William Stewart Halsted was a true medical renaissance man. His
innovations in medicine during the late 19th century are still influencing how
medicine is practiced in the United States, more than a century after the
height of his career.
Among his numerous accomplishments, Halsted was fundamental in the
formalization of a training system for surgeons in the United States. He also
performed early biliary tract operations, introduced the plate and buried screw
technique for long bone fractures and started the practice of operating with
Halsteds thorough performance as a surgeon and his attention to
patient conditions were out of step with rough-and-tumble, rapid surgical
methods of the time.
William Stewart Halsted
Source: Johns Hopkins Medicine
Although Halsteds career was decorated with numerous achievements
and advancements in surgical practice, his pioneering work with local and
regional anesthesia served as both a crowning achievement and a bane that would
follow him the rest of his life.
Halsted was born in New York City in 1852. He was the first of four
children born to Mary Louisa Haines and William Mills Halsted Jr. He grew up in
affluent surroundings and attended boarding school at Andover. After graduating
from Andover in 1869, he spent a year of preparatory study at home before
matriculating at Yale University. Halsteds interest in medicine began in
earnest after reading medical texts during his tenure at Yale.
Halsted enrolled in the College of Physicians and Surgeons in New York
following his graduation from Yale in 1874. Although he was a mediocre
undergraduate student, Halsted showed great promise at the College of
Physicians and Surgeons. Halsteds aptitude for medicine propelled him to
an early internship at Bellevue Hospital, and following graduation, he became
house physician at the New York Hospital.
During his time at the New York Hospital, Halsted developed the idea of
a patient chart: a system for monitoring a patients respiration,
temperature and pulse. After one year, Halsted traveled to Europe to continue
his studies, and in 1880, he returned to New York and became a demonstrator of
anatomy at the College of Physicians and Surgeons. Between 1880 and 1886,
Halsted was at the height of his career. He maintained his own private practice
and started tutorial sessions for students.
Halsted expanded on many of the ideas and techniques he learned while
abroad, such as antisepsis and anesthesia. He soon began performing surgery in
own his custom-built domed structure to further his concepts of antisepsis.
During the same time, Halsted helped develop the outpatient department at
Roosevelt Hospital and assisted physicians at numerous other hospitals.
In 1883, Halsted was appointed visiting surgeon to Bellevue Hospital.
During his time at Bellevue, he made modifications to the Volkmann splint.
Although details regarding the type of changes Halsted made to the splint are
not available, he described the modifications at a New York Surgical Society
meeting in February 1883.
In the fall of 1884, Halsted read an article regarding a demonstration
of the anesthetic potential of a cocaine solution on the cornea and conjunctiva
when placed in the eye of a patient. Sparked by these reports, Halsted and
numerous colleagues soon began to experiment with the application of cocaine as
an anesthetic. His trailblazing discovery was that cocaine could be used to
numb almost all the peripheral nerves in the body during surgery.
A consequence of these experiments was that Halsted and several
colleagues became addicted to cocaine. Halsted was one of only two who survived
the ordeal. In the spring of 1886, Halsted entered a rehabilitation facility at
a hospital in Rhode Island where his treatment included substituting morphine
for cocaine. With drug dependency hampering his career, Halsted resigned from
Bellevue in 1887.
After his release from rehabilitation, Halsted accepted an offer from an
old friend, Dr. William Welch, to relocate to Baltimore. There he worked in
Welchs laboratory and developed his technique of anchoring intestinal
sutures in the submucosal layer.
Halsted was named associate professor of medicine, surgeon in chief to
the dispensary and acting surgeon to Johns Hopkins Hospital when it opened in
1889. He was named surgeon in chief to the hospital and appointed professor of
surgery in 1892.
During his tenure at Johns Hopkins, Halsted published his work regarding
surgical treatment of vascular aneurysm, improved on the technique for
thyroidectomy, made further developments to the operation for carcinoma of the
breast and developed the Halsted operation for treating inguinal hernia.
It was also at Johns Hopkins that Halsted implemented a system in which
clinicians were trained as both surgeons and academics this helped to
raise the standards of instruction through advancements in the operating room,
the lab and the classroom. Halsteds concept of a residency-training
program that made the resident the focal point soon filtered to other
institutions across the country, helping to solidify a standard for medical
In 1919, Halsted underwent gallbladder surgery, but later suffered a
relapse. Halsted died in Baltimore in 1922 due to postoperative complications
following an operation to remove residual gall stones. Halsted held his
position as professor and chairman of the department of surgery at Johns
Hopkins University and chief of surgery of Johns Hopkins Hospital until his
death. by Paul Burress
For more information:
- Cameron K. Our surgical heritage. Ann Surg.
- Dumont A. Halsted at Bellevue: 1883-1887. Ann Surg.
- Rankin J. William Stewart Halsted: a lecture by Dr. Peter D. Olch.
Ann Surg. 2006;243:418-425.