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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Theo Dirix 
Theo Dirix

Note: The following article was recently published in Dutch by my good friend Theo Dirix. Theo is one of our "Vesaliana" contributors, and he has written or has been part of several of the articles in this website. Theo was kind enough to provide a translation of his publication for this blog. There are footnotes in the original publication and I have added them to the end of this article. Dr. Miranda


Christie’s in New York recently sealed the deal of an exceptional copy of the Fabrica, the masterpiece by Andreas Vesalius. The sound resonated widely: buyers were the alma mater of the doctor, the KULeuven (University of Louvain, Belgium), and the Flemish government.

Earlier, a copy of Vesalius’s 1538 adaptation of a teacher’s manual, with his own notes, had already gone under the hammer. This copy of the second edition of the Fabrica from 1555, also richly annotated by the author, was not allowed to escape.

Vesalius enthusiasts eagerly anticipate seeing this historical wonder with their own eyes, following the promised digitization by the KULeuven and its exhibition in their ‘experience center’.

Non-medical or non-Latinist individuals may also find Vesalius captivating. The allure of such a well-traveled, exceptionally driven, and art-loving man is infectious and timeless. The Inquisition had no control over him, and his free-spirited mind and interactions with those of differing beliefs, such as Protestants or Jews, continues to inspire today.

At the end of the First Book of the Fabrica, there is a list of names for the bones of the skeleton as Vesalius knew them: first as he himself preferred to use them, then in Greek and in the Latin of others, and finally in Hebrew. In a certain way, the latter is also the Arabic translation, so he says, as they are “almost all taken from the Hebrew translation of Avicenna by my good Jewish friend and eminent physician Lazarus de Frigeis (with whom I usually study Avicenna).” 1

The opening print of the Fabrica may even feature an image of his friend.  After all, Vesalius had one of his public dissections illustrated. 2

"A colorful crowd, rows deep, stands, hangs, and drums around the table on which a corpse is being dissected. Three quarters of almost two hundred guests are students, with about fifty doctors and other notables also in attendance."

That is how the German student Baldasar Heseler described in his diary a public dissection in Bologna, conducted by the Flemish anatomist Andreas Vesalius.

Among the attendees were likely curious individuals who also frequented public executions or animal fights. Dissections were not serene practical lessons like today. Sometimes several dissections followed each other, often chaotic and in a festive atmosphere during the carnival period: today a hanged man, tomorrow a prostitute, in between a dog.

The image Vesalius chose for his first version of the Fabrica in 1543 is more symbolic in nature. Various authors see allegories in the ninety characters, as well as historical and contemporary prominent figures and acquaintances. 3

A striking figure who is central yet isolated is a man with a long beard, red in some colored versions, wearing a truncated conical headdress such as a tarboosh or fez. He turns towards his neighbor who whispers or shouts something to him. Or is he responding to the scene unfolding beneath him with the dismissive gesture of his left hand? With understanding or disgust?

Like other guests, he wears a heavy cloak; dissections were preferably performed during the cold winter months. It may be far-fetched, but don’t those stripes on his cloak remind us of the threads of a Jewish prayer shawl? Is this “his good Jewish friend and leading physician Lazarus de Frigeis”?

In the opening print of the second version from 1555, the stripes or threads are less clear. The sharp gaze is also blurred. And isn’t that beard shorter? Things have indeed changed in twelve years.

Title Page 1543 Fabrica

Title Page 1555 Fabrica

For example, the originally naked spectator on the balcony now wears a suit. The dog, bottom right, has a goat or goat next to him: is that perhaps the devil? The pennant of the all-dominating skeleton in the center becomes a scythe in the hands of Death.

Many find the later image less appealing than the original and speculate as to the reasons: Was it created by a different and perhaps less talented artist? Was the initial woodcut set aside because it had already been extensively used? Do the alterations suggest censorship or self-censorship, perhaps with an eye towards the advancing Inquisition?

Vesalius also made numerous changes to the text in the second edition. It remains a mystery how he communicated these changes to his Basel printer, Oporinus. This curiosity extends to his annotations and the third edition he had in mind. For instance, in the second edition, he omitted all references to his friends, retaining only the mention of Lazarus de Frigeis. However, the descriptors ‘Jewish’ and ‘leading physician’ were removed. Lazarus is still described as “his good friend.” Why did the reference to Judaism have to vanish?

One explanation posits that the descriptor ‘Jew’ had become redundant. Following the perspective of a researcher who identifies Lazarus de Frigeis as Lazzaro Freschi, the son of Rabbi Raffaele Fritschke, it is thought that Lazarus converted to Christianity in 1549, assuming the name Giovanni Battista Freschi Olivi. 4

Another explanation suggests that it may have been safer at the time to avoid allusions to Jewish beliefs or conversions. According to the same source, Lazzaro Freschi and his mother moved, or were compelled to move, to the Venice ghetto in 1547.

The word ‘getto’ is Italy’s ‘contribution’ to anti-Semitism, akin to later terms such as ‘pogrom’ from Russian, ‘Endlösung’ from German, and the slogan in English today commonly heard on European streets: “From the River to the Sea”.

Vesalius, however, continued to refer to Lazarus de Frigeis as his good friend. Not only was the anatomist well-traveled, passionate about his work, and an admirer of art, he was also loyal, open-minded, and, above all, courageous.

Theo Dirix

With gratitude to Omer Steeno, Maurits Biesbrouck, and Theodoor Goddeeris

Footnotes:

1. based upon: Maurits Biesbrouck. Nederlandse vertaling van het eerste boek van Andreas Vesalius’ Fabrica 1543, handelend over het Menselijk Skelet. P. 394.
2. with differences in the frontispieces of the Fabrica’s of 1543 and 1555: https://exhibitions.lib.cam.ac.uk/vesalius/
artifacts/coloured-frontispiece-1543/, and https://library.missouri.edu/specialcollections/exhibits/show/vesalius500/fabrica/a-tale-of-two-title-pages
3. for example: C.D. O’Malley. Andreas Vesalius of Brussels 1514-1564, University of California Press, Berkeley and Los
Angeles, 1964, p. 140.
4. Toaff, Ariel. Pasque di sangue, Ebrei d’Europa e omicidi rituali, Societa editrice il Mulino, Bologna, 2007, p. 197 - 198