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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
(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 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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In medical terms a [sign] is an objective, observable, measurable expression of a pathology. To a physician, the combination of a patient's clinical and familial history (anamnesis), combined with the patient's symptoms and signs allows for a proper diagnosis. Some signs are so subtle and specific that they can only be observed and understood by a trained health care professional. Furthermore, some signs are pathognomonic, that is, by their presence they define a pathology. Furthermore

Contrary to symptoms (which are subjective), signs are not only objective, but comparable between individuals of the same species. Therefore we can compare the heart rate bmp (beats per minute) between normal and sick individuals allowing us to chart a range from normal to abnormal. The same is true for most signs such as body temperature, respiratory capacity, breathing rate, weight, height, etc.

Some signs are particular to a pathology, although they may not be pathognomonic. These specific signs are usually eponymic, such as:

• McMurray's sign: A click caused by the meniscus during manipulation of the knee; indicative of meniscal injury.

• Blumberg's sign: Sharp piercing pain on the abrupt release of steady pressure over the site of a suspected abdominal lesion, indicative of peritonitis. When used to diagnose appendicitis over McBurney's point it may be called Aaron's sign.

• Musset's sign: Rhythmical jerking of the head following the heart pulsations in aortic aneurysm and aortic insufficiency.

• Cardarelli's sign: An abnormal pulsation of the trachea that may be found in patients with an aneurysm of the aortic arch that causes left tracheal displacement.

• Caput medusae: A ring of dilated varicose veins radiating from the umbilicus, usually indicative of portal hypertension.

• Papal Benediction Sign: A contraction of the fourth and fifth digits, as in benediction (see image).

There are many more medical signs, this list is only an illustration of the concept

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