Hopkins in June 1889, on a thirty-eight-year-old mother of ten who had
furtively battled a growing, abscess-filled tumor for six months:
Halsted inscribed an extensive incision from the axilla, near
the old abscess site, counterclockwise down and along the
sternum, under the breast, encompassing the entire breast, and
up the lateral aspect, meeting the original swipe and forming a
giant, bloody teardrop.
Hardened by infection, the skin near the axilla was
unusually difficult to reflect upward, and the lymph nodes
under the arm couldn’t be reached. The recent abscess had
matted them down. Common sense dictated returning to the
axilla on another day. Dissecting with a scalpel, Halsted
mobilized the entire breast and much of the underlying
pectoralis major muscle. He applied artery forceps to arteries
and veins as they appeared, and secured the vessels with fine
silk sutures to minimize blood loss and crushed tissue. He
removed the anatomical specimen in its entirety and carefully
examined it at the operating table. Having taken great care to
avoid cutting into the tumor for fear of spreading the cancer,
Halsted now rolled the mass between bare fingers, and cut
through its substance, making careful mental notes of its
consistency and appearance before sharing his thoughts with
his assistant. He placed numerous suture tags on areas of
interest before sending the specimen to Welch’s pathology
laboratory, where microscopic sections would be prepared for
later examination.^25Halsted, like his mentors in Vienna and Halle, was attempting the first
forays into the war against cancer. Pioneers like Virchow had identified the
bizarre and warped cells that characterized tumors. These brigand cells,
pathologic by nature, bunched into colonies and then whole masses,
feeding off the host, multiplying, occupying, and eventually achieving a
self-defeating coup d’état when the host succumbed. Richard von
Volkmann, Billroth, and now Halsted, believed that cutting wider, deeper,