Fanny Burney and Her Mastectomy

280px-Frances_d'Arblay_('Fanny_Burney')_by_Edward_Francisco_Burney-wiki

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.”

Samuel_Johnson_by_Joshua_Reynolds-wikipedia

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.

Larrey and Dubois-x300

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.

Burney_tombstone-x300

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.
FacebookTwitter | Google+ | Instagram | Pinterest

Advertisements

Bones, Blood, Barbers, and Butchers: Surgeons in the 18th Century

In the eighteenth century, the record for the fastest amputation at the thigh was nine seconds, start to finish, including sawing through the bone. Are you impressed yet? Even the average, thirty seconds, was pretty damned fast.

And speed was of the essence. Let’s face it. If you needed surgery in the eighteenth century or the first half of the nineteenth, you’d better be strong and brave, because it wasn’t a doddle. Not for the surgeon, and not at all for the patient.

Patients faced three major killers

They’d solved one of the major issues that killed people who needed surgery, reinventing ligatures to tie off blood vessels so the patient didn’t bleed out on the table. Before the sixteenth century, they’d used cautery—burning—to seal any gushers, vastly adding to the pain. And, of course, closing up the wound as fast as possible helped.

And pain was the second issue. No effective anesthetics. Not until the mid-nineteenth century. The patient was awake for the entire operation, which was the main reason why speed (and some strong helpers to hold the patient down) mattered.

The biggest killer was factor number three. Germs.

Not that they knew that, of course. The prevailing opinion was that wound infections were caused by air, though how nobody quite knew. They had no way of knowing that the surgeon’s hands and clothes, the bed sheets, the surgical instruments, the dressings, and a myriad of other surfaces that would come into contact with the patient were covered with organisms too tiny to see, but that would infect the wound. Most people sickened. More than half died.

Keep out the air to keep out the contagion

Some hospitals did pretty well. Their theory was that the infective element was carried in noxious fumes; that is, if it smelled like bad air, it would be bad for their patient. Alexander Monro (Primus and Secundus), a father and son team who headed the Royal Infirmary in Edinburgh, must have run a clean operation. They managed to get the death rate for amputations down to eight percent. Given that other hospitals of the time managed rates of 45 to 65 percent, that’s truly impressive.

Most surgeons relied on speed to limit the amount of time the wound was exposed to the air, thus—they hoped—cutting down on the damage the air did to the tissues.

More butchery than medicine

So a fast surgeon was far more likely to be a successful surgeon for three reasons: less blood flow, a shorter time of acute agony, and (they thought) less contagion. No wonder that, to the rest of the human race, surgery seemed more a matter of butchery than medicine.

Naturally, as they thought at the time, physicians did not perform surgery. Physicians had, since medieval times, been university trained. They were gentlemen’s sons with a medical doctorate, highly educated and knowledgeable about the humours of the body and the appropriate ways to balance them. In theory, their superior knowledge made them the only proper people to practice medicine and oversee surgery. They did not involve themselves in physical labour, but expected rather to command those who distilled the medicines they prescribed (apothecaries) or who carried out operations they deemed necessary.

Surgeons, barber surgeons and apothecary surgeons

Specialist surgeons learned their craft on the job, working as a surgeon’s mate in the navy or the army, or as the apprentice to a barber surgeon or an apothecary surgeon.

Barbers were good men with a blade, so an obvious choice for removing some part that shouldn’t be there or performing a beneficial bloodletting. The familiar red and white barber’s pole dates from the time of the barber surgeon, representing the rod the patient held tightly during the operation and the bloodied and clean bandages used. When washed and hung to dry, they would twist together in the wind, forming the spiral we see today.

Apothecary surgeons had won a landmark case in the first decade of the eighteenth century, when an apothecary was taken to court by the Guild of Physicians for compounding and administering medicines without the benefit of a physician’s advice. The Physicians won, but the Society of Apothecaries appealed to the House of Lords, who were unimpressed with the argument that allowing apothecaries to care for the sick would:

“Deprive the gentry of one of the processions by which their younger sons might honourably subsist and be a great detriment to the Universities.”

The Lords reversed the judgement.

The rise of a profession

By the eighteenth century, surgeons were giving physicians a run for their money, some attending university as well as learning their craft by apprenticeship. However, they seldom had any formal qualifications before the Royal College of Surgeons was founded in London in 1800. They were ‘Mister’ compared to the physician’s more prestigious ‘Doctor’, though the brilliant work of a plethora of eighteenth century surgeons raised their status and the work of medical teaching hospitals such as the Royal Infirmary mentioned above raised their knowledge.

By the time Victoria ascended the throne, the confidence of surgeons, and the income they could command, had risen to the point that the cheeky surgeons made the former insulting honorific into a badge of honour. In the UK, Eire and New Zealand to this day, surgeons are called ‘Mister’ rather than ‘Doctor’.

Jude Knight’s writing goal is to transport readers to another time, another place, where they can enjoy adventure and romance, thrill to trials and challenges, uncover secrets and solve mysteries, delight in a happy ending, and return from their virtual holiday refreshed and ready for anything.

She writes historical novels, novellas, and short stories, mostly set in the early 19th Century. She writes strong determined heroines, heroes who can appreciate a clever capable woman, villains you’ll love to loathe, and all with a leavening of humour.

A Raging Madness is out May 9th. Stop by our sister blog today to see surgery in action in a new excerpt and enter two giveaways!

The Age of Agony: Surgery in the 19th Century

Amputation. Thomas Rowlandson, 1793.

Amputation. Thomas Rowlandson, 1793.

Surgery in the early 19th century usually meant a death sentence. It was the last resort and never undertaken lightly. Statistics from the time put the chance of dying as a result as high as 80% and surgeons were still not really considered to be proper doctors. Even the simplest of procedures carried a level of risk because there were three ferocious killers that had to be contended with: infection, pain, and bleeding.

Complex operations on the internal organs were impossible, so most operations at this time were either amputations of gangrenous limbs or the hacking away of obvious and engorged tumours and growths. It was not uncommon for a person to succumb to shock and die during such an operation. The pain must have been excruciating. Without anaesthetics, they would feel every cut, their only comfort a leather strap to chew on while they were forcibly held down by however many people it took to keep them in place. In the British army, soldiers had to ‘bite the bullet’ before the field surgeon got to work, although all surgeons were trained to prefer their patients screaming. It was a good gauge to know whether or not they were actually still alive.

L0001337 Amputation of the thigh, 19th century Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Amputation of the thigh, 19th century 1820 Illustrations of the Great Operations of Surgery Bell, Sir Charles Published: 1820 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Amputation of the Thigh. Sir Charles Bell, 1820.

Assuming these tragic individuals did not expire from heart failure on the table, the loss of blood would probably kill them. The discovery of blood types, which made successful transfusion possible, would not come until 1901, so surgeons had to devise other ways to stop their patients bleeding out on the table. Tourniquets were standard issue, but when amputating a limb, many arteries and veins would be cut through. To quickly stem the flow of bleeding the only weapon a surgeon had in his arsenal was a cautery, a metal tool which could be heated in a fire and then pressed firmly onto an open wound to seal the blood vessels. This technique was more successful on smaller wounds than larger, and even then, speed was off the essence. The poor soul on the table would enjoy both the horrendous pain of cauterisation alongside the sounds and smell of his own burning flesh.

Because of the risk of excessive blood loss, operations had to be quick, and no one was quicker than Robert Liston. Although brilliant for his time, Liston was also a bit of a showman and throngs of eager fans turned up to watch him work. He would stalk into the operating theatre at the same moment the patient had been restrained, with the ominous words “Time me, gentleman!” Then he would grab the unfortunate’s offending leg and begin to cut. Spectators reported Liston frequently held his knife in his teeth while he quickly sawed through the bone, then threw the severed limb into a bucket at his feet before he tied off the arteries. His average speed from first incision to wound closure was two and a half minutes. As barbaric as this seems, few people died on Liston’s table…of course, they died afterwards in their droves.

His legend was further embellished by his brutish behaviour. Once, when a patient fled the operating room crying in terror and barricaded himself into an adjoining room, Liston single-handedly broke down the door and dragged the man kicking and screaming back to the table. In one operation, not only did he amputate a man’s leg, he accidentally cut off his testicle as well. In another, he sawed through both the leg of the patient and three of the fingers of the man holding the patient down. Both men later died of infection.

Robert Liston Operating. Ernest Board, 1912.

Robert Liston Operating. Ernest Board, 1912.

Infection was by far the biggest risk. In 1800, the concept of germs and bacteria even existing was at least another sixty years away. As was antiseptic. Surgeons worked in unhygienic conditions, rarely washing either their hands or their knives before an operation. Often in hospitals, because it was such a rarity, the procedure would be carried out in front of an audience, hence the term ‘operating theatre’ we still use today. The opportunities for contamination under these circumstances were huge. Both the surgeon and the audience wore their street clothes and boots, and the cramped gallery would be filled with the potentially deadly microbes released by their breath. ‘Surgical sepsis’ could set in within hours of the operation, and once that occurred, it was curtains for the patient. In a world where germs had yet to be discovered, they certainly did not have any medicines to treat them.

In fact, people would try anything to avoid having surgery. There are hundreds of recorded cases of giant tumours which would be inconceivable today. Liston once removed a forty-five-pound tumour from one man’s scrotum which was so large, the patient pushed it around in a wheelbarrow rather than face the spectre of a death which came from a visit to a sawbones. Despite all of my research, I still have no idea if this poor fellow actually survived. Statistically speaking, I sincerely doubt that he did.

Virginia Heath writes witty, raunchy Regency romances for Harlequin Mills & Boon. That Despicable Rogue is available now and her second novel, Her Enemy at the Altar, comes out in July 2016.

Website | Facebook | Twitter | Amazon