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Halsted-Holman Vascular Trauma Legacy View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector HISTORICAL VIGNETTES IN VASCULAR SURGERY Norman M. Rich, MD, Section Editor Halsted-Holman vascular trauma legacy Norman M. Rich, MD, Thomas M. Krummel, MD, and David G. Burris, MD, Bethesda, Md; and Stanford, Calif Emile F. Holman, who was the last Chief Resident to been emphasized about his interest in vascular surgery and William Stewart Halsted at Johns Hopkins University, the management of vascular injuries. In comments about identified a number of contributions that Halsted made to Halsted, Holman indicated that Halsted’s “. specula- vascular surgery.1 Holman had been a Stanford University tions and discussions on arterial lesions were a constant undergraduate, class of 1911, and a Johns Hopkins Medi- source of inspiration to his students and associates.”4 cal School graduate in 1918. He became the first full-time Halsted encouraged Bertram Bernheim, working in the Professor and Chairman of the Department of Surgery at Hunterian Research Laboratory at Johns Hopkins Univer- Stanford Medical School in San Francisco, California, in sity, to work with vascular anastomoses. In 1916 Halsted 1926. Stimulated in part by the teaching and writing of encouraged Bernheim to do the Lexer “Ideal Operation,” Halsted, Holman continued with an interest in vascular as had been done in Germany in 1907, and this was the first surgery and, particularly, the management of vascular inju- autogenous great saphenous vein repair of an artery in the ries. His classic monograph in 1937 on the pathophysiol- United States.5 This became the most frequently used and ogy of arteriovenous fistulas is a landmark contribution in highly successful repair of extremity arterial injuries in the the 20th century in vascular trauma.1 This review, based in 20th century.6 part on personal experiences, emphasizes the great value of mentorship and the legacy that can be passed on, as it has in EMILE F. HOLMAN (1890-1977) the Halsted-Holman vascular trauma legacy, to continue to improve combined efforts in providing the best surgical As the first Professor and Chairman of the Department management possible for those who have the misfortune to of Surgery at Stanford University School of Medicine, be injured. Emile F. Holman maintained those responsibilities for 29 years, retiring in 1955. Like Halsted, he had many and WILLIAM STEWART HALSTED (1852-1922) varied contributions to medicine and surgery, particularly As the first Professor and Chairman of the Department on the West Coast. The pathophysiology of arteriovenous of Surgery at the Johns Hopkins University School of fistulas, published by MacMillan and Company in New Medicine, Halsted is known for many contributions to York in 1937, was a sentinel contribution by Holman that American medicine and surgery.2,3 This is particularly is informative and interesting even today.1 The title of that noted by his contributions to surgical education. Less has book was Arteriovenous Aneurysm: Abnormal Communica- tions Between The Arterial And Venous Circulations.” One From the Norman M. Rich Department of Surgery, F. Edward Hébert of the ironies, particularly considering the strong mentor School of Medicine, Uniformed Services University of the Health Sci- relationship of Sir William Osler to Emile Holman, is ences; and the Department of Surgery, Stanford University School of Osler’s comment in 1905 on arteriovenous communica- Medicine. tion: “The only problem with the operation is with the Competition of interest: none. gangrene that is apt to follow.”7 Presented in part as the Emile F. Holman Lecture in Surgery at Stanford University School of Medicine, Mar 7, 2003, and at the Seventy-Eighth It is possible that this dismal concern by Osler helped Annual Meeting of The Halsted Society, Stanford University, Sept 2004. propel the interest that Halsted had and that he projected Reprint requests: Norman M. Rich, MD, FACS, DMCC, Department of to many of his trainees, including Holman and Mont Reid, Surgery, F. Edward Hébert School of Medicine, Uniformed Services to successfully repair arteriovenous communications. Dur- University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (e-mail: [email protected]). ing his undergraduate years, Holman was the personal The editors and reviewers of this article have no relevant financial relationships secretary of the first Stanford University President, David to disclose per the JVS policy that requires reviewers to decline review of any Starr Jordan. Holman graduated in 1911 and went to manuscript for which they may have a competition of interest. Oxford University in England as a Rhodes Scholar. He did J Vasc Surg 2010;52:508-11 very well at Oxford University, coming under the mentor- 0741-5214/$36.00 Copyright © 2010 by the Society for Vascular Surgery. ship of Sir William Osler, who wrote to Johns Hopkins doi:10.1016/j.jvs.2010.01.093 University encouraging admission of Holman to the 508 JOURNAL OF VASCULAR SURGERY Volume 52, Number 2 Rich et al 509 Fig 1. During the 1914 graduation of Johns Hopkins Univer- sity School of Medicine in Baltimore, a senior medical student from Astoria, Oregon, and Stanford University took a number of candid photographs of William Stewart Halsted and others on the faculty. In the group picture above, Otto E. Utzinger (small circle) is standing behind Halsted (large circle). (Photo courtesy of David H. Utzinger.) fourth-year medical school class, which was permitted after an examination.8 Holman, who had also served during World War I in France in the Ambulance Corps, graduated from Johns Hopkins University School of Medicine after 1 year! Hol- Fig 2. Emile F. Holman’s encouraging support of the Vietnam man was accepted into the Halsted Surgical Program at Vascular Registry was recorded in the second edition of his book, Johns Hopkins University and enjoyed the close association which was published by Charles C. Thomas Publisher. and mentorship of Halsted until the latter’s death in 1922. One of Holman’s classmates and good friends at Stan- ford University was Otto E. Utzinger of Astoria, Oregon, the Battle of Peleliu when he was serving with the United who was a 1914 graduate of the Johns Hopkins School of States Marines in one of their bloodiest battles in the South Medicine (Fig 1). The primary author (N. M. R.) was Pacific during World War I: influenced by Utzinger throughout his developing years in “...and the Korean War to a fortunate concatenation of Ray, Arizona, a Kennecott copper mining community. circumstances provided an opportunity to discard the disas- Utzinger served in France with the American expeditionary trous treatment of an injured artery by ligation and to forces in 1917-1918 after completing surgical training apply instead the principle of immediate reconstruction and under John M. T. Finney at Union Memorial in Baltimore, repair, a method rarely employed successfully in World War Maryland, part of the Halsted-Johns Hopkins program. He II in 1943, I attempted the primary repair of the divided regaled the primary author with many experiences, includ- popliteal artery under primitive conditions in the South ing the frustration of multiple amputations of combat Pacific but it was saddening failure ...” 4 casualties who were received in military hospitals with an average delay of 12 hours after wounding. Utzinger, like It was this type of experience by Holman that added to Holman, talked about the interest that Halsted had in his encouragement of Carl W. Hughes during the Korean vascular surgery and in vascular trauma. Conflict8 and Norman M. Rich during the Vietnam War6 Despite being 51 years old and serving as Professor and (Fig 2) to continue to work toward successful repair of both Chairman of the Department of Surgery at Stanford Uni- arteries and veins under less than ideal circumstances. versity School of Medicine, Holman voluntarily joined the Navy to serve in World War II. Also, he voluntarily served MATAS, DEBAKEY, SHUMACKER, HUGHES, in the South Pacific. SPENCER, AND OTHERS In 1953 Holman delivered the first David W. Yandell In the relatively small community of clinicians, educa- Lecture in Louisville, Kentucky, “New Concepts Of Sur- tors, and scientists, there are interesting interconnections gery in the Vascular System: The Immediate and Late among a number of surgeons. Rudolph Matas (1860- Treatment of Our Arterial Injuries.” He included the fol- 1957), considered by many to be the father of vascular lowing regarding the discouraging status of attempting to surgery, and also the first American international surgeon, manage vascular injuries at that time, particularly during described his approach to the management of arterio- JOURNAL OF VASCULAR SURGERY 510 Rich et al August 2010 uniform and he went to Southeast Asia. Later he was given the responsibility at one of three established vascular cen- ters in the United States in Galesburg, Illinois.11 Matas noted that Shumacker had more experience in a relatively short period of 2 or 3 years in the management of vascular injuries than he had had in 50 years of practice. Dr Shumacker published extensively on the approach to man- aging arteriovenous fistulas and false aneurysms, and this adds to the combined legacy in the management of vascular injuries. Shumacker was the first full-time professor to join Rich in the new developing Department of Surgery at USUHS. Rich remains a Distinguished Professor of Sur- gery at USUHS, with a Harris B Shumacker Jr Distin- guished Surgical Lecture named after him delivered annu- ally at the Society for Military Vascular Surgery at USUHS. Carl W. Hughes, along with Frank C. Spencer, made significant contributions from experiences in the Korean Fig 3. Rudolph Matas (center) presenting his Award to Emile F. Conflict (1950-1953).8 Hughes had similar exchanges Holman (left) and Michael E.
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