Genius on The Edge

“Today, our challenge is to understand and objectify how a modern day medical device influences individual tissue properties and how this influence can affect patient outcomes.” E. Chekan, MD

Dr. Imber, the author of the book. Genius on the Edge, points out the many accomplishments in Dr. Halsted’s career: the first surgical residency program, the importance of antisepsis in surgical technique and the use of cocaine as an anesthetic to name a few.   Dr. Halsted is also credited with developing and performing the first of many now commonplace surgical procedures: the first cholecystectomy (on his own mother, no less), the first radical mastectomy, and the Halsted technique for inguinal hernia repair.  I found it interesting how much he and his contemporaries – Welch, Osler and Kelly at the Johns Hopkins Hospital continue to influence surgical teaching and practice today.

The Professor showed us how to appropriately manage tissue – most surgeons still incorporate these tenets into their everyday surgical practice. Today, our challenge is to understand and objectify how a modern day medical device influences individual tissue properties and how this influence can affect patient outcomes.

Here are a couple of passages:

The current ideas among surgeons are not only incomplete, but absolutely incorrect as regards to some important details in the structure of the intestinal coats.  My experiments have led me to attach great weight to an accurate knowledge of the thickness of and physical characteristics of the submucosal coat of the intestine.  I am not aware that the importance of this coat in connection with this operation has hitherto been emphasized.”  Halsted April 5, 1887.   (p. 90)

 “Halsted set about suturing cut intestines together, incorporating various suturing levels and techniques, and ultimately coming to believe the key to a strong anastomosis was, in fact, the mysterious submucosa” (p. 89)

 “Halsted exhibited meticulous attention to detail in every aspect of surgery.  He insisted on the gentle handling of tissue, and consistently made the point that rough handling of or crushing tissue in an attempt to control bleeding was counterproductive.  Devitalized tissue was the perfect medium for infection.” (p. 140)

On Breast Cancer:

“The concept of cancer spreading through microscopic lymphatic channels draining tissue fluid and lodging in lymph nodes was generally accepted, but the idea of the removal of regional lymphatic channels and lymph nodes was not.” (p. 119)

 “The Halsted mastectomy became the gold standard for care until the mid-20th century.”  (p. 124)

 “HISTORICAL NOTE:  by the 1960s, proponents of both more radical surgery and less radical surgery were challenging the Halsted mastectomy.”  (p. 124)

 “By the 1970s, the surgical community had rallied behind the muscle sparing modified radical mastectomy.” (p. 125)

On antisepsis:

“The innovation of rubber gloves to surgery began as simply and unremarkably as protecting a nurse’s skin from irritation.  No one, it seems, saw this innovation as anything more than that.  Halsted had inadvertently set into motion the single greatest advance in the history of sterile technique.” (p. 115)

On surgical training:

“Osler and Halsted would institute the graduated responsibility residency system and forever change the way doctors were trained” (p. 107)

In order to understand where we are going with medical device innovation, it is important to know where we came from.  This book should be read by all who have an interest in advancing medical devices and furthering our understanding of device/tissue interaction.

  1. Imber, Gerald MD.  Genius on the Edge:  The Bizarre Double Life of Dr. William Steward Halsted.  Kaplan Publishing.  New York.  2010.
  2. Baltimore SunBook Review.
  3. The Huffington PostBook Review

About Ed Chekan, MD, FACS

Minimally Invasive Surgeon An American Board of Surgery certified, Fellowship trained Minimally Invasive Surgeon that fills the gap between the clinical practice of surgery and the business of medical device innovation. Minimally Invasive Surgery Medical Devices Device Tissue Interaction Life Science Education Professional Education Opinions expressed here are my own.
This entry was posted in Device/Tissue Interaction (DTI), Recommended Reading, Stapling, Surgical Education. Bookmark the permalink.

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