the vagus nerve, phrenic nerve, and left recurrent laryngeal nerve, trachea, esophagus, thoracic duct and the remains of the thymus gland

• Anterior mediastinum: A narrow space, more developed on the left side, anterior to the pericardial sac and contains some lymph nodes and connective tissue

• Middle mediastinum: The largest mediastinal region, it contains the pericardial sac, the heart, the bifurcation of the trachea, the inferior vena cava, and the cardiac end of the great vessels.

• Posterior mediastinum: Contains the descending aorta, the azygos and hemiazygos veins, the esophagus, and thoracic duct.

Personally, I do not use the description of the mediastinum as a "the space beween the lungs", as it conjures the image of literal "open spaces" around or between the organs. The fact is that the mediastinum is tightly packed with no spaces between the organs. This is why I prefer the definition of the mediastinum as an "area" or "region" between the lungs. Dr. Miranda.

Mediastinum

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