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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By Maurits Biesbrouck, MD. Continued from "Andreas Vesalius’ fatal voyage to Jerusalem (1)".


Charles Donald O'MALLEY, Andreas Vesalius of Brussels 1514 1564, Berkeley and Los Angeles: University of California Press, 1964, 8°, XV-480 pp
Front cover of C. D.O'MALLEY,
Andreas Vesalius of Brussels 1514 1564,


Many other letters of Languet, in that period, to his friends and acquaintances were published but surprisingly in none of them he repeated the story, just as if it was of no importance (or even wrong) (4). We found it not even in his Historica descriptio susceptae a caesarea maiestate executionis... (Aug. 1567), in a copy of which North found his manuscript on the first flyleaf. In his biography of Hubert Languet the French biographer Henri Chevreuil found no mention of it either (5). The overall impression is that this short message is not more than a gossip written by Languet as a fait divers, perhaps who knows somewhat light-hearted after a couple of glasses on that first day of the new year. Apparently Languet didn’t believe in the story himself as he begins with the words ‘Fama est…’ (Rumour has it…) and he continues with the remark that the story with the direct motive for his Jerusalem travel is a remarkable (mirabilis) one. His letter concerns only that motive, thus things that happened some twelve months before, and were not at all very recent. He gives no details on Vesalius’s death itself. Languet and Peucer knew each other well. That same year 1565 Languet returned to Germany after a mediation of Peucer, but later on he returned to France (6). In any case it can not be regarded as a genuine letter, as such writings, for obvious reasons, normally treat on different subjects and are considerably longer. C.D. O'Malley, who gives an English translation too, calls this story "wholly unacceptable" (7).

The best and most detailed account of Vesalius’s last months is indeed to be found in O’Malley’s biography, but he was apparently not yet aware of the letters found by Barón Fernández. Yet it represents the first proper attempt to distinguish truth from fabrication. O’Malley was convinced that the ulterior motive behind Vesalius’ journey to Jerusalem was to escape the Spanish court and take up for a second time the chair in anatomy in Padua, which had fallen vacant, as a result of the death of Gabriele Falloppio, well before Vesalius’s departure.

The letters found by José Barón Fernández

After the congress of 1962 José Barón Fernández, a Spanish pediatrician, published his discovery of the four relevant letters, that he came across in the archives of Simancas (Spain), also in his Vesalius biography of 1970 (8). They were:

• a letter from the king of Spain to Garcihernandez, at his embassy in Venice;
 an answer from his ambassador ad interim;
 followed by an additional letter; and
 a letter from Bonifacio de Ragusa, custodian in Jerusalem, also addressed to the king (9).

Each of them concerns Vesalius’s trip to the Holy Land, a journey or pilgrimage, which was the subject of so much speculation.

Letter 1: from Philip II to Garcihernandez

This first letter is thus from Philip II, son of Emperor Charles V, and king of Spain, and is addressed to Garcihernandez, secretary to his ambassador, who was temporarily in charge of the Spanish embassy in the then powerful and wealthy Republic of Venice. The letter was written in Monzon, in Aragon, and dated January 1564. It reads in translation:

“ … Doctor Vesalius, who gives you this [letter], was the physician of the Emperor, my late father, and is now the same for me. He served his Majesty and likewise serves me, so that I have now very willingly allowed him and granted him permission, to travel to Jerusalem and visit the Holy Sepulchre of our Redeemer, in which he is motivated by piety. With my grateful consent, I expressly urge you, to help him on his way, so that he has a good passage, and to give him every help and assistance, …, so that he may swiftly travel there in safety, and remain there for as short a time as possible, in order that he may return with the same speed, so as to resume his service to me. Kindly encourage him to do this on my behalf. Monzon, January 1564.” 

So, the king stresses that he gave Vesalius the permission to travel, and that the motive was his pious desire to visit the holy places. The Spanish ruler asks his ambassador to provide Vesalius with the necessary facilities for his journey, and to guarantee his safety, and also to ensure that he returns as soon as possible, in order to resume his service at the royal court.


Article continued here: Andreas Vesalius’ fatal voyage to Jerusalem (3).


Sources and author's comments:
4. Huberti Langueti Epistolae ad Joachimum Camerarium Patrem et Filium, Lipsiae et Francofurti, Mauritius Georgius Weidmannus, 1685. Also The Correspondence of Sir Philip Sidney and Hubert Languet, London: William Pichering, 1845. And Hubert Langueti ... Epistolae secretae ad principem ... Augustum Sax. Ducem ..., Halae Hermunduror., J. F. Zetler  en H. G. Mussellus, 1699
5.Henri CHEVREUIL, Hubert Languet, Paris: L. Potier, 1856.
6. Oscar SCHOLTZ, Hubert Languet als kursächsischer Berichterstatter und Gesandter in Frankreich wärend der Jahre 1560-1572, Halle: Hermann Gesenius, 1875, 62 pp.
7. Charles Donald O'MALLEY, Andreas Vesalius of Brussels 1514 1564, Berkeley and Los Angeles: University of California Press, 1964, 8°, XV-480 pp.; see p. 304.
8. BARON FERNANDEZ, José. Andrés Vesalio: su vida y su obra, Madrid, Consejo Superior de Investigaciones Cientificas, Instituto “Arnaldo de Villanova”, 1970, 8°, XIX-312 pp., ill.; see pp. 234-248.
9. Ragusa is Italian for Dubrovnik in Croatia.