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 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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Anterior view of the left scapula.  Image in Public Domain, by Henry Vandyke Carter, MD - Gray's Anatomy
Anterior view of the left scapula.


UPDATED:
The scapula is a flat, triangular bone that forms the posterior portion of the shoulder girdle. It is described with two surfaces, three borders, and three angles. The scapula attaches to the clavicle by way of the acromioclavicular joint and ligaments. . Seventeen muscles attach to the scapula and are listed here alphabetically:

1. Biceps brachii
2. Coracobrachialis 
3. Deltoid  
4. Infraspinatus 
5. Latissimus dorsi
6. Levator scapulae 
7. Omohyoid (inferior belly)
8. Pectoralis minor 
9. Rhomboid major 
10. Rhomboid minor 
11. Serratus anterior 
12. Subscapularis 
13. Supraspinatus 
14. Teres major 
15. Teres minor 
16. Trapezius
17. Triceps brachii (long head)

By surfaces, borders, and structures, these muscles group and attach as follows:

Posterior surface:
1. Supraspinatus
2. Infraspinatus
3. Teres major
4. Teres minor

Scapular spine and acromion:
5. Trapezius
6. Deltoid

Anterior surface:
7. Subscapularis
8. Serratus anterior

Medial border:
8. Serratus anterior
9. Rhomboid major
10. Rhomboid minor
11. Levator scapulae


Superior border:

12. Omohyoid (inferior belly)

Medial border:
13. Triceps brachii (long head)

External angle:
14. Biceps brachii (long head)

Coracoid process:
14. Biceps brachii (short head)
15. Coracobrachialis
16. Pectoralis minor

Inferior angle:

17. Latissimus dorsi

Note: Because the long and the short head of the biceps brachii attach to different locations of the scapula, some authors and Internet websites say that there are 18 muscles that attach to the scapula. I do not agree, as the biceps brachii is a single muscle that happens to have two separate attachments to the scapula. It would be different if this article was titled "Name the 18 separate muscular attachment points of the scapula". Dr. Miranda 

Sources:
1. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
Image in the Public Domain, by Henry Vandyke Carter - Gray's Anatomy