Chronology (http://www.medicalarchives.jhmi.edu/halsted/hbio.htm)

  1. 1. Born September 23, 1852 to wealthy family in New York City
  2. 2. 1870-1874 Attends Yale college, although he is apparently not a serious student and is noted for never having checked out a book from the Yale library.
  3. 3. 1873- the Yale-Eton football game- first football game with 11 players. Halsted is the captain of the Yale team and scores the winning goal.
  4. 4. 1874-1877 Halsted returns to Manhattan and attends College of Physicians and Surgeons Medical School in New York City. At this time the school was located in a four-story building at the corner of 23rd street and 4th avenue. The first floor was rented for business purposes, the second floor was occupied by a lecture room, chemical laboratory and offices, the third floor contained an anatomic museum, the amphitheater, which could seat 300, and the 4th floor was the general dissecting lab with 25 tables. Halsted is socially confident, at ease and a leader. He is also a serious student, excelling in his studies. He decides to take the exam for internship (house physician) a year early. Most of the students stay in town, over study to the point of exhaustion, with some even "bracing up on strychnine and quinine during the hot weather". Halsted goes to Block Island where he studies and also relaxes. He returns to New York City. The others taking the exam are pale and tired; he is tan and rested. He does so well he is awarded an internship a year early. Halsted graduates at or near the top of his class. During this year Lister visits the USA from England preaching antisepsis, few, with the exception of Halsted, listen.
  5. 5. 1877-1878 House Physician at Bellevue, then New York Hospital. Develops modern hospital bedside chart that traces pulse, temperature and respiration to track patient vital signs. During the end of this year he meets the pathologist Dr. William Welch. They would become close friends.
  6. 6. 1878-80. Travels abroad to get more training in Europe. Vienna (studies under Chiari in Pathology, Schneck in embryology, Surgery under Billroth and Braun- makes friends with Bilroth's assistants Mikulicz and Woelfler), Würzburg (embryology with Kolliker and histology with Stoeher and surgery with von Bergmann), Hamburg (surgeon Schede), and Kiel (under Esmarch).
  7. 7. 1880-1886. "New York period"- Most vigorous period of his life- "indefatigable with great energy." Dr. Halsted is on the staff at Roosevelt hospital (where he ran the outpatient department with the assistance of Richard Hull and Frank Hartley and operated several mornings a week), Bellevue (where they built him a special tent-like structure so that he could perform surgery using the technique of antisepsis), Presbyterian (visiting staff), and Chambers Street Hospital. Dr. Halsted is also on the faculty at College of Physicians and Surgeons as a demonstrator of anatomy, a visiting physician at the Charity Hospital on Blackwell's Island, and Chief of Surgery at Emigrant Hospital on Ward's island. Described as bold, daring and original. Because he was so over committed, Dr. Halsted's surgery at Charity Hospital was generally performed at night.
  8. 8. Treated Lamp-lighters disease (carbon monoxide poisoning) at Chambers Hospital by taking blood out from the patient, aerating it (shaking it) and returning it to the patient.
  9. 9. He also ran a private "quiz" for 65 students (together with George Munroe and Austin Flint Jr)- students were taken on ward rounds, given lectures, as well as anatomic and pathologic demonstrations by Dr. Halsted. Dr. Halsted was described as "inspiring and charismatic teacher,"and his students do very well. His private class went to his office 2 nights a week at 9 o'clock where they were quizzed until 11 or 12 o'clock.
  10. 10. Lived with an intern Thomas McBride on East 25th Street (between Madison and 4th Ave). They entertained other young professionals several nights a week with dinner parties, musicals, plays and lively discussions. Dr. Halsted is described as "A model of muscular strength and vigor, full of enthusiasm and the joy of life".
  11. 11. 1881- Dr. Halsted is only 29. His sister had delivered her first baby and severe hemorrhage followed. When other physicians despaired of saving her life, Dr. Halsted took over. He managed to check the hemorrhage, but blood loss was so great it was clear that death was near. Plunging a syringe into his own arm he gives her a direct blood transfusion of his own blood. This is probably the first transfusion in the US. His sister recovered.
  12. 12. 1882- A year after the episode with his sister, Dr. Halsted's mother was desperately ill. Arriving at the scene in the middle of the night, Dr. Halsted finds her jaundice with tenderness over her gallbladder. He correctly diagnosed an infected gallbladder. Working by lamplight at 2am he drains the pus from his mother's gallbladder and removes 7 stones. This is one of the first gallbladder surgeries performed in the US.
  13. 13. September 15, 1884, in Heidelberg Germany, at the meeting of the German Ophthalmological Society Dr. Joseph Brettauer reads a paper for Dr. Carl Koller of Vienna describing experiments to anesthetize the eye with cocaine hydrochlorate. Dr. Noyes of NY is present. October 11, 1884 Halsted reads a paper in the Medical Record in which Dr. Henry Noyes reports the work of Carl Koller - "It remains, however, to investigate all of the characteristics of this substance. We may yet find that there is a shadow side as well as a brilliant side to the discovery"
  14. 14. 1884- Halsted realizes the importance of Koller's work- If cocaine could block the nerves in the eyes, why not the nerves elsewhere in the body? Dr. Halsted conducts a series of experiments on himself, his medical colleagues and medical students. They found that they could induce local anesthesia by injecting cocaine into nerves. Tragically, they all become addicted and all die except for Dr. Halsted and Richard Hall who moved to Santa Barbara, California. Dr. Halsted publishes an article in New York Medical Journal on cocaine-it contains one of the most discombobulated sentences ever published. "Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than the belief that an opportunity existed for assisting others to an appreciable extent, induced me, several months ago to write on the subject in hand that greater part of a somewhat comprehensible paper, which poor health disinclined me to complete".
  15. 15. February and March 1886, in an apparent attempt to cure himself, Dr. Halsted takes a trip on a sailboat to the Winward islands. He brings along only half the cocaine he would need. Hecannot bear it and breaks into the captain's cabinet and steals cocaine.
  16. 16. May- December 1886 – at the urging of his father, younger brother Richard and Dr. Welch, Dr. Halsted is admitted to Butler Hospital (in Providence Rhode Island) as "William Stewart" for treatment of his addiction. During the course of his treatment he becomes addicted to morphine.
  17. 17. December 1886- Dr. Halsted joins William Welch in Baltimore where he conducts research in Welch's experimental lab. Dr. Halsted works with the anatomist Franklin Mall and together they develop the intestinal suture. It had been thought that you should sew through the thick muscular layer of the intestine. They found that the submucosal layer is where the sutures hold best. Dr. Halsted goes to Harvard Medical School and gives a talk in which he demonstrates this in dog intestine. Uses fresh dog intestine, sutures it, then pulls hard. Sutures in the submucosa hold. This advance forms the basis for modern intestinal surgery.
  18. 18. 1887- returns to Butler Hospital for nine months of treatment (March to December).
  19. 19. 1888- returns to Johns Hopkins where he continues his laboratory experiments and begins seeing patients
  20. 20. 1889- Johns Hopkins Hospital opens. Dr. Halsted is appointed Surgeon in Chief to the Dispensary, Acting Surgeon to the Hospital, Associate Professor
  21. 21. 1890- Dr. Halsted is made the Surgeon-in-Chief of the Hospital, and he marries his scrub nurse, Caroline Hampton.
  22. 22. 1892- Dr. Halsted is promoted to the rank of Professor.
  23. 23. 1893- He becomes Chairmen of the Department of Surgery.
  24. 24. 1889-1922- "the Baltimore period"- Dr. Halsted's accomplishments include:
    • His consuming interest was scientific surgery- he wanted to know how wounds heal, how infection could be minimized
    • Hernia repair- Halsted spent months in the lab before he found the method of overlapping tissues, and adding other refinements that made a firm closure.
    • Breast cancer surgery- removes the breast in a single block all of the tissues- the breast, portions of the muscle under the breast, and lymph nodes, closing the incision by grafting skin from the thigh.
    • Bile duct surgery
    • First surgeon to resect a periampullary cancer
    • Repair of subclavian artery aneurysm- treats a patient with a large aneurysm extending above his shoulder
    • First to useof the buried plate and screws technique for fixing long bone fractures
    • Thyroid and parathyroid surgery- Previously most operations on the thyroid resulting in the patients bleeding to death (because of the rich blood supply in the neck). Dr. Halsted's lab work convinced him it could be done safely provided extreme care was taken to tie off all of the vessels.
    • Surgical gloves- Dr. Halsted developed the idea for surgical gloves because his wife, who was his scrub nurse, had a skin reaction to the carbolic acid used to clean the instruments. He writes to the Goodyear Rubber Company and they send him rubber gloves in 1889. Six years later Dr. Bloodgood then suggested that they all wear them.
  25. 25. Dr. Halsted was an immaculate dresser, he ordered his suits from London, he sent his shirts to Paris for laundering.
  26. 26. Other surgeons at this time performed rapid surgery even though general anesthesia had been introduced years before. Dr. Halsted develops the philosophy of "safe" surgery. This is characterized by the gentle handling of tissue, the reapproximation of tissue planes, avoidance of dead space, and meticulous care. "He had an extraordinary gentleness in his handling of the tissue".
  27. 27. Dr. Halsted is extra-ordinarily focused during surgery. "Would you mind moving a little?" he said to one of his assistants in the operating room. "You've been standing on my foot for the last half hour".
  28. 28. Charles Mayo (co-founder of the Mayo clinic) visits Johns Hopkins and comments- "Watching Halsted operate was the first time I ever saw the upper half of an incision heal before the lower end was closed."
  29. 29. A scientist, Dr. Halsted wrote "It is now, as it was then, and as it may ever be, conceptions from the past blind us to facts which almost slap us in the face", "how blind we are, and how blind we will ever be."
  30. 30. Introduced modern residency training of 8 years. He encouraged his residents to do research.
  31. 31. Dr. Halsted was opposed to surgeons marrying young- "Goetsch" he said, "Can you imagine a situation such as this: It is five o'clock and you are in the laboratory at work on a problem that will occupy you far into the night. The telephone rings. It is your wife saying that you are expected for dinner as guests are coming. Goetsch, can you imagine?"
  32. 32. Dr. Halsted vacationed at his summer home- "High Hampton" in North Carolina which was named after his wife's side of the family.
  33. 33. September 1919, Dr. Richard Follis, Dr. Halsted's former resident performs a cholecystectomy and choledocholithotomy on Halsted. Dr. Halsted gets relief, but the pain and jaundice come back in fall of 1921.
  34. 34. September 1922- Dr. Halsted became jaundiced in North Carolina. He delays treatment and arrives at Hopkins deathly ill. He telegraphs ahead and asks that Drs George Heuer and Reid be summoned from Cincinnati to operate on him. Heuer had been Halsted's Chief Resident and on the faculty at Hopkins before he went to Cincinnati to head the program there and Reid was Heuer's right hand man. Despite the successful removal of several common duct stones, Halsted developed gastrointestinal bleeding. His residents try to save his life by transfusing their own blood into him. Despite these efforts he dies on September 7th, 1922.