William Halsted

William Stewart Halsted (1852-1922) pioneered many methods of preventing surgical infection and introduced the use of general anesthesia.

In an era when more surgery patients died from bacterial infections than the illness prompting the initial surgery, William Stewart Halsted introduced new preventative methods that significantly reduced bodily infections introduced through invasive surgery techniques. His main concern was the prevention of infection through the methodical sterilization of all medical equipment, as well as pioneering efforts in the design and use of surgical gloves. More important, Halsted introduced new procedures for the handling of bodily tissues and organs that minimized trauma and infection, as well as methods to control and stop hemorrhaging. Well-versed in human physiology and anatomy, a knowledge not necessarily common nor applied in 19th-century medicine, he taught that bodily tissues that are damaged during surgery are more susceptible to infection, subsequently rendering the patient less likely to recover. He also pioneered the use of general anesthesia, which proved tremendously valuable in minimizing surgical pain for patients, which, in turn, enabled surgeons to devote more time to performing surgeries on patients prompted to move reflexively from pain.

Slow Rise to Medical History

Halsted was a descendent of Timothy Halsted, an English emigrant who came to America around 1660 and settled in Hempstead, Long Island, New York. Halsted was born in New York City to William Mills and Mary Louisa Haines Halsted on September 23, 1852. Halsted's father was the president of a textile-importing firm, Halsted, Haines and Co., and his mother came from the family of Richard Townley Haines, her husband's partner. When he was ten years old, Halsted's parents sent him to a private school. He subsequently attended Andover, graduating in 1869, and Yale University. At Yale, he distinguished himself more on the gridiron than in the classroom, serving as captain of the school's football team during his academic tenure. He purchased copies of Gray's Anatomy and John C. Dalton's Physiology during his senior year and attributed much of his subsequent interest in medicine to those two works. Following his graduation from Yale in 1874, he enrolled in the College of Physicians and Surgeons in New York City. He served as assistant professor of physiology under Dalton until his graduation with honors in 1877. That same year, he interned at Bellevue Hospital under the auspices of William H. Welch, who later became a founding member of the Johns Hopkins Medical School. He was selected later that year to establish the medical service guidelines as house physician at the recently completed New York Hospital. In 1877, English surgeon Joseph Lister visited New York and impressed Halsted with his findings on the effectiveness of antiseptic surgical methods in preventing operation-induced infection.

In 1878, Halsted embarked for Europe, spending the majority of his time in Vienna, Austria, where he spent two years studying surgical procedures, as well as embryology and histology. He returned to the United States in 1880 and became a surgeon of renown. Over the course of the next five years, he became visiting surgeon to many New York City hospitals, including Bellevue, Roosevelt, the Charity, Emigrant, Chambers Street, and Presbyterian as needed during his afternoons and oversaw the outpatient program at Roosevelt Hospital each morning. During the evenings, he taught anatomy and conducted medical classes. Throughout the 1880s, Halsted revolutionized surgical medicine in the United States. He conducted one of modern medicine's first transfusions in 1881 when his sister nearly died from a postpartum hemorrhage. He wrote: "After checking the hemorrhage, I transfused my sister with blood drawn into a syringe from one of my veins and injected immediately into hers." One year later, he successfully operated on his mother in order to remove gallstones.

In 1884, Halsted was impressed by an announcement of Carl Koller at the Opthalmological Congress in Heidelberg, Germany. Koller discovered that the entire conjunctiva and cornea area of a patient's eye could be anesthetized by injecting anesthetic directly into a nerve. Halsted subsequently began his own experiments in anesthesia. The most readily available anesthetics at the time, however, were cocaine and morphine, and Halsted succumbed to both drugs' highly addictive qualities through his experiments. For the remainder of his life, historians and biographers believe he remained addicted to morphine. He discovered, however, that an injection of cocaine into the trunk of a sensory nerve resulted in a numbing of pain in all that nerve's branches. Halsted concluded that a small amount of injected anesthetic could be used to anesthetize a wide portion of the patient's body, thereby introducing general anesthesia to modern medicine. The practice had its most widespread use in dental surgery and earned Halsted a gold medal from the American Dental Association in 1922.

A Changed Man at Johns Hopkins

By 1886, Halsted's morphine and cocaine addictions caused his surgical abilities to become dangerously unreliable, and his medical career was nearly destroyed by the time he was forced to leave New York City. He subsequently exhibited a withdrawn, reticent personality that sharply contrasted with his former outgoing self. He relocated to Baltimore, Maryland, where his former mentor, Dr. Welch, worked with him to overcome his addictions, and it is believed Welch was successful in curing Halsted of his cocaine addiction. Halsted reentered the medical profession by working in Welch's laboratory around which was built Johns Hopkins Hospital. In 1889, he was named acting surgeon and supervisor of the outpatient department at Johns Hopkins. His initial term was for one year, due to the hospital's concerns about Halsted's diminished capabilities from drug addiction. His exemplary performance resulted in a permanent appointment the following year. In 1890, he became surgeon-in-chief and married Caroline Hampton, the head operating room nurse at the hospital. Hampton had complained about the dermatitis she experienced due to Halsted's insistence that she use mercuric bichloride as a surgical antiseptic, resulting in her future husband drafting the Goodyear Rubber Company to produce surgical gloves to protect his staff. In 1892, he became the founding professor of surgery at Johns Hopkins Medical School.

Medical Breakthroughs

As professor of surgery at Johns Hopkins, Halsted instructed many students who would graduate to medical prominence, including Hugh Young, John M. T. Finney, and neurosurgery pioneers Harvey Cushing and Walter Dandy. Halsted was an ardent medical researcher, exploring new methods to operate on hernias, thyroid glands, and gall bladders and its ducts. He contributed to new procedures in intestinal sutures and treatment of tuberculosis, hernias of the groin, goiters, radical mastectomys for breast cancer, and circulatory problems, including aneurysms and surgery on blood vessels. He is admired also for establishing new procedures for training medical students, requiring that students study physiology and anatomy. His views were expressed in the article "The Training of the Surgeon," which was reprinted in the Johns Hopkins Hospital Bulletin in 1904. Halsted is credited also with changing the approach of modern medicine from its previously unrefined reputation to a more calculated manner that emphasized controlled blood loss and minimized tissue damage, which also marked his emphasis on physiological and anatomical knowledge. He was considered to be a slow and methodical surgeon, careful to not disrupt any area of the patient's body that was in close proximity to the operated area.

For the remainder of his life, Halsted traveled extensively throughout the medical capitals of Europe, visiting clinics in Germany, Austria, and Switzerland. He was an honorary member of the German Surgical Association and attended several of the group's congresses. His research and teaching made him an invaluable asset to Johns Hopkins, and he helped establish the institution as among the United States's most respected centers of medical research and knowledge. His breakthroughs in the medical use of anesthesia and antiseptics and his deliberate approach to surgery are credited as significant medical advancements. In 1919, he recovered from an operation to remove gallstones. He failed to recover from a second gallstone operation, however, and died in 1922. His medical writings, entitled Surgical Papers in Two Volumes, were published in 1924 and reprinted in 1961.

Books

American National Biography, Volume 9, edited by John A. Garraty and Mark C. Carnes, Oxford University Press, 1999.

Dictionary of American Biography, Volume IV, Part I, Charles Scribner's Sons, 1960. □

Halsted, William Stewart

(b. New York, N.Y., 23 September 1852; d. Baltimore, Maryland, 7 September 1922)

surgery.

Halsted was the son of William Mills Halsted, Jr., and Mary Louisa Haines. His grandfather and father were successful merchants in New York City, and the family occupied a prominent position financially and philanthropically. His early education included a private school in Monson, Massachusetts, and Phillips Academy, Andover, Massachusetts, prior to his entering Yale College in 1870. Halsted was a mediocre student but an exceptional athlete who first became interested in medicine in his senior year. He entered the College of Physicians and Surgeons of New York in 1874, when it was essentially a proprietary school allied to Columbia College in name only. His preceptor was Henry Burton Sands. Halsted absorbed much of the philosophy of John Call Dalton, professor of physiology, with whom he worked as a student assistant. He graduated among the top ten members of his class in 1877 and in April 1878 completed an eighteen-month period of training in the fourth surgical division of Bellevue Hospital, under the guidance of Frank Hastings Hamilton. He then served briefly as house physician at New York Hospital.

In the fall of 1878 Halsted went to Europe for two years of further study in Austria and Germany, chiefly in the basic sciences and particularly in anatomy under Emil Zuckerkandl and Moriz Holl. He attended many clinical lectures and first became acquainted with the German method of graduate surgical education which was to have a profound effect on his future. In 1880 he returned to New York City. Shortly thereafter he joined the faculty of the College of Physicians and Surgeons as a demonstrator in anatomy. He became associated with Sands at Roosevelt Hospital, where he initiated the outpatient department, and held visiting or attending positions at four other hospitals. He also established a private practice limited to surgery and a quiz session which was academically sound.

In 1884, while experimenting with cocaine hydrochlorate as a surgical anesthetic, Halsted and several of his colleagues and students became addicted. In an attempt to overcome the addiction, he was hospitalized in Butler Hospital, Providence, Rhode Island, for six months in 1886 and for nine months in 1887. This illness ended his professional career in New York City, and he moved to Baltimore, Maryland, to work in the laboratory of William H. Welch, professor of pathology at the Johns Hopkins University, in December 1886. When he had apparently regained his health and the authorities of the Johns Hopkins Hospital (and later the Johns Hopkins Medical School) were convinced of his capabilities and reliability, he was appointed surgeon in chief to the hospital in 1890 and professor of surgery in 1892. The question of Halsted’s drug addiction and his apparent cure have been discussed for years. William Osler’s “The Inner History of the Johns Hopkins Hospital” confirms that Halsted was treated for morphine addiction as late as 1898.

In New York City before his illness Halsted was an aggressive and extraordinarily active surgeon who was rapidly rising in the ranks of the gifted surgical specialists. His career in Baltimore was that of a thoughtful, painstaking operator who returned to the laboratory to study a succession of basic problems in surgery. In a sense he left the path of Sands and Hamilton to follow a career more akin to that of his former teacher John C. Dalton.

Halsted’s important contributions included the development of neuroregional anesthesia through his cocaine experiments, a technique he used with some hesitation in future years because of his personal experience and for which he received no credit until shortly before his death; a radical operation for carcinoma of the breast, which incorporated certain modifications and improvements on the radical procedures developed by others; a radical operation for the treatment of inguinal hernia; physiologic studies of the thyroid and parathyroid glands and a technique for thyroidectomy; and the surgical treatment of vascular aneurysm. More important was the methodical manner in which he approached any surgical problem. Whether in the laboratory studying basic problems of the care and handling of wounds or at the operating table or bedside, his scholarly and painstaking approach was a model for many, although an annoyance to those surgeons who felt dexterity and rapidity were the hallmarks of greatness.

Halsted was an excellent teacher of the exceptional student and resident but devoted little time to others. Those selected few residents who trained under him for seven years or more were given complete patient responsibility, a significant alteration of the German system enthusiastically adopted by Halsted. This system of residency training is a major contribution of the Johns Hopkins Hospital to American medicine. Halsted felt that the leading surgeons in Germany, Austria, and Switzerland were the world’s finest, and he made frequent trips to their clinics. Although often considered a classic example of the salaried, full-time clinical professor, he was in fact a public supporter of the geographic full-time system (salaried position supplemented by private fees) and had a modest but lucrative private practice prior to the institution of full-time clinical chairs at Johns Hopkins in 1914.

Halsted’s meticulous nature and search for perfection in surgery were mirrored in his personal life, particularly in matters of dress and cuisine. To the majority of his colleagues he was cold and reserved, avoiding social intercourse whenever possible. To a few intimate friends he was warm and exceedingly hospitable, and displayed a rich sense of humor. He rebelled against his strict Presbyterian upbringing and was an agnostic in his adult life. In 1890 he married Caroline Hampton, a niece of Wade Hampton III of South Carolina. She was formerly the chief nurse in his operating room. They had no children. Following his marriage he retired to his estate, High Hampton, in Cashiers Valley, North Carolina, for a portion of each summer. In 1919 he underwent cholecystectomy, but in 1922 he had another attack of jaundice and pain that required an operation. He died the day after he had undergone surgery.

BIBLIOGRAPHY

I. Original Works. Halsted’s major publications appear in Surgical Papers by William Stewart Halsted, W. C. Burket, ed., 2 vols. (Baltimore, 1924; repr. 1952).

Halsted’s papers are preserved at the Welch Medical Library, Johns Hopkins University.

II. Secondary Literature. The most complete biography available is William G. MacCallum, William Stewart Halsted, Surgeon (Baltimore, 1930). An interesting view of Halsted is also found in George W. Heuer, “Dr. Halsted,” in Bulletin of the Johns Hopkins Hospital, 90, supp. (1952), 2. A detailed review of his career in New York City is found in Peter D. Olch, “William S. Halsted’s New York Period, 1874–1886,” in Bulletin of the History of Medicine, 40 (1966), 495–510. Osler’s candid comments about Halsted are found in William Osler, “The Inner History of the Johns Hopkins Hospital,” in Johns Hopkins Medical Journal, 125 (1969), 184–194. Another biographical sketch that includes biographical notes about his colleagues is Samuel J. Crowe, Halsted of Johns Hopkins: The Man and His Men (Springfield, Ill., 1957).

Peter D. Olch