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 Breast Cancer: Revisiting Accepted Wisdom in the Management of Breast Cancer - Part 1 

The Legacy of William Stewart
Virchow and Halsted were characterized by monumental achievements. Just as Virchow was credited as the most influential early figure in German medicine, so Halsted occupies that position in American surgery. More than any other physician, Halsted was personally instrumental in the genesis and rise of the specialty of surgery. First, he performed operations that only highly trained specialists could duplicate; second, he transformed surgical education by establishing a residency program in surgery, overturning a hierarchy in medicine that had endured for centuries in both Europe and America. Halsted singularly hoisted surgeons to the pinnacle of the social caste of medicine.

In 1852, when Halsted was born, his family owned the textile import firm of Halsted, Haines and Company (note 4). Halsted attended boarding school at age 10, graduated from Phillips Andover, and joined the Yale Class of 1874. He then entered the College of Physicians and Surgeons in New York (which was to become the Columbia School of Medicine) for the customary 3 years, interned at Bellevue in 1876 during medical school, then in 1878 studied for 2 years in the illustrious medical centers of Vienna and Germany. After returning from abroad, Halsted put Virchow's theories into practice, performing operations that removed the entire Iymphatic and muscular field surrounding carcinoma. The golden rule for the management of breast cancer hence became the Halsted radical mastectomy.

Halsted introduced techniques and set standards that are now customary, but which at that time were startling surgical innovations--namely, radical en bloc removal of the breast; hernia repair; refined thyroidectomy and intestinal anastomosis operations; a completely bloodless operating field and uncompromising sterility; careful, meticulous, anatomically precise surgical dissection that minimized undue trauma to surrounding tissue; direct blood transfusion; and fastidious closure of the j wound, layer by layer, with silk sutures.11(pp386-421) When Halsted's operating room nurse and soon-to-be wife, Caroline Hampton, developed a rash from handling irritating solutions of mercuric chloride, Halsted wrote to Goodyear Rubber and requested that they produce an experimental pair of thin rubber gloves. On trial, they were so successful that more were ordered, and now no surgery can be imagined without them. (Although Halsted was neither the first surgeon to perform a mastectomy nor the first to use rubber gloves, because he popularized them in America it is he who is given credit for them [note 51.)

Halsted was surgeon-in-chief and professor of surgery at Johns Hopkins at the time the medical school opened in 1893. Having personally observed the European medical nobility (Virchow, Billroth, Kocher, von Volkmann), he emulated them, hitching the pathology laboratory to the surgical theater, splicing science with clinical practice. Reproducing the best of w hat he had witnessed a dozen years before, Halsted created the first and foremost surgical residency program in America, directing it for 3 decades. The seeds of his philosophy were sown deep, far, and wide--his residents initiated top-notch residency programs across the country, graduating 166 chief residents who bred successive generations of surgeons. Halsted also trained more than 50 teachers--among them men who became professors of surgery at Harvard, Stanford, Yale, Johns Hopkins, Cornell, Pittsburgh, Cincinnati, Virginia, and other exceptional schools of medicine. This group produced a second generation of 139 teachers of various ranks, influencing a prestigious and vast swath across the geographical landscape of medical education.15 They proceeded to teach others, insuring that Halsted's views were so broadly disseminated that they became the official guideposts and doctrine of the surgical world.

(Excerpted from Alternative Therapies in Health and Medicine)
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 About The Author
Harriet Beinfield LAcHarriet Beinfield, L.Ac. and Efrem Korngold, L.Ac., O.M.D. have pioneered the practice of Chinese medicine in America for the last 28 years as educators, writers, and practitioners. They are the co-authors of the......more
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