Number of words: 474<\/p>\n\n\n\n
Moore\u2019s hypothesis had an obvious corollary. If breast cancer relapsed due to the inadequacy of the original surgical excisions, then even more breast tissue should be removed during the initial operation. Since the margins of extirpation were the problem, then why not extend the margins? Moore argued that surgeons, attempting to spare women the disfiguring (and often life-threatening) surgery were exercising \u201cmistaken kindness\u201d\u2014letting cancer get the better of their knives. In Germany, Halsted had seen Volkmann remove not just the breast, but a thin, fanlike muscle spread out immediately under the breast called the pectoralis minor, in the hopes of cleaning out the minor fragments of leftover cancer.<\/p>\n\n\n\n
Halsted took this line of reasoning to its next inevitable step. Volkmann may have run into a wall; Halsted would excavate his way past it. Instead of stripping away the thin pectoralis minor, which had little function, Halsted decided to dig even deeper into the breast cavity, cutting through the pectoralis major, the large, prominent muscle responsible for moving the shoulder and the hand. Halsted was not alone in this innovation: Willy Meyer, a surgeon operating in New York, independently arrived at the same operation in the 1890s. Halsted called this procedure the \u201cradical mastectomy,\u201d using the word radical in the original Latin sense to mean \u201croot\u201d; he was uprooting cancer from its very source.<\/p>\n\n\n\n
But Halsted, evidently scornful of \u201cmistaken kindness,\u201d did not stop his surgery at the pectoralis major. When cancer still recurred despite his radical mastectomy, he began to cut even farther into the chest. By 1898, Halsted\u2019s mastectomy had taken what he called \u201can even more radical\u201d turn. Now he began to slice through the collarbone, reaching for a small cluster of lymph nodes that lay just underneath it. \u201cWe clean out or strip the supraclavicular fossa with very few exceptions,\u201d he announced at a surgical conference, reinforcing the notion that conservative, nonradical surgery left the breast somehow \u201cunclean.\u201d<\/p>\n\n\n\n
At Hopkins, Halsted\u2019s diligent students now raced to outpace their master with their own scalpels. Joseph Bloodgood, one of Halsted\u2019s first surgical residents, had started to cut farther into the neck to evacuate a chain of glands that lay above the collarbone. Harvey Cushing, another star apprentice, even \u201ccleaned out the anterior mediastinum,\u201d the deep lymph nodes buried inside the chest. \u201cIt is likely,\u201d Halsted noted, \u201cthat we shall, in the near future, remove the mediastinal contents at some of our primary operations.\u201d A macabre marathon was in progress. Halsted and his disciples would rather evacuate the entire contents of the body than be faced with cancer recurrences. In Europe, one surgeon evacuated three ribs and other parts of the rib cage and amputated a shoulder and a collarbone from a woman with breast cancer. <\/p>\n\n\n\n