The Halsted mastectomy: present illness and past history.

The Halsted mastectomy put American surgeons of the late 19th century ahead of competing general practitioners at home and the preeminent German surgeons abroad. It thus served economic and nationalistic drives in the nascent specialty of surgery. Such socioemotional forces-and not scientific principles-may explain why Halsted's expansion of the mastectomy to include the pectoral muscles became lastingly institutionalized.