Statues of Liberty: Wily Meyer, William Halsted, and the Development of the Radical Mastectomy from 1880 to 1920

STATUES OF LIBERTY
Willy Meyer,William Halsted,and the Development of the
Radical Mastectomy from 1880 to 1920
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ABSTRACT
Senior Thesis Edition
by Beatrix Thompson, JE ‘20
Advised by Professor Toby Appel
Edited by Grace Blaxill PC’22 and Julianna
Gross DC’23

n November 12, 1894, New York surgeon
Willy Meyer presented his “Radical Opera-
tion for Carcinoma of the Breast” to the Sec-
tion of Surgery at the New York Academy
of Medicine. He claimed it was more “radical,” even,
than the operation published by Johns Hopkins’ sur-
geon, William Stewart Halsted, only ten days earlier
in the Annals of Surgery.
The two techniques were nearly identical. Both
sought to obliterate breast cancer by removing as
much tissue as possible. This operation shaped the
term “radical surgery,” which generally indicated that
a procedure was invasive and that it removed a con-
siderable amount of healthy tissue alongside a malig-
nancy.1
Meyer and Halsted excised a woman’s entire
cancerous breast, as well as one or both of her un-
derlying pectoral muscles, axillary glands, and sur-
rounding fat tissue. The critical feature was that the
two men removed all tissue “en-bloc,” in one large
piece, by cutting through healthy flesh. This overuti-
lized technique, later named the radical mastectomy,
remained the standard treatment for breast cancer
until the 1970s.2
Halsted and Meyer were also both aware that,
in most cases, the success of surgical intervention
strongly depended on the extent to which the cancer
had already spread.3
As cancer historian Siddhartha
Mukherjee eloquently sums up, the procedure was “a
peculiar misfit... In both cases, women are forced to
undergo indiscriminate, disfiguring, and morbid op-
erations – too much, too early for the woman with lo-
cal breast cancer, and too little, too late for the woman
with metastatic cancer.”4
Decades later in the 1970s,
1 David Cantor, “Cancer: Radical Surgery and the Patient,” in The Palgrave Handbook of the History of Surgery, ed.
Thomas Schlich (London: Palgrave Macmillan, 2018), 459-460.. Cantor’s article is a straightforward history of radical
surgery and its defining characteristics.
2 M Plesca et al., “Evolution of Radical Mastectomy for Breast Cancer,” Journal of Medicine and Life 9, no. 2 (2016):
183–84..
3 Willy Meyer, “An Improved Method of the Radical Operation for Carcinoma of the Breast,” New York Medical Journal
46, no. 24 (December 15, 1894): 748. Meyer was cautious, writing that he was “fully aware” that his procedure “will not
prevent recurrence of the growth “en loco,” nor metastases in remote parts, especially not, if the patients be subjected
to the operation in an advanced stage of the disease.”
4 Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer (New York: Scribner, 2011), 67.
5 Plesca et al., “Evolution of Radical Mastectomy”, 183–84. For more on the fight against the radical mastectomy in the
late 20th century, see Barron H. Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth
Century America (Oxford: Univ. Press, 2003).
6 William Halsted, “The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins
Hospital from June 1889 to January 1894,” Johns Hopkins Hospital Report 4 (1894): 505.
pressure from female activists and physicians investi-
gating the merits of the radical mastectomy led to less
extensive tissue removal. The Modified Radical Mas-
tectomy (MRM) was proposed in 1972, which pre-
served the pectoral muscles without sacrificing the ef-
fectiveness of the procedure. The term “mastectomy”
did not appear in medical literature until the 1930s,
when both Meyer and Halsted had ceased their disfig-
uring, potentially life-threatening operation.5
Because
the surgery could not guarantee a life free of breast
cancer, early male surgeons justified the radical mas-
tectomy by crafting alternative definitions of success.
Meyer, Halsted, and their contemporaries ap-
peared optimistic about the operation’s potential to
achieve prestigious, rare “radical cures.” German
surgeon Richard von Volkmann first introduced the
term in 1875 to establish when a surgeon could claim
to have cured a patient’s breast cancer. According to
Volkmann, this could be ensured “almost without
exception” for living patients who had neither local
recurrence nor swollen glands within three years of
the time of operation.6
After the three years, a wom-
an’s cancer could come back and surgeons could still
claim to have achieved a “radical cure.”
This paper traces the changing meaning of rad-
ical breast cancer cures from 1880 to 1920. I intro-
duce Willy Meyer, who independently developed the
radical mastectomy, but is little known compared to
Halsted. My paper is the first investigation of Mey-
er’s role in developing and promoting the procedure
through the first two decades of the twentieth centu-
ry. Together, Halsted and Meyer redefined the radical
cure for breast cancer in terms of lowered local recur-
rence rates, achieved through even more extensive tis-
sue removal and bolstered by questionable statistics.
More importantly, this paper reveals key differenc-
es between Meyer and Halsted that position Meyer as
INTRODUCTION
O

a progressive surgeon, sympathetic to female patients
and their concerns about surgery. I trace their differ-
ential approaches back to their childhood, their medi-
cal training environments, and their attitudes towards
female patients in New York and at Johns Hopkins
respectively. Meyer was more compassionate, incor-
porated the rehabilitation of disabled arm mobility
into his overall method of care, and seemed attuned
to early notions of breast reconstruction. Halsted, in
contrast, was almost exclusively interested in his pro-
cedure’s mortality and local recurrence rates, narrow-
ing his definition of success and reducing women to
tallies in data charts. Despite being a brilliant tech-
nical surgeon, Halsted was cold and abrasive. These
attitudes are highlighted in their surgical papers, il-
lustrations, and discussions, as well.
It must be noted that both Meyer and Halsted were
convinced of the power and necessity of radical sur-
gery. However, historians writing about breast cancer
agree that neither Halsted nor Meyer were particu-
larly innovative in their methods. As Sakorafas and
Safioleas elegantly argue in their 2010 article, both
built on precedent from German, British, and earli-
er American surgeons, “Breast Cancer Surgery: An
Historical Narrative.”7
More importantly, secondary
sources and histories of breast cancer mostly attribute
the procedure and its eighty years of popularity to
Halsted.
Scholars may mention Meyer, but they barely ex-
pand on his contributions in 1894 and his subsequent
publications on the topic. In Unnatural History: Breast
Cancer and American Society, author Robert Aronow-
itz devoted one sentence to Meyer in the context of
Halsted’s reflections on his surgical legacy before he
died.8
Barron Lerner twice mentioned Meyer in pass-
ing in his chapter on Halsted in The Breast Cancer
Wars: Hope, Fear, and the Pursuit of a Cure in Twen-
tieth Century America.9
James Olson, in Bathsheba’s
7 G. H. Sakorafas and Michael Safioleas, “Breast Cancer Surgery: An Historical Narrative. Part II. 18th and 19th Centu-
ries,” European Journal of Cancer Care 19, no. 1 (2010): 6–29.
8 Robert A. Aronowitz, Unnatural History: Breast Cancer and American Society (Cambridge ; New York: Cambridge
University Press, 2007), 89-90.
9 Barron H. Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth Century America (Ox-
ford: Univ. Press, 2003), 20, 38.
10 James Stuart Olson, Bathsheba’s Breast: Women, Cancer, and History (Baltimore, Maryland: Johns Hopkins Univ.
Press, 2002), 41.
11 Mukherjee, Emperor of All Maladies, 65.
12 “NCI Dictionary of Cancer Terms,” National Cancer Institute, accessed February 14, 2020, https://www.cancer.gov/
publications/dictionaries/cancer-terms/def/halsted-radical-mastectomy.
13 Ira M. Rutkow, “Moments in Surgical History: Willy Meyer’s Radical Mastectomy,” JAMA Surgery 132, no. 12 (Decem-
ber 1, 1997): 1362.
14 Sakorafas and Safioleas, “Breast Cancer Surgery,” 26-27.
Breast: Women, Cancer, and History, wrote less than
a paragraph about Meyer’s removal of the pectoralis
muscles and misspelled his name. Olson merely stat-
ed, “across town, at New York Hospital, Willie Mey-
er was moving in the same direction [as Halsted]. In
1894, he published his own clinical experience.”10
In
The Emperor of all Maladies, Siddhartha Mukherjee
noted that “Willy Meyer, a surgeon operating in New
York independently arrived at the same operation in
the 1890s.”11
Today, the National Cancer Institute still
defines the procedure the two men introduced in 1894
as the “Halsted Radical Mastectomy.”12
Medical historian and surgeon Ira Rutkow wrote a
brief, one-page highlight about Meyer’s role in breast
cancer surgery in a 1997 issue of JAMA. “Despite the
importance of his clinical work,” he wrote, “Meyer
never received any semblance of the recognition ac-
corded his Baltimore-based colleague.”13
Rutkow cites
Meyer’s 1894 paper but does not analyze or expand on
Meyer’s other contributions to breast cancer surgery.
Similarly, Sakorafas and Safioleas position Meyer as
an afterthought to Halsted, vaguely noting his “sig-
nificant contribution” and the anatomical differences
between his procedure and Halsted’s.14
Like Rutkow,
the authors give no further historical exploration or
analysis of Meyer’s body of work.
There is much to be explored about Willy Meyer.
Whereas Halsted embodied the fraternity of doc-
tors who founded Johns Hopkins and brought it to
the forefront of American medicine, Meyer is a lesser
known, but incredibly influential figure in the history
of breast cancer surgery. Comparing the two surgeons
reveals key differences between their approaches,
characters, and institutional contexts that reflect the
state of American surgery at a critical juncture in its
history.
I will contrast Halsted and Meyer in terms of their
backgrounds, their operations, and their definitions

of operative success. First, this paper examines the
decade preceding Halsted and Meyer’s critical publi-
cations to show that the radical mastectomy as they
performed it was a continuation of prior surgical work
and theory about breast cancer. Next, I trace Meyer’s
upbringing and development in Germany and em-
igration to New York City, where he practiced as a
general surgeon and was widely affiliated with various
hospitals and was involved in women’s medical educa-
tion. To contrast the New York City medical environ-
ment with that of Johns Hopkins in Baltimore, I will
summarize the vast secondary literature on Halsted
in order to point out critical differences between him
and Meyer and perhaps reinforce why his legacy be-
came so robust.
The last two sections will focus first on the develop-
ment and evolution of Meyer’s radical operation, and
second, Meyer’s focus on post-operative arm mobility
and his attempts to alleviate such disability with sur-
gical techniques and post-operative treatment. Meyer
was a progressive surgeon focused on the entirety of
his female patients, not just the cancer in their breasts.
He empathetically sought to restore normalcy and in-
tegrity to their lives.
BACKGROUND:
RADICAL CURES
UNTIL 1880
reast cancer’s marks on the female body
were horrible reminders of cancer’s elusive-
ness to cure and impending destruction.
Whereas other cancers lurked internally,
those of the breast bubbled to the surface. As cancer
historian Olson argues, this gruesome, heightened
visibility meant that for most of history, “breast cancer
was cancer,” and for centuries, physicians devised and
disseminated advice on what might “cure” this terrible
disease.15
By the 1860s, breast cancer was no longer
seen as a systemic disease treatable with alternative
15 Olson, Bathsheba’s Breast, 48-49.
16 Ibid, 33-34.
17 Ibid, 35.
18 Ibid, 36.
19 Ibid, 39.
20 Ibid, 40.
21 Ibid.
remedies or caustics. Thus, surgery became the only
viable treatment. In the decade preceding Meyer and
Halsted’s landmark 1894 papers, a typical cure reflect-
ed palliative or short-term relief from well-progressed
cancer, and radical cures were rarely achieved. The
death of humoral theory and the rise of anesthetics,
antiseptics, and cellular pathology in the latter half of
the 19th century built the theoretical and functional
framework behind Halsted and Meyer’s 1894 radical
mastectomies.
Benjamin Rush was the first advocate for early sur-
gical intervention for breast cancer in 18th century
America. Rush embarked on a European medical tour
in 1766, which was a rite of passage for any credible
18th and 19th century physician and one that Halst-
ed would later undertake himself. When he arrived in
Paris, Rush learned that German physicians had been
performing mastectomies since the 1600s, and French
physicians were even removing axillary glands during
breast amputations.16
Rush returned to America with
the conviction that “the knife should always be pre-
ferred to the caustic.”17
If locally-derived cancers
were to be caught and destroyed before they spread, it
could only be through surgery.
In 1789, Rush consulted Mary Ball Washington,
mother of George Washington, about her two-year
struggle with breast cancer. He dismissed any possi-
bility of a cure because her disease was too far pro-
gressed.18
On the contrary, in 1811, when a forty-two
year old Abigail Adams, daughter of John Adams,
wrote to Rush, describing a tiny dimple on her breast
that eventually evolved into a movable tumor,19
Rush
wrote back to Adams’ family, suggesting a “radical
remedy” of surgery. He believed her tumor was a good
candidate because it was small and moveable, and he
could cut through non-cancerous tissue to extract it.20
Rush perhaps intuitively linked slicing through tu-
mors to adverse surgical outcomes a century before
Halsted and Meyer did.
Rush declared that mastectomy was urgent and
necessary. “Let there be no delay in flying to the
knife,” he wrote, “her time of life calls for expedition
in this business.”21
He was careful not to make men-
tion of a cure, only a “remedy” for the fear and dread
B

Adams felt. He encouraged differential treatment for
well-progressed cancers like Washington’s versus ear-
ly-stage, treatable breast cancers.
Adams was not cured. John Warren, a skilled Bos-
ton surgeon, performed a brutal, twenty-five-minute
mastectomy in the upstairs bedroom of the Adams’
home. He plunged a two-pronged fork into her breast,
lifted it from the chest wall, and sliced the tissue away
with a razor. Warren observed a tumor lurking in the
lymph nodes under her left arm, so he sliced away at
those as well. He cauterized Adams’ bleeding wound
with a red-hot spatula and wrapped bandages around
her chest as she laid awake in agony. After a painful re-
covery, she experienced a local recurrence of tumors
in her scar, indicating that Warren failed to remove all
microscopic traces of cancerous tissue.22
She passed
away in August of 1813. Adams’ cancer was deceptive-
ly far progressed, but Warren also performed surgery
without anesthetics, sterilized tools, or the knowledge
of cellular pathology that would enable a painless,
clean procedure that did not spread cancer through-
out her incision.
Radical surgery can be traced back to these early
mastectomies. Although surgeons knew very little
about cancer’s origins, they did know that any mas-
tectomy should be performed as early as possible to
remove as much tissue as possible. However, pre-1890
forms of radical surgery, historian David Cantor ar-
gues, aimed to be aesthetically and psychologically
palliative rather than curative. Surgeons focused on
alleviating physical and psychological symptoms of
breast cancer rather than permanently curing the dis-
ease.23
In contrast, the surgical practice that grew to
dominate by 1890 was grounded in a belief that the
body was composed of separate organs with discrete
functions. A diseased breast could be rectified with a
thorough surgical removal as its local character was
thought to have little bearing on remote organs and
tissues.
22 Ibid, 41-42.
23 Cantor, “Cancer,” 458-459.
24 Thomas Schlich, “The Technological Fix and the Modern Body,” In The Cultural History of the Body, vol. 6 (2010): 72.
25 Mukherjee, Emperor of All Maladies, 49.
26 For an overview of the emergence of the surgical specialty, as well as historical contention over whether surgery
should be a licensed specialty or therapy available to all physicians, see Peter J. Kernahan, “Surgery Becomes a Spe-
cialty: Professional Boundaries and Surgery,” in The Palgrave Handbook of the History of Surgery, ed. Thomas Schlich
(London: Palgrave Macmillan, 2018), 95–113.
27 Mukherjee, Emperor of All Maladies, 60-66; Sakorafas and Safioleas, “Breast Cancer Surgery,” 18-21; Olson, Bathshe-
ba’s Breast, 54-55, 58.
28 Charles E. Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (New York: Basic Books, 1987),
92-93.
Whereas Rush exemplifies the theoretical founda-
tion for the radical mastectomy in the 18th century,
the rise of anesthetics, anti-sepsis, and cellular pathol-
ogy enabled the practical foundation to implement an
effective surgical procedure in the second half of the
19th century. Thomas Schlich sums up early 19th cen-
tury surgery as “the art of bodily manipulation… seen
as a manual craft, separate from the learned medical
profession and less prestigious.”24
Operations were
life-threatening, often performed in the back rooms
of barbershops with rusty tools and leather straps
for restraints.25
However, with these aforementioned
advancements, the specialty slowly moved from the
periphery of medicine to the center.26
Historians like
Mukherjee, Olson, and Sakorafas are in agreement
that Halsted’s adoption, and adherence to these meth-
ods, likely contributed to his initial surgical successes
and the later adoption of his methods by American
surgeons.27
Anesthesia was a critical innovation that en-
abled surgeons to perform longer, intricate surgeries
with subdued patients. Anesthesia was first public-
ly demonstrated at Massachusetts General Hospital
in 1846, and ether was widely accepted within a few
years. However, “the possibilities for the growth of
surgery were limited” without knowledge of anti-sep-
sis.28
Antiseptic methods, which aimed to make surgery
cleaner and safer by reducing post-operative infec-
tions, were not as readily accepted by the surgical
community. British surgeon Joseph Lister introduced
his carbolic acid or phenol spray in 1867 as a method
to sterilize surgical instruments and to clean wounds.
However, phenol was not readily adopted in America
even by the 1880s. Samuel Gross, the esteemed sur-
geon who founded the American Surgical Society in
1880, declared that “little if any faith is placed by an
enlightened or experienced surgeon of this side of the
Atlantic in the so-called carbolic acid treatment of

Professor Lister.”29
It wasn’t until 1882 that German
bacteriologist Robert Koch demonstrated that micro-
organisms caused disease, and the adoption of anti-
septic methods would slowly come into practice in
America over the next three decades.
The 19th century also saw an expansion in fun-
damental knowledge about cellular pathology and
the nature of disease. In the first part of the century,
microscopes enabled scientists to visualize cells and
differentiate between normal and cancerous tissues.
Later on, scientists began to postulate theories about
cancers’ origins and, by the late 19th century, most
were in agreement that cancer infiltrated locally be-
fore spreading to other tissues.30
This notion further
justified surgeons’ rationale behind radical opera-
tions.
However, despite the innovations, for the most part,
surgical intervention almost never prevented breast
cancer from coming back. Joseph Pancoast, the fa-
mous surgeon and professor at Jefferson Medical Col-
lege, described and graphically depicted various sur-
geries in his book, A Treatise on Operative Surgery. In
Pancoast’s 1852 edition, he wrote that “removal of the
breast is at times considered necessary in several be-
nign or non-malignant tumors, as well as those which
are of a scirrhous or encephaloid character.”31
He was
one of the earliest American surgeons to advise ampu-
tation of the entire breast and axillary nodes through
the same incision.32
The professor advised amputa-
tion only for “well-circumscribed and local” tumors,33
the same small, “movable” types Rush described. Al-
though removal might “diminish suffering,” Pancoast
argued, “it must suffice to state the general fact, which
no one will gainsay, that perfect recovery occasionally
takes place… in the greater number of cases a return
of the disease is to be expected.”34
Pancoast was aware
of the poor prognosis for well progressed cancers.
Samuel Weissel Gross, son of Samuel Gross and
later professor of clinical surgery at Jefferson Medical
College, had a similar bleak outlook on breast sarco-
mas. In 1880, Gross published his Practical Treatise on
Tumors of the Mammary Gland, where he extensively
discussed breast tumors’ observed histology and pa-
29 Sakorafas and Safioleas, “Breast Cancer Surgery,” 19.
31 Joseph Pancoast, Pancoast’s Operative Surgery, 3rd ed. (Philadelphia: A. Hart, 1852), 269.
33 Pancoast, Pancoast’s Operative Surgery, 269.
34 Ibid.
35 Samuel Gross, A Practical Treatise on Tumors of the Mammary Gland: Embracing Their Histology, Pathology, Diagno-
sis, and Treatment, (New York: D. Appleton and Company, 1880), IX-X.
thology, as well as varying diagnoses and treatment.
He devoted general chapters to the classification and
frequency of these growths, their evolution, and their
etiology. Gross also wrote sections on each identifi-
able mammary neoplasm: fibroma, sarcoma, myxo-
ma, adenoma, carcinoma, and cysts.35
Gross viewed surgery as an intervention rather
than a cure. He encouraged radical surgery to “avert
mental anxiety and physical suffering, and to prolong
life, but [surgeons] do not entertain the most remote
Figure 1. Samuel Gross, “Fig. 26, Disseminated Sim-
ple Carcinoma,” A Practical Treatise on Tumors of
the Mammary Gland: Embracing Their Histology,
Pathology, Diagnosis, and Treatment (New York: D.
Appleton and Company, 1880), 149.

idea of effecting a radical cure.”36
Although intend-
ed to illustrate the pathology of various diseases of
the breast, Gross’ depictions of patients’ deforming
breast cancers illustrate the persistent visual remind-
ers of disease that women saw on their bodies (Fig. 1).
Although the medical community could not ensure
lifelong freedom from the disease, breast cancer’s psy-
chological impact on women was enough to warrant
intervention for short-term relief.
These interventions were still risky. According to
Gross, a woman in 1880 had a better chance of dy-
ing from the radical mastectomy than living to see
her carcinoma cured. He cited that sixteen percent
of carcinoma patients died from the procedure itself,
whereas “thorough operations definitely cure 9.05%
of all patients.”37
In his overall summation of can-
cerous tumors, Gross cited a local recurrence rate of
81%.38
Mirroring his father’s view, he “never resorted
to antiseptic precautions in amputating the mammary
gland,”39
which likely contributed to his high mortali-
ty and recurrence rates.
By the 1880s, surgeons defined incredibly rare rad-
ical cures for breast cancer surgery in medical terms.
Although few had data to support it, American phy-
sicians in the 1880s were nonetheless hopeful about
the curative power of radical surgery. They were not
alone. In Europe, surgeons had been progressively in-
creasing the radicality of their operations by remov-
ing more and new tissues. Charles Moore of Middle-
sex Hospital in London adamantly critiqued partial
breast cancer operations in 1867, and in 1868 he pos-
tulated essential tenets of the radical mastectomy. He
concluded that surgeons should extend the amputa-
tion to “adjacent diseased tissues, including gener-
ous margins of skin, the nipple/areola, the pectoral
muscles - if necessary - and axillary lymph nodes,”
because “it is not sufficient to remove the tumor, or
any portion only of the breast in which it is situated;
mammary cancer requires the careful extirpation of
the entire organ.”40
Lister shared Moore’s views, and
similarly did not systematically remove the pectoralis
muscles, but rather split them at their origin to give
36 Ibid, 221.
37 Ibid, 169.
38 Ibid, 202.
39 Ibid, 234.
40 Sakorafas and Safioleas, “Breast Cancer Surgery,” 14-15.
41 Ibid.
42 Ibid, 17.
43 Ibid.
44 Rudolph Matas, “In Memoriam: Dr. Willy Meyer 1858-1832,” Journal of Thoracic Surgery 1, no. 5 (June 1932): 455.
better access to underarm lymph nodes.41
European surgeons dove deeper and deeper into a
woman’s chest and her pectoralis muscles. Volkmann’s
procedure that he introduced in 1875 dissected off
the pectoral fascia, the thin layer of fibrous tissue
that enclosed the muscle. While looking at the tissues
under a microscope, Volkmann “repeatedly found,
when [he] had not expected it, that the fascia was
already carcinomatous, whereas the muscle was cer-
tainly not involved.”42
Lothar Heidanhein, his pupil,
was convinced that cancer cells also spread through
blood vessels and the lymphatic system. In 1889, he
explained that he removed a small piece of the pecto-
ralis major muscle if the tumor was freely mobile and
the entire muscle if the tumor was fixed.43
Meanwhile
that same year, Meyer and Halsted were refining their
surgical techniques in Germany and New York City
before presenting their own radical mastectomy pro-
cedures to the world.
WILLY MEYER
eyer’s emigration to New York City
and his widespread affiliation with hospi-
tals and medical education there shaped his
progressive approach to caring for patients.
He established himself as a male surgeon allied with
female physicians and medical students. Meyer was
concerned with quality treatment and patient care
rather than hierarchical status and prestige.
Meyer was born into a tight-knit Jewish family
on July 24, 1858 in Minden, Germany. He enjoyed
a stable, loving childhood in which education was
of paramount importance. Meyer’s father, a well-off
grain merchant, enrolled his six children in Minden’s
best grammar schools and Gymnasium, the most ad-
vanced secondary school in the German education
model. Willy studied classics in addition to English
and French.44
Dr. Abraham Jacobi, Meyer’s uncle, a famous Ger-
M

man pediatrician who had migrated to America,
sparked Meyer’s interest in medicine.45
On one of his
periodic visits to Germany, Jacobi recruited Meyer to
be his secretary. Jacobi believed the young academ-
ic’s skill in German shorthand could be useful in his
lecture tours through German clinics.46
Meyer agreed
and was inspired by his service to Jacobi and soon
45 Jacobi’s first marriage was to Fanny Meyer, the sister of Abraham Meyer, Willy’s dad.
46 Matas, “In Memoriam,” 455.
47 Ibid, 456.
48 Herbert W. Meyer, “Dr. Willy Meyer,” The American Journal of Surgery 17, no. 2 (August 1, 1932): 288.
49 Meyer, “Dr. Willy Meyer,” 288.
50 Ibid. Trendelenburg entrusted Meyer to publish the first paper detailing the “Trendelenburg Position,” a high abdomi-
nal position originally used for abdominal and pelvic surgeries.
51 Ibid.
52 Ibid, 289.
53 Ibid, 288. For more about Mary Putnam Jacobi and her work, see Carla Jean Bittel, Mary Putnam Jacobi & the Politics
of Medicine in Nineteenth-Century America, Studies in Social Medicine (Chapel Hill: University of North Carolina Press,
2009).
54 Christopher Gray, “1880s Features, Unveiled Again,” The New York Times, August 15, 2008, sec. Real Estate.
asked permission from his parents to study medicine.
He matriculated at the Medical School in Bonn, Ger-
many and, in 1880, he graduated with a medical de-
gree.47
Meyer then joined the medical faculty at the
University of Bonn and remained there until the fall
of 1884.48
Meyer’s mentors were critical to shaping his sur-
gical expertise. After his second year at Bonn, he
was appointed first surgical assistant in 1883, work-
ing under Wilhelm Busch, former Surgeon Gener-
al of the German Army.49
After Busch passed away,
Meyer attended to all the operations of Friederich
Trendelenburg, a Professor of Surgery with whom he
fostered a close friendship.50
Meyer recalled the ex-
citement when Lister’s carbolic acid spray, found to
cause dangerous chemical burns, was done away with
for new sterilization methods in the clinics.51
Early in
his training he was exposed to less toxic, innovative
antiseptic methods, so it is unknown what antiseptic
method he adopted in his own surgical practice.
The young doctor emigrated to New York City in
the fall of 1884 and had plenty of reasons to choose
the city as his landing ground. Back in Germany in
1881, he became engaged to Lily Maass, a childhood
playmate who lived in New York and visited her Ger-
man hometown of Minden in the summers.52
Fur-
thermore, Jacobi and his wife, Dr. Mary Putnam Jaco-
bi, had a strong foothold in the city and encouraged
their nephew to join them.53
They opened many doors
for the young surgeon, and Meyer quickly found suc-
cess in the fast-paced, booming medical culture of
New York City. He worked in a variety of hospitals
and teaching institutions, the first as an assistant in
the Surgical Department at the German Dispensary.54
The opening of the new German Dispensary in
1884 was emblematic of many dramatic changes that
American hospitals underwent from 1880 to 1920. The
Dispensary was founded in 1857 as a facility to care
for sick German immigrants who could not afford to
Figure 2. Moses King, Notable New Yorkers of 1896-
1899: A Companion Volume to King’s Handbook of
New York City (New York, N.Y. : M. King, 1899), 339.

pay for health care, as charitable individuals and Ger-
man societies funded the medical care.55
However, by
the 1870s, hospitals were shifting from being “wells
of sorrow and charity” to bustling centers of medical
innovation and “the production of health.”56
Hospitals
became central to medical education, with the later
paragon of excellence being Johns Hopkins Hospital,
jumpstarting a newfound faith in science’s curative
power.57
Anna Ottendorfer, a German philanthropist, ded-
icated to the welfare of women, funded the new Dis-
pensary housed at 137 Second Avenue in New York
City. Two years earlier she had donated a pavilion in
the building specifically for the treatment of wom-
en.58
Abraham Jacobi gave a speech at the opening
reception in which he detailed a history of hospitals
and dispensaries, positioning the new building as a
site devoted to the advancement of medicine and sci-
ence.59
It was here, in this progressive, female-backed
institution, that Meyer developed his skills as a gen-
eral surgeon.60
New York City was remarkable in its inclusion of
women in medical education. In 1886, after practic-
ing and teaching at the Dispensary, Meyer joined the
Woman’s Medical College of the New York Infirmary
as Professor of Surgery. The Infirmary was founded
by Elizabeth and Emily Blackwell in 1857 with the in-
tention of providing opportunities for training female
physicians. However, there were few places where
women could get a medical degree beforehand. Ten
years later, the Blackwells founded the Woman’s Med-
ical College of the New York Infirmary. The College,
under the leadership of Emily Blackwell as Dean,
55 “The German Dispensary,” The New York Times, May 8, 1869.
56 Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 2017), 146.
57 Charles E. Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (New York: Basic Books, 1987),
117-137.
58 “In and About the City: The New German Dispensary,” The New York Times, May 25, 1884, 3.
59 “In and About the City,” 3.
61 Carla Jean Bittel, Mary Putnam Jacobi & the Politics of Medicine in Nineteenth-Century America (Chapel Hill: Univer-
sity of North Carolina Press, 2009), 101.
62 Bittel, Mary Putnam Jacobi, 103.
63 Meeting notes pages 192, 209, 211, 1893-1895, Box 1, Folder 6, Minutes of the New York Infirmary for Women and
Children: 1883-1997, Medical Center Archives of New York-Presbyterian/Weill Cornell Hospital, New York, New York.
65 NY Infirmary for Women and Children / Woman’s Medical College: 1890 Dispensary Rules page 6, Box 1, Folder 7,
Miscellaneous 1881-1891, Medical Center Archives of New York-Presbyterian/Weill Cornell Hospital, New York, New
York.
66 NY Infirmary for Women and Children / Woman’s Medical College: “Salaries of College” page 6, Box 1, Folder 7, Mis-
cellaneous 1881-1891, Medical Center Archives of New York-Presbyterian/Weill Cornell Hospital, New York, New York.
68 Franz Torek, “Willy Meyer, M.D., 1858–1932,” Annals of Surgery 97, no. 1 (January 1933): 157.
grew into “a strong institution that equaled and even
surpassed some male-only medical schools,” histori-
an Carla Bittel argues.61
Five to ten female physicians
graduated each year, and the Infirmary provided ser-
vices to between 6,000 and 7,000 female patients per
year.62
Some men were hired alongside women as pro-
fessors, and Meyer remained on staff as a consulting
physician to the College until at least 1907.63
Here, he
was devoted to the cause of women in medicine and
served as professor and resident physician.64
By 1890 at
the Infirmary, all cases of “diseases of the breast” were
sent to his surgical department.65
Although Meyer
did not begin performing his radical operations until
1894, it is notable that cases of breast cancer were im-
mediately sent to the department in which he worked.
The College reported to the Regents of the Universi-
ty of the State of New York, the overseeing body for
medical colleges in the state, that they paid Meyer a
salary of $350 in 1890 for his work at the infirmary.66
Dr. Herbert Willy Meyer, Meyer’s son, would write
upon his death in 1932 that his father “gave a helping
hand at all times to women doctors, for whom he held
the highest esteem and greatest regard, and aided the
cause of women in medicine to the last.”67
Meyer worked in a wide range of New York City
hospitals in addition to the German Dispensary and
the New York Infirmary. In 1886, he was appointed
Attending Surgeon to the New York Skin and Cancer
Hospital, the German Hospital (now known as Lenox
Hill Hospital), and one year later to the Postgradu-
ate Hospital.68
Meyer was also Professor of Surgery at
the Postgraduate Medical School and eagerly trained

young surgeons in their craft. He was consulting staff
to the Hospital for Joint Diseases, the Montefiore Hos-
pital, and the Glens Falls Hospital for many years.69
At
the time of his death in 1932, Meyer was consulting
surgeon to nine different hospitals in the city,70
a tes-
tament to his widespread, de-centralized involvement
in the medical community there.
Meyer is best remembered for his contributions to
thoracic surgery. In February of 1917, Meyer, along
with twenty of his close surgical colleagues, founded
the New York Association for Thoracic Surgery and
was appointed chairman.71
Their main goal was to
expand nationally. Soon thereafter in June, the first
meeting of a larger national society of thoracic sur-
geons met at the Waldorf Astoria in New York City.72
This new American Association for Thoracic Surgery
elected Meyer’s close friend Samuel Meltzer as their
first president in 1919. Franz Torek, fellow thoracic
surgeon and colleague of Meyer’s, wrote that “tho-
racic surgery in America owes a great deal to Meyer’s
pioneer work.”73
Meyer served as second president
for two terms. He never ceased his work on cancer,
tortured by the unknowns of its origins and how it
spread. In 1931, the year before he died, Meyer pub-
lished a book titled Cancer: Its Origin, its Develop-
ment and Its Self-Perpetuation.
WILLIAM STEWART
HALSTED
alsted’s upbringing and training, on
the other hand, deviated wildly from Mey-
er’s. Halsted was born into wealth, and his
family promised the highest quality of edu-
69 Ibid.
70 Matas, “In Memoriam,” 460.
71 J. Gordon Scannell, “Willy Meyer (1858-1932),” The Journal of Thoracic and Cardiovascular Surgery 111, no. 5 (May 1,
1996): 1112.
72 Ibid.
73 Torek, “Willy Meyer,” 157.
74 Halsted played shortstop for the Yale baseball team, rowed crew, and captained the 1873 Yale football team. He
scored the winning touchdown in Yale’s opening game his senior year, which is often cited as the first American foot-
ball game. For more on Halsted, see Johns Hopkins University, “About Halsted,” Halsted: The Documentary, accessed
March 1, 2020, http://halstedthedocumentary.org/halsted.php.
75 J L Cameron, “William Stewart Halsted: Our Surgical Heritage,” Annals of Surgery 225, no. 5 (May 1997): 447; Gerald
Imber, Genius On the Edge: The Bizarre Double Life of Dr. William Stewart Halsted, 2011, 25; S. Robert Lathan, “Caroline
Hampton Halsted: The First to Use Rubber Gloves in the Operating Room,” Proceedings (Baylor University. Medical
Center) 23, no. 4 (October 2010): 390.
76 Imber, Genius On the Edge, 31.
cation to him. Despite his lifelong battle with addic-
tion, Halsted did prove his immense aptitude and skill
as a physician. However, as a practitioner and teach-
er, Halsted was abrasive. He built and strengthened
a patriarchal medical system at Johns Hopkins, dis-
interested in the education of female doctors or the
students who sought to learn from him.
William Stewart Halsted was born into a privileged
New York City family in 1852. He attended Andover,
a prestigious Massachusetts private school, before
matriculating at Yale College in 1870. At Yale, Halsted
was a poor student, far more interested in sports than
his studies.74
However, in his last year, he found inter-
est in anatomy and physiology and attended lectures
at the nearby Yale Medical School.
Halsted returned to New York City in 1874 where
he enrolled at the Columbia University College of Phy-
sicians and Surgeons, dedicating himself to a career in
medicine. He studied hard and did incredibly well. He
took his internship exam one year early, which grant-
ed him a prestigious yearlong internship in 1877 at
Bellevue Hospital. Here, Halsted met Lister and was
introduced to his methods of aseptic surgery. Where-
as most were dismissive, Halsted was convinced of the
importance of the concept.75
After his internship, Halsted spent the follow-
ing year as house surgeon at the New York Hospi-
tal, where the lack of dynamic postgraduate surgical
training became apparent to him.76
He embarked on
a whirlwind academic tour of Europe to learn from
the best European scientists and surgeons, arriving
in Paris in the fall of 1878. Soon thereafter, Halsted
moved to Germany, where he threw himself into his
studies of pathology, eye, ear, and skin diseases, and
gynecology. In 1879, he studied with Volkmann, who
had published a paper on breast cancer surgery in
which he first defined “radical cures” only four years
H

earlier.
Halsted returned to New York City in 1880 with
refined surgical training. Historian and surgeon John
Cameron refers to the period between 1880-1886 as
Halsted’s whirlwind “New York Years,” “the most vig-
orous and energetic of his career.”77
Like Meyer, he
took positions in charity hospitals, such as the Emi-
grant Hospital on Ward’s Island and Roosevelt Hospi-
tal, where he worked in the lab as well as the clinic and
77 Cameron, “William Stewart Halsted,” 448.
78 Ibid.
79 Ibid.
80 Ibid, 449.
81 Imber, Genius On the Edge, 77.
82 In the fall of 1890, William Osler, the only colleague who explicitly knew about Halsted’s addiction, confronted him
about his suspected relapse. Halsted revealed his management of his addiction, and that he could not function without
enormous amounts of morphine. He used almost four times the normal therapeutic dose. See Imber, Genius On the
Edge, 141-142.
operating room. At Bellevue, he found the implemen-
tation of antiseptic techniques imperative to his sur-
gical work, and convinced the Hospital board to erect
an operating room for his personal use after finding
theirs too dirty to operate in.78
During his New York
Years, Halsted’s students and colleagues saw him as
a bold, daring surgeon and a charismatic teacher. He
was energetic and seemingly indefatigable.79
This would all change in 1884. Halsted experiment-
ed with cocaine as a local anesthetic and in his explo-
rations became addicted to the drug himself. In 1886,
he published an article on the topic, which Camer-
on describes was a “rambling, incoherent paper that
[was] a testament to the addicted debilitated state that
Halsted had reached.”80
After a failed attempt to cure
himself of his addiction alone, Halsted’s close friends
and family urged him to check into Butler Hospi-
tal in Rhode Island in May of 1886. During his sev-
en-month stay, his cocaine addiction was treated with
morphine, and he became heavily dependent on both.
After he was discharged, Halsted arrived at Johns
Hopkins University in 1886 as one of only sixteen
graduate students selected by William H. Welch to
study at the department of pathology.81
Halsted lived
with Welch and worked in his lab, but after a short
time, Halsted re-admitted himself to Butler for nine
months. Although he claimed he was fully recovered,
the 1887 hospitalization made little to no impact on
his addiction.82
When the Johns Hopkins Hospital opened in 1889,
Welch was named Chief of Pathology and Halsted
was appointed Associate Professor of Surgery. The
two men comprised half of Hopkins’ “big four,” the
group of founding professors at Hopkins, along with
William Osler, Physician in Chief, and Howard Kelly,
Professor of Gynecology (Fig. 4). In this environment,
Halsted reimagined a new training system for young
surgeons. His system of residency was grounded in
the notion of total immersion until surgeons reached a
superior level of competence and skill. Residents lived
in the hospital and were on duty every day for twen-
ty-four hours a day. This intense system of graduated
Figure 3. Thomas C. Corner, “William Stewart Halst-
ed,” Oil on Canvas, 1936, Portrait Collection of the
Johns Hopkins Medical Institutions, http://portrait-
collection.jhmi.edu/portraits/halsted-william.

responsibility would become the paragon of graduate
medical school education and training, perhaps de-
rived from Halsted’s experience with the disorganized
undergraduate and postgraduate medical education
in New York City.
Johns Hopkins University struggled to gather funds
to open a medical school. There was an open appeal
for financial help to open the Johns Hopkins School
of Medicine, and a group of four feminists, all daugh-
ters of Hopkins trustees, organized the Women’s Fund
Committee, a fundraising campaign with the goal
that the school admit women as well as men.83
By the
1890s, there were some medical schools that admitted
women and others founded specially for the medical
education of women. None were of the educational
caliber of Hopkins. Sentiment within the Hopkins
leadership was generally against co-education and
they were reluctant to accept the endowment, which
they viewed as a bribe. Halsted was notably silent on
the topic, and Welch, Halsted’s mentor, claimed he
would be embarrassed discussing certain topics in
front of female students.
Mary Garrett, the wealthiest of the four women,
contributed a majority of the funds to reach the nec-
essary $500,000 to open the School of Medicine. She
insisted on upholding Welch’s early requirements that
all students must have earned a bachelor’s degree pri-
or to admission with the necessary premedical stud-
ies.84
On the condition of her final donation, Garrett
required that women be admitted on the same terms
as men and not under separate criteria.85
In the fall of
1893, after almost four years of intense debates, the
first class of medical students enrolled at the Johns
Hopkins School of Medicine. The group was com-
posed of fifteen men and three women. The next year,
five women and thirty-five men were admitted.86
Halsted’s reliance on cocaine and morphine had
fundamentally changed his personality and hindered
his ability to teach medical students. At Hopkins,
Halsted gained a notorious reputation for his biting
sarcasm, reclusiveness, and negligence towards his
students.87
He was chronically absent. When students
and house staff like Harvey Cushing got the opportu-
83 The fight to include women in Johns Hopkins School of Medicine was dramatic and highly political. For a full nar-
rative of the events, see Imber, Genius on the Edge, 184-188 and Michael Bliss, William Osler: A Life in Medicine (New
York: Oxford University Press, 2007), 199-206.
84 Imber, Genius on the Edge, 186.
85 Ibid, 187.
86 Ibid, 189-190.
87 Michael Bliss, Harvey Cushing: A Life in Surgery (New York: Oxford University Press, 2005), 195.
88 Bliss, Harvey Cushing, 94.
nity to watch Halsted operate, he was “exasperatingly
slow, lacked both showmanship and easy dexterity,
made no helpful comments to observers, and con-
stantly nagged his assistant.”88
Gerald Imber, Halsted’s
biographer, revealed that “Halsted had no relation-
ship with the medical students and made no effort to
develop one. Not only did he skip his weekly lectures,
but the subjects upon which he lectured were so far
over the heads of the students that they felt exclud-
Figure 4. John Singer Sargent, “The Four Doctors,”
Oil on Canvas, 1906, Portrait Collection of the
Johns Hopkins Medical Institutions. From left to
right: William Welch, William Stewart Halsted, Wil-
liam Osler, and Howard Kelly.

ed.”89
Some speculated about his bizarre behavior, but
most of Halsted’s colleagues overlooked or brushed
aside signs of his addiction.90
But despite Halsted’s personal shortcomings, he
proved himself to be a brilliant, dexterous surgeon,
whose slow, painstaking manner of operation was
the antithesis to surgeons of the century prior who
were called “rippers” and “quick slashers.”91
The year
of 1889 saw two of Halsted’s major surgical innova-
tions. He performed his first operation for breast can-
cer in May of that year. In late winter of 1889, Halsted
noticed that Caroline Hampton, his scrub nurse, suf-
fered from severe dermatitis on her hands due to the
toxic antiseptic chemicals used in his operating room.
He sent for Goodyear Rubber in New York to make a
pair of thin, sturdy, reusable rubber gloves for Hamp-
ton. This was both revolutionary and romantic. Out
of concern for the woman he would soon marry in
June of 1890, Halsted introduced rubber gloves into
the operating room.92
Although nurses and assistants
adopted the method, surgeons rarely wore gloves due
to concerns losing manual dexterity. In 1896, Halst-
ed’s resident, Joseph Bloodgood, began wearing rub-
ber gloves for every operation. The entire Hopkins
team followed suit, and rates of post-surgical infec-
tion plummeted.93
Halsted’s commitment to slow,
controlled, aseptic surgery changed the standards of
the field and his techniques, including his design for
hierarchical medical education, were passed down at
Johns Hopkins.
THE RADICAL
OPERATION
he surgical, training, and personal en-
vironments of these two men were notably
different. Nonetheless, after years of exam-
ining patients in Baltimore and New York,
90 Bliss, William Osler, 212.
91 Ibid.
92 Lathan, “Caroline Hampton Halsted,” 389–90; Imber, Genius On the Edge, 114-115.
93 Imber, Genius On the Edge, 116; Lathan, “Caroline Hampton Halsted,” 391.
94 Meyer, “An Improved Method,” 748.
95 Ibid.
96 Willy Meyer, “Cancer of the Breast,” Surgery, Gynecology, and Obstetrics 24 (1917): 555.
Halsted and Meyer described a nearly identical breast
cancer surgery in November of 1894. Meyer present-
ed “An Improved Method of the Radical Operation
of Cancer of the Breast” on November 12, ten days
after Halsted’s publication in the Annals of Surgery on
November 2nd. Halsted’s “complete operation” made
mention of a “radical cure,” but it was Meyer who ac-
tually described the procedure itself as “radical.” Mey-
er addressed Halsted’s paper in an addendum, insist-
ing that “the idea of removing the carcinoma in the
breast in this way [“en-bloc”] was conceived of me last
winter,” but that no breast cancer cases came under
his care at the German Hospital until the following
September when he started writing.94
Although it was
Meyer’s procedure that would become popularized,
Halsted published earlier and the procedure remained
linked to his name.
A. Procedural Differences
Initially, Meyer and Halsted’s procedures differed
anatomically from one another in three ways. First,
they used different incision techniques. Whereas
Halsted made a teardrop incision around the base of
the breast, Meyer made three straight, diagonal inci-
sions (Figs. 5-6, 11). Halsted also explored and cleaned
out all contents of the sub clavicular space, a method
which Meyer found to be “no doubt, a very wise ad-
dition,” vowing to remove the lymph nodes above a
patient’s clavicle in all subsequent operations.95
The third major difference between the two sur-
geon’s techniques prompted Meyer to redefine what
constituted a radical operation; indeed, he claimed his
procedure to be even more radical than Halsted’s. Be-
fore 1894, it was customary to first remove the breast
by dissecting it off the pectoral fascia, and then to re-
move either one or both of the pectoralis major and
minor muscles.96
Halsted’s initial method split the two
muscles and removed the pectoralis minor, whereas
Meyer excised both together, keeping the muscles,
fat, and axillary contents anatomically in place rela-
T

tive to one another.97
Halsted later adopted Meyer’s
technique of removing both, but he claimed to have
“independently come to the conclusion that [it] better
be done.”98
Meyer defined the radical operation as that
which excised both pectoralis muscles in one piece
with the breast tissue (Fig. 7).
Meyer’s technique, he wrote retrospectively in
1917, resulted from a failed procedure on a “rather
stout” private patient.99
The woman died from the
operation, during which Meyer removed the muscles
only after he removed her breast, leading to signifi-
cant blood loss and ultimately death. Meyer recalled
that “the sad experience persistently haunted the op-
erator,” prompting him to revise his technique and
radicalize his “en bloc” removal.100
It was Meyer’s
“hard luck,” he wrote, “not to get a single cancer of
the breast, either in private practice or at the hospitals
97 Meyer, “An Improved Method,” 748; Sakorafas and Safioleas, “Breast Cancer Surgery,” 26.
99 Meyer, “Cancer of the Breast,” 556.
100 Ibid.
101 Ibid.
103 Mukherjee, The Emperor of All Maladies, 60.
with which he was connected at the time, until nine
months later, September 19, 1894.”101
In his presenta-
tion to the New York Surgical Academy two months
later that same year, Meyer passed around a specimen
of the removed breast to the surgeons in attendance
in order to “show nicely how radical the operation has
been done. The whole mass is in one piece.”102
Historian Siddhartha Mukherjee argues that Halst-
ed “inherited the idea [of the radical mastectomy]
from his predecessors and brought it to its extreme
and logical perfection.”103
However, it was Meyer who
initially redefined in clear terms what it meant to be
a radical procedure. Later on, both surgeons adopted
one another’s invasive techniques of muscular remov-
al and of extending surgery into the neck. The proce-
dures removed so much tissue that one of the order-
lies at Johns Hopkins once joked about which half of
Figure 5. Willy Meyer, “Figure 3. Incision of Willy
Meyer’s radical operation, as first devised in 1894,”
in “Cancer of the Breast,” Surgery, Gynecology, and
Obstetrics 24 (1917): 560.
Figure 6. William Stewart Halsted, “The Results of
Operations for the Cure of Cancer of the Breast
Performed at the Johns Hopkins Hospital from June
1889 to January 1894,” Johns Hopkins Hospital Re-
port 4 (1894): Plate I.

104 Bliss, Harvey Cushing, 101.
106 Ibid.
107 Willy Meyer, “Carcinoma of the Breast: Ten Years’ Experience with My Methods of Radical Operation,” Journal of the
American Medical Association 45, no. 5 (July 29, 1905): 301.
Halsted’s patient should be returned to the ward.104
Halsted’s “Results of Operations for the Cure of
Cancer of the Breast Performed at the Johns Hopkins
Hospital from June 1889 to January 1894” overshad-
owed Meyer’s contributions. Halsted reported on fif-
ty “hopeless and unfavorable” cases of breast cancer
treated over the course of five years. Meyer, in con-
trast, had performed a total of six mastectomies and
only one by his radical technique. Nine months after
his failed operation, Meyer operated with his newly
conceived technique on another woman on Septem-
ber 19, 1894, less than two months before he present-
ed his paper. He removed a tumor the size of a goose
egg from his thirty-seven year-old patient, “Mrs.
F.O,” who had suffered from the disease for eighteen
months.105
Meyer was modest about the results, writ-
ing, “I am, of course, fully aware that this most radical
method of operation will not prevent the recurrence
of the growth ‘en loco,’ nor metastases in remote parts,
especially not, if the patient be subjected to the oper-
ation in an advanced stage of the disease.”106
But re-
markably, this patient survived Meyer’s intervention
and lived for at least ten years after.107
Whereas Meyer had surgical theory and a case
Figure 7. Willy Meyer, “Cancer of the Breast,”
Surgery, Gynecology, and Obstetrics 24 (1917):
561.
Figure 8. William Stewart Halsted, “The Results of Operations for the Cure of Cancer of the
Breast Performed at the Johns Hopkins Hospital from June 1889 to January 1894,” Johns Hopkins
Hospital Report 4 (1894): Table XI. Note the wavy lines, which indicate Halsted’s weak addition of
regionary recurrence to the graph.

study to report, Halsted shocked the medical pro-
fession with his statistics that seemed too good to be
true. Meyer was careful not to use the word “cure”
in 1894, but Halsted explicitly claimed in his title to
“cure cancer of the breast.” Of Halsted’s fifty patients,
he claimed only three suffered a “true” local recur-
rence of the disease in the scar tissue, a six percent
rate. Eight additional women suffered from what
Halsted classified as “regionary recurrence,” marked
by skin metastasis close to but not immediately in the
area of operation. He acknowledged that late local re-
currence, occurring upwards of three years post-sur-
gery, “was not rarely met with.”108
Thus, Halsted’s real
recurrence rate was more likely around 22%, still im-
pressive when lined up against his predecessors like
Volkmann and Heidanhein (Fig. 8). Of the thirty-four
patients assumed to still be living, two could not be
located for follow-up. Halsted included very recent
cases in his statistics as successes. Since November of
1893, within only one year of his publication, he had
operated on six cases using his “complete operation.”
Halsted classified all six as having “no local or region-
ary recurrence,” and all but one as having favorable
prognoses post-operation.109
Halsted shaped his own definition of what it meant
to cure breast cancer. He conceded that “the efficiency
of an operation is measured truer in terms of local re-
currence than of ultimate cure.”110
Such a cure, he later
elaborated, was what Volkmann previously defined as
a radical cure, three years’ freedom from the disease
without local recurrence.111
This modified definition
allowed Halsted to tout a high success rate for his op-
eration, strengthening the reputation and legitimacy
of radical surgery even though women were not walk-
ing out of Johns Hopkins freed from breast cancer for
life.
B. Institutional Differences
Followingtheseinitialpublications,MeyerandHalst-
ed continued to operate on patients and publish papers
108 Halsted, “The Results of Operations,” 510.
109 Ibid, 527-529.
110 Ibid, 502.
111 Ibid, 505.
112 Bliss, Harvey Cushing, 94
113 Halsted and Cushing had a fascinating relationship marked by profound mutual respect and tainted by Halst-
ed’s erratic behavior. See Jennifer R. Voorhees et al., “William S. Halsted and Harvey W. Cushing: Reflections on Their
Complex Association: Historical Vignette,” Journal of Neurosurgery 110, no. 2 (February 1, 2009): 384–90, https://doi.
about the radical mastectomy. Meyer’s environment in
New York City differed greatly from Halsted’s medical
system at Johns Hopkins. Ultimately, Halsted’s narrow
definition of success and lack of adherence to the three-
year convention was overlooked, likely because of his
powerful role at Johns Hopkins. He had prestige and re-
spect as a surgeon, despite the fact that many regarded
his character and teaching skills as problematic. Halsted
had a breadth of female patients to operate on and a tal-
ented surgical team of assistants and residents. Meyer,
on the other hand, had stature and respect, and his pro-
cedure was acknowledged at the time in the New York
surgical community. However, he was involved with a
variety of hospitals and did not benefit from the steady,
centralized infrastructure offered at Hopkins.
Halsted, it seems, could not keep up with the pace of
breast cancer cases admitted to the surgical department,
often leaving many parts or the entire procedure to oth-
er Hopkins surgeons like Harvey Cushing or Joseph
Bloodgood, Halsted’s surgical pathologist and one of
his earliest residents. Furthermore, he seemed far more
interested in the cancer pathology and histology than
the patient, as Cushing recalled a day of ward rounds
with his mentor.
“If [Halsted] were sufficiently interested, he
might ask that he be permitted to do the
operation; and if he came and did operate, as
soon as the breast was removed, leaving the
huge closure and skin graft for Bloodgood,he
would depart with the tissues.Then he would
study and ruminate over for an interminable
time, meanwhile tagging innumerable areas
which he wished to have sectioned – a duty
which he devolved upon the house officer
[Cushing].”112
This hand-off of work was not uncommon for Halst-
ed. In an 1898 report on the histology of very rare ad-
enocarcinoma tumors, Halsted admitted that “during
the past two years, my assistants, Drs. [John] Finney,
Bloodgood, and Cushing,113
have probably performed
the majority of breast operations; prior to this, almost

all of the breast cancers were operated on by the writer
[Halsted].”114
Halsted also left the patient follow-up to
Bloodgood, who compiled all of the mortality and mor-
bidity follow-up statistics for Halsted’s 1894 and 1898
articles.115
Bloodgood and Halsted’s ruthless partnership em-
bodied the institutional support awarded to Halsted
at Hopkins. Moreover, in a 2018 article in the Bulletin
of the History of Medicine, James Wright Jr. argues that
Bloodgood, the head of pathology at Johns Hopkins, was
actually responsible for Halsted’s aggressive approach to
breast cancer surgery despite the lack of supporting data
for his claim. Wright is critical of Bloodgood’s change
of heart in the use of intraoperative frozen section bi-
opsy (IFS), which he only became an advocate for late
in his surgical career, after Halsted’s death.116
IFS was
developed at Hopkins and first published in 1895. The
technique consisted of surgeons removing a small piece
of tissue and studying it under a microscope as the
operation proceeded. The pathological analysis deter-
mined what operation the surgeon would pursue. IFS
technology allowed surgeons to differentiate between
benign and malignant lesions, and it could also be used
to determine how much cancer had spread and whether
the surgical margins were free of the disease. Critically,
the adoption of IFS might have given surgeons empiri-
cal indication that less invasive tumors could be excised
without disfiguring, excessive tissue removal.
Although IFS was not available at the time Meyer
and Halsted perfected their radical mastectomy tech-
nique, neither surgeon adopted it in the years following.
Wright explains that because Halsted did not initial-
ly have the option of this kind of diagnostic support,
he “compensated by developing a fine-tuned ability to
recognize the gross appearance of breast cancer. Un-
doubtedly, hearing his surgical pathologist Bloodgood
repeatedly say over the years that frozen sections were
no better than gross examination reinforced that this
continued to be true.”117
While he and Halsted worked
together, the most radical operation, in Bloodgood’s
org/10.3171/2008.4.17516.
114 William Halsted, “A Clinical and Histological Study of Certain Adenocarcinomata of the Breast: And a Brief Consid-
eration of the Supraclavicular Operation and of the Results of Operations for Cancer of the Breast from 1889 to 1898 at
the Johns Hopkins Hospital,” Annals of Surgery 28, no. 5 (November 1898): 575.
116 James R. Wright, “The Radicalization of Breast Cancer Surgery: Joseph Colt Bloodgood’s Role in William Stewart
Halsted’s Legacy,” Bulletin of the History of Medicine 92, no. 1 (April 20, 2018): 141–71.
117 Wright, “The Radicalization of Breast Cancer Surgery,” 148.
118 Joseph C. Bloodgood, “The Relation of Surgical Pathology to Surgical Diagnosis,” Detroit Med. J. 3 (1904): 338.
120 Ibid, 554.
121 Charles N. Dowd, “A Study of Twenty-Nine Cases of Cancer of the Breast Submitted to Operation,” Annals of Sur-
mind, was always the safest bet. Bloodgood summed
up his view on cancer surgery in 1904 when he wrote
that “in regard to tumors . . . lynch law is by far the bet-
ter procedure than ‘due process.’”118
Such “lynch law”
supported an unforgiving removal of all breast cancers.
Backed by their powerful positions at Hopkins, these
extreme views held great weight.
Meyer shared the same sentiment. He wrote in 1917
that he “disapprove[d] of the procedure still often prac-
ticed in cases of doubt as to the diagnosis, i.e., of cutting
down upon and into the tumor to obtain a piece for ex-
amination in frozen section, and then add the radical
operation, if malignancy is proved.”119
Their reluctance
to do so was perhaps due to the still unknown nature of
how cancer spread, although the medical and surgical
community was well aware of how dangerously it did.
In the same paper, Meyer posited that cancer might be
of infectious parasitic origin.120
Meyer’s operation was well-known in New York
City surgical circles but received far less recognition
than Halsted’s. Dr. Charles Powers, attending surgeon
to St. Luke’s Hospital and the Cancer Hospital of New
York, wrote on “cancer of the breast” in 1895 and com-
pared Halsted and Meyer’s techniques. He found both
surgeons’ operations highly respectable, saw Meyer’s
removal as more radical, and predicted the potential
power of Hopkins to bolster Halsted’s results. In No-
vember of 1897, Dr. Charles Dowd, an attending sur-
geon to the New York Cancer Hospital, presented “A
Study of Twenty-Nine Cases of Cancer of the Breast” to
the Surgical Society of the New York Academy of Med-
icine. In his address, he outlined the surgical method
he performed on each patient. Dowd differentiated be-
tween Halsted and Meyer’s operation by their varying
removal of the pectoralis muscles, while also asserting
that both were more invasive than Volkmann’s, which
went only as far as dissecting off the pectoral fascia. He
echoed that “these extensive operations have been done
by many surgeons since that time, but few reports have
been made concerning their efficacy.”121
Eight women

underwent the procedure outlined by Volkmann, twen-
ty underwent that of Halsted’s, and one underwent a
Meyer radical mastectomy.122
Dowd did not detail why
more cases were operated on according to the Halsted
method.
While surgeons applauded Halsted’s report, it was
clear that further data was needed to support his claims.
Powers explained, “with the magnificent resources of
the Johns Hopkins Hospital at his command, we might
well expect definite and extensive histological reports
of the involvement or freedom from invasion of the
muscles, lymphatics, fascia, fat and other tissues. Such
details are, however, lacking in the reports of his cas-
es… We shall await with much interest further reports
on the all-important question of radical cure.”123
Powers
was rightfully dubious about the radical cure, critical of
the extent of Halsted’s report, but he was optimistic, as
were many American surgeons following 1894.
C. Post-1894 Outlooks and
Operations
At the turn of the century, surgeons across the coun-
try believed that major strides had been made in the
fight against breast cancer and were optimistic about the
radical mastectomy’s potential. However, Halsted and
Meyer felt pressured to publish more data and operate
on more women to cement their initial findings. Meyer
presented further statistics much later than Halsted did:
he focused more on caring for the women on whom he
operated than on the data his patients represented.
The surgical community was confident that with
more data, the radical mastectomy would prove to fi-
nally cure this elusive disease. W.W. Keen, Professor of
Surgery at Jefferson Medical College in Philadelphia,
spoke on breast cancer to the Cleveland Medical Soci-
gery 27, no. 3 (March 1898): 288.
122 Dowd, “A Study of Twenty-Nine Cases,” 294–302.
123 Charles Powers, “The Technique of Operations for Cancer of the Breast,” Journal of the American Medical Associa-
tion 24, no. 9 (March 2, 1895): 300.
124 William W. Keen, “Amputation of the Female Breast,” reprint from the Cleveland Medical Gazette, December 1894.
Available through the U.S. National Library of Medicine Digital Collections, 2.
125 Keen, “Amputation,” 10. The validity of Keen’s statistics should be regarded with a reasonably high level of skepti-
cism. For a detailed discussion of the history and construction of breast cancer risk and falsified statistics, see Robert
A. Aronowitz, Unnatural History: Breast Cancer and American Society (Cambridge; New York: Cambridge University
Press, 2007).
126 Powers, “The Technique of Operations,” 302.
127 Emmanuel Senn, Amputation of the Breast by Means of the Anterior Axillary Incision, Chicago: American Medical
Association Press, 1899, 1.
128 Halsted, “A Clinical and Histological Study,” 575-576.
ety in December of 1894, describing the “extraordinari-
ly good results of modern surgical treatment… not only
as to mortality but as to a definite cure.”124
After com-
piling data from five surgeons, including recently pub-
lished data from Halsted, Keen estimated the American
mortality rate from breast operations themselves to be
less than one percent.125
Although skeptical, Powers at
St. Luke’s asserted that breast cancer was indeed “a cur-
able disease and that the keynote to its successful man-
agement is to be found in the earliest possible diagnosis
[and] prompt and wise excision.”126
Five years later in
1899, Chicago surgeon Dr. Emanuel Senn proclaimed
in a brief JAMA article that “amputation of the breast
in malignant disease is no longer regarded as a pallia-
tive operation in prolonging life, but should have… a
permanent result.”127
The definite reports Powers sought
never came.
Nonetheless, Halsted did include updated data at
the end of his 1898 paper. He reported similar recur-
rence rates to his initial analyses. Out of one hundred
and thirty-three total breast cancer surgeries done at
Hopkins, thirteen women, or 9%, suffered from local
recurrence and twenty-two, or 16%, suffered from re-
gional recurrence, revealing a total recurrence rate of
25%. However, of the seventy-six women that Halsted’s
team operated on at least three years earlier, ten women
had passed away after the three-year cut-off and thir-
ty-five women died within the three-year cut-off. The
total death rate was, thus, forty five out of seventy-six
women, or 59%. Over half of Halsted’s patients perished
following his intervention.128
Seven years after Halsted in 1905, Meyer published a
paper in the Journal of the American Medical Association
titled “Carcinoma of the Breast - Ten Years’ Experience
with my Method of Radical Operation,” where he finally
debuted his data (Fig. 9). Out of seventy patients and
seventy-two radical mastectomies - he had performed
bilateral procedures on two patients - Meyer claimed

Figure 9. Willy Meyer, “Carcinoma of the Breast: Ten Years’ Experience with My Methods of Radical Opera-
tion,” Journal of the American Medical Association 45, no. 5 (July 29, 1905): 311.

to lose only two as a result of the procedure. The first
patient was diabetic and died from a coma shortly after
the procedure.129
The second suffered from metastatic
cancer.130
He removed a carcinoma of her right breast
in 1901, but nine months later, the cancer had spread
to her left breast and stomach.131
Meyer performed a
radical mastectomy on her left breast, but she passed
away shortly after.132
He still considered the mortality
from his operation to be zero.133
The second woman on
whom he radically removed both breasts, Meyer proud-
ly stated, was alive and well in 1905.
How did Meyer stand in terms of a radical cure?
He admitted having a hard time compiling long term
statistics because in New York City, “with its ever shift-
ing population, it is not an easy task to keep track of
one’s patients operated on at the wards of various hos-
pitals.”134
He did not have a team of talented residents
or pathologists at his disposal to finish operations or
compile statistics. Nonetheless, Meyer located all but
three patients for follow-up. He explicitly adopted
Halsted’s definitions for local and regional recurrence,
as well as Volkmann’s three-year radical cure cut-off.135
Of sixty-seven patients, thirty-four, or 52%, had since
passed away. The remaining patients were still alive at
the time Meyer published, but six of them had local or
regional recurrence. The remaining 35.8% were “alive
and well.”136
Now that the procedure was no longer in its
infancy, Meyer was convinced that success rates could
only be improved if women sought surgical interven-
tion earlier.
Halsted shared this view in his final publication on
breast cancer in 1907. He compiled statistics to high-
light the importance of operating on cancers early on,
before metastasis occurred. Halsted reported on a total
of 252 cases,137
over three times as many patients Meyer
reported seeing two years earlier. Additionally, by this
time, Halsted’s complete method included a decision
129 Meyer, “Carcinoma of the Breast: Ten Years’ Experience,” 303.
130 Ibid.
131 Ibid.
132 Ibid.
133 Ibid.
134 Ibid, 309.
136 Ibid, 311-313
137 William Stewart Halsted, “The Results of Radical Operations for the Cure of Carcinoma of the Breast,” Annals of
Surgery 46, no. 1 (July 1907): 2
138 Halsted, “The Results of Radical Operations,” 2.
139 Ibid.
140 Willy Meyer, “Correspondence: The Operative Treatment of Cancer of the Breast,” Annals of Surgery 41, no. 1 (Janu-
ary 1905): 159.
141 Meyer, “Correspondence,” 159.
about whether or not to remove sub-clavicular lymph
nodes and extend surgery into the neck region, which
depended on how much the cancer had spread before
operation. Thus, for statistical analysis, Halsted split his
patients into three data categories. Halsted performed
the “complete subclavian and neck operation” for pa-
tients in Group I. Those in Group II had two successive
surgeries, the first being the en-bloc, “complete pecto-
ral or subclavian” and the second, “the supraclavicular
or neck part was performed.”138
Group III underwent
the “complete pectoral operation” without exploration
of the neck.139
Of note, Halsted finally adhered to Volk-
mann’s three-year convention for denoting a cure and
did not include recent patients in his cure statistics.
Without the number of patients, prestige, and band-
width afforded to Halsted at Hopkins, Meyer went to
great lengths to defend his method and attribute his
name to his work. In a 1904 letter to the Annals of Sur-
gery, Meyer lamented that Boston surgeon J. Collins
Warren, descendant of the Harvard surgeon who oper-
ated on Abigail Adams, wrote about Meyer’s procedure
without due credit. Warren claimed to have improved
upon Halsted’s operation with a procedure that Mey-
er believed “is in every essential the operation which I
published in… 1894.”140
Meyer used the opportunity to
defend his method against Halsted’s as “the more ana-
tomical one” because he worked from “the axilla to the
thorax, from the tendons to the pectoral muscles in an
almost bloodless way.”141
Meyer remained bitter about
Warren’s mix-up.
Meyer passionately published on the operation
thrice more, seeking to differentiate his method from
Halsted’s. In 1917, the Journal of Surgery, Gynecology,
and Obstetrics published his talk to the Clinical Con-
gress of Surgeons of North America in Philadelphia.
Meyer touched on the etiology of cancer, his thoughts
on its infectious origins, and then on the history of the

C
radical mastectomy. He then extensively compared his
procedure to Halsted’s, regretting that his initial wait to
publish a second paper was “perhaps injudicious... for
my first paper, it seems, was therefore lost sight of.”142
Meyer recalled that “the points of difference between
the Halsted and the Willy Meyer operation did not
become generally and clearly established in the minds
of surgeons. Many did Willy Meyer’s operation and
called it Halsted’s. Others called Willy Meyer’s opera-
tion a modification of, or improvement on, Halsted’s
operation.”143
He illustrated the anatomical differences
between the two procedures in a table and relayed the
sentiment that, because surgical intervention was at its
most radical, the fate of patients rather depended on the
duration of disease before operation and whether sur-
geons entered the infected area during surgery.144
One
year later in late April, 1918, Meyer advocated for his
longtime practice of removing both pectoral muscles at
once in an extended address to the New York Surgical
Society.145
In 1920, Meyer presented an abbreviated paper on
breast cancer to the New York Surgical Society in Febru-
ary and to the Surgical Section of the New York Acade-
my of Medicine in April. He spoke about successful and
still-living surgical cases and echoed his major points
from his 1917 address.146
Meyer boasted of six cases that
remained alive in 1920, as well as five others who lived
cancer-free for many years before passing away from
other diseases.147
A few months before Halsted died, he wrote Welch,
a longtime confidante, and reflected on his legacy in the
history of breast surgery. Halsted admitted that he was
not the first surgeon to recommend a complete and rad-
ical excision. He also credited Meyer directly, the only
mention Halsted ever made of the New York surgeon,
for independently recommending removal of the pecto-
ralis minor muscle the same year he did. “Revealingly,”
historian Robert Aronowitz wrote, “Halsted took major
credit not so much for these extensions of the operation
143 Ibid.
145 Willy Meyer, “The Advisability of Totally Excising Both Pectoral Muscles in the Radical Operation for Cancer of the
Breast,” Annals of Surgery 68, no. 1 (July 1918): 17–26.
146 Willy Meyer, “Late Results After the Radical Operation for Cancer of the Breast,” Annals of Surgery 72, no. 2 (August
1920): 177–80.
147 Meyer, “Late Results,” 178.
148 Robert A. Aronowitz, Unnatural History: Breast Cancer and American Society (Cambridge ; New York: Cambridge
University Press, 2007), 89-90.
151 Ibid.
but for a set of proper surgical attitudes, such as meticu-
lousness in cleaning out cancer from the axillary area, a
respect for the dangers of cutting into tissues for biopsy,
and the surgeon’s privileged position as cancer diagnos-
tician.”148
Without another article about the procedure
which carried his name, Halsted passed away from
pneumonia on September 7, 1922 in his own surgical
ward at The Johns Hopkins Hospital.149
STATUES OF
LIBERTY
ancer recurrence and death were not
the only threats of radical surgery. Wom-
en who underwent the radical mastectomy
faced a particularly troubling problem: per-
manent disfiguration of their bodies. Impaired shoulder
mobility was a well-known result following the invasive
procedure. Whereas Halsted was dismissive of women’s
fears about arm mobility and made little attempts to ad-
dress them, Meyer made it a focus of his all-encompass-
ing surgical practice.
As early as their first papers on the subject, Halsted
and Meyer addressed their patients’ concerns about arm
disability with very different attitudes. After describing
his successful operation on Mrs. F. O. in 1894, Meyer
mentioned the subsequent removal of her dressings
and drains. Of chief concern, however, was her postop-
erative arm mobility: “today arm freely movable.”150
He
justified his method of total pectoralis muscle removal,
the initial defining characteristic between his procedure
and Halsted’s, by saying it “never interfered with the
motion of the arm.”151
It was a selling point for Meyer
that he could grant women shoulder mobility far earlier
in their recovery process.
Halsted, on the other hand, regarded disability as an

afterthought. In 1894, he wrote that it was “a matter of
little importance compared to the life of the patient” be-
cause “these patients are old.... They are no longer very
active members of society.”152
In the case descriptions
compiled by Bloodgood, the status of a patient’s arm dis-
ability is mentioned only for patients who were marked
as likely to survive without recurrence after their ini-
tial operation. For example, a woman with early breast
cancer and a favorable prognosis had “good use of arm.
Chops wood with it.”153
In addition to many aspects of
his personal life, Wright explained that Halsted “was ca-
pable of hiding or repressing the truth about important
aspects of his life and work, including… his dogmatic
insistence that lymphedema and restricted arm move-
ment after radical mastectomies was not a complication
of the surgery despite almost overwhelming evidence
that it was.”154
Halsted was unwavering in his assertion
153 Ibid, 522.
154 Wright, “The Radicalization of Breast Cancer Surgery,” 165.
155 Meyer stated that of the sixty-seven patients he had operated on and traced the post-operative outcomes of, twen-
that arm mobility was unimportant.
In his second publication on breast surgery ten years
later, Meyer’s generous attention to his patients’ arm
mobility was unmistakable. The 1905 paper was replete
with striking illustrations that visualize each step in his
procedure and implicitly point to the mastectomy’s psy-
chological impact on women. The images Meyer selects
contrast the prototypical pre-surgical and post-surgical
patient. A woman before surgery is youthful, attractive,
and able to raise her arm freely above her head (Fig.
10). Meyer does not identify her, and such anonymity
suggests she could be any woman, as all women were
threatened by breast cancer and its only acceptable
treatment. In contrast, the post-surgical woman is a
56-year-old who Meyer operated on in 1899 (Fig. 11).
She was included in the third of Meyer’s patients who
seemed “alive and well” after the procedure.155
He only
Figure 10. Willy Meyer, “Carcinoma of the Breast:
Ten Years’ Experience with My Methods of Radical
Operation,” Journal of the American Medical Associ-
ation 45, no. 5 (July 29, 1905): 303.
Figure 11. Willy Meyer, “Carcinoma of the Breast:
Ten Years’ Experience with My Methods of Radical
Operation,” Journal of the American Medical Associ-
ation 45, no. 5 (July 29, 1905): 308.

shows three-quarters of her wrinkled, aged face, and
next to her pre-surgical, two-breasted counterpart, this
woman appears dulled and defeated.
However, the same woman is then shown in a pose
Meyer calls “The Statue of Liberty,” mimicking the stat-
ue of the colossal woman holding a torch, welcoming
eager immigrants into New York City (Fig. 12).156
Mey-
er, an immigrant himself, evidently placed much value
in his patient’s ability to achieve this point as she looks
liberated. She is newly empowered by an ability to lift
ty-four (35.4%) were alive and well in 1904. Six others were living with locally recurrent growths, and the remaining
thirty-seven had died, mostly because their breast cancer came back. See Meyer, “Carcinoma of the Breast: Ten Years’
Experience,” 313.
157 Ibid, 305.
her arm above her head and may be freed from her tu-
mor, if only temporarily.
Whereas other physicians might have merely ceased
treatment after removing the cancerous mass, Meyer
was not satisfied with leaving his patients inhibited or
disempowered. To accompany these images, Meyer ex-
panded on the “functional results” of his method. He
was proud of his patients’ abilities to move freely after
surgery. Meyer explained,
“Time has shown that the total removal of the
pectoralis major muscle does not mean mu-
tilation,as it was thought by some colleagues
ten years ago, when I first brought out this
method. On the contrary, my patients have
always been much pleased with the free and
perfect use of the arm they have obtained.
Ability to assume the posture of the Statue of
Liberty is the rule,not the exception.Besides,
the arm remains strong and useful. Quite a
number of poorer patients scrub and wash
without any discomfort.”157
This was a very different definition of success than
Halsted’s. It was a rule, not just a preferred result, that
Meyer’s patients raised their arms unimpeded to achieve
the Statue of Liberty posture. He was notably proud of
the functional result of his method, sympathetic to a
patient’s desire to return to normalcy after such dras-
tic changes to her body. Furthermore, Meyer’s language
seems encouraging of the strength and resilience his pa-
tients reclaimed after surgery. They were indeed “active
members of society” with “strong and useful” arms who
deserved to perform daily tasks without discomfort. In
his final publication on breast cancer surgery in 1920,
Meyer included images of six patients still living with-
out breast cancer (Fig. 13). The six “Statues of Liberty”
are profound visuals of the triumph over the disease
and freedom of movement.
Meyer also responded to women’s complaints of
tightness in the operating area due to the amount of
skin removed. The final step of all Meyer’s procedures
involved the grafting skin from patients’ thighs, which
he did immediately following the en-bloc resection (Fig.
14).158
Meyer wrote that the sterilized graft was to be
Figure 12. Willy Meyer, “Carcinoma of the
Breast: Ten Years’ Experience with My Methods
of Radical Operation,” Journal of the American
Medical Association 45, no. 5 (July 29, 1905):
312.

Figure 13. Willy Meyer, “Late Results After the Radical Operation for Cancer of the Breast,” Annals
of Surgery 72, no. 2 (August 1920).

placed with great care and bandaged tightly.159
After he finished surgery, Meyer did not cease at-
tending to his patients’ concerns. He included a large
section on “After-Treatment,” where he discussed
arm rehabilitation in depth. Meyer removed a patient’s
first dressing six days after surgery, the earliest time he
felt it was guaranteed that the grafts had taken well. He
changed the second dressing two days following that.
On this same day, Mayer removed his patient’s arm from
the dressing sling, allowing it to move about. He writes
that no earlier than ten to twelve days after surgery,
159 Ibid.
160 Ibid, 303.
162 Ibid.
“The patients are made frequently to move
and to raise the arm above the head. After
they are up and about, they are taught to
stretch the arm with the hand resting against
the wall or on anything of sufficient height to
enable them, by bending their knees, to give
it perfect elevation. Another exercise is to lift
the arm,when flexed at the elbow,sufficiently
high to form a right angle with the body and
then push it horizontally backward. They are
always able to dress themselves without assis-
tance when sent home.”160
These exercises, he hoped, would shorten the time it
would take a patient to regain normal mobility of the
arm. His description does not just outline a rehabilita-
tion program for patients designed to restore range of
motion in the arm. Meyer makes sure that a woman was
able to independently take care of herself when she left
the hospital. He sought to restore a woman’s integrity,
granting her the freedom to experience intimate mo-
ments like dressing herself.
If a woman’s grafts did not take well, Meyer resort-
ed to innovative open-wound treatment. He explains
that it was easy to allow for wounds to heal when the
patient was stationary and proved much harder when
she was “up and about.”161
His solution consisted of “one
half of one of those so-called artificial busts as they are
sold in our large department stores. This cup-shaped
arrangement is tied over the grafted area… it will serve
as a protection, under the patient’s dress, so that open
wound treatment can be safely continued.”162
Instead of
confining a woman to a hospital bed, Meyer innovated
a solution that allowed her to move about while their
grafts healed.
Furthermore, Meyer had a keen understanding of his
female patients and their fears about their newly ampu-
tated chests. Perhaps indirectly, yet no less significantly,
Meyer revealed his attention to the aesthetic concerns
of women after he excised their breasts. As the radical
mastectomy was the sole acceptable form of treatment
for breast cancer, many women must have sought to
regain physical and aesthetic normalcy. These artificial
breast forms were designed for the purpose of women’s
fashions. However, Meyer, twenty years before plastic
reconstructive surgery would become available, linked
the male-dominated realm of surgery to these cosmet-
Figure 14. Willy Meyer, “Carcinoma of the
Breast: Ten Years’ Experience with My Methods
of Radical Operation,” Journal of the American
Medical Association 45, no. 5 (July 29, 1905):
312.

ic breast forms. Meyer did not deem the restoration of
normalcy for his patients a frivolous pursuit. In fact, ex-
amination of medical literature on breast surgery and
breast cancer treatments revealed that Meyer was the
first to mention or make use of artificial breasts, forging
a connection between the surgical and fashion worlds.163
Breast forms were being patented and commercial-
ly sold throughout the early 20th century. An inventor
named Laura Wolfe of Columbus, Ohio filed an ana-
tomically correct, elastic “Artificial Breast” patent in
1904. She claimed that her design did not lose shape
163 Theodore W. Uroskie and Lawrence B. Colen, “History of Breast Reconstruction,” Seminars in Plastic Surgery 18,
no. 2 (May 2004): 65–69. My extensive research into American medical literature on breast cancer revealed no connec-
tions between artificial breast forms and breast cancer surgery before Meyer’s 1905 paper. Halsted never discussed
breast forms in his 1894 or 1898 publications or in his final publication on the topic in 1907. The earliest attempt at
surgical breast reconstruction was in the form of fat grafting, first by an Italian surgeon in 1895 and later by American
physician Willard Bartlett in 1917. Silicone breast implants were not used for cosmetic surgery until the 1960s. See Wil-
lard Bartlett, “An Anatomic Substitute for the Female Breast,” Annals of Surgery, 66, 2 (1917): 208. For a comprehensive
history of cosmetic breast surgery, see Elizabeth Haiken, “Beauty and the Breast,” In Venus Envy: A History of Cosmetic
Surgery, (Baltimore: The Johns Hopkins University Press, 1997): 232-233.
164 Laura Wolfe, Artificial Breast, U.S. Patent 814,181 filed November 04, 1904, and issued March 06, 1906, 1. This
was not the earliest patent for an artificial breast form. In 1873, Frederick Cox of Brooklyn, New York filed the first U.S.
patent for “Breast-Pads,” inflatable rubber forms intended to be worn under heavy Victorian clothing. Ten years later in
1884, Charles Morehouse built upon Cox’s design and filed his “Breast Pad” patent, which featured a harness to hold it
in place. See Frederick Cox, Breast-Pads, U.S. Patent 146,805 filed December 20, 1873, and issued January 27, 1874 and
Charles L. Morehouse, Breast-Pad, U.S. Patent 326,915 filed July 09, 1884, and issued September 22, 1885.
upon puncture, unlike prior inflatable breast forms,
making it “serviceable, efficient, and less liable to incur
humiliation.”164
The device appeared realistic due to its
simplicity of design, elasticity, and its false nipple (Fig.
15). These forms were also being sold commercially.
Advertisements for products from the American Bust
Form Company, based in New York City, proliferated
in Vogue Magazine in these years. In 1902, the company
advertised that their “H&H Bust Form” could be worn
with or without a corset, promising that it would give
“grace, form, and beauty wherever these attributes are
Figure 15. Laura Wolfe, Artificial Breast, U.S. Patent
814,181 filed November 04, 1904, and issued March
06, 1906.
Figure 16. “Advertisement: American Bust Form
Co.,” Vogue Magazine, September 18, 1902, 368.

lacking” (Fig 16).165
Another 1907 advertisement in
Vogue claimed that the H&H Bust Form was “so natu-
ral… that dressmakers fit gowns over them and never
know they are artificial” (Fig. 17).166
Women were sold
breast forms that promised to make them look natural
as well as more voluptuous.
Although Meyer’s procedure amputated a woman’s
breasts, he repurposed tools designed for fashion in or-
der to perhaps restore integrity and confidence to the
women he operated on. He went further than the stan-
dard surgical concerns of wound care and preventing
recurrence. Halsted stated that women should be happy
with merely being alive, reflecting his privileging sta-
tistical success over quality of life. Meyer, on the oth-
er hand, anticipated a woman’s struggle to accept and
navigate her new, entirely different body. Thus, Meyer’s
“Statue of Liberty” promise encompassed far more than
an achievable arm position. It reflected progressive,
compassionate care alongside radical, often debilitating
surgical interventions.
165 “Advertisement: American Bust Form Co.,” Vogue Magazine, September 18, 1902, 368.
166 “Advertisement: H. & H. Pneumatic Bust Forms,” Vogue Magazine, April 25, 1907, C3.
167 Carl Eggers, “Obituary of Doctor Willy Meyer,” Bulletin of the New York Academy of Medicine 8, no. 3 (March 1932):
148.
168 “Dr. Meyer, Surgeon, Dies at Meeting,” New York Times: Times Machine, February 25, 1932, 28.
169 “Dr. Meyer, Surgeon,” 28.
CONCLUSION
n the evening of February 24, 1932, the sev-
enty-three-year-old Meyer attended a meeting
of the New York Surgical Society. Just before
midnight, he rose suddenly and passionately
to defend the importance of early radical operations for
breast cancer.167
Overcome with weakness, Meyer col-
lapsed from a heart attack on the floor of the New York
Academy of Medicine.168
Police rushed oxygen to the
scene, and colleagues attempted to revive him. Among
those scrambling to help was Dr. Herbert Willy Mey-
er, who tended to his beloved father for an hour before
Meyer was pronounced dead at 12:20am.169
Carl Eggers, a fellow New York thoracic surgeon,
published an obituary in the Bulletin of the New York
Academy of Medicine the following month. He reflected
on the “dramatic ending to the brilliant career of this
Figure 17. “Advertisement: H. & H. Pneumatic Bust Forms,” Vogue Magazine, April 25, 1907, C3.
O

great surgeon, for it was the radical operation for cancer
of the breast which first made him famous,” and it was
the radical mastectomy he died defending.170
Meyer was
“respected by all and loved by many. His outstanding
qualities were great personal charm and unfailing cour-
tesy to others,” wrote Eggers.171
The New York Times reported that more than one
thousand people flooded the Saint Thomas Chapel in
Midtown on February 28th. Meyer’s death personally
touched the New York City medical community. Many
prominent surgeons attended the service, and hundreds
of floral arrangements filled the chancel of the church,
sent by various organizations, hospitals, and individu-
als.172
This paper is the first to introduce Willy Meyer and
give shape to his critical role in inventing and develop-
ing the radical mastectomy. Meyer operated and taught
in New York City for the entirety of his career, partici-
pating in an alternative form of postgraduate education
that became obsolete after the widespread adoption
of Halsted’s hospital residency system. Meyer’s wide-
spread, de-centralized involvement in hospitals limited
the number of surgical cases he saw, contrasting to the
cases available at the prestigious, centralized surgical
center at Johns Hopkins. In addition, Meyer was com-
mitted to including women in medicine and medical
education, whereas Halsted was an integral part of the
fraternity of Hopkins surgeons who were less than en-
thusiastic about admitting women to the Johns Hopkins
School of Medicine, only accepting a steep bribe to do
so.
Implicated in these institutional differences was the
way Meyer and Halsted viewed cures and the recovery
of their female patients. The brutal, mutilating proce-
dure proved ineffective in terms of statistically “curing’’
breast cancer and limiting recurrence. By 1907, it was
apparent to Halsted and Meyer that outcomes relied
more on the extent cancer had already spread than
the amount of tissue removed. Although no less con-
vinced than Halsted of the merits of the radical proce-
dure, Meyer was far less concerned with statistics. He
held different views of what constituted a cure for breast
cancer, rather focusing heavily on mitigating post-oper-
170 Eggers, “Obituary,” 148.
171 Ibid, 149.
172 “1,000 at Funeral of Dr. Willy Meyer,” New York Times: Times Machine, February 28, 1932, 7.
173 “The Treatment of Primary Breast Cancer: Management of Local Disease,” National Institutes of Health Consensus
Statement 2, no. 5 (June 5, 1979): 29–30, accessed online at https://consensus.nih.gov/.
174 “The Treatment of Primary Breast Cancer: Management of Local Disease,” 30.
175 Barron H. Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (Ox-
ford: Univ. Press, 2003), 170-195.
ative limitations of movement.
The radical mastectomy remained the standard op-
tion for breast cancer until the 1970s. In 1972, surgeons
introduced the Modified Radical Mastectomy (MRM),
seeking to achieve similar results without removing
both pectoral muscles. Surgeons outside the United
States were generally in agreement that the radical mas-
tectomy was outdated. However, it was rightfully angry
female patients who ultimately ended the practice of
Halsted and Meyer’s procedure, as well as other surgical
practices which diminished women’s agency.
After over seventy years of its practice, the disfigur-
ing radical mastectomy failed to produce results that
matched its extremity. Furthermore, newer problems of
non-consent emerged. At the time, surgeons routinely
performed diagnostic biopsies while a woman was un-
der anesthesia. If surgeons believed the tumor was ma-
lignant, they often decided to remove a woman’s breast
without her input. Having failed to consent to a radi-
cal mastectomy and completely unbeknownst to her, a
woman might wake up without a breast.
Pressured by women’s movement activism through-
out the 1970s, the National Institutes of Health offered
two solutions that granted breast cancer patients greater
autonomy. In 1979, the NIH appointed a panel to eval-
uate primary treatment options for breast cancer. The
panel made two important conclusions. First, they rec-
ommended that diagnostic biopsies be done and dis-
cussed with patients prior to surgical intervention.173
They also came to the consensus that a procedure that
preserves a woman’s pectoral muscles was just as ben-
eficial to patients than the “Halsted radical.”174
These
major changes in medical practice were due in no small
part to Rose Kushner, a journalist and activist and the
only laywoman appointed to the panel.
Kushner introduced a female voice to the discussion
as she led the feminist charge against the radical mas-
tectomy. When she was diagnosed with breast cancer,
Kushner became a vehement opponent to the radical
mastectomy and refused to undergo the procedure.175
She took to journalism to broadcast important messag-
es to women. She asserted that Halsted’s method was
outdated and that cancer specialists, not general sur-

Statues of Liberty: Wily Meyer, William Halsted, and the Development of the Radical Mastectomy from 1880 to 1920

Statues of Liberty: Wily Meyer, William Halsted, and the Development of the Radical Mastectomy from 1880 to 1920

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