Halstedian Surgery 1904 – Respect for the Human Body

In 1889, Johns Hopkins Hospital opened in Baltimore, and a system for training surgeons began. It led to the modern internship system, in which students are enrolled in a university program while also affiliated with a hospital. In this system, students gradually develop skills and assume clinical responsibilities. 

The American surgeon William Halsted, the first head of surgery at Johns Hopkins Hospital, established the first formal surgical residency training program in the United States. He emphasized that residents should learn not only to become surgeons but also to teach surgery. His residents often became respected surgeons at other schools and promoted their teacher's ideas.

Halsted is also known for “Halstedian surgical techniques”, which take a slow, methodical approach. The surgeon respects human tissues and handles them extremely gently to minimize damage and blood loss. 

Halsted also:

• Emphasized fine silk sutures to minimize tissue damage and infection at a time when cat intestines were still used for suturing. 
• Introduced rubber gloves and surgical clothing into the operating room. 
• Successfully designed his renowned thyroid, intestinal and hernia operations to restore proper form and function.

In 1913, the surgeon Harvey Cushing said of Halsted's approach: 

“Observers no longer expect excitement in the operating room; the dramatic public performances of the past are no longer welcome, replaced by quiet, rather dull procedures... The patient on the table, like a passenger in a car, is at greater risk with a talkative driver who exceeds the speed limit.”

When Halsted attended medical school, many surgeons operated in street clothes with bare hands. Surgeons of the past boasted of 30-second amputations, whereas careful Halstedian surgeons now close individual layers of tissue one by one. 

In a 1904 address entitled “The Training of the Surgeon”, Halsted said: 

“We need—and undoubtedly will have—a system that produces not surgeons, but surgeons of the highest type, a system that encourages the country's best young people to pursue surgical studies.” 

About the Article Image: Portrait of William Stewart Halsted, Yale University class of 1874. (Photograph courtesy of Yale University.)

Names Mentioned in the Article: William Stewart Halsted (1852–1922)

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