Stephen J. Birchard DVM, MS, Diplomate ACVS

Thursday, August 22, 2013

The Halsted Chant!

When I was on the faculty of the College of Veterinary Medicine at Ohio State, I taught the "Instruments and Tissue Handling" lecture to the 2nd year veterinary students. I tried to emphasize the importance of the surgical principles developed by Dr. William Halsted, a great surgeon who is considered one of the patriarchs of modern surgical technique in humans. His principles were:

Gentle handling of tissues
Meticulous hemostasis
Close dead space
Maintain blood supply to the organs and tissues
Maintain asepsis
Do not suture tissue under tension
Accurately align the tissue layers when closing

Rather than have the students memorize that list of principles, I modified them into a silly but fun exercise we called the "Halsted Chant".  I had one member of the class stand in front of his or her fellow students and yell the first part of each line with the students responding with the second half of each line.

I have to say each time we did it I found it to be a wonderful experience. If it helps you remember the most important principles of surgery, commit the Chant to memory and say it out loud before beginning the intended surgery.


When in doubt . . . cut it out!

A chance to cut . . . a chance to cure!

Above all else . . . do no harm!


Tight stitches . . . incision itches!

Unhappy tissues . . . healing issues!

Leave dead space . . .    seroma in place!

Hemostasis . . . bloodless spaces!

Handle rough . . . inflamed stuff!

Asepsis . . . no abscess!

Layers aligned . . . healing sublime!

Repeat the Chorus


  1. Way to go Dr. B! Even now I use your Halsted Chant as my principles for surgery! Thanks again for making me a true surgeon!


    H - Handle tissues gently
    A - Arrest all bleeding
    L - Leave the blood supply intact
    S - Strict asepsis
    T - Tension minimized
    E - Edges together nicely
    D - Dead space minimized

    RT Bentley, DACVIM (Neurology), Purdue Vet Med

  3. You're the best, Dr. Birchard. I loved your lectures, even though my heart has always been with internal medicine :) Thank you for doing this, love it!

  4. Thank you Sarah! Internal medicine is cool too.
    Honestly, surgeons would be lost without internists.

  5. Well if this doesn't bring back fond memories! Good to see you blogging. Between the Halsted Chant and calmly saying, "There," while my finger stops a huge bleeder, I've got some enduring recollections of your class from *gasp*10+ years ago, as well as principles from soft tissue surgery rotations that stick with me to this day.

  6. Memories abound! I finally found your chant. I want to teach my residents this. I still hear you in my head saying “there” and “I don’t like what you’re doing there”. U were a great teacher and i hope i can pass along some of your wisdom to my students. Thx.

    1. Thank you so much for your comments. Sorry for my delay in replying. I appreciate your kind words.
      When in doubt . . . .!