preeminence of laboratory science was poised to change healthcare in the
new world, and Welch (under the watchful eye of Gilman) would establish
on Laudenslager’s Hill in Baltimore the pantheon of American medicine.
It cannot be overemphasized that the first building was the Pathology
research building. Instead of conceiving a medical campus with medical
wards, surgical amphitheaters, and a lying-in clinic, the enterprise’s
cornerstone would be a building dedicated to the understanding of disease.
Morgagni, Rokitansky, and Virchow would have been proud.
With the hospital not scheduled to open until 1889 (and the first
medical school class not convening until 1893), Halsted’s proposed role in
life would be to work in the pathology laboratory with Welch. For the next
several years Halsted focused on animal experimentation and basic
science research, greatly advancing the science of surgery.
In Vienna, Billroth had blazed a trail in abdominal surgery, but his
outcomes were still hit-and-miss. Halsted theorized that a better technique
might improve the clinical results, but what was demanded was a
scientific analysis of the technique and more important, a technique based
upon microanatomy. Within a week of his arrival, Halsted and Franklin
Mall began animal surgery and microscopic evaluation of the different
layers of the intestines, discovering the heretofore unappreciated role of
the seemingly mundane “submucosa.”
The intestines have a three-layer configuration: an outer muscular layer,
an absorptive interior lining layer, and a thin middle lining of connective
tissue—the submucosa. Over the course of a few months, sixty-nine
experiments were performed, evaluating the role of the submucosa and
testing the strength of the new repair. In April 1887, Halsted presented a
paper at the Harvard Medical School, advancing the understanding of how
best to achieve robust tissue healing. This groundbreaking research (a
cornerstone of general surgery to this day) made intestinal anastomosis
(the sewing together of two ends) dependable, immediately impacting the
survivability of abdominal surgery. Intestinal surgery would never be the
same.
Curiously, Halsted couldn’t be positive he was correct; he was not
operating on humans. Welch had brought him to Baltimore to labor under
his supervision, but as a surgical pariah, he was not to be trusted with real
patients. The laboratory was his clinic, and dogs were his patients.
Admirably, Halsted administered fastidious care to the dogs. In fact, he
marcin
(Marcin)
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