Last Friday, September 30, 2016, was the 205th anniversary of Fanny Burney’s mastectomy—without anesthesia. Here’s her story.
“Yet—when the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision …”1
Writing from Paris to her sister Esther in March 1812, Fanny Burney (known as Madame D’Arblay after her marriage), described the operation she endured the previous September to cut out a breast tumor. Only think of it: the famous novelist—author of the popular novels Cecilia, Evelina, and Camilla and a contemporary of the youthful Jane Austen—endured a mastectomy without anesthesia or antiseptics or antibiotics or, indeed, without much of anything other than a wine cordial given to her by one of her doctors.
A surgical operation in a Dublin drawing room to remove a malignant tumor from a man’s left breast and armpit, 1817 (Source: Wellcome Library, image #L0013110, CC BY 4.0)
Surgery—Regency Style
Can you imagine how awful surgery was before anesthesia? The image above reveals the magnitude of it. This disturbing drawing depicts a surgical procedure for removing a cancerous tumor from a man’s breast—an operation similar to the one Burney underwent. Note the blood-smeared floor, the poor patient sitting upright in a chair (as was common before the advent of anesthesia in 1846), the bowls of blood scattered around, and the six helpers—four dressed in black—who were likely all surgeons and doctors. The assistants appear to have come straight from an evening at the opera house, what with their long coattails and black top hats. This is a priceless image of surgery—Regency style.
A woman has a breast removed with a “tenaculum helvetianum” (which looks much like a special kind of pruning shears). (Source: Wellcome Library, London, image #L0031627, CC BY 4.0) The assistant wears a case of lancets attached to his belt. Several cautery irons smolder on the stand at left. The patient, seated, appears to be fainting. Who can blame her?
Fanny Burney’s Dread
Burney had a pain in her breast that was “rather heavy than acute.” In the beginning she felt little anxiety about it because she had experienced such “breast attacks” before and found relief by fasting and eating a low-protein diet, except for drinking rich and fatty asses’ milk (see footnote 1 below). But by the summer of 1810 the attacks were occurring more frequently. Her husband insisted that she consult a doctor, which she did reluctantly, first seeing Monsieur Dubois, the most celebrated surgeon in France at that time. (The D’Arblays lived in Paris, the capital of Napoleon’s empire.)2 He told her a “small operation would be necessary to avert evil consequences,” leading Burney to believe only a small incision would be required.3
When the breast pains grew stronger, she consulted the distinguished surgeon Baron Larrey, who prescribed a program that at first eased her suffering but later helped very little. As the breast mass became more tender and firm,3 several leading practitioners—the surgeon Mr. Larrey, the physician Dr. Moreau, and the anatomist Dr. Ribe— met to review her case, reached a decision, and “condemned” her to surgery.2 Burney dreaded the operation, for although the breast appeared mostly normal, if slightly enlarged, she believed “the evil to be deep, so deep” that an operation was her only recourse. She prepared herself to “meet the coming blow.”4
A procedure for the removal of a woman’s breast, c. 1675 (Source: Wellcome Library, London, image #L0041078, CC BY 4.0)
A Long Wait for Surgery
Burney wrote her sister that “after sentence thus passed, I was in hourly expectation of a summons to execution.” Yet three weeks drifted by without word of a date for surgery, even though Mr. Larrey visited periodically to check on her. Finally, one morning while she was dressing, she received a letter from Mr. Larrey informing her that he would arrive, “properly accompanied,” at 10 o’clock for the operation; she was asked to make sure her husband was absent. On short notice, Burney was forced to call on her son to implement a plan to distract her husband and thus prevent him from knowing about or attending the surgery.5 Feeling time pressured to prepare the operating theater—in this case, the salon in their first-floor residence—she begged for a delay until 1 o’clock so that surgical supplies—bandages, sponges, compresses, lint and the like—could be readied. A dreadful interval followed, in which she paced, tried to calm her emotions, and wrote notes to her husband and son in case of a fatal outcome. In the end, the surgical team didn’t arrive until 3 pm.
Surgeons performing an operation on a woman’s breast in the 17th century. Because the patient is lying down, as would occur in surgery done under anesthesia, it appears that this painting is a late 19th-century depiction of what a 17th-century operation might have been like. However, Fanny Burney was lying down during her mastectomy operation in 1811. (Source: Wellcome Library, London, image #L0048608, CC BY 4.0)
Seven Men in Black
Dr. Moreau gave her the wine cordial, Burney called for her nurses and maid, and seven men in black—her surgeons and doctors and two medical students—suddenly descended upon her. She considered whether she might escape when a bed, two old mattresses, and a sheet were brought into the salon. On seeing Mr. Larrey’s face “pale as ashes,” she submitted to the inevitable. Mr. Dubois positioned her on the mattress and placed a cambric handkerchief over her face. She refused to be held down but closed her eyes on seeing the steel surgical knife through the cambric veil. When the surgeon cut her flesh, she began her long, unending scream. At one point she felt the knife scraping the breast bone. She fainted twice. The operation and dressing of the wound lasted 20 minutes.1 Incredibly, she lived another 29 years.
Mrs Prince of Leeds, after surgical removal of a breast, 1841. The wound has been left open, presumably to heal. (Source: Wellcome Library, London, image #L0037321, CC BY 4.0)
A Horror for the Patient and the Surgeon
After the operation was over, the doctors and surgeons put Fanny Burney to bed. She was weak and exhausted, her face drained of color. When she opened her eyes, there stood her surgeon, Mr. Larrey, “pale nearly as myself, his face streaked with blood, and its expression depicting grief, apprehension, and almost horror.”1 The terror for the patient is readily appreciated, but it is also true that surgery was difficult for the practitioner. He knew his skills inflicted pain and suffering on his patients. He knew he must ignore his patient’s fierce cries while he concentrated on the operation. It’s a wonder anyone became a surgeon in those days, but it is a great testament to the surgeon’s creed that he believed his actions might allow his patient to live a better life.
Footnote 1: In the nutrient content table shown on the Wikipedia entry for donkey milk, the fat content of human breast milk and cow’s milk is about 2.5 times greater than the fat content of donkey’s or mare’s milk. These data suggest that Burney was misinformed about the fat content of asses’ milk.
Sources:
1Sabor P, Troide LE, eds. Frances Burney: Journals and Letters. London: Penguin Books, 2001, pp. 440-443.
2Chisholm, K. Fanny Burney: Her Life. London: Vintage, 1988, pp. 209-212.
3Sabor and Troide, pp. 432-433.
4Ibid., p. 436.
5Ibid., pp. 437-438.