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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Andreas Vesalius Bruxellensis

 Andreas Vesalius Bruxellensis (1515-1564) is considered to be the father of modern anatomy, remembered because an illustrious life and by his book “De Humani Corporis Fabrica, Libri Septem” published first in 1543. Scores of books, translations, articles, and analyzes of his work have been published in the over 500 years since his birth.

With such an incredible pedigree we would expect his name to be attached to more than a few anatomical structures, many of which were first described in his opus magnus, the “Fabrica”, I wonder why this is not so. It is true that modern anatomy is trying to move from eponyms to more descriptive anatomical terms. Still, there are many that will not go away, as is the famous ligament of Treitz, or the sphincter or Oddi.

Today there is only one recorded eponym for Andreas Vesalius, the os vesalianum, a rare accessory bone in the foot located proximally to the base of the fifth metatarsal. It is usually asymptomatic, but in rare cases it can cause pain. It is formed by the failed fusion of the secondary ossification center of the fifth metatarsal.

Reviewing history, I was able to find other references to Andreas Vesalius eponyms or potential eponyms, now in disuse or misnamed:

      • Suspensory ligaments of the mammary gland. Although first described by Vesalius in the Fabrica, these structures are named after Sir Astley Paston Cooper (1768 -1841), almost 300 years after being described by the great anatomist, who called them a “fleshy membrane” that stretched between the pectoral fascia and the skin.

      • The vermiform appendix. Although called by many just “the appendix”, this structure is mentioned, but not named, by Jacobo Berengario da Carpi in 1524. It was Andreas Vesalius who first described it as an appendix, suggested it looked like a worm (Lat: vermis) calling it the “vermiform appendix”.

      • The ligamentum suspensorium Vesalii or crural arch. First described by Giovanni Baptista Morgagni (1682-1771), it was named in honor of Vesalius by Dr. Laurentii (Lorenz) Heisters in his “Compendium Anatomicum” published in 1756. Other authors point to Gabrielle Fallopius as the first to describe this structure in 1561, although he did publish later than Vesalius (1543). Although named after Vesalius, it was later named after Francois Poupart who described it in 1695. You probably know this structure as the inguinal ligament.

      • The ligamentum teres femoris. The round ligament of the femur was also first described by Vesalius in 1543.

NOTE: If you have other structures that have been named after Vesalius, please let me know by clicking here

Sources:
1. “A Rare Cause of Foot Pain with Golf Swing. Symptomatic Os Vesalianum Pedis—A Case Report” Petrera, M et al. Sports Health. 2013 Jul; 5(4): 357–359.
2. “Andreas Vesalius’ 500th Anniversary: First Description of the Mammary Suspensory Ligaments” Brinkman RJ, Hage, JJ. World J Surg (2016) 40:2144–2148
3. “Compendium Anatomicum” Heisters, L. 1756 (German)
4. “Anatomy: An Encyclopedic Reference to the Language of Anatomy and Neuroanatomy. It Provides the Fascinating Origin of Terms and Biographies of Anatomists/Physicians Who Originated Them” Bergman, RA, Afifi, AK 2016