Dr. Húmer Húltl

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at www.nih.gov

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Details: Published: June 09, 2014

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

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Dr. Húmer Hültl (1868 – 1940) Hungarian surgeon, Húmer Hültl was born in 1868 in Felsobanya. Hültl studied in Budapest, earning his medical degree in 1891, and after surgical training he started to work as a surgeon in 1893.

By 1900, Dr. Hültl was the chief surgeon at the St. Stephen’s Hospital and later at the Sr. Rokus Hospital, and during WWI he was a commander of a Hungarian military hospital. Dr. Hültl’s attention to detail, careful asepsis (after Ignaz Semmelweis) and superb surgical technique earned him the moniker “The Paganini of the Knife”. Hültl was the first in his country to introduce the use of face masks, gloves, sterile cotton, and rubber gloves.

Dr. Hültl was very concerned about the consequences of spillage of gastrointestinal contents in the peritoneal cavity during surgery, covering all the walls of the cavity with sterile towels. At that time some surgical instruments had been invented to keep the edges of the intestines together while suturing. In 1907 Dr. Hültl envisioned a mechanical instrument that could place rows of staples transversely in the intestines thus avoiding spillage. With the aid of Victor Fisher, a German mechanical engineer, the first surgical stapler was constructed.

This original instrument was very bulky and heavy, weighing close to 11 pounds, and used a “bicycle-chain” type of mechanism to push a crankshaft that would push the staples into the anvil to form “B” shaped staples. It placed four rows or staggered staples. This device was first used in surgery on May 9^th, 1908. A later, lighter variation of the instrument was later created, with a different crankshaft and weighing 8 pounds. Images of these instruments are available here.

Not many of these instruments were sold, but Dr. Hültl had set the stage for the development of the modern surgical stapler. Even today we still use the basic principles of his surgical stapler: “B" shaped staples, staggered rows of staples, and attention to the avoidance of leakage through the staple line. All of this makes Dr. Hültl an integral part of the history of surgical stapling.

Sources:
1. "Húmer Hültl: The Father of the Surgical Stapler" Robicsek, F.& Konstantinov, I. J Med Biogr February 2001 9: 16-19
2. “Current Practice of Surgical Stapling" Ravitch, MM; Steichen, FM, 1991.
Original image courtesy of "Surgical Stapler Museum" at www.surgicalstaplermuseum.com

Dr. Húmer Húltl

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