William Stewart Halsted: Surgical pioneer

Halsted’s skills as both a surgeon and an innovator placed him at the center of many important medical breakthroughs of his time.

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 rubber gloves.

Halsted’s 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 Halsted’s 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.

Privileged roots

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. Halsted’s 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. Halsted’s 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 patient’s 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.

Fall from grace

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.

Return to medicine

After his release from rehabilitation, Halsted accepted an offer from an old friend, Dr. William Welch, to relocate to Baltimore. There he worked in Welch’s 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. Halsted’s 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 training.

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. 1997;225:445-458.
• Dumont A. Halsted at Bellevue: 1883-1887. Ann Surg. 1970;172:929-935.
• Rankin J. William Stewart Halsted: a lecture by Dr. Peter D. Olch. Ann Surg. 2006;243:418-425.