The Crab’s Hidden Claws: Wilhelm Fabry, the Secret in the Armpit and the First Lymph Node Operation
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Day 49 (The History of Cancer in 365 Days Series)
Oncology enters a radical era with the “Father of German Surgery”, who discovered that cancer is not merely a mass, but a regional spread.
The previous day, we discussed how Ambroise Paré’s ligation of blood vessels with silk threads stopped operations from being an “execution”. Surgeons were still helpless, however, because cancer sprouted again elsewhere in the body after successful operations. Wilhelm Fabry (Fabricius Hildanus) was the first physician to recognise that cancer was not merely a “local” (limited to a site) problem, but a “regional” (area-wide) one: the tumour extended stealthy claws towards the “glands” (lymph nodes) in the armpit. This article describes the first awakening of modern “Radical Mastectomy” and awareness of metastasis, even before cells had been discovered. Healing begins by following the tumour’s trail.
After a peaceful period in which they thought they had recovered, women who had undergone breast cancer surgery returned to doctors with new hard lumps appearing on their chest walls or in their armpits. Cancer was not merely a “stone” sitting in that spot; it seemed to have invisible networks extending deep into the body.
The person who would recognise these stealthy networks and achieve a first in medical history, earning the title “Father of German Surgery” through his intelligence, powers of observation and unwavering courage, was Wilhelm Fabry (Fabricius Hildanus, 1560-1634).
The “glands” in the armpit: The silent testimony of lymph nodes
In 1598, Wilhelm Fabry experienced one of the most critical awakenings in the history of oncology. As he meticulously examined breast cancer cases, he noticed that the tumour did not grow only in the breast: it also swelled and hardened the glands (lymph nodes) in the armpit, which were normally about the size of a chickpea.
Surgeons before Fabry removed only the main mass they could see, leaving the hard lumps in the armpit alone as “untouchable”. Fabry, however, proclaimed this historical truth: “If you leave these swollen glands (metastases) in the armpit inside the body, there is no point in cutting out the tumour; the disease will certainly return!”
The first regional clearance: The birth of radical surgery
Fabry was one of the first physicians to grasp that cancer was not merely local, but a problem of a “region”. In 1598, he performed an operation unprecedented in the medical literature:
During breast surgery, he extended his scalpel into the armpit and removed the diseased lymph nodes to which cancer had spread, one by one. This is one of the most fundamental principles of modern oncology.
Cells and the lymphatic system had not yet been defined under the microscope, but Fabry had proved through “clinical foresight” that cancer travels through the body.
Fabry’s forceps: Mechanical genius working in seconds
In an age without anaesthesia, clearing the armpit, with its delicate networks of vessels and nerves, demanded incredible speed. To complete these operations in seconds, Fabry invented his own surgical instrument that would go down in history: “Fabry’s Forceps” .
A Primitive Form of Local Anaesthesia
When this instrument clamped the breast at its base like a vice, it both stopped bleeding immediately and reduced the patient’s pain by compressing the nerves. With the stability it provided, the surgeon could remove the tumour in a single stroke and immediately turn to the danger in the armpit.
The hardened glands Wilhelm Fabry extracted from the armpit were the most tangible evidence that cancer was a “traveller” within the body. Yet a question remained unanswered: How did cancer reach these glands?
Healing means seeing the whole
Wilhelm Fabry bequeathed to us the most vital vision in oncology: Regional awareness. Centuries ago, he saw that solving only the conspicuous “big problem” was not enough; the “lymphatic traces” hidden in its shadow also had to be cleared. His achievement was that the surgeon’s insight saw what the microscope did not.
Today, as we try to spare our patients major operations with methods such as “Sentinel Lymph Node Biopsy”, we are actually refining the philosophy of regional clearance that Fabry initiated and making it more precise. Cancer is not a stationary stone, but a stealthy traveller; healing means erasing that traveller’s footprints in time. Tomorrow, we will meet in the world of Gaspare Aselli, who accidentally found these hidden pathways while examining a dog’s stomach.
Scientific sources and further reading
- 1. Bland KI. "The history of breast cancer." The American Journal of Surgery, 1981.
- 2. De Moulin D. A Short History of Breast Cancer. Springer, Dordrecht, 1983.
- 3. Sakorafas GH, Safioleas M. "Breast cancer surgery: an historical narrative." European Journal of Cancer Care, 2009.
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