The interesting story of “Sutures in Ancient Surgery” (2)

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A Moment in History

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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Details: Published: April 29, 2024

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.

Folder of "Sutures in Ancient Surgery"

This article is the continuation of The interesting story of “Sutures in Ancient Surgery” (1).

3. The content of the publication, images, and controversy

Each tableaux vivant depicted a scene of history of surgery, with a short description of the individual and their accomplishments. In general, these descriptions are accurate, but very short. The objective was to allow the doctor to read the text, admire the image and leave time for the medical representative to deliver their presentation of a particular product.

Each page was printed in black and white, on a high quality paper measuring 12 by 9 ¼ inches. The paper itself was originally lightly yellowed to denote that this was an historical image. In fact, many doctors believed that these were reproductions of antique paintings, which they were not! The image itself was 6 ½ by 5 ¼ inches.

In some images it is clear that the background was painted. In fact, the image of Hyeronimus Fabricius Ab Aquapendente (157-1619) published in 1927, shamelessly copies part of the background of the 1555 title page of the Fabrica of Andreas Vesalius (1514-1564), or one of the many plagiarisms of the same book.

The controversy today lies with a number of women depicted with their nude breasts. In one case, (“Aspasia”, published in 1933) the photograph depicts five women including Aspasia, all of them showing a naked breast. Although “Sutures in Ancient Surgery” is criticized for this easy depiction of nudity, only 30% fall in this category.

Adding Aspasia of Miletus to this collection of physicians also brought criticism, not only for the nudity, but for the fact that Aspasia is a legendary figure whose life is in question as well as her place in Greek society. Some say that she was a prostitute and the regent of a house of ill repute, other say that she was a teacher of philosophy along with Socrates and that she was married to Pericles. Others say that she never existed, yet her name and life has been used in a novelized two-tome book. Why was she selected for this collection? No one knows.

Following are some images from "Sutures in Ancient Surgery".

Pierre Pigray (d.1613)

Walter Herman Ryff

Fabricius Ab Aquapendente (1537-1619)

Yasuhoi Tambu (c. 980 A.D.)

4. Missing prints

Because these prints were presented as loose-leaf items to the doctors, many of them have been lost. Some historians comment that doctors would frame these images and use them in their offices, so a complete collection of the 83 photographs is extremely difficult to find. In once case, it is known that a hospital had the complete collection framed in one of its hallways (Sobieszek, 1988) which hospital, or what happened to that collection is unknown.

Today, the “Sutures in Ancient Surgery” folders found for sale in antique libraries have a varying number of prints, all of them incomplete. Some universities list them in their libraries and in one case, they have only three prints in their collection!

My research has been able to find the names of 76 of the tableaux vivants in this collection, but I have not been able to find the names of seven of these prints.

The folder that I received from Jack Kennedy contains 75 prints, and I am looking for the last eight including that of Teodorico Borgognoni, year of printing unknown.

If you have any or know of someone that owns a few in this collection, please contact me. I prepared an PDF file with the prints I have as well as those I do not. You can download it here.

Once again, thanks to Jack Kennedy for his addition to my collection. It has been an interesting research and I look forward to the next one!!

Sources:
1. UConn library Archives and Special Collections: Davis and Geck company records.
2. SNAC-Social Network and Archival Context: Davis and Geck Company.
3. “Soak it up: Examining bioabsorbable polymers in healthcare” Medical Plastic News
4. “The striking social tableaux vivants of Lejaren à Hillier” J.T.H. Connor. Hetkoen International
5. “Photography view; when tableaux vivants flowered in the magazines” Gene Thorton. The New York Times. March 2, 1986.
6.” Tableaux Vivants: A Long History of Recreating Art” Karolina Dzimira-Zarzycka. Daily Art May 1, 2020
7. “Medical History’s Moment in Art Photography (1920 to 1950): How Lejaren à Hillier and Valentino Sarra Created a Fashion for Scenes of Early Surgery” Journal of the History of Medicine and Allied Sciences, Volume 72, Issue 4, October 2017, Pages 381–421
8. “Aspasia” Wiki,org
9. “The Art of Persuasion: A History of Advertising Photography” Sobieszek, Robert A. 1988
10. “Aspasia” A Romance of Art and Love in Ancient Hellas” Mary J Safford German) Robert Hamerling (Translator) 1882. NY. W.S. Gottsberger, Publisher.
11. “Lejaren A. Hillier Photography Collection” University of Texas, Harry Ramson Center.

The interesting story of “Sutures in Ancient Surgery” (2)

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