Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

William S. Halsted, MD

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles, also known as  "Halsted's Rules of Surgery", set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov


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Heart model - LAO cranial view [UPDATED] The term [atrium] is Latin, its plural form is [atria]. The atrium was the center hall of a Roman home, around which the rest of the rooms opened. Since the atrium was the first area of the house that was entered once passing through the front door, the term [atrium] has been used to describe the "entrance hall', such as the atrium of a hotel. The atria are the two superior chambers of the heart. (see image, items "A=right atrium" and "B=left atrium")

An interesting question is why are the atria called so, since they are part of the heart, and not just the entrance?. The reason is that early anatomists considered the heart to be composed only by the ventricles. The atria were then chambers where blood would wait before entering the "heart proper", ergo [atria].

Each atrium has a smooth wall (sinus venarum) and a muscular extension akin to a closed-end bag. These are the atrial appendages or auricles. Anatomically they are quite different. The right atrial appendage communication or opening to the right atrium is wide and allows blood to easily flow from and to the atrium. On the contrary, the left atrial appendage has a very small opening (ostium) and its morphology is convoluted with lobulations and a complicated mesh of atrial muscle wall.

The very structure of the left atrial appendage is quite conducive to the formation of clots in atrial fibrillation (AFib). These anchored clots (thrombus/thrombi) can detach and become free clots (embulus/emboli) that will enter the blood stream, pass into the left ventricle, then though the aortic valve, and then pass into the ascending aorta and main circulation. Unfortunately, two of the first arteries that arise from the aorta are the common carotid arteries that take blood to the brain and these thrombi can cause a brain stroke.

Personal note: On November 7, 2023 Dr. Randall K. Wolf invited me to a seminar where we reviewed the anatomy of the left atrial appendage, the problems it can cause in atrial fibrillation as a cause for stroke, and the reasons for its exclusion in AFib surgery. 

Image property of:CAA.Inc.Photographer:D.M. Klein