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 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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Statue of St. Peter (St. Peter´s Basilica), it is possible to observe the pope blessing sing in his right hand
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Also referred to as “benediction hand”, “Preacher`s hand”, “Papal Hand”, “Pope Blessing hand”, etc. This sign is linked to an ulnar nerve neuropathy, and there is a long time controversy about the name of this sign as well as its etiology, where some authors contend that there may be involvement of the median nerve.

Scholars, books and Internet sites are not clear about it. If there is an ulnar nerve neuropathy the person attempting to open his hand would be left with the second and third digits in extension, while the fourth and fifth digits would be flexed at the interphalangeal joints but extended at the metacarpophalangeal joints due the loss of the function of the interossei muscles and lumbrical muscles of the fourth and fifth digits. 

The key for this sign is based in on the blessing act which is performed with an open hand and not with a fist. This is the reason why an ulnar neuropathy and not a median nerve neuropathy is the undelaying cause of the Papal Benediction Sign.

Presumably this term was the result of an injury of Saint Peter’s (the first Pope) ulnar nerve which caused him to bless using the “Preacher’s hand”. It stands to reason that everyone copied him as we can see in the lustrations and the art of the Catholic Church.

Article written by: Prof. Claudio R. Molina, MsC

Sources:
1. Futterman, B. (2015). Analysis of the Papal Benediction Sign: The ulnar neuropathy of St. Peter. Clinical Anatomy (New York, N.Y.), 28(6), 696–701. Click here for the article
2. "From Vulcan Salute To Papal Blessing, Ulnar Nerve Damage Caused Original Benediction Sign | Box | NYIT". Nyit.edu. N.p., 2017. Web. 14 Jan. 2017
Image by By Mattana [Public domain], via Wikimedia Common: Click here for the link to the original image