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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Different scalpel models (Wikipedia)
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The term [scalpel] arises from the Latin word [scalpellum], meaning “a small knife”. Celsus (c.25BC - c.50BC) in De Re Medicina, uses the term [scalpellus] to refer to a surgeon’s knike.

The use of knives in Medicine is very old. 10,000 year old Mesolithic skulls have been found with craniotomies made with flint stone knives. The first one to describe surgical knives in recorded history was Hippocrates of Cos (460 BC - 370 BC).

Surgical knives were developed in a multitude of shape and forms, some of them veritable works of art. These scalpels were made by cutlery makers on demand by surgeons and had a fixed blade that had to be sharpened constantly, as surgery requires a very sharp blade.

The invention of the disposable razor by King Gillette in 1904 changed this. In 1910, Dr. John Benjamin Murphy (1857 – 1916) invented a handle that could hold a single-sided or a double-sided safety razor blade.

The design was improved by the invention of a disposable, sterilized surgical blade that could be easily installed on a reusable, sterilizable metal handle. Today sterile, disposable handle-blade combination scalpels of varying shapes and sizes are available, ensuring the surgeon the sharpest scalpel every time.

Sources
1. “The surgical knife” Ochsner J. Tex Heart Inst J. 2009; 36(5): 441–443
2. "History of the Surgical Blade" Shuja, A. Indep Rev Oct-Dec 2012;14(10-12)
3. "Masters of the Scalpel: The History of Surgery"" Riedman SR, R MacNally 1962  

Images in the public domain, courtesy of 
Wikipedia