‘A Very Wide and Deep Dissection’

None of the physicians in attendance at the April 20, 1894, meeting of the Clinical Society of Maryland doubted that the medical paper about to be presented would be the highlight of the day. In fact, some in the auditorium had traveled long distances to Baltimore just to hear it, and they paid attention to little else until the name of the speaker, William Stewart Halsted, was announced. Although the hospital he worked in had been established only six years earlier, it was already recognized as having excellent possibilities for reforming the American system of medical education. Johns Hopkins Medical School, with which the hospital was associated, was even newer, having opened less than a year before that day. The school had already showed the promise of accomplishing its announced mission, which was to revolutionize the teaching of young physicians by introducing them to a scientific approach to healing that was virtually absent anywhere else in the US. Of all the talented and enthusiastic young faculty members who had been recruited to the Johns Hopkins Medical School and its hospital, none was more the object of professional and personal curiosity than Halsted. The forty-two-year-old surgeon seemed to many an odd, withdrawn figure.

As he stood there, obviously ill at ease and yet at the same time detached, his dour expression suggested that he would much prefer the company of his microscope or operating table to that of the assembled doctors. For this patrician man resented any distraction from his single-minded crusade to apply the principles of laboratory science to the undisciplined and still immature American specialty of surgery. To Halsted, it was important to understand not only the complex processes of disease but also the body’s methods of healing itself when aided by the efforts of a scientifically based surgery.

The word had gone out that the paper to be read by the Hopkins professor that morning would present the results of a new operation he was proposing, one that held the promise of providing successful treatment for breast cancer, a disease against whose ravages physicians had been impotent throughout the course of medical history. This cancer killed, and in a particularly devastating way, almost every woman who fell victim to it. In most cases, an untreated malignant lump in the breast would slowly continue to enlarge until it burst open onto the skin surface and proceeded to eat away at the surrounding tissue. Most patients died only after years of enduring the presence of an expanding ulcer where the breast had been, painfully eroding its way through the underlying muscle of the chest wall and in time even the ribs beneath, all the while exuding the stench of foul fluid that oozed constantly from its ever-widening circumference. Most experienced physicians had never seen a woman live as long as five years after the initial discovery of a cancerous mass. Usually, the interval between diagnosis and death was less than half that period.

To operate—even when the patient first…

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