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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Lateral schematic view of the peritoneal membranes. Image modified from the original by Henry VanDyke Carter. Public Domain
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The [greater omentum] is a large, fatty apron-like structure that covers the abdominal viscera inferior to the greater curvature of the stomach. It is formed by a double peritoneal layer that contains fat, vessels, lymphatics, and nerves. This double peritoneal structure is continuous with the anterior and posterior serosal layers of the greater curvature of the stomach, drapes inferiorly, sometimes all the way to the pelvis and the folds upon itself posteriorly and superiorly ascending to become continuous with the anterior and posterior serosal layer of the transverse colon. Because it folds upon itself, the greater omentum can be considered to be a four-layered structure. See accompanying image.

The greater omentum contains vessels that arise from the right and left gastroepiploic arteries and veins as well as omental (epiploic) branches of the greater curvature vascular arcade.

The left border of the greater omentum reaches to the splenic hilum, while the right border extends as far as the pylorus and inferior aspect of the first portion of the duodenum. Because of its location, covering the intestines and its apron-like structure, the greater omentum is also known as the “surgeon’s apron”.

Abdominal dissection
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The term ‘abdominopelvic ligament” has been discussed in this article. The greater omentum has several “ligament” components that stretch between abdominal viscera. They are the:

• Gastrocolic ligament: Main portion of the greater omentum extending between the stomach and the transverse colon
 Gastrosplenic ligament: The portion of the greater omentum stretching between the stomach and spleen
• Splenorenal ligament: A continuation of the greater omentum stretching from the left kidney to the spleen.

As a side note, the lesser omentum (related to the lesser curvature of the stomach) contains less fat than the greater omentum.

First image(s) modified from the original by Henry VanDyke Carter. Public Domain
Second i
mage(s) property of: CAA.Inc.Photographer: D.M. Klein