William Stewart Halsted

William Stewart Halsted ( September 23, 1852-September 7, 1922) was one of the most influential surgeons of the 20th Century - by virtue of both his innovations in surgical practice, and , most importantly, his spawning of an entirely new methd of training surgeons. He developed basic techniques in surgery that hybridized the then newly emerging fields of bacteriology, and of histologic pathology, with a detailed knowledge of anatomy and understanding of investigative methods. He oversaw the training of "housestaff" who rarely left the hospital, but dedicated themselves to the care of patients along with study and research. As surgical house officers at Johns Hopkins, he trained, personally, over a hundred men who then went on to themselves establish key training programs in General Surgery, Orthopedics, and Urology, among other subspecialties. These men taught Halstead's precepts, with attribution, to new generations of sugical house officers, in programs that were modelled on the one at Hopkins that they had trained in, themselves. Even today, in the United States and throughout the world, Halstead's name is still heard in the operating rooms where attending surgeons and resident surgeons operate together, and younger surgeons are taught techniques and ideas that the older surgeons had been schooled in.

Early life to early adulthood

Born in New York City to William Mills Halsted, Jr., and Mary Louise Hanes, an affluent family. William was born the eldest of four children, followed by two younger sisters, Bertha and Mary Louisa, and finally by a brother, Richard. The Halstead family had physicians in previous generations, but the comfortable living of William's parents was due to his paternal grandfather's land investments in Chicago, and his father's frugality, and operation of his own business, an import company called Halsted, Haines, and Company. Halsted was raised on 5th Avenue in privileged circumstances, summering in the family house on the Hudson River at Irvington-on-Hudson in Westchester.

He was privately educated as a boy, and then attended Yale University. He is said to have been undistinguished as a scholar but notable on the playing fields, being one of the first captains of the Yale football team ("William Stewart Halsted."Dictionary of American Biography Base Set. American Council of Learned Societies, 1928-1936. Reproduced in Biography Resource Center. Farmington Hills, Mich.: Thomson Gale. 2007)." Friendships and close associations during this part of Halsted's life apparently were common. He was outgoing, popular, and socially very active and at ease." (reference for quote:Cameron JL. William Stewart Halsted. Our surgical heritage. Annals of Surgery. 225(5):445-58, 1997 May. UI: 9193173)

The youngest child in the family, Richard, never went to college but became a stockbroker.

Medical School

After college, he returned to Manhattan, and where he studied Medicine, graduating from the College of Physicians and Surgeons in 1877 after completing the 3 year course. Although this was certainly one of the better medical schools in the United States at that time, it was not the scholarly institution it would later become when fully integrated into Columbia University.

Early Postgraduate Training

Unlike most physicians of his day, Halsted took further clinical training and became a house surgeon at Bellevue for a period of 18 months, and then, briefly, a house physician at New York Hospital. Still, he felt that more training and education was required, and spent the next 2 years in Austria and Germany, studying the basic sciences, including bacteriology, chemistry and focusing on human anatomy. At the time, education and training in laboratory science was considered to be at the highest level in the world in those countries.

Return to New York, a young professor

Halsted became an imstructor of anatomy at P&S, while attending patients at Roosevelt Hospita and establishing a surgical practice. He, and several colleagues, experimented with cocaine hydochloride, and developed an effective method of regional anesthesia using the drug. Halsted also developed an addiction to cocaine, that persisted despite voluntary hospitalizations lasting months at a time. Leaving his professiomal career behind in NYC, he moved on to Baltimore to start afresh. Although he apparently was also able to leave behind his habitual dependance to cocaine, it was only by replacing self-administration of that stimulant with self-administration of a narcotic, the drug morphine sulfate.

John Hopkins

He married Caroline Hampton, the head nurse of the operating suites at Hopkins; an unusual woman who had left her aristocratic Southern upbringing to obtain professional training as a nurse "graduating from the New York Hospital in 1888". "When Dr. Halsted married Caroline Hampton, it was a merging of the wealthy merchant class of the north, with the planter aristocracy of the south."(reference for both quotes:Rankin JS. William Stewart Halsted: a lecture by Dr. Peter D. Olch. Annals of Surgery. 243(3):418-25, 2006 UI: 16495709). William Welch, the great pathologist who along with Halsted, Kelly, and Osler was one of the Hopkins professors known as "The Big Four", was best man.

Halsted was chairman from 1890 to 1922.

sterile technique

It was at Hopkins that Halsted began the practice of wearing sterile gloves. Previously, he used disinfectants on his hands, as was the practice of Louis Pasteur and is still followed in some laboratories in France. However, Caroline had severe skin reactions to the disinfectants used (mercuric chloride) and rubber gloves were initially obtained for her use. Apparently another surgeon, Dr. Joseph Bloodgood, adopted the gloves for asepsis within a few years, and so established this new method.

training of surgeons

"Up until the opening of The Johns Hopkins Hospital in 1889, there was no formal system to train surgeons in the United States. All surgeons were self-trained or learned by way of an apprenticeship, and few spent more than 1 or 2 years in a hospital setting. Halsted introduced a system in which medical school graduates entered a university-sponsored, hospital-based surgical training program that, over a several-year period of increasing responsibility slowly led to the training of young surgeons who were well versed in anatomy, pathology, bacteriology, and physiology. The training program culminated in a final period of near-total independence and autonomous activity." (reference for quote:Cameron JL. William Stewart Halsted. Our surgical heritage. Annals of Surgery. 225(5):445-58, 1997 May. UI: 9193173) Original research was required of all surgical residents during training.

Death

His tombstoned grave lies in Greenwood Cemetery, Brooklyn, NY.

Addiction

There is no doubt that Halsted drug addictions affected his life, His brother, Richard, was an alcoholic who developed esophogeal varices and there may have been some genetic predisposition to substance abuse. On the other hand, at the time that Halsted began using cocaine the drug was new and its potential for addiction was unknown. Further, both it and narcotic drugs were common ingredients of over the counter remedies in his lifetime.

Much of his personality during his most productive years at Hopkins may have been colored by his addiction. He has been described, during those years, as “an elusive personality, so hidden in his habitual reserve and so hedged round with the formality of his manner that few knew him well". One of his most outstanding students, and a great admirer, Dr. George W. Heuer, described Halsted as follows: “he was intimate with few and his habits at work precluded frequent contacts with his colleagues. . .his own shyness made it difficult for him to participate easily in the friendly, laughing intercourse of a large group. . .he avoided people, very often deliberately. . .in relation with his colleagues he seemed a lonely figure.”(reference for quotes: (Cameron JL. Gordon TA. Kehoe MW. McCall N. William Stewart Halsted: letters to a young female admirer. Annals of Surgery. 234(5):702-7, 2001 Nov.)

Contributions to Surgery

"There is little doubting the fact that his efforts introduced a "new" American surgery, based as much on pathology and physiology as on anatomy. Halsted's list of accomplishments seems nearly endless, including: pioneering the use of cocaine for local anesthesia and setting the foundations for neuroregional anesthesia; introducing a host of surgical techniques and procedures for dealing with cancers, goiters, hernias, and aneurysms; and emphasizing the necessity for careful exacting procedures in the operating room, especially the need for aseptic surgery and tedious dissection. " (Reference for quote: Rutkow IM. Moments in surgical history: William Stewart Halsted. Archives of Surgery. 135(12):1478, 2000 Dec. UI: 11115357)

He developed the surgical training program at John Hopkins University that became a model for post-graduate residency training for both medical and surgical specialists in the United States. His contributions to surgical techniques lay in advocation of preservation of anatomy and gentle handling of tissues. He invented the operation called radical mastectomy, which provided the only cures for breast cancer in his era. He introduced regional anesthesia.

Regional Anesthesia

-References- Rankin JS. William Stewart Halsted: a lecture by Dr. Peter D. Olch. [Biography. Historical Article. Lectures] Annals of Surgery. 243(3):418-25, 2006 Mar. UI: 16495709