Through years of careful badgering, we all learned how to be elegant
surgeons. “Aseptic technique, gentle handling of tissue, scrupulous
hemostasis, and tension-free, crush-free, and anatomically proper surgery
are the rules. And they are Halsted’s rules. Although “Halsted” is not a
household name, every individual in America who undergoes successful
surgery owes William Stewart Halsted a nod and a deep debt of
gratitude.”^29
As important as Halsted was in transforming “the shunned black sheep
of the medical world into a specialty offering the promise of mightily
alleviating the suffering of the human condition,”^30 helping reinvent a
discipline and a surgical philosophy,^31 perhaps one of his greatest
innovations was performing elective surgery.
From the beginning of time, prototypical surgeons were busy draining
abscesses, applying salves, and engaging in bonesetting. These primordial
healers, retaliating against the gods and evil spirits, were always reflexive,
responding to bad fortune. The forebears of surgery were the physicians to
the gladiators and military doctors. With advancement, surgeons turned
from hopeless emergency cases to conditions where their intervention
might actually be beneficial. Patients submitted at a point of in extremis
prior to Billroth, but cancer patients in Vienna, ill and racked with cancer,
allowed him to remove parts of their bowels. Confidence in surgery was
growing.
In the same month that Halsted executed his first Hopkins mastectomy,
he performed, arguably, the most important elective operation ever
attempted.
Children are born with inguinal hernias at a rate of 5 percent, but the
incidence rises to almost 15 percent among adults, with men eight times
more susceptible. “Turn your head and cough,” is the stuff of legends, but
prior to successful surgery, hernias led to millions of deaths around the
world. Prior to safe operations, hernia belts (“trusses”) and postural
exercises were the only remedies offered, even if ineffective.
A hernia is a loop of bowel spouting into a weakened portion of the
abdominal wall. This can occur at the umbilicus or at a surgical incision,
but most commonly in the groin. An inguinal hernia occurs when “a ring
in the lower abdomen through which the spermatic cord exits is
unnaturally expanded to allow the insinuation of bowel, which follows the
path of the spermatic cord through the external inguinal ring and into the