Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

William S. Halsted, MD

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, also known as  "Halsted's Rules of Surgery", 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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LAD= left anterior descending artery; lca=left conal artery; OM1= obtuse marginal artery 1; rca= right conal artery; acv=anterior coronary veins; RCA=right coronary artery 
Anterior view of the heart

 

The conus arteriosus is a conical region of the right ventricle as seen from the anterior aspect. This conical region is found between the atrioventricular sulcus on the right side and the left anterior descending artery (LAD), also known as the anterior interventricular artery. At the apex of the conus arteriosus are the pulmonary valve and the pulmonary trunk.

A short fibrous band has been described originating from the superior aspect of the conus arteriosus and the fibrous region of the atrioventricular sulcus and the base of the aorta. It is called the “conus arteriosus tendon”.

Internally the conus arteriosus is smooth-walled and is called by clinicians the “outflow tract” of the right ventricle. Because of the funnel-shape of the outflow tract and its continuation with the pulmonary trunk this area is also called the “infundibulum” of the right ventricle.

Blood supply to the conus arteriosus is by way of the conal artery. This is usually the first anterior branch of the right coronary artery

Sources:
1. “The clinical anatomy of the conal artery” Loukas, M el al. J Clin Anat 2014 DOI: 10.1002/ca.22469
2. “The Clinical Anatomy of the Coronary Collateral Circulation: Loukas, M, et al J Clin Anat (2009) 22:146–160
3. “The Normal and Abnormal Anatomy of the Coronary Arteries” Loukas, M et al J Clin Anat (2009) 22:114–128
4 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
5. "Anatomy of the Human Body" Henry Gray 1918. Philadelphia: Lea & Febiger
Image modified by CAA, Inc, Original image courtesy of bartleby.com