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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Galen of Pergamum
Galen of Pergamon 
(129AD - 200AD

The word sympathetic is the adjectival form of sympathy. This word arises from the Greek [συμπάθεια]and is composed of [syn/sym] meaning “together” and [pathos], a word which has been used to mean “disease”. In reality “pathos” has to do more with the “feeling of self”. Based on this, the word sympathy means “together in feeling”, which is what we use today.

How the term got to be used to denote a component of the so-called autonomic nervous system is part of the history of Medicine and Anatomy.

Galen of Pergamon (129AD-200AD), whose teachings on Medicine and Anatomy lasted as indisputable for almost 1,500 years, postulated that nerves were hollow and allowed for “animal spirits” to travel between organs and allowed the coordinated action of one with the other, in “sympathy” with one another. As the knowledge of the components of the nervous system grew, this concept of “sympathy” stayed, becoming a staple of early physiological theories on the action of the nervous system.

Jacobus Benignus Winslow (1669-1760) named three “sympathetic nerves” one of them was the facial nerve (the small sympathetic), the other the vagus nerve, which he called the “middle sympathetic”, and the last was what was known then as the “intercostalis nerve of Willis” or “large sympathetic", today’s sympathetic chain. Other nerves that worked coordinated with this “sympathetics” were considered to work in parallel with it. It is from this concept that the term “parasympathetic” arises.

Interestingly, the ganglia on the sympathetic chain were for years known as “small brains” and it was postulated that there was a separate multi-brain system coordinating the action of the thoracic and abdominopelvic viscera. The coordination between this “autonomous nervous system” and the rest of the body was made by way of the white and gray rami communicantes.

Today we know that there is only one brain and only one nervous system with an autonomic component which has a “sympathetic” component that is mostly in charge of the “fight or flight” reaction and a “parasympathetic” component that has a “slow down” or “depressor” function. Both work coordinated, so I guess Galen was not "off the mark" after all.

So, we still use the terms “sympathetic” and “parasympathetic”, but the origin of these terms has been blurred by history.

Sources:
1. "Claudius Galenus of Pergamum: Surgeon of Gladiators. Father of Experimental Physiology" Toledo-Pereyra, LH; Journal of Investigative Surgery, 15:299-301, 2002
2. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
3. "Medical Meanings:A Glossary of Word Origins" Haubrish, WS American College of Physicians Philadelphia, 1997
4. "The History of the Discovery of the Vegetative (Autonomic) Nervous System" Ackerknecht, EH Medical History, 1974 Vol 18. 
Original image courtesy of Images from the History of Medicine at nih.gov

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