Presidential address: William Stewart Halsted—A profile of courage, dedication, and scientific search for truth
1989; Elsevier BV; Volume: 10; Issue: 3 Linguagem: Inglês
10.1016/0741-5214(89)90434-5
ISSN1097-6809
Autores ResumoIn John Singer Sargent's famous 1905 painting of the senior professors, The Four Doctors, at Johns Hopkins University School of Medicine, William Stewart Halsted is seen as a slender, somewhat indistinct figure standing alone in the background (Fig. 1).He does not stand out as clearly or predominantly as the others: William Welch, William Osler, and Howard Kelly. According to Chesney,1Chesney AM. Halsted.Johns Hopkins Mag. 1952; 3: 5-7Google Scholar a former dean of the medical faculty, this interesting contrast in appearances reflects the manner in which the four were perceived by the general public and some members of the medical profession when the portrait was painted. Unlike his distinguished colleagues, Halsted's reserve and caution in making new acquaintances “… made him rather difficult of approach and kept at a distance men who fully aware of his great worth … were eager to meet him but made no advances, owing to the impression that Dr. Halsted would not be over-responsive to their attentions.”2Matas R. In Memoriam—William Stewart Halsted, an appreciation.Bull Johns Hopkins Hosp. 1925; 36: 2-27Google Scholar The softer colors used to depict Halsted in the background of the painting create an illusion that his likeness is gradually fading. Perhaps McClure and Szilagyi3McClure RD Szilagyi DE. Halsted—teacher of surgeons.Am J Surg. 1951; 82: 122-131Abstract Full Text PDF PubMed Google Scholar had this in mind when they wrote about Halsted:As the great figures of history recede into the dimness of the past, the physical reality of their persons if not completely forgotten becomes strangely blurred or distorted … in science the achievements of the truly great, as if by forces derived from life itself, come slowly to grow into the organism of our everyday existence; it seems to be their fate that the details of their persons dissolve into the results of their work. Judged by this standard, Halsted ranks among the truly great surgeons of all time. His numerous contributions to both surgical craftsmanship and medical science have become so closely integrated with present concepts and standards that they appear impersonal and separated from the man responsible for them. To fully appreciate the magnitude and importance of Halsted's accomplishments, it is necessary to cast a backward glance at the status of surgery when he began his medical career. The fundamental principles dealing with the prevention of infection, control of hemorrhage, handling of tissues, drainage, and wound healing were just beginning to be appreciated. The cranial and thoracic cavities had been approached only in accidental injuries. Surgery of the thyroid was in an early phase of development, and no successful operative procedures for breast cancer or for inguinal hernia had been developed. Resection of the stomach had not yet been accomplished, and intestinal resection with suture could scarcely be contemplated. In this country surgery of the gallbladder and biliary tract were almost never considered.4Heuer GJ. Dr. Halsted.Bull Johns Hopkins Hosp. 1952; 90: 1-105PubMed Google Scholar In the 45 years between Halsted's graduation from medical school in 1877 and his death in 1922, surgery in America underwent a remarkable transformation, largely through the impact of his original thinking and scholarly attainments. MacCallum5MacCallum WG William Stewart Halsted, surgeon. : The Johns Hopkins Press, Baltimore1930Google Scholar wrote, “… he (Halsted) worked out an attitude of operating upon the human body which must forever be the proper attitude of the surgeon.” This was based on the now universally accepted concepts of absolute asepsis; utmost care in handling of tissues; complete hemostasis; careful approximation of wound edges; and provision of physiologic rest for the affected part. Thus Halsted is properly credited as the “father of a school of safety in surgery,” a school in which brilliance and speed of execution were subordinated to accurate, safe, and thorough performance.6Leriche R. WS Halsted.Lyon Chirurg. 1922; 19: 671-672Google Scholar Additionally, Halsted's surgical genius served as a wellspring for other notable contributions that included discovery of local and neuroregional anesthesia7Halsted WS. Practical comments on the use and abuse of cocaine; suggested by its invariably successful employment in more than a thousand minor surgical operations.NY Med J. 1885; 42: 294-295Google Scholar; use of rubber gloves in surgical procedures8Halsted WS. Ligature and suture material. The employment of fine silk in preference to catgut and the advantages of transfixing tissues and vessels in controlling hemorrhage; also—an account of the introduction of gloves, gutta-percha tissue and silver foil.JAMA. 1913; 60: 1119-1126Crossref Scopus (118) Google Scholar; formulation of an operation for the cure of inguinal hernia9Halsted WS. The radical cure of inguinal hernia in the male.Ann Surg. 1893; 17: 542-556PubMed Google Scholar; development of a radical operation for cancer of the breast10Halsted WS The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889 to January. 1894Google Scholar; and the inauguration of a surgical residency at The Johns Hopkins Hospital that was the original program of its kind in this country.11Halsted WS. The training of the surgeon.Bull Johns Hopkins Hosp. 1904; 15: 267-275Google Scholar, 12Rutkow IM. William Stewart Halsted and the Germanic influence on education and training programs in surgery.Surg Gynecol Obstet. 1978; 147: 602-608PubMed Google Scholar, 13Harvey AM. The influence of William Stewart Halsted's concepts of surgical training.Johns Hopkins Med J. 1981; 148: 215-236PubMed Google Scholar Matas2Matas R. In Memoriam—William Stewart Halsted, an appreciation.Bull Johns Hopkins Hosp. 1925; 36: 2-27Google Scholar stated, “… he (Halsted) has left a legacy that would crown the lives of a dozen great, but lesser men!” Reflecting on Halsted's life, one wonders what there was about this truly remarkable and allegedly “eccentric” man, so-called by Sir William Osler,14Osler W. The inner history of the Johns Hopkins Hospital. Johns Hopkins Med J. 125. 1969: 184-194Google Scholar that accounts for his monumental achievements. In an effort to elucidate the matter a biographic sketch of Halsted is presented that focuses on his personal characteristics and the salient influences that affected his surgical career. Halsted, the son of a wealthy importer of wholesale dry goods, was born in New York City on Sept. 23, 1852. The family was prominent in social, business, and philanthropic activities. Both his father and grandfather were on the board of governors of New York Hospital, and his father was also a member of the board of trustees of the College of Physicians and Surgeons. His uncle Thaddeus Halsted, a well-known and highly respected surgeon, was attending surgeon to the New York Hospital for many years. Writing to Welch, Halsted supplied some details of his early education:… I was taught at home by governess until the summer of 1862. In the autumn … was sent to a private school at Monson, Massachusetts … I can recall very little of the method of instruction, but I must have studied Latin for I was given the choice of learning a lesson in Latin grammar or stirring soft soap in a great cauldron … when I was kept at home for misdemeanor … went to Andover in the fall of 1863 and graduated in 1869 (aged 16+). Was considered too immature to go to college … and was placed in a private day school in New York for one year. …5MacCallum WG William Stewart Halsted, surgeon. : The Johns Hopkins Press, Baltimore1930Google Scholar Halsted entered Yale University in 1870 and graduated in 1874. He was an indifferent student and his scholastic record was generally poor. Contrarily, he excelled in football, played shortstop on the baseball team, was a member of the class crew in the barge race, and participated as one of 20 performers in a special gymnastic exhibition. During his senior year he developed an interest in medicine as evidenced by his statement, “… purchased Gray's anatomy and Dalton's physiology and studied them with interest; attended a few clinics at the Yale Medical School.”5MacCallum WG William Stewart Halsted, surgeon. : The Johns Hopkins Press, Baltimore1930Google Scholar Halsted was described by his college roommate Samuel Bushnell as slight but well built and exceptionally strong with blond hair, a mustache, and outstanding ears. He was careful in matters of dress, did not drink, and was a good dancer. Although he had a caustic tongue, he was always respectful to his teachers and was generally popular with the student body.15Park EA. A pediatrician's chance recollections of Dr. Halsted.Surgery. 1952; 32: 472-478PubMed Google Scholar After graduation Halsted enrolled as a medical student at the College of Physicians and Surgeons in New York. His preceptor was Dr. Henry B. Sands who was professor of anatomy but also active as a surgeon. Through a personal friendship he became a student assistant to Professor John C. Dalton, the author of his physiology text. Halsted immediately demonstrated his interest and ability in medical studies and became an outstanding student. He spent most of his time in anatomic dissection. In the fall of 1876 he took the examination for an internship at Bellevue Hospital even though he did not yet have a medical degree; he placed fifth and was assigned to the fourth surgical division. A short time before, Dr. Joseph Lister had visited the United States, and Stephen Smith and Thomas Sabine (but no other surgeons at Bellevue) had adopted his antiseptic techniques.4Heuer GJ. Dr. Halsted.Bull Johns Hopkins Hosp. 1952; 90: 1-105PubMed Google Scholar Consequently Halsted had the opportunity to compare operative results with and without Lister's methods and these, he stated, were strikingly in favor of the former. Halsted obtained his medical degree in 1877, ranking among the top 10 students. As a result he was eligible to compete in a written examination for a $100 prize, which he won. According to Crowe,16Crowe SJ Halsted of Johns Hopkins. : Charles C Thomas, Springfield1957Google Scholar he never ceased to be grateful to three of his teachers for their personal interest and for the influence of their teachings on his future career. Sands and Sabine inspired in him an interest in anatomy and surgery. Dalton, who had studied under Claude Bernard and who taught physiology as an experimental science, instilled in him the love of truth. Halsted's internship at Bellevue continued for an 18-month period. He subsequently competed for and won the position of house physician to the New York Hospital and served on the medical wards for 8 months. During the summer of 1878 he first became acquainted with Welch, who was so greatly to influence his future life. In October 1878 Halsted went to Europe for 2 years of graduate study. It was the period of German supremacy in medicine, and Germany and Austria had become the mecca of aspiring students from all parts of the world. Halsted witnessed and participated in the revolutionary advances occurring in several fields of medicine: bacteriology was a new and active science; antiseptic surgery was developing in Germany more rapidly than in any other country; embryology and histology were making great strides; and pathology was being studied from new viewpoints, with improved understanding. In Germany, Halsted encountered a powerful and thoroughly established education system in which the requirements of the highest medical instruction were duly recognized and provided by state-controlled universities. The contrast between these institutions and the disjointed, unendowed, and student-supported schools in the United States was clearly apparent. He was particularly impressed with the organizational efficiency and discipline in surgical training that concentrated on the idea that surgery is a science in the making. Halsted took full advantage of his opportunities and formed close associations with the younger assistants, many of whom later became professors and his lifelong friends. In Vienna he attended courses in pathology with Chiari and studied embryology with Schenck. He also studied clinical medicine but devoted the greatest amount of time to anatomy. He became friendly with Woelfler and Mikulicz, the former being Billroth's first assistant. Woelfler gave him access to the surgical wards and Billroth's operating amphitheater. Halsted was chiefly impressed by the magnitude of the operations, the surgical skill of Billroth and his assistants, and the large number of arterial forceps used.4Heuer GJ. Dr. Halsted.Bull Johns Hopkins Hosp. 1952; 90: 1-105PubMed Google Scholar Halsted left Vienna for Würzburg in the spring of 1879 to take additional courses in embryology and histology; also, he regularly attended the surgical clinics of von Bergmann. He then spent brief periods with Weigert and Thiersch in Leipzig, Volkmann in Halle, Schede in Hamburg, and Esmarch in Kiel. During these student years abroad Halsted took an active interest in the life around him. He attended the opera and the theater and was a member of a small dancing circle. He joined a dining club with some of the docents and assistants. At vacation time he visited Italy, Switzerland, and France. Halsted's 2 years of study abroad were altogether an extremely stimulating and broadening experience of permanent and fructuous influence on his entire future professional life. He returned to America with a command of methods, a broad foundation of knowledge, an active spirit of inquiry, and an enlarged outlook by no means limited to surgery. Halsted's return to New York in September 1880 marked the beginning of intense professional activity, the first part of which he later described as the 5 happiest years of his life. He was young and talented, socially distinguished, full of energy, and fired by a laudable ambition to put to use the knowledge he had acquired. He began a private practice limited to surgery and was among the first to confine himself exclusively to that specialty. He joined the faculty of the College of Physicians and Surgeons as second demonstrator in anatomy and subsequently became demonstrator in charge of the dissecting room. In 1882 Sands, his former preceptor, asked him to become his associate at Roosevelt Hospital, a position Halsted held for the next 4 years. He inaugurated the outpatient department at Roosevelt Hospital, which he directed 7 mornings a week with the assistance of Richard Hall and Frank Hartley. He became visiting physician to Charity Hospital (1881 to 1883), consulting surgeon to the New York Emigrant's Hospital (1883 to 1886), visiting surgeon to Bellevue Hospital (1883 to 1887), and visiting surgeon to Presbyterian Hospital (1885 to 1886). For a time in 1882 and 1883 he was attending surgeon at the Chambers Receiving Hospital. He also conducted an extracurricular “quiz” to prepare medical students for examinations. His quiz was an outstanding teaching group and in no way resembled the usual “cram sessions” of the day. He and his associates provided intensive training in anatomy and physiology, conducted daily teaching rounds at Roosevelt Hospital and outpatient department, and arranged for students to attend courses in pathology and bacteriology in Welch's laboratory at Bellevue Hospital.17Olch PD. William S. Halsted's New York period, 1874–1886.Bull Hist Med. 1966; 40: 495-510PubMed Google Scholar Dr. Charles A. Powers, a former student, recorded the impressions that Halsted made on those who knew him as a teacher:Halsted was a remarkable teacher of anatomy. Pupils in his private class went to his office at 9 o'clock in the evening, two evenings a week, where they were “quizzed” until 11 or 12 o'clock. His patience, steadiness, diligence, and above all his thoroughness, brought out the very best that there was in those with whom he came in contact. His thoroughness and success as a teacher are furthermore attested by the fact that, in a graduating class, ten out of the first twelve men were members of his “quiz.”18Heuer GH Miller RT Matas R. In memoriam: William Stewart Halsted 1852–1922.Arch Surg. 1925; 10: 293-305Crossref Google Scholar Despite his increasing duties and responsibilities, Halsted published or presented 21 scientific papers during the period 1882 to 1886. Most were case reports; however, one of his most noteworthy contributions was presented before the exclusive New York Surgical Society and then published as his first contribution to the surgical literature. The paper “Refusion in the Treatment of Carbonic Acid Poisoning” reported a series of cases of arterial reinfusion of blood in carbon monoxide—poisoned patients after the blood had been withdrawn and oxygenated.19Halsted WS. Refusion in the treatment of carbonic acid poisoning.NY Med J. 1883; 28: 625-629Google Scholar At the height of his New York career, Halsted was known as a bold, daring, and original surgeon, an indefatigable worker, and most of all an inspiring teacher. He was a luminary among New York surgeons and was a great favorite of such eminent surgeons as Sands, Bull, and Stimson. As a bachelor he lived and shared an office with his friend Dr. Thomas McBride in a house on east 25th Street. The house was luxuriously furnished and was the scene of frequent dinner parties and musicales. Welch was often among the guests, as were young men from other professions.17Olch PD. William S. Halsted's New York period, 1874–1886.Bull Hist Med. 1966; 40: 495-510PubMed Google Scholar On Sept. 15, 1884, an event occurred that was to have a profound influence on both the practice of surgery and Halsted's life. At a meeting of the German Ophthalmological Society in Heidelberg, Dr. Josef Brettauer presented a paper for Dr. Carl Koller **Dr. Koller could not afford to attend the meeting.of Vienna on the use of cocaine to anesthetize the cornea and conjunctiva.20Olch PD. William S. Halsted and local anesthesia.Anesthesiology. 1975; 42: 479-486Crossref PubMed Scopus (40) Google Scholar Dr. Henry D. Noyes of New York was present and later described Koller's findings in an open letter to The Medical Record (published Oct. 11, 1884).21Noyes HD. The Ophthalmological Congress.Heidelberg. Med Rec (NY). 1884; 26: 417-418Google Scholar In December 1884 an editorial in The Medical Record stated, “a body of gentlemen in this city (New York) … have been experimenting with a view to determine the hypodermic effects of cocaine when applied directly to the sensory cutaneous nerves.”22Shrady GF The earlier employment of cocaine.Med Rec (NY). 1884; 26: 659Google Scholar Among this body were Halsted and his associates at the Roosevelt Hospital outpatient department and his colleagues and students in his quiz.20Olch PD. William S. Halsted and local anesthesia.Anesthesiology. 1975; 42: 479-486Crossref PubMed Scopus (40) Google Scholar Through experiments on one another, Halsted's group demonstrated the local and neuroregional methods of anesthesia.23Hall RF. Hydrochlorate of cocaine.NY Med J. 1884; 40: 643-644Google Scholar In the course of their experiments Halsted and several other members of the group unwittingly became addicted to cocaine. During periods of agitation brought about by taking the drug, he apparently turned at one point to morphine and later he turned to alcohol. Information about this period is sketchy, but it seems that his work was quite erratic, and his attendance at meetings of the New York Surgical Society declined precipitously. Also, despite considerable preparation, he was unable to deliver a series of lectures in competition for the chair of surgery at the College of Physicians and Surgeons.17Olch PD. William S. Halsted's New York period, 1874–1886.Bull Hist Med. 1966; 40: 495-510PubMed Google Scholar Even though he had accumulated a considerable amount of experimental data on local cocaine anesthesia, Halsted published only one short article (September 1885, New York Medical Journal).7Halsted WS. Practical comments on the use and abuse of cocaine; suggested by its invariably successful employment in more than a thousand minor surgical operations.NY Med J. 1885; 42: 294-295Google Scholar It was written while he was seemingly under the influence of cocaine, and it contrasts markedly with the clarity and precision of his other writings. Because of the confusion of his illness and the resulting lack of publications on the subject, his contributions to the clinical use of cocaine were generally unknown for years. Finally, through the efforts of Matas, Halsted was honored by the National Dental Association in 1922, 6 months before his death, as the originator of regional anesthesia.24Matas R. The story of the discovery of dental anesthesia by nerve blocking.Surgery. 1952; 32: 530-537PubMed Google Scholar By the time of Halsted's collapse, Welch had moved to Baltimore to take part in the final planning for The Johns Hopkins Hospital. Realizing the extent of Halsted's disability, he arranged a “therapeutic” sailing trip to the Windward Islands. The trip turned out to be a failure when Halsted broke into the ship's medical supplies and seized cocaine. Later with the encouragement of friends and family, Halsted voluntarily entered the Butler Institution, a leading mental hospital, in Providence, R.I.; he was discharged in November 1886, after 7 months of treatment. After an exhaustive study of Halsted's addiction, Olch20Olch PD. William S. Halsted and local anesthesia.Anesthesiology. 1975; 42: 479-486Crossref PubMed Scopus (40) Google Scholar concluded that during the later hospitalization Halsted was weaned from cocaine but became dependent on morphine for the rest of his life. This tragic episode ended the New York period of Halsted's life. In December 1886 he accepted Welch's invitation to come to Baltimore and work in his laboratory at Johns Hopkins. When Halsted arrived in Baltimore, The Johns Hopkins Hospital was under construction; however, the pathology building had been completed in October 1886, and Welch had initiated a graduate program in pathology and bacteriology. Halsted found himself in the company of a brilliant group of young men, most of whom were soon engaged in original investigation. He had the good fortune to work in close association with Franklin P. Mall (later professor of anatomy at Hopkins), George H. Nuttall (later professor of biology at Cambridge), Walter Reed (later to work with yellow fever), and Simon Flexner (who was to become director of the Rockefeller Institute). In April 1887 Halsted, who was still not well, reentered the Butler Hospital. On this occasion he was hospitalized for 9 months, and after discharge he returned to Welch's laboratory. It was during this period before the opening of the hospital and medical school that he carried out his intricate analysis of Lister's antiseptic methods. To these methods he added the principles of careful handling of tissues, exquisite hemostasis, and exact approximation of tissues, with avoidance of dead space to achieve even more superior results.8Halsted WS. Ligature and suture material. The employment of fine silk in preference to catgut and the advantages of transfixing tissues and vessels in controlling hemorrhage; also—an account of the introduction of gloves, gutta-percha tissue and silver foil.JAMA. 1913; 60: 1119-1126Crossref Scopus (118) Google Scholar, 25Halsted WS. The treatment of wounds with special reference to the value of blood clot in the management of dead spaces.Johns Hopkins Hosp Rep. 1890–1891; 2: 255-314Google Scholar His studies of hand disinfection and the use of fine silk suture were no less exacting. Councilman,5MacCallum WG William Stewart Halsted, surgeon. : The Johns Hopkins Press, Baltimore1930Google Scholar Welch's associate in pathology, wrote that it was difficult to think of surgery more carefully conducted than the experimental surgery by Halsted. The Johns Hopkins Hospital officially opened on May 7, 1889. Welch had been appointed professor of pathology in 1884 and became pathologist-in-chief to the hospital. Late in 1888 Osler was appointed physician-in-chief and professor of medicine. Kelly was appointed to the chair of obstetrics and gynecology in 1889. The chair of surgery was first offered to William Macewen of Glasgow who refused the offer when he was not permitted to bring with him a full complement of nurses. Subsequently, Welch convinced the trustees of Halsted's ability to hold the position. With apparent hesitation, the trustees in February 1889 “invited” Halsted to be surgeon-in-chief to the dispensary and acting surgeon to the hospital for 1 year.26Chesney AM. The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine, vol 1. : The Johns Hopkins Press, Baltimore1943Google Scholar In March Osler16Crowe SJ Halsted of Johns Hopkins. : Charles C Thomas, Springfield1957Google Scholar wrote to President Gilman, “Halsted is doing remarkable work in surgery and I feel his appointment to the university and hospital would be quite safe.” The following October Halsted was made associate professor11Halsted WS. The training of the surgeon.Bull Johns Hopkins Hosp. 1904; 15: 267-275Google Scholar, 13Harvey AM. The influence of William Stewart Halsted's concepts of surgical training.Johns Hopkins Med J. 1981; 148: 215-236PubMed Google Scholar; finally, in 1892 he was appointed surgeon-in-chief to the hospital and professor of surgery. By the time the hospital opened, Halsted had already developed his ideas and formulated in part his plans for the surgical department.4Heuer GJ. Dr. Halsted.Bull Johns Hopkins Hosp. 1952; 90: 1-105PubMed Google Scholar He was fully aware of the defects of surgical training in this country and had been deeply impressed with the German system.12Rutkow IM. William Stewart Halsted and the Germanic influence on education and training programs in surgery.Surg Gynecol Obstet. 1978; 147: 602-608PubMed Google Scholar The latter had two principal features: (1) a unification of the work in the basic sciences and clinics and (2) a prolonged, postgraduate training program in which only the best residents were retained. His primary modification of the German system involved the concentration of responsibility and authority in the resident rather than in the professor. Consequently, he selected house officers with the greatest care. He usually gave preference to men interested in research and assigned them to the laboratory to assist him in investigations. Halsted maintained that a man should pursue a surgical specialty only after a long and thorough preparation in general surgery. He also seemed to have a prescient talent for placing the proper men in the various specialties as evidenced by his choice of Hugh Young in urology, Harvey Cushing and Walter Dandy in neurosurgery, William Baer in orthopedics, and Samuel Crowe in otolaryngology.16Crowe SJ Halsted of Johns Hopkins. : Charles C Thomas, Springfield1957Google Scholar, 27Harvey AM. Halsted's innovative ventures in the surgical specialties: Samuel J. Crowe and the development of otolaryngology at Johns Hopkins.Johns Hopkins Med J. 1977; 140: 101-120PubMed Google Scholar Whereas specialists had the privilege of admitting and caring for a limited number of patients, general surgeons were not afforded the same privilege. The patients in the wards were Halsted's, and it was understood that unless he specifically designated patients on whom he wished to operate, they were entirely under the care of the resident surgeon. For some time after the hospital opened, Halsted performed most of the surgical work. However, as work increased a considerable portion was turned over to either Dr. John M. T. Finney, Halsted's only full-time associate, or to the resident surgeon as part of his training. According to Heuer,4Heuer GJ. Dr. Halsted.Bull Johns Hopkins Hosp. 1952; 90: 1-105PubMed Google Scholar it was rare for Halsted to operate more often than 3 mornings a week and rarely on more than one patient in a morning. During the early years of the hospital the equipment in Halsted's operating room was modest.28Bloodgood JC. Halsted thirty-six years ago.Am J Surg. 1931; 14: 89-148Abstract Full Text PDF Google Scholar, 29Mitchell JF. Memories of Dr. Halsted.Surgery. 1952; 32: 451-460PubMed Google Scholar The original operating table was made of wood and constructed to allow any irrigation to collect in the open box beneath it. The table was covered by a heavy oak board, which was also used to transport the patient to the operating room. If the foot of the table was elevated, an orderly had to hold the patient's legs since there was no shoulder strap. No arm boards or special lights to illuminate the room were provided. Halsted was apparently the first to insist that the surgeon and his assistants change their street clothes before operating.4Heuer GJ. Dr. Halsted.Bull Johns Hopkins Hosp. 1952; 90: 1-105PubMed Google Scholar Halsted wore a white duck scrub suit, tennis shoes, and a scrub cap (Figs. 2 and 3).Fig. 3Halsted's operating team. Standing: Young, Follis, Finney, Cushing, Bloodgood, Mitchell. Seated: Halsted. (From Crowe SJ. Halsted of Johns Hopkins. The man and his men. Springfield: Charles C Thomas, 1953:48.)View Large Image Figure ViewerDownload Hi-res image Download (PPT)Although he did not introduce long-sleeve gowns and face masks, he used them at an early date. All gauze, towels, and sheets were sterilized by steam. Instruments were boiled in a soda solution and then placed in carbolic acid. Halsted is generally
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