Fanny Burney and Her Mastectomy

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Fanny Burney

In 1811, before anesthesia was invented, Frances Burney d’Arblay had a mastectomy aided by nothing more than a wine cordial. She wrote such a gripping narrative about her illness and operation afterwards readers today still find it riveting and informative.

Fanny came from a large family and was the third child of six. From an early age, she began composing letters and stories, and she became a phenomenal diarist, novelist, and playwright in adulthood. Certainly, her skillful writing was a primary reason her mastectomy narrative had such appeal.

In her narrative, Fanny provides “psychological and anatomical consequences of cancer … [and] while its wealth of detail makes it a significant document in the history of surgical techniques, its intimate confessions and elaborately fictive staging, persona-building, and framing make it likewise a powerful and courageous work of literature in which the imagination confronts and translates the body.” Prior to her surgery, she had written similar works about “physical and mental pain to satirize the cruelty of social behavioral strictures, especially for women.”

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Dr. Samuel Johnson

Fanny grew up in England and had been embraced by the best of London society. She had served in George III and Queen Charlotte’s court as Second Keeper of the Royal Robes. Moreover, she was admired by such literary figures as Hester Thrale, David Garrick, and Edmund Burke. Fanny also befriended Dr. Samuel Johnson, the English writer who made significant contributions to English literature as a poet, essayist, moralist, literary critic, biographer, editor and lexicographer. In fact, some of Fanny’s best revelations are about Johnson, how he teased her, and the fondness that he held for her.

In 1793, Fanny married Louis XVI Alexandre-Jean-Baptiste Piochard d’Arblay and became Madame d’Arblay. D’Arblay was an artillery officer who served as adjutant-general to the famous hero of the American Revolution, Gilbert du Motier, Marquis de Lafayette. D’Arblay had fled France for England during the Revolution just as had many other Frenchmen. However, in 1801, d’Arblay was offered a position in Napoleon Bonaparte’s government. He and Fanny relocated to France in 1802 and moved to Passy (the same spot where Benjamin Franklin and the princesse de Lamballe had lived), and they remained in France for about ten years.

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Baron Dominique-Jean Larrey (left) and Antoine Dubois (right)

While living in France, Fanny suffered breast inflammation in her right breast in 1804 and 1806. She initially dismissed the problem but then in 1811 the pain became severe enough that it affected her ability to use her right arm. Her husband became concerned and arranged for her to visit Baron Dominique-Jean Larrey, First Surgeon to the Imperial Guard, as well as the leading French obstetrician, surgeon, and anatomist, Antoine Dubois.

The French doctors treated Fanny palliatively but as there was no response to the treatment, it was determined surgery was necessary. Fanny’s surgery occurred on 11 September 1811. At the time, surgery was still in its infancy and anesthesia unavailable. Cocaine was later isolated, determined to be an effective local anesthetic, and used for the first time in 1859 by Karl Koller. So, it must have been horrific for Fanny to experience the pain of a mastectomy with nothing more than a wine cordial that may have contained some laudanum. Fanny was traumatized by the surgery and it took months before she wrote about the surgery details to her sister Esther exclaiming:

“I knew not, positively, then, the immediate danger, but every thing convinced me danger was hovering about me, & that this experiment could alone save from its jaws. I mounted, therefore, unbidden, the Bed stead – & M. Dubois placed upon the Mattress, & spread a cambric handkerchief upon my face. It was transparent, however, & I saw through it, that the Bed stead was instantly surrounded by the 7 men & my nurse. I refused to be held; but when, Bright through the cambric, I saw the glitter of polished Steel – I closed my Eyes. I would not trust to convulsive fear the sight of the terrible incision. A silence the most profound ensued, which lasted for some minutes, during which, I imagine, they took their orders by signs, & made their examination – Oh what a horrible suspension! … The pause, at length, was broken by Dr. Larry [sic], who in a voice of solemn melancholy, said ‘Qui me tiendra ce sein?”

Fanny went on to describe “torturing pain” and her inability to restrain her cries as the doctors cut “though veins – arteries – flesh – nerves.” Moreover, she noted:

“I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound. … I attempted no more to open my Eyes, – they felt as if hermetically shut, and so firmly closed, that the Eyelids seemed indented into my Cheeks. The instrument this second time withdrawn, I concluded the operation over – Oh no! presently the terrible cutting was renewed – and worse than ever … I then felt the Knife rackling against the breast bone – scraping it! – This performed, while I yet remained in utterly speechless torture. “

Despite the excruciating pain, Fanny lived through the operation, and her surgery was deemed a success. Larrey produced a medical report about his brave patient stating that he removed her right breast at 3:45pm and that Fanny showed “un Grand courage.” Courageous as she was, there was no way for doctors to determine if Fanny’s tumor was malignant or if she suffered from mastopathy.

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Fanny’s Commemorate Plaque. Courtesy of Bath-heritage.co.uk

Fanny’s healing took a long time, and while still recuperating, she and husband returned to England in 1812. Six years later, in 1818, her husband died from cancer, and she died twenty-two years later, at the age of eighty-seven, on 6 January 1840 in Lower Grosvenor-street in London. As Fanny had requested, a private funeral was held in Bath, England, and attended by a few relatives and some close friends. She was laid to rest in Walcot Cemetery, next to her beloved husband and her only son Alexander, who had died three years earlier. Their bodies were then moved during redevelopment of the Walcot Cemetery to the Haycombe Cemetery in Bath and are buried beneath the Rockery Garden.

References

DeMaria, Jr., Robert, British Literature 1640-1789, 2016
“Died,” in Northampton Mercury, 18 January 1840
Epstein, Julia L., “Writing the Unspeakable: Fanny Burney’s Mastectomy and the Fictive Body,” in Representations, No. 16 (Autumn, 1986), pp. 131-166
Madame D’Arblay, in Evening Mail, 20 January 1840
Madame D’Arblay’s Diary, in Evening Mail, 18 May 1842
“The Journals and Letters of Fanny Burney (Madame D’Arblay), Volume VI, France 1803-1812,” in Cambridge Journals 

61yLoQ9ugKL._SX345_BO1204203200_-347x381Geri Walton has long been interested in history and fascinated by the stories of people from the 1700 and 1800s. This led her to get a degree in History and resulted in her website, geriwalton.com which offers unique history stories from the 1700 and 1800s. Her first book, Marie Antoinette’s Confidante: The Rise and Fall of the Princesse de Lamballe, discusses the French Revolution and looks at the relationship between Marie Antoinette and the Princesse de Lamballe.
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Suffering in Some Strange Heaven: An Introduction to Laudanum

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Illustration for the cover of The Goblin Market. Dante Gabriel Rossetti, 1862

“– I should much wish, like the Indian Vishna, to float along an infinite ocean cradled in the flower of the Lotus, and wake once in a million years for a few minutes – just to know that I was going to sleep a million years more.” – Samuel Taylor Coleridge

While the medicinal properties of opium have been known since prehistoric times, it was 16th century Swiss alchemist Paracelsus who first developed laudanum. He discovered that when mixed with alcohol as opposed to water, opium’s pain-killing properties were heightened. He mixed it with crushed pearls, musk, saffron, and ambergris* and called it laudanum, from the Latin word laudare: to praise.

Now thought of as primarily a Victorian drug, laudanum first reached England in the 1660s when physician Thomas Sydenham developed his own recipe. While Sydenham left out the ambergris, the fundamentals remained the same: alcohol and opium was a potent cure-all and in his Medical Observations Concerning the History and Cure of Acute Diseases (1676), he gave it the praise Paracelsus had predicted a century before. Laudanum took off during the eighteenth century and by the nineteenth, it could be found in almost every home in Britain.

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“Papine,” an opium tincture

Although the recipe was flexible, it remained at heart an uncomplicated but potent combination of alcohol and opium. It was an over the counter drug cheap enough to be used across the social spectrum and simple enough to be brewed at home. Laudanum was used for an endless list of ailments including but not limited to teething, insomnia, anxiety, nerves, hysteria, menstrual cramps, pregnancy pains, mood swings, depression, stomach upset, diarrhea, consumption, cough, heart disease, and cholera.

It was certainly an effective cough suppressant; related opioids such as morphine and codeine are still prescribed for cough today. It was a potent painkiller, induced deep sleep and vivid dreams, produced feelings of euphoria, and was addictive as it was cheap. Not to be limited to medicinal purposes, laudanum was taken recreationally or mixed with other alcohol such as absinthe to stimulate creativity among artists. Some notable fans of the substance include Dickens, Bram Stoker, Samuel Taylor Coleridge, George Elliott, Dante Gabriel Rossetti, and Rossetti’s wife, model Elizabeth Siddal, who tragically died of a laudanum overdose.

Women tended to be medicated more than men, and many opium-derived medications were known euphemistically as “Woman’s Friend.” Likewise, Godfrey’s Cordial, a mixture of water, treacle, and opium specifically for infants was knows as “Mother’s Friend.”

Charles Kingsley describes opium addiction in Alton Locke (1850) as ‘elevation’, a particular problem of women:

“Oh! ho! ho! — yow goo into druggist’s shop o’ market-day, into Cambridge, and you’ll see the little boxes, doozens and doozens, a’ ready on the counter; and never a ven-man’s wife goo by, but what calls in for her pennord o’ elevation, to last her out the week. Oh! ho! ho! Well, it keeps women-folk quiet, it do; and it’s mortal good agin ago pains.” “But what is it?” “Opium, bor’ alive, opium!”

There were several different laudanum varieties available and they could be made at home. It was dreadfully bitter, so sweeteners like honey and spice were added to improve the flavor. Sydenham’s recipe from 1660 was still in use by the 1890s when it was published in William Dick’s Encyclopedia of Practical Receipts and Processes:

“Sydenham’s Laudanum: This is prepared as follows: opium, 2 ounces; saffron, 1 ounce; bruised cinnamon and bruised cloves, each 1 drachm; sherry wine, 1 pint. Mix and macerate for 15 days and filter. Twenty drops are equal to one grain of opium.”

Dick’s Encyclopedia contains dozens of recipes for homemade laudanum, and even more for other remedies containing opium. As relatively appealing as cinnamon and cloves sound, by the 19th century, laudanum could also be mixed with mercury, ether, chloroform, hashish, or belladonna; if it didn’t kill you, it would make you see some very interesting things.

Whether or not the malady justified the use of such a powerful drug, laudanum and other opium derivatives were used frequently and without a great deal of hesitation. It was a good cough suppressant, kept children quiet, and induced restful sleep. Rhapsodic descriptions of its effects make it sound like magic.

In The Picture of Dorian Gray, Oscar Wilde conveys the horrors and pleasures of an East End opium den in a single paragraph (it isn’t exactly laudanum, but it’s the same active ingredient):

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Opium Smokers in the East End of London. Illustrated London News, 1874.

“As Dorian hurried up its three rickety steps, the heavy odour of opium met him. He heaved a deep breath, and his nostrils quivered with pleasure. When he entered, a young man with smooth yellow hair, who was bending over a lamp lighting a long thin pipe, looked up at him and nodded in a hesitating manner. […] Dorian winced and looked round at the grotesque things that lay in such fantastic postures on the ragged mattresses. The twisted limbs, the gaping mouths, the staring lustreless eyes, fascinated him. He knew in what strange heavens they were suffering, and what dull hells were teaching them the secret of some new joy.”

Strange heavens aside, laudanum was not a friendly substance. In 1889, The Journal of Mental Sciences published what was purported to be an anonymous letter by the wonderful title of Confessions of a Young Lady Laudanum-Drinker which describes at length her experience of addiction:

“It got me into such a state of indifference that I no longer took the least interest in anything, and did nothing all day but loll on the sofa reading novels, falling asleep every now and then, and drinking tea. Occasionally I would take a walk or drive, but not often. Even my music I no longer took much interest in, and would play only when the mood seized me, but felt it too much of a bother to practice. I would get up about ten in the morning, and make a pretence of sewing; a pretty pretence, it took me four months to knit a stocking!

“Worse than all, I got so deceitful, that no one could tell when I was speaking the truth. It was only this last year it was discovered; those living in the house with you are not so apt to notice things, and it was my married sisters who first began to wonder what had come over me. By that time it was a matter of supreme indifference to me what they thought, and even when it was found out, I had become so callous that I didn’t feel the least shame. (…) My memory was getting dreadful; often, in talking to people I knew intimately, I would forget their names and make other absurd mistakes of a similar kind. As my elder sister was away from home, I took a turn at being housekeeper. Mother thinks every girl should know how to manage a house, and she lets each of us do it in our own way, without interfering. Her patience was sorely tried with my way of doing it, as you may imagine; I was constantly losing the keys, or forgetting where I had left them. I forgot to put sugar in puddings, left things to burn, and a hundred other things of the same kind.”

While this anonymous writer did recover, laudanum addiction was difficult to beat. People became tolerant to it quickly, and recovery was more likely to be achieved by tapering doses. Although laudanum was a common cough suppressant, it could work too well by causing shortness of breath and respiratory depression, or keeping the user from breathing at all. It can also inhibit digestion, cause constipation, depression, and itching. It was so potent that it was easy to overdose accidentally as an adult, and many infants and children died from it, as well. Tragically, it was also a common method of suicide.

laudanumWe might not understand the appeal of such a debilitating and ultimately lethal substance, but for most people in the nineteenth century, laudanum must have felt like a godsend. Disease, poverty, and hunger were widespread, and those lucky enough to be employed suffered through long hours in terrible conditions to earn their pittance. Even for the wealthy and well-to-do, Britain was cold, wet, and overrun with discomforts that may necessitate its use. Menstrual cramps, insomnia, anxiety, nerves, cough, stomach upset, cholera, tuberculosis — if one drug could treat them all and that drug happened to be miraculously affordable and so common there was little to no stigma attached to it, there was no reason not to rely on it from time to time.

Laudanum is still in production today, but it is no longer available over the counter. Now referred to almost exclusively as Tincture of Opium, it is listed as a Schedule II substance due to its highly addictive nature and is used for stomach ailments, pain, and to treat infants born to mothers with opioid addiction.

Jessica Cale

Sources

Anonymous. Confessions of a Young Lady Laudanum-Drinker. The Journal of Mental Sciences January 1889

Berridge, Victoria. “Victorian Opium Eating: Responses to Opiate Use in Nineteenth-Century England,” Victorian Studies, 21(4) 1978.

Dick, William B. Encyclopedia of Practical Receipts and Processes. New York: Dick & Fitzgerald, Publishers, 1890.

Diniejko, Andrzej. Victorian Drug Use. The Victorian Web. http://www.victorianweb.org/victorian/science/addiction/addiction2.html

Kingsley, Charles. Alton Locke (1850).

O’Reilly, Edward. Laudanum: A Dose of the Nineteenth Century.

Sydenham, Thomas. Medical Observations Concerning the History and Cure of Acute Diseases (1676)

Wilde, Oscar. The Picture of Dorian Gray (1890).

*presumably crushed diamonds would have been too extravagant