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Dr. Halsted at Hopkins and at High Hampton

2010; Taylor & Francis; Volume: 23; Issue: 1 Linguagem: Inglês

10.1080/08998280.2010.11928580

1525-3252

S. Robert Lathan,

History of Medicine Studies

Much has been written about Dr. William Stewart Halsted, considered one of the greatest and most influential surgeons of all time (Figure ​(Figure11). Halsted was born in 1852 in New York City, the son of a wealthy dry goods importer, and lived on Fifth Avenue. Upon graduation from Andover, Yale, and the Columbia University College of Physicians and Surgeons, he trained in New York and spent 2 years in Europe studying anatomy and embryology. Figure 1 Dr. William Stewart Halsted (portrait by Stocksdale). Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. In 1880, he began the private practice of surgery. He was very busy, operating at multiple hospitals, and also taught anatomy. In 1884, he became an “accidental addict.” He was impressed by a report by Dr. Carl Keller at a conference in Heidelberg, Germany, on the successful use of cocaine for anesthesia of the eye. Halsted and several colleagues and medical students in New York City began a series of experiments on themselves. The results, which led to the development of local and regional anesthesia, were published by Halsted in 1885. Unfortunately, Halsted became addicted and in 1885 was approached by his good friend, Dr. William Henry Welch, who was then a pathologist at Bellevue Hospital. A treatment plan proposed by Welch consisted of a sea trip to the Windward Islands but failed. Halsted then admitted himself to the Butler Hospital in Providence, Rhode Island, and was treated by substituting morphine for cocaine. In late 1886, Halsted was invited by Welch to move to Baltimore and live with him and work in his laboratory while the new Johns Hopkins Hospital was being constructed. (Welch had recently been appointed professor of pathology.) Halsted worked diligently in the lab along with associates Franklin Mall and William Councilman, testing surgical techniques and doing investigations on dogs. A few months later, Halsted readmitted himself to the Butler Hospital for further treatment for 9 months. Halsted returned to Baltimore in early 1888, and, after the endorsements of Welch and Osler to the trustees, was later appointed surgeon in chief to The Johns Hopkins dispensary and acting surgeon at the hospital for 1 year. The hospital officially opened in 1889 and Halsted was named surgeon in chief in 1890 and finally professor of surgery in 1892. Dr. William F. Rienhoff Jr., who was the last surgical resident of Dr. Halsted, entered Johns Hopkins in 1910 as a medical student and later became a well-known professor of surgery at Hopkins. Dr. Rienhoff produced an interesting manuscript of his personal reminiscences from 1915 to 1960. In this, he discussed Halsted's principles of surgical technique, advising surgical students to “handle tissues with great care, avoiding interruption of the circulation, and closing the incision carefully and gently, layer by layer, the sutures thus avoiding tension which might interfere with the blood supply.” Further, the “end of the forceps should be small to avoid crushing surrounding tissue” and a drain was “essential where there is necrotic tissue and infection.” Rienhoff stated, “These lessons to us as third and fourth year medical students were constantly drilled into us.” Halsted's addiction to morphine continued, and his personality changed as he became more reclusive. Nevertheless, it is amazing and somewhat miraculous that he was able to continue as the chief of surgery at Hopkins for 30 more years until his death in 1922. His creative genius led to numerous innovations and contributions to surgery, some of which are listed in the Table. Table Halsted's innovations and contributions to surgery Dr. Halsted worked with Dr. Franklin Mall, professor of anatomy in the Hunterian Laboratory of Experimental Medicine. In their surgery on dogs, they focused on intestinal anastomosis. Halsted favored fine silk sutures and was the first to show that the submucous layer was the strong layer of the intestine. Dr. Rienhoff was of the opinion that Halsted's “addiction to cocaine was a great assistance to him in his experimental and clinical studies.” His withdrawal from the pressures of his previous busy life in New York City gave him “leisure to think and develop powers within himself that otherwise may have lain dormant.” Voiced this way, his accidental cocaine addiction was a “blessing.” Halsted was said to be a “very meticulous” operator but was a “head surgeon, not a hand surgeon,” according to his close associate Dr. John M. T. Finney. Halsted selected his house officers with great care and made his school of surgery distinctive, training his young men in every technical detail to make surgery a safer form of therapy (Figure ​(Figure22). Figure 2 All-star operation in 1904 by Dr. Halsted and his colleagues. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. Next to Dr. Halsted are Dr. Joseph Bloodgood, Dr. Hugh Young, and Dr. Harvey ...