An incredible find in surgical stapling history

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.

You are welcome to submit questions and suggestions using our "Contact Us" form. The information on this blog follows the terms on our "Privacy and Security Statement" and cannot be construed as medical guidance or instructions for treatment.

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

"Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.

Click here for more information

Details: Published: December 20, 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.

Dr. Mark M. Ravitch

Young surgeons today use surgical staplers without a thought as to the history of the development of these surgical devices. The same is true for many who work in the medical devices (surgical staplers) industry. I have worked as a consultant and a trainer for the stapler industry both with Ethicon Endosurgery (today Ethicon, stapling division) and the United States Surgical Corporation (today Medtronic, stapling division) and developed a special interest in the medical history related to the origin, research, and development of surgical staplers.

The history of surgical stapling is quite interesting and has many characters, starting with the early works of Humer Hutl. There are whole books dedicated to this topic.

It cannot be denied that one of the main drivers of surgical stapling in the United States was Dr. Mark M. Ravitch (1910-1989). History tells us that he saw these staplers in action being used by Dr. Nikolai Mikhailovich Amosov (1913–2002) during a visit to the Thoracic Surgical Institute in Kiev in September 1958. Kiev was then part of Russia (then called the USSR).

What I did not know is that Dr. Ravitch had his notes typewritten, and those loose leaf notes are now part of my library in a binder.

The notes in this binder are the carbon copies in onionskin paper of notes typewritten personally by Dr. Mark. M. Ravitch during his trip to the USSR in September 1958. According to his family, Dr, Ravitch had notoriously bad handwriting and he liked to maintain records of his work, so he was a very fast typewriter. He used his personal typewriter and he traveled everywhere with it even during his military service in WWII.

Dr. Nikolai Mikhailovich Amosov

Cover of Dr. Ravitch's personal notes

The original notes were bound in a book (also in my collection) and gifted by Dr. Ravitch to his parents. Unfortunately, the paper he used for the originals was not acid-free and the pages in this unique book are slowly crumbling and some of them are today unreadable. Thankfully, the carbon copies are acid-free, and the pages have been carefully scanned in TIF and PDF format by David M. Klein and then placed in separate plastic sleeves for preservation in a binder that is now in my library.

After Dr. Ravitch’s parents passing, both these notes were in the library of his son, Michael M. Ravitch, Ph.D. Michael lent these notes to Dr. Felicien Steichen (1926 – 2011) , who after a time returned the notes with a letter, also included in this binder. In this letter Dr. Steichen says that these notes should be preserved for future research, even mentioning Leon Hirsch (CEO of the United States Surgical Corporation) to support this endeavor.

Michael Ravitch’s widow, Myrnice Ravitch contacted me in 2017 because of my interest in medical history and the life and work of Dr. Ravitch. She donated some books that were in Dr. Ravitch’s library. In early 2024, and with the blessing of Dr. Ravitch’s daughter Binnie and the rest of the Ravitch family, they donated these notes that are now part of the history of surgical stapling and are today part of my library.

In a separate article I will present some of the actual notes regarding surgical stapling, although these notes also include invaluable observations on medicine and surgery in the USSR and Dr. Ravitch’s comments on the Russian culture and people at the time. Keep in mind that Dr. Ravitch’s parents where Russian immigrants and he was fluent in Russian.

In the future, and following Dr. Steichen’s suggestion, I will try to publish a book with these notes along with additional notes on Dr. Ravitch’s trip to China in 1983

Note: The photograph of Dr. Asomov was taken by Dr. Ravitch, but it has since degraded, so it was enhanced using Winxvideo AI.

Note: Dr. N.M. Amosov had an incredible surgical career and recognized with medals and honors. The Institute where Dr. Ravitch saw him operate with surgical staplers is today known as the Amosov National Institute of Cardiovascular Surgery in Kiev, Ukraine.

Sources:
1. "Current practice of surgical Stapling" Ravitch, MM; Steichen, FM; Welter,W. 1991 Lea & Ferbiger USA
2. "Stapling in Surgery" Ravitch, MM; Steichen, FM.1984 Year Book Medical Publishers USA.
3. "Surgical Rounds" Edition dedicated to Dr. M.M. Ravitch May 1990
4. "Notes by Dr. Mark Ravitch on Trip to Russia - September 1958" Personal notes, unpublished.

An incredible find in surgical stapling history

Recent