Jean-Annet Bogros

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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, 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
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Details: Published: January 05, 2024

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.

Jean-Annet Bogros (1786 - 1825) French physician, surgeon and anatomist. He was born in Bogros, a village in the mountains d’Auvergne, France.His family wanted him to become a priest, but his inclination towards medicine took him to an apprenticeship in the Hôtel-Dieu de Clermont, a hospital under the tutelage of Drs. Fleury, Lavort, and Bertrand. He continued his studies in Paris where he excelled at anatomy. He soon became an intern in Paris Hospitals, and in 1817 he became an assistant at the Faculty of Medicine. He was praised for his anatomical and surgical skills.

In August 29, 1823 he submitted his thesis for his Doctorate in Medicine “Essai Sur L’Anatomie Chirurgicale de la Region Iliaque: Et Description D’un Nouveau Procédure Pour Faire La Ligature Arteres Epigastrique Et Iliaque Externe”. His thesis challenged and improved the technique of ligation of the epigastric and iliac vessels proposed by Abernathy and Astley Cooper. His teaching rivaled the Astley Cooper technique, with an emphasis on hemostasis that was well recognized at the time.

Today his name is eponymically tied to the subinguinal space of Bogros, a triangular area posterior to the superior pubic ramus, lateral to the space of Retzius. This area is bound anteriorly by the deep preperitoneal fascia, and posteriorly by the peritoneum. The medial boundary of this space is either the lateral wall of the urinary bladder, or a sagittal plane passing at the origin of the inferior (deep) epigastric vessels. The superior boundary is the inguinal ligament, while the inferior and lateral boundaries are not described.

Bogros died in 1825 when he was 39 years of age. His cause of death in unknown, but many postulate tuberculosis.

Unfortunately, he was a good and simple man and was described as being meek and soft-spoken. Because of this, he only left one posthumous publication (1827) “Mémoire sur la Structure des Nerfs” where he explains a novel system to inject and identify nerves. This publication, in French, can be read and downloaded here.

Some biographical articles wrongly show his name as Jean-Antoine Bogros, others change the name to Annet Jean Bogros. Both are not correct. In our research we could not find a portrait of Bogros, so we used the cover or his posthumous memoir on the structure of the nerves.

Sources:

1. “Totally Extraperitoneal Herniorrhaphy (TEP): Lessons Learned from Anatomical Observations” Xue-Lu Zhou; Jian-Hua Luo; Hai Huang, et al. Minimally Invasive Surgery 2021(1):5524986
2. "Crucial steps in the evolution of the preperitoneal approaches to the groin: An historical review" R.C. Read Hernia 2010. 15(1):1-5
3. "Retzius and Bogros Spaces: A Prospective Laparoscopic Study and Current Perspectives" Ansari, MM Annals of International Medical and Dental Research, 2017 Vol (3), Issue (5) 25-31
4. " The Preperitoneal Space in Hernia Repair" Lorenz, A et al. Front Surg (2022) Visceral Surgery Vol 9
5. "Essai Sur L’Anatomie Chirurgicale de la Region Iliaque:: Et Description D’un Nouveau Procede: Pour Faire La Ligature Arteres Epigastrique Et Iliaque Externe” J.A. Bogros Imprimerie de E. Duverger. 1827 Paris

Jean-Annet Bogros

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