Antonio Maria Valsalva

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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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Details: Published: December 15, 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.

Antonio Maria Valsalva

Antonio Maria Valsalva (1666 – 1723). Italian physician, surgeon, pathologist and anatomist, Antonio Maria Pini was born in the city of Imola. His father Pompeo Pini, a well-to-do goldsmith, adopted the family name Valsalva based on the location of his grandfather’s castle. Valsalva was well educated by Jesuits in mathematics, natural sciences and humanities, and continued his studies in Bologna, where he was trained in anatomy by Marcello Malpighi (1628 – 1694).

In 1687, at the age of 21, Valsalva received his Doctorate in Medicine and Philosophy. He was very dedicated to the practice of medicine, research and anatomical studies. Because of his anatomical knowledge he routinely used cadaver dissection in his clinical practice, advancing his knowledge as a pathologist. In 1694 he was appointed Professor of Anatomy at the University of Bologna.

One of his areas of interest was the anatomy of the hearing system, and his only known publication in 1704 is “De Aure Humana Tractatus” (The Study of the Human Ear) , where he described the ear as composed of the three regions known to us today: internal, middle, and external.

He described a maneuver to inflate the middle ear to erase deafness and increase suppuration caused by middle ear congestion. This is known today as the Valsalva maneuver used in medical practice, but also in deep sea diving and by pilots to clear the middle ear and balance the air pressure in the middle ear with that of the external environment. Today the cardiophysiological bodily response to Valsalva’s maneuver has been studied in detail.

Valsalva is responsible for the eponym “Eustachian tube” that refers to the muscular tube communicating the superior aspect of the pharynx (rhinopharynx) with the middle ear. He did dissections to study in detail the aorta and aortic valve, describing what today are known as the “sinuses of Valsalva”, a pocket-like dilation of the aortic valve between the aortic valve wall and the valve cusps (leaflets). Each of the coronary arteries arises from a sinus of Valsalva. Similar sinuses are found in the pulmonary valve.

During his studies of the mentally ill, Valsalva was of the opinion that madness was an organic disease and therefore mentally ill patients deserved humanitarian treatment, which was not the standard during his times.

One of his best students and pupil was Giovanni Battista Morgagni (1682-1771) who, after the death of Valsalva in 1723, used some of his unpublished material to complement his own studies and publications.

Besides the Valsalva maneuver and the sinuses of Valsalva, there are other eponyms that honor this great anatomist:

• Valsalva Antrum or mastoid antrum is a cavity in the petrous portion of the temporal bone.
• Valsalva’s ligament attaches the pinna to the side of the head.
• Valsalva’s muscle: a band of vertical muscular fibers on the outer surface of the tragus of the ear, innervated by the temporal branch of the facial nerve

Sources:
1. “Seeing the Anatomy of Hearing: New Tools and Approaches Chart the Pathways Underlying How We Process and Integrate Sound” Laitman, JT The Anatomical Record (2006) 288A:323–324
2. “Antonio Maria Valsalva - Biographical Profile of a Pioneer on Otology” Meirelles, RC et al Int. Arch Otorhinolaryngol (2008)12: 2, 274-279
3. “The Valsalva manoeuvre and Antonio Valsalva (1666-1723)” J R Soc Med. (2006) 99(9): 448–451
4. “A short biography on the life of the dedicated anatomist –Valsalva” Kazi, R . J Postgrad Med (2004) 50:314-5
5. “Antonio Maria Valsalva (1666 – 1723)” Yale SH Clin Med Res (2005) 3(1): 35–38
Original image courtesy of the National Library of Medicine

Antonio Maria Valsalva

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