Walter Bastedo

Biographical timeline

• Born on March 8, 1873 in Newmarket, Ontario, Canada.
• 1889 – Emigrated to the United States; became a naturalised US citizen in 1901.
• 1894 – Graduated Ph.G. from the New York College of Pharmacy.
• 1897–1899 – Curator of the New York Botanical Garden; also lectured in botany at the New York College of Pharmacy during his medical studies.
• 1899 – Graduated MD from the College of Physicians and Surgeons, Columbia University.
• 1899–1901 – Intern at St Luke’s Hospital, New York; subsequently worked at Sloane Maternity Hospital.
• 1902 – Appointed chief of the Gastroenterological Clinic at Vanderbilt Clinic.
• 1903 – Appointed tutor in Materia Medica and Pharmacology at Columbia University.
• 1905–1908 – Progressed through teaching appointments in pharmacology, therapeutics and applied therapeutics at Columbia; appointed Associate in Pharmacology and Therapeutics in 1908.
• 1909 – Presented his observations on artificial dilatation of the colon and its application to the diagnosis of chronic appendicitis before the Medical Society of the County of Richmond.
• 1914–1929 – Attending physician at St Luke’s Hospital, subsequently serving as consulting physician.
• 1914–1920 – Attending physician at City Hospital, New York.
• 1915–1919 – Member of the Advisory Council of the New York City Department of Health.
• 1916 – Appointed Assistant Professor of Clinical Medicine at Columbia University.
• 1918–1919 – Chairman of the American Medical Association Section on Pharmacology and Therapeutics.
• 1919 – President of the American Gastroenterological Association.
• 1920–1930 – Vice-president of the United States Pharmacopeial Convention.
• 1921 – President of the New York Gastroenterological Association.
• 1924 – Elected Fellow of the American College of Physicians.
• 1929 – Awarded an honorary Doctor of Science degree by Columbia University.
• 1930–1940 – President of the United States Pharmacopeial Convention; subsequently chairman of its board.
• 1934 – Awarded an honorary Master of Science degree by the Philadelphia College of Pharmacy and Science.
• Died July 20, 1952 aged 79, following a cerebrovascular accident.

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Medical Eponyms

Bastedo sign (1909)

Bastedo sign is the production or accentuation of pain and tenderness at McBurney’s point following artificial distension of the colon with air, described by Walter Arthur Bastedo as an aid to the diagnosis of chronic appendicitis.

1909 – Bastedo presented Artificial dilation of stomach and colon as aids in abdominal diagnosis; with a helpful sign in chronic appendicitis before the Medical Society of the County of Richmond. The paper was subsequently published in the St. Luke’s Hospital Medical and Surgical Reports in 1910.

Bastedo used artificial colonic distension during the examination of patients with gastrointestinal disease. A soft rubber rectal tube was passed twelve inches and air introduced with an atomizer bulb. He noted that distension of the colon could produce acute pain or tenderness at McBurney’s point in patients subsequently found to have appendicitis:

Bastedo described a method of dilating the colon with air and causing acute right lower abdominal pain over McBurney’s point to aid in the diagnosis of chronic appendicitis. His original descriptions were presented to the Medical Society of the County of Richmond (1909), and published in St. Luke’s Hospital Medical and Surgical Reports:

In the routine examination of digestive patients by colon dilation, I noted, some three years ago, that acute pain or tenderness in the region of McBurney’s point on dilation of the colon regularly meant appendicitis.

Bastedo, 1910: 108-110

Bastedo’s work with artificial dilatation included localisation of the sigmoid and transverse colon and caecum, assessment of suspected obstruction, and localisation of abdominal masses or tenderness.

1911 – Bastedo published The dilatation test for chronic appendicitis, with a description of his manoeuvre. A colon tube was passed eleven or twelve inches into the rectum and air injected using an atomizer bulb. Progressive colonic distension producing or increasing pain and tenderness at McBurney’s point constituted a positive test.

Bastedo used the test for suspected chronic or latent appendicitis in patients with persistent or recurrent abdominal symptoms in whom the diagnosis remained uncertain. He felt stated that the test was unnecessary and potentially contraindicated during an acute attack.

Bastedo also compared his technique with the Rovsing sign as both attempted to reproduce right iliac pain through manipulation of the colon. However, Bastedo deliberately introduced air to produce colonic distension rather than relying on existing colonic contents being displaced proximally by external compression.

1913 – Arthur Frederick Hertz published Bastedo’s sign: A new sign of chronic appendicitis, helping establish the Bastedo sign in the medical literature. Hertz reported his own experience with the test and reviewed reports from European investigators. He considered Bastedo and Rovsing signs closely related as both attempted to reproduce appendiceal pain through distension or movement of the caecum and colon.

Hertz observed that after artificial inflation of the colon, pressure applied along the descending colon in the manner described by Rovsing could sometimes reproduce right iliac pain. He regarded Bastedo’s deliberate insufflation as a means of making the proposed colonic-distension phenomenon more reproducible.

The sign was reported by other authors, but remained principally a test for chronic appendicitis. Bastedo sign is now primarily of historical interest.

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Major Publications

• Bastedo WA. Artificial dilation of stomach and colon as aids in abdominal diagnosis; with a helpful sign in chronic appendicitis. St. Luke’s Hospital Medical and Surgical Reports. 1910; 2: 104-111. [Bastedo sign]
• Bastedo WA. The dilatation test for chronic appendicitis. American Journal Of The Medical Sciences. 1911; 142: 11-14
• Bastedo WA. Materia medica, pharmacology, therapeutics, prescription writing. 1913 [2e 1918]
• Bastedo WA. The Treatment of Chronic Dyspepsia. Medical Clinics of North America. 1938;22(5):1407-1417.

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References

Biography

• Walter Arthur Bastedo JAMA. 1952; 150(3): 233.
• Andresen AF. Dr. Walter Arthur Bastedo, 1873-1952. Gastroenterology. 1953; 25(1): 91-92.
• [Walter A. Bastedo] US National Library of Medicine: 101410060
• Bibliography. Bastedo, Walter Arthur. WorldCat Identities

Eponymous terms

• Hertz AF. Bastedo’s sign: A new sign of chronic appendicitis. Lancet 1913; 181(4673): 816-817
• Lichty JA. Chronic Appendicitis. JAMA. 1922; 79(11): 887–893.
• Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs of Inspection and Medical Eponyms. Clin Med Res. 2019; 17(3-4): 115-126.
• Cadogan M. Appendicitis eponymous signs. LITFL