and bone are removed. Halsted did dramatically improve cancer mortality,
but a cure was (and is) still on the horizon.
If radical mastectomy did not have staying power, other initiatives of
Halsted did. Halsted had been inspired by the German way of training
surgeons, notably Langenbeck’s and Billroth’s ideas of robust, demanding
inculcation. Osler agreed with Halsted, and the first formal residencies in
American institutions were at Hopkins. By 1893 Halsted was granted the
title “Professor,” and he formalized his total immersion training system,
where young men (required to be unmarried) would live at the hospital,
and be available twenty-four hours a day, seven days a week. Old-time
surgeons laugh at young American trainees who complain about “living at
the hospital,” when in fact they “only” work eighty hours per week, as
limited by federal law. (My wife reported a sobering story to me while I
was a resident, years before the law went into effect and I regularly
worked more than one hundred hours per week. Driving by the Penn State
Hospital, my young daughter cried out, “Mommy, that’s where Daddy
lives!” I actually shed a tear when I heard the story, pangs of guilt and
remorse crushing me.)
Halsted’s particular skill of identifying potential, imbuing confidence
and crafting surgical skill potentiated his reach across the United States
for decades, since so many of his disciples became surgical leaders
themselves. Gone were the days of part-time hacks with no scientific
training masquerading as surgeons. “Laboratories were integrated into the
great hospitals, aseptic surgery was slowly accepted, and postgraduate
training became available.”^27 “Halsted’s legacy was built on two equally
potent, unimpeachably world-altering platforms. The first was the
establishment of the school of scientific, safe, and anatomically correct
surgery; the second, a working environment that shaped the education of
generations of surgeons and propelled American surgery to its preeminent
position in the world. The former brought about an undeniable surgical
revolution, proven by consistently superior results ...”^28
As a young surgical resident, learning the delicate technical points of
surgery, a professor of mine, displeased with my unrefined approach, said
at one point, “Did you just hear that?”
Confused, I said, “No, I didn’t hear anything.”
My professor replied, “I think that was the ghost of Dr. Halsted rolling
over in his grave, the way you just crushed that tissue in your forceps.”