William Stewart Halsted

William Stewart Halsted ( September 23, 1852-September 7, 1922) was one of the most influential surgeons of the 20th Century. 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.

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 in handling his inheritance from that fortune. Halsted was raised on 5th Avenue in privileged circumstances. 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).

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.

Bellevue Hospital

Halstead time at Bellevue Hospital has remained legendary for generation of surgical housestaff trained there.

He despaired of attaining the degree of antisepsis and sterility that he insisted upon in the old hospital's operating rooms, and through what must have been an incredible force of personal determination, succeeded in creating his own operating theaters in tents that he had constructed outside the hospital.

His years at Bellevue would change his life as well as the hospital's standard practices.

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, Cushing, and Osler was one of the Hopkins professors known as "The Big Four", was best man.

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.

Death

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

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)

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