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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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.

Image of the Annotated Fabrica 
Annotated Fabrica

Everybody has the hope of someday finding a treasure, and we look for it in garage sales, antique shops, anywhere and everywhere. As a book collector, I live for the day when I find a precious book that has been overlooked and that I can add to my collection. This is the story of such a find by a book collector who not only found the treasure, but sold it!!.

No one knows exactly how many copies were printed of Andrea Vesalius' magnificent book “De Humani Corporis Fabrica, Libri Septem”. It is estimated that each run of the first (1543) and second (1555) editions were between 600 -1000 copies, maybe less.  The censuses on the surviving copies of this book published by S. Joffe, MD and V. Buchanan in 2015 tell us that less than 60 copies of each of these books exist in the USA, and the total worldwide number is unknown.

Most of the books available today are in rare book repositories at university libraries, and only a few are available to private book collectors.

The price for a good copy today is close to half a million US dollars (or more). Although some copies can be found for less, they are probably not original, and could be one of the many plagiarized copies of this wonderful book.

In 2007, Vancouver pathologist and book collector Dr. Gerard Vogrincic bought a Fabrica at auction in Germany. This was not the best copy of the Fabrica. The index (an important part of the book, as it was the first anatomy book to ever have one) was missing, but most important, the book text was heavily underlined and annotated; some paragraphs were crossed out with ink, and over one thousand annotations were found on the sides of the pages, as well as in the images, a critical part of this book and the reason for its fame. As a result, the price at the auction was not too high, as it sold for US$14,256.

A careful revision of the handwritten notes led Dr. Vogrincic to believe that the notes may have been written by Vesalius himself, but he had no idea of how to confirm it and he could not read Latin, the language of the annotations. There are only a few examples of Vesalius’ handwriting, as Vesalius burned many of his notes and letters, and only some survived. Dr. Vogrincic obtained a facsimile of one of Vesalius’ letters and was surprised that indeed the writings matched!

Dr. Vogrincic contacted Dr. Vivian Nutton, Emeritus Professor at the UCL Center for the History of Medicine in London. Dr. Nutton, a Latin scholar and Vesalius expert confirmed that this was a book that not only belonged to Vesalius, but that the handwriting, and the style of the Latin annotations was Vesalius'!. The book includes corrections to the style, grammar, anatomy, images, and also instructions for a third edition that was never published.

For a time, the book was on a "permanent" loan at the Thomas Fisher Rare Book Library in University of Toronto, Canada, part of a 2015 exhibit, and was an important addition to the translation and annotations for the “New Fabrica” authored by Drs. M. Hast and D. Garrison. The New Fabrica is now out of print.

In 2022, toward the end of the COVID pandemic,  the University of Cincinnati and the Henry R. Winkler Center for the History of the Health Professions, held an online and in-person exhibit and series of lectures entitled  "The Illustrated Human: The Impact of Andreas Vesalius". One of the lectures was on the Annotated Fabrica. You can watch the whole lecture and interview with Dr. Gerard Vogrincic and Dr. Vivian Nutton here. Here is the link for "The Illustrated Human online exhibit".

Following is a YouTube video by Philip Oldfield, curator of the Thomas Fisher Rare Book Library in University of Toronto, Canada, talking about this book

This book was sold on February 2nd, 2024 on auction at Christie's New York, for the incredible sum of 2.23 million US dollars. his is one of the top 10 highest amounts of money ever paid for a book. The link posted here will take you to the auction page and 17 images and a video by Christie's curator Rhiannon Kohl.  

It is only fitting that the buyer of the Annotated Fabrica was non other than the University of Leuven, in Belgium, which is the first University that Vesalius attended. In fact, one of the most treasured documents of this University (until now) was the book where Vesalius signed when he matriculated at the University of Louvain (Louven) on February 25, 1530, at 15 years of age. He signed this registry as "Andreas Vesalius Bruxellensis". I had the opportunity of seeing this document personally in 2003.

My personal thanks to my good friend Ron Blumenfeld, MD, world traveler, collector, and author of the book "The King's Anatomist, The Journey of Andreas Vesalius" for bringing this auction to my attention.  He also posted an article about this auction titled "Five Centuries Later, Andreas Vesalius Flashes His Star Power". 

Another article on this topic was published by New Atlas titled ""Bookfind of the century" sells for $2.23 million"

Sources:
1. “The annotated Vesalius” Duffin, J; Duffin, J. CMAJ (2014) 186:11, 856-857
2. “A Clever Collector Makes an Astonishing Discovery” Vogrincic, Click here for the article
3. “Vesalius Revised. His Annotations to the 1555 Fabrica” Nutton, V. Med. Hist. (2012), 56(4), 415–443 Click here for the article
4. “Updated Census in USA of First Edition of Andreas Vesalius’ ‘De Humani Corporis Fabrica’ of 1543” Joffe, SN; Buchanan V. International Archives of Medicine; 2015: 8:1
5. “An Updated Census of the Edition of 1555 of Andreas Vesalius’ De Humani Corporis Fabrica in the United States of America” International Archives of Medicine; 2015: 8:1
6. “Vesalius’ notes for unpublished edition of De Fabrica” Click here for the website 
7. "A Spectacular New Arrival" Oldfield, P; The Halcyon, Issue 49, June 2012 Click here for the article
Note: This article was originally published in 2017, and has been updated several times, in 2019, 2022, and 2023. This is the last version (for now).