William Stewart Halsted
name = William Stewart Halsted
caption = William Stewart Halsted
September 23 1852
New York City
September 7 1922
William Stewart Halsted (
September 23 1852– September 7 1922) is considered by many to be the most innovative, influential and important surgeon America has ever produced.
Early life and education
William S. Halsted was born on 1852 in
New York City. His mother was Mary Louisa Haines and his father William Mills Halsted, Jr. The family was relatively well-to-do, with a nice house on Fifth Avenue, thanks to the father's successful business, Halsted, Haines and Company. Halsted was educated at home by tutors until the age of ten, when he was sent to boarding school in Monson, Massachusetts. He didn't like his new school and even ran away at one point. He was then sent to Andover where he graduated in 1869.
Yale Collegein 1870. At Yale, Halsted excelled in athletics. He was captain of the football team, played baseball and rowed crew. He even scored the first touch-down in the Yale-Eton football game,Fact|date=July 2008 the first football game played with 11 players on each side. Halsted was, however, a poor student. Indeed, it is said that there is no record of his ever checking out a book from the Yale library!
Columbia UniversityCollege of Physicians Surgeons in New York in 1874. He excelled in medical school and after three years, in 1877, he graduated at or near the top of his class.
After graduation, Halsted joined the
New York Hospitalas house physician, where he introduced the hospital chart which tracks the patient's temperature, pulse and respirations. It was at New York Hospital that Halsted met his closest friend, the pathologist William H. Welch.
Halsted then went to Europe to observe the great European surgeons and scientists, including Chiari, Zuckerkandl, Schneck, Billroth, Braun, Wöelfler, Mikulicz, Kölliker, Stoehr, von Bergmann, Volkmann, Schede, and Esmarch. He returned to New York in 1880 and for the next six years would lead an extraordinarily vigorous and energetic life. He operated at multiple hospitals, including
Roosevelt Hospital, the College of Physicians and Surgeons, Charity Hospital, Emigrant Hospital, Bellevue Hospitaland Chambers Street Hospital. He was an extremely popular, inspiring and charismatic teacher. As a surgeon he was characterized as bold, daring, original and indefatigable. In 1882 he performed one of the first gallbladdersurgeries in the United States (a cholecystotomy performed on his mother on the kitchen table at 2 A.M.!). He also performed one of the first blood transfusions in the United States. He had been called to see his sister after she had given birth. He found her moribund from blood loss, and in a bold and daring move withdrew his own blood, transfused his blood into his sister, and then operated on her to save her life. At that time, of course, they had no knowledge of blood groups and matching blood.
Halsted's career and life forever changed on
October 11, 1884. He read a report, from a student of Sigmund Freud, describing the anesthetic power of cocainewhen cocaine is instilled into the eye. Halsted realized that cocaine may be a great local anesthetic, the solution to a terrible problem in the early days of surgery. Having learned the scientific method when he was in Europe, Halsted, together with his students and fellow physicians, began to experiment with cocaine. They injected each other's nerves and showed that cocaine when injected into a nerve can produce safe and effective local anesthesia. They all became addicted, and they all died except for Halsted and his colleague Dr. Richard Hall. Halsted was sent to Butler Sanatorium in Providence, Rhode Island. In an attempt to cure him, Halsted's addiction was converted from cocaine to morphineat Butler. After being discharged from Butler in 1886, Halsted moves to Baltimore, Maryland to join his friend William Welch at the soon to be opened Johns Hopkins Hospital. At Johns Hopkins, Halsted was a fundamentally changed man. Gone was the gregarious risk-taker. At Johns Hopkins he was slow, methodical, and careful. And unbeknownst to almost all, he remained a morphine addict until his death in 1922.
Halsted was named the first chief of the Department of Surgery at Johns Hopkins Hospital when it initially opened in May 1889. He was named Surgeon-in-chief in 1890 and promoted to Professor of Surgery in 1892. At Johns Hopkins, Halsted is accredited with starting the first formal surgical residency training program in the United States.
Halsted’s surgical residency program consisted of an internship period (the length was left undefined and individuals advanced once Halsted believed they were ready for the next level of training). Internship was followed by 6 years as assistant resident and then 2 years as house surgeon. Halsted’s first resident was Frederick J. Brockway who started in May 1889 but dropped out of the program in October 1890 to teach anatomy. Halsted went on to train many of the academic surgeons of the time including
Harvey Cushingand Walter Dandy.
He is also well known for his many other medical and surgical achievements. As one of the first proponents of
hemostasisand investigators of wound healing, Halsted pioneered the modern surgical fundamental principles of absolute control of bleeding, accurate anatomical dissection, complete sterility, exact approximation of tissue in wound closures without excessive tightness, and gentle handling of tissues. In short, he is the father of "safe" surgery. The first radical mastectomyfor breast cancerwas performed by Halsted. Other achievements include the introduction of the surgical glove, advances in thyroid, biliary tree, hernia, intestinal, and arterial aneurysmsurgeries.
Though raised a
Presbyterian, Halsted was agnosticby adulthood. [ [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1448951 William Stewart Halsted ] at www.pubmedcentral.nih.gov] [ [http://www.whonamedit.com/doctor.cfm/2944.html William Stewart Halsted (www.whonamedit.com) ] at www.whonamedit.com]
In 1890, Halsted married Caroline Hampton, the niece of famed Confederate general
Wade Hampton III. They purchased the High Hampton mountain retreat in North Carolinafrom Caroline's three aunts. There, Halsted raised dahlias and pursued his hobby of astronomy. [ [http://www.highhamptoninn.com/history.aspx High Hampton history] ]
Achievements, Personal events, "Historical background".
*"Use of ether for
general anesthesiaby William T.G. Morton"1852
September 23- Born in New York City1867
March 16- Joseph Listerpublishes series of articles in " The Lancet" on the " Antiseptic Principle of the Practice of Surgery" describing the use of carbolic acid( phenol) on surgical wounds to reduce the incidence of gangrene.1870
*Graduates from Phillips Academy Andover
*Captain of first American 11-player
**This is played against
Eton College, two years prior to the first annual Yale-Harvard football game.
**Other sports: rowing,
gymnastics, baseball( shortstop).1874
**A multi-sport athlete, Halsted is a mediocre student.
**Does show not any interest in medicine until senior year, when his interest is piqued by
Gray's Anatomyand a physiology textbook by John C. Dalton.
Columbia University College of Physicians and Surgeonsin New York
**Halsted is assigned to assist
John C. Daltonhimself and anatomist and surgery professor Henry B. Sandsas a mentor.1876
*October - Begins internship at
Bellevue Hospitaldespite having completed only two years of medical school.1878
*July to October - Serves as house physician at New York Hospital
* November - Begins training in
Viennaunder Theodor Billroth1879
*Returns to New York"1880-1886"
*Appointments at several hospitals, including Bellevue and
blood transfusion, performed on sister
**Upon discovering his sister nearly dead from a
postpartum hemorrhage, Halsted boldly draws his own blood and injects it into his sister, saving her life.
**Halsted implies knowledge of
*Performs one of first operations for
gallstonesin U.S., performed on mother
**Visiting his mother in Albany, he finds her exhibiting
Charcot's triad(fever, right upper quadrant pain, jaundice).1882
Halsted radical mastectomyas treatment for breast cancer"1883-1886"
*Papers describe blood transfusions,
autotransfusions, saline infusions
**Among the first to suggest the replacement of blood during surgery as well as autotransfusion and
intravenous salinefor use in shock, although these ideas forgotten for dozens of years before becoming the standard of care.1884
cocainefor local anesthesiademonstrated by Carl Koller"
*Begins cocaine research, developing the
nerve blockand other local anesthesiatechniques.
**Halsted and colleagues develop severe
**He only publishes one paper on the topic, in the "New York Medical Journal"
***Halstead's writing is indubitably stained by the evidence of intoxication.1886
Harvey Cushingnever suspects the cocainehabit.
**This period between fighting cocaine addiction and beginning Johns Hopkins marks an abrupt personality change for Halsted from bold and vivacious
extrovertto diffident, anti-social introvert.
**In later years, Halsted becomes addicted to
morphine, also unsuspected by nearly everyone. This was revealed in a book by William Osler: "The Inner History of Johns Hopkins Hospital".1888
Johns Hopkins Hospitalopens"
**Contemporaries here include
William H. Welch, William Osler, Howard Kelly, Franklin Mall, William Howell, and John Jacob Abel.
*Invention of surgical gloves
**Head operating room nurse and wife-to-be
Caroline Hamptondevelops dermatitisfrom chemicals used to disinfect hands for surgery.
**This prompts Halsted to hire the
Goodyear Rubber Companyto manufacture thin gloves that will not interfere with necessary sensitivity.
**Halsted only later realizes the impact of gloves on
*Publishes inguinal hernia repair method at the same time as
**Inguinal hernias had been previously associated with high mortality rates.
**Although infrequently performed, the Halsted II remains the
gold standardtoday, with post-operative complication rates only slightly improved from Halsted's 7%.1890
*Is appointed first Chief of
Surgeryat Johns Hopkins Hospital
*June 4 - Marries Caroline Hampton, niece of General Wade Hampton of
**The married couple are described as opposites in appearance.
***A dandy garbed in European tailored suits and Parisian cobbled boots, Halsted is known to dress impeccably, even sending his dress shirts yearly to Paris to be laundered.
***Mrs. Halsted's style is described as austere.
**Halsted and wife never had children, but they did have
Dachshunds, including Sisley (or Sisly,) Fritz, Nip and Tuck. In 1915, he wrote that Nip had died just a few weeks after Sisly (MacCallum, 1930, p 120).
**They live separately in a three-story brick home in Baltimore: Halsted on the second floor, Caroline and canines on the third.
**Each summer they spend one month at High Hampton, Caroline's 2000-acre (8 km²)
North Carolinafamily estate.1892
*Performs first successful subclavian artery ligation1893
Johns Hopkinsmedical students, 15 men and 3 women, begin training"
**This is due to the efforts of four young Baltimoreans--all women--who raised the money needed to open the school only on the condition that women be granted
**These women were university trustees' daughters:
M. Carey Thomas, Mary Elizabeth Garrett, Mary Gwinn, and Elizabeth King.
**Garrett contributed an additional amount with additional strings: these established pre-requisites for medical school admission.1896
Harvey Cushingbegins training under Halsted"1898
*"'American Surgical Association establishes Halsted's
mastectomyand inguinal herniarepair as gold standards1901
blood groupsby Karl Landsteiner"1909
Theodor Kocherbecomes first surgeon to win Nobel Prize"1918
*Halsted elected president of the Maryland Medical Chirugical Society.1919
*Halsted's gall-bladder is removed by former student Richard Follis1920
*Publishes "The Operative Story of Goiter"1922
choledocholithiasis, has complications post-operatively; dies in Baltimore, Maryland, September 7 1922.
**Former students Heuer and
Mont Reidperform operation.
**They use Halsted's own technique in closing the bile duct.
**Complications include a
gastrointestinal hemorrhageand post-operative pneumonia, which was the cause of death.
*Halsted's law - Transplanted tissue will grow only if there is a lack of that tissue in the host.
*Halsted's operation I - Operation for inguinal hernia.
*Halsted's operation II - Radical mastectomy for cancer of the breast.
*Halsted's sign - A sign for carcinoma of the breast.
*Halsted's suture - A mattress suture for wounds that produced less scarring.
*Halsted published 180 papers in his lifetime.
*Halsted is also known for inventing
*Halsted was responsible for the inclusion of temperature charts in
*Halsted never joined the
American College of Surgeons.
*Halsted's Maryland address was 1201 Eutaw Place.
*Halsted's students called him "The Professor."
*Halsted's first resident was
Frederick J. Brockway.
*Halsted's secretary's name was Miss Stokes.
*Halsted's gardener's name was Bradley.
*While at Andover, Halsted played the role of Hans in "
The Office Seekers".
*Halsted attended his 40 year Yale
Florence Sabinto the National Academy of Science.
*Halsted's hobbies included
dahliaraising, astronomy, and collecting antique furnitureand rugs.
bowlingat the University Club in New York City.
*Halsted bought eyeglasses, pens, and cigarette holders in huge quantities.
*Halsted smoked Pall Mall cigarettes.
*Halsted shopped for fruit at the
*Halsted's Yale roommate was
breakfastwas coddled guinea heneggs.
*Halsted had his shirts laundered in Paris, France
*cite journal | author=Cameron, John.| title=Williams Stewart Halsted: Our Surgical Heritage| journal=
Annals of Surgery| volume=225| issue=5| year=1997| pages=445–458| doi=10.1097/00000658-199705000-00002
*cite journal | author=Bryan, Charles S.| title=Caring Carefully: Sir William Osler on the issue of competence vs. compassion in medicine| journal=
Baylor University Medical Center Proceedings| volume=12| issue=4| year=1999| pages=277–284
*cite journal | author=Halsted, William S.| title=Practical comments on the use and abuse of cocaine| journal=
The New York Medical Journal| volume=42| year=1885| pages=294–195
*cite journal | author=Halsted, William S.| title=Practical Circular suture of the intestines; an experimental study| journal=
The American Journal of the Medical Sciences| volume=94| year=1887| pages=436–461| doi=10.1097/00000441-188710000-00010
*cite journal | author=Halsted, William S.| title=Practical The radical cure of hernia| journal=
The Johns Hopkins Hospital Bulletin| volume=1| year=1889| pages=12–13, 112
*cite journal | author=Halsted, William S.| title=The treatment of wounds with especial reference to the value of the blood clot in the management of dead spaces| journal=
The Johns Hopkins Hospital Reports| volume=2| year=1890-1891| pages=255–314 First mention of rubber gloves in the operating room.
*cite journal | author=Halsted, William S.| title=Ligation of the first portion of the left subclavian artery and excision of a subclavio-axillary aneurism| journal=The Johns Hopkins Hospital Bulletin| volume=3| year=1892| pages=93–94
*cite journal | author=Halsted, William S.| title=The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1899, to January, 1894| journal=The Johns Hopkins Hospital Reports| volume=4| year=1894-1895| pages=297
*cite journal | author=Halsted, William S.| title=The Contribution to the surgery of the bile passages, especially of the common bile-duct| journal=
The Boston Medical and Surgical Journal| volume=141| year=1899| pages=645–654
*cite journal | author=Halsted, William S.| title=Auto- and isotransplantation, in dogs, of the parathyroid glandules| journal=
The Journal of Biological Chemistry, Baltimore| volume=63| year=1925| pages=395–438
*cite journal | author=Halsted, William S.| title=Partial progressive and complete occlusion of the aorta and other large arteries in the dog by means of the metal band| journal=
The Journal of Experimental Medicine, New York| volume=11| year=1909| pages=373–391
*cite journal | author=Halsted, William S.| title=A diagnostic sign of gelatinous carcinoma of the breast| journal=
Journal of the American Medical Association, Chicago| volume=64| year=1915| pages=1653
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