Genius on the edge

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Genius on the Edge

Genius on the EdgeThe life of William Stewart HalsteadJonathan McFarlandMarch 2015

The Knick: TV series

The Knick In New York City in 1900, the Knickerbocker Hospital operates with innovative surgeons, nurses and staff who have to overcome the limitations of the then-current medical understanding and practice, to prevent staggeringly high mortality rates. Dr. John Thackery.The Knickerbocker Hospital

John Thackeray ( Clive Owen) William Stewart HalsteadPreamble ..One dark and stormy night in 1882, a critically ill 70 year old woman was at the verge of death at her daughters home, suffering from fever, crippling pain, nausea, and an inflamed abdominal mass.At 2am, a courageous surgeon put her on the kitchen table and performed the first known operation to remove gallstones. (Harriet Hall)

The patient recovered.The patient was the surgeons own mother.And the surgeon was William Stewart Halstead.Short biographyBorn september 23, 1852 in New York.After graduating at Yale he entered Columbia University College of Physicians and Surgeons.Graduated in 1877.He joined the New York Hospital as house physician.Here he introduced the hospital chart which tracks the patient's temperature, pulse and respiration. Halsted then went to Europe to study under the tutelage of several prominent surgeons and scientists.Halsted returned to New York in 1880 and for the next six years led an extraordinarily vigorous and energetic life. He operated at multiple hospitals.He was extremely popular, inspiring and charismatic teacher. In 1882 he performed one of the first gallbladder operations in the United States (a cholecystotomy performed on his mother on the kitchen table at 2am).

A bit of light relief..Another family patientHalsted also performed one of the first blood transfusions in the United States. He had been called to see his sister after she had given birth. He found her moribund from blood loss, and in a bold move withdrew his own blood, transfused his blood into his sister, and then operated on her to save her life. Local anaesthesia In 1884, Halsted read a report from Karl Koller, describing the anesthetic power of cocaine when it is instilled into the eye. Halsted realized that cocaine might be an excellent local anesthetic. Having learned the scientific method when he was in Europe, Halsted, together with his students and fellow physicians, began to experiment with cocaine.

The doctor addicted They injected each other's nerves and showed that cocaine when injected into a nerve can produce safe and effective local anesthesia.Halstead became addicted to cocaine.They attempted to cure him by converting his addiction from cocaine to morphine.He remained dependent upon morphine for the remainder of his life, but continued as an innovative and pioneering surgeon Johns Hopkins Hospital, Baltimore

1899-1900Founding Fathers of Modern Medicine

The Four Doctors by John Singer Sargent, 1905,From left to right William Welch, William Halstead, William Osler, Howard KellyIn 1886, Halsted moved to Baltimore, Maryland to join his friend William Welch at the soon-to-be-opened Johns Hopkins Hospital.Halsted was the first chief of the Department of Surgery at Johns Hopkins Hospital when it opened in May 1889. He was appointed surgeon-in-chief in 1890 and became Professor of Surgery in 1892 with the opening of Johns Hopkins University School of MedicineAt Johns Hopkins, Halsted was credited with starting the first formal surgical residency training program in the United States.Osler introduced the first Medical residency. Halsteds surgical residency program consisted of an internship (the length was left undefined and individuals advanced once Halsted believed they were ready for the next level of training). Internship was followed by six years as an assistant resident and then two years as house surgeon.

Greatness can often be measured by what people learned from youAnd Halstead was a fine teacher

Halsted went on to train many of the academic surgeons of the time including Harvey Cushing, Walter Dandy and Hugh Hampton Young ( Founders of neurosurgery, and urology respectively.)

Harvey Cushing

Walter Dandy

Hugh Hampton YoungHe is also known for many other medical and surgical achievements. As one of the first proponents of Hemostasis and investigators of wound healing. He pioneered Halsteads principles, modern surgical techniques of bleeding, accurate anatomical dissection, complete sterility, exact approximation of tissue in wound closures without excessive tightness- and gentle handling of tissues.Other achievementsHalsted performed the first radical masectomy for breast cancer in the US in 1891 ( in France it had been performed previously)

Other achievements included the introduction of the latex surgical glove and advances in Thyroid, biliary tract, hernia, intestinal and arterial aneurysm surgery.

Henry Louis "HL" Menckenan American journalist, satirist, cultural critic and scholar of American English, wrote His contributions to surgery were numerous and various. He introduced the use of local anesthetics, he was the first to put on rubber gloves, and he devised many new and ingenious operations.

Humanity to surgery..But his chief service was rather more general, and hard to describe. It was to bring in a new and better way of regarding the patient. And this strongly reminds me of Osler, on the medical side, who emphasized the importance of the patient.

From Barber to scientific surgeonHe changed all that. He showed that manhandled tissues, though they could not yell, could yet suffer and die. He studied the natural recuperative powers of the body, and showed how they could be made to help the patient. He stood against reckless slashing, and taught that a surgeon must walk very warily.

Though, like most men of his craft, he had no religion, he yet revived and reinforced the ancient saying of Ambroise Pare: God cured him; I assisted.

Ambroise Pare - (c. 1510 20 December 1590) was a French barber surgeon who served in that role for kings Henry II, Francis II, Charles IX and Henry III.

Docere Above all, he was a superb teacher, though he never formally taught. DOCTOR - Middle English (in the senses learned person and Doctor of the Church): via Old French from Latin doctor teacher (from docere teach).EponymsHalsteads law transplanted tissue will grow only if there is a lack of tissue in the host.Halsteads sign a medical sign for breast cancerhalsteads suture a mattress suture for wounds Cocaine addict The title of this short biography is Genius on the edgeBecause this medical genius, who accomplished so much for science was a drug addict for 40 years of his life.Given morphine to help withdraw from cocaine, and he became hooked on both.He only worked part of the yearHe would disappear for months / to binge on cocaine.Sometimes he would leave in the middle of an operation complaining of a headache.But it is a very interesting story Provides insight into a crucial time in medicine, transitioning from superstition to science.When scientific surgery and modern medical education were born.Maybe the path the genius treads is thin.Amazing that this flawed man was able to maintain an incredibly productive scientific career for 4 decades with these addictions. And today, would this be possible?

In the series Thackeray when introducing the cocaine as a local anaesthesia says Thanks

Bibliography Genius on the Edge: the bizaare double life of Dr Willaim Stewart Halstead, by Gerald Imber William Stewart Halstead, A lecture by Dr Peter D.Olch edited by J.Scott Rankin, Annals of Surgery, 2006.The four founding physicians, Johns Hopkins Medicine.H.L. Mencken, "A Great American Surgeon," American Mercury, v. 22, no. 87 (March 1931) 383. Review of William Stewart Halsted, Surgeon, by W.G. MacCallum. [1] Mencken on Halsted.

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