By Ellen Leopold

A Twentieth-Century tale of Breast melanoma, ladies, and Their DoctorsIn the 1st cultural historical past of breast melanoma, Ellen Leopold asks how sexual politics have formed the connection among sufferer and surgeon, and the way a sickness lately shrouded in secrecy has develop into so public.

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Already marked as sinners by their evident symptoms, they could be blamed for whatever social ills stalked their communities. As both carriers and victims of malevolent spirits, they had to be cast out, as by a spell. So the ill and the infirm would be punished several times over, first, for displeasing God; second, for reminding others of God's awful power; and third, for bringing the contagion of evil into human society. Martin Luther is said to have believed that deformed children had been fathered by the Devil so that killing them was no sin.

Disease, in other words, could be life-threatening in many ways. These ideas and many others like them have been woven in and out of the literature and mythology of Western culture for centuries. Even now, they have not lost their sting. 3 Modern ideas that enable us to identify bacteria, viruses, and damaged genes are relative newcomers compared to the venerable explanations of causality enshrined, among other places, in the Bible. There are, of course, those who still accept these ideas in their original form, who cannot wholly dismiss the idea that breast cancer may be a sign of sin.

It meant that many more women suffering from painful symptoms of disease in the breast could now be treated. But it also meant that more women submitted to treatment that exacted a terrible toll on their bodies. By the turn of the century, the radical mastectomy, as refined by William Stewart Halsted, first professor of surgery at Johns Hopkins, had become the "gold standard," and survival rates following surgery appeared to improve. But the apparent success of radical treatment had as much to do with the benefits of earlier detection, a more careful selection of surgical candidates, and improvements in anaesthetic and pre- and postoperative care as with any curative powers of the surgery itself.

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