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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NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.


...continued from: An answer regarding the death of Andreas Vesalius (1)...


Pavlos Plessas
Pavlos Plessas
Click on the image for author information

8. Echtius’ treatise was only published after his death in 1556

This is incorrect. Echtius was alive almost a decade after that and heard Boucherus describe Vesalius’ death with his own ears. The treatise was first published in 1564, the year of Vesalius’ death, albeit was wrongly attributed to Wierus.

9. Echtius believed scurvy was caused by a blocked spleen, leading to an excess of black bile

Echtius believed that an excess of black bile (melancholic humour) caused scurvy. He wrote that in addition to eating preserved foods and mouldy biscuit, and drinking foul water, the following conditions led to an excess of black bile: warm air, lack of sleep, hard manual work, anxiety and fevers. Each one individually could cause scurvy even if the diet was good . The reasons for Vesalius’ illness as indicated by the sources are: eating rotten biscuit, drinking corrupt water, hot weather and extreme worrying. Please compare with the list of causes given by Echtius in his treatise.

10. It is claimed that extreme fear and irrational behaviour … are well known early symptoms [Plessas]. This is not the case

I quote Rev. Richard Walter of the Anson expedition, who saw many of his shipmates die from scurvy: This disease is likewise usually attended with a strange dejection of spirits; and with shiverings, tremblings, and a disposition to be seized with the most dreadful terrors on the slightest accident (4). 


11. This (absence of extreme fear and irrational behaviour) is also the observation of one of the authors (RC) having observed scurvy patients in Ethiopian prisons

Did any of Dr. Coninx’s patients see other inmates die from scurvy? Did he ever observe one of his patients witness an accident? Were his patients evaluated by a psychiatrist? I would hazard the guess that the answer to all the questions is no. I choose to believe Rev. Richard Walter.

12. The Italian Pietro Bizzari based his account on what he had been told by an anonymous Venetian goldsmith

Bizzari’s account is not credible. It clashes with the accounts of three different people, who saw Vesalius’ grave in Santa Maria delle Grazie.

13. Metellus describes the symptoms of Vesalius’ illness

No, he does no such thing.

14. The possibility of rotten food as a cause of death on the ship is plausible

I hope this is not a suggestion that a great physician like Vesalius could not recognise the symptoms of food poisoning in others. If he did, it would have been possible to identify the particular source and he would not have fallen ill himself. Even if that was not possible they could have resorted to sharing the supplies of the crew, who had suffered no cases of illness. Surely it is best to be malnourished than risk death from food poisoning. In addition, had the cause of death been food poisoning, the sources would not have blamed Vesalius’ worrying for his illness. Finally, since the authors seem to agree that Metellus’ version of events is the most reliable, how is it possible for a man on the verge of death from food poisoning to be walking on the seashore of Zakynthos? Food poisoning as a cause of death is not plausible even though the sources claim the disease was somehow related to food and water shortage.

15. A 1971 study by Kinsman and Hood which allegedly claims that personality changes are amongst the first symptoms of scurvy

Why allegedly? I quote from the study: The personality changes occurred at an earlier stage of depletion than the psychomotor changes, which did not appear until obvious clinical scurvy was present (5). So the study does claim that personality changes are amongst the first symptoms of scurvy, the very first as a matter of fact. According to figure 3 of the study the MMPI T-scores started increasing when the level of Vitamin C in the body was at the equivalent of 761 mg. Clinical signs of scurvy became apparent only when the level went down to 300 mg. 

Article continued here: An answer regarding the death of Andreas Vesalius (3)

Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.