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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Dissection of the abdomen. The greater omentum is being pulled anteriorly
Click for a larger image

UPDATED: The term [mesentery] is of Greek origin. The prefix [mes(o)-] arises from the Greek [μέσο] meaning "middle", the root term [-enter-] means "small intestine" or "intestine", and the suffix [-y] means "process" or "structure". Thus, the mesentery is "a structure in the middle".

The term [mesentery] can be used as a generic word to denote a double-layered peritoneal membrane that stretches between an abdominal viscus and the abdominal wall. A more precise use of the term is that of mesentery proper, which extends between the posterior abdominal wall and the jejunum and ileum. The superior mesenteric artery and veins are found at the root of the mesentery proper, along with a large accumulation of lymphatic nodes, and sympathetic and parasympathetic nerves.

Between the two layers of the mesentery proper, there are jejunal and ileal arteries and veins, a complex system of arterial and venous arches, as well as lymphatic vessels,  autonomic nerves, and varying degrees of fat. Because of the presence of the mesentery proper, the jejunum and ileum are mobile or intraperitoneal, that is, they can slither, turn and twist with the movements of peristalsis. This movement is helped by the presence of a small amount of peritoneal fluid.

Transillumination of the transverse mesocolon. Courtesy of Michiaki Akashi, MD
Click for a larger image

The fact that the mesentery is intraperitoneal is important in surgery. If the organ can already move around because of its mesentery, then it does not need to be "mobilized", it is already mobile!! If the organ (jejunum or ileum) have adhesions that limit their mobility within the abdominal cavity, the surgeon may have to perform and adhesiolysis to restore their mobility.

The first image shows an anatomical dissection where the greater omentum has been pulled anteriorly, exposing the small intestine and its mesentery, as well as the transverse mesocolon. Click on the image for a larger depiction. The second image (courtesy of Dr. Michiaki Akashi) is artwork depicting the surgical technique of transillumination, where the surgeon will shine a light through the mesentery to visualize the blood supply to the intestine prior to ligation and transection. The mesentery-like structure being transilluminated is the transverse mesocolon

WARNING: The first image is a photograph of a human dissection and can be considered descriptive.

NOTE: My personal thanks to Michiaki Akashi, M.D.for allowing us to use his artwork in this article. Dr. Akashi works as a surgeon and pathologist in the Saga Prefectural Hospital Koseikan in Saga, Japan.Dr. Miranda

First image property of: CAA.Inc. Photographer: David M. Klein