Eyes tightly open: Fanny Burney's 1812 'terrible operation'

I then saw my good Dr Larry, pale nearly as myself, his face streaked with blood, & its expression depicting grief, apprehension, & almost horrour

At the beginning of the 19th century, the British novelist Fanny Burney was diagnosed with cancer and forced to undergo breast ablation to save her life. As a legacy, she left us the heart-wrenching account of her operation, performed in a time when surgery was still carried out without anaesthesia.

S IR HUMPHRY DAVY'S MIND will always be remembered as possessing the "genuine quality of genius" ¹. This prolific natural philosopher lived fifty short years between the 18th and the 19th century, and illustrated himself by his multidisciplinary talents, endless curiosity, and an unquenchable thirst for experimentation from which some of his most brilliant inventions and theories were brought to life.

At the age of only 21, the future president of the Royal Society published a 580-page volume entitled Researches Chemical and Philosophical, chiefly concerning Nitrous Oxide and its Respiration — which, for obvious practical reasons, we will from now on refer to as Researches. Written during his superintendency at the Pneumatic Institution, this tremendous piece of work explores in detail the chemical and physical attributes of nitrous oxide, a gas first synthesized by Joseph Priestley in 1772².
After several months of tweaking and experimenting, Davy was able to produce a mixture capable of eliciting a surge of enthusiasm bordering on mania, having him "dancing round the room and vociferating"³. One of his test subjects and friends, the renowned poet Samuel Taylor Coleridge, offers the following analogy: "I felt a highly pleasurable sensation of warmth over my whole frame, resembling that which I remember once to have experienced after returning from a walk in the snow into a warm room." ⁴

Davy regularly sought to reiterate his experiments with what he called the ‘laughing gas’, to the point where he arguably grew addicted to its effects ⁵. But most importantly, he was soon to discover the anaesthetic power of the gas. In the conclusion of Researches, he writes ⁶:

As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.

Though carbon dioxide and “hydrocarbonate” were already used as sedatives in his time ⁷, Davy was offering a safer and much more powerful alternative, capable of effectively suppressing sensitivity to pain while, say, one’s leg was being sawed off. His intuition proved prophetic. Two hundred years later, nitrous oxide is still widely employed in surgical rooms all over the world ⁸. Unfortunately for Davy, however, his observation would remain ignored for another 40 years.

In 1844, a dentist by the name of Horace Wells attended a ‘Grand Exhibition’ of the effects produced by nitrous oxide. The ‘laughing gas parties’ initiated by Davy as soon as 1799, assembling his closest friends and members of the British elite, had sparked a public interest for the gas and by the 1830s, it was all the rage. Spectacular demonstrations were held in England, and although the flyer presented below assures us that “the object is to make the entertainment in every respect, a genteel affair”, people undoubtedly attended them in the hope of getting a good show and trying the gas for themselves ⁹.
During this lecture, Wells saw an apothecary under the influence of nitrous oxide strike his legs quite badly after running into a wooden bench. It is only once the effects of the gas had dissipated that the man realised the bruises on his knees and felt the sharp sting of pain. Inspired by this event, Wells put nitrous oxide to the test on the very next day while performing a tooth extraction. One month and several successful operations later, he presented his results to the public and anaesthesia slowly starting taking hold in the medical world ¹⁰.

'Amputation', T. Rowlandson, 1793

Surgeons were often perceived as heartless butchers, as is shown in this satirical illustration by Thomas Rowlandson, 1793.

(source: Wellcome Library)

Sir Humphry Davy, by T. Phillips

Portrait of Sir Humphry Davy, by Thomas Phillips, date unknown

(source: Wikimedia Commons)

Experimenting with laughing gas, 1820

‘Doctor and Mrs Syntax, with a party of friends, experimenting with laughing gas’, by Thomas Rowlandson, 1820. ‘Laughing gas parties’ started as soon as 1799 among the British upper class.

(source: Wellcome Library)

'A Grand Exhibition!', 1845

“A grand exhibition of the effects produced by inhaling nitrous oxide”, 1845. Flyer of the event attended by Wells, during which he saw a man strike his legs against a bench without expressing any pain after the inhalation of nitrous oxide.

(source: general-asthesia.com)

Portrait of Horace Wells, by H. B. Hall

The dentist Horace Wells pioneered the use of nitrous oxide for anaesthesia.

(source: Henry Bryan Hall,The Discovery of Modern Anæsthesia)

Young man receiving ether from a sponge

From the 1840s, anaesthesia using ether or nitrous oxide started slowly taking hold in the medical word. Ether dome (date unknown, spring 1847 or later)

(source: Harvard Medical Library)

Back to the beginning of the 19th century and to our main protagonist.
Though the name of Fanny Burney might not sound familiar today, she was one of the most popular writers of the late 18th century. She published her first and most celebrated novel, Evelina, anonymously; however its critical acclaim soon brought her out of the shadows. In a style precursory to the writings of such authors as Jane Austen and Edith Wharton, she satirised the way of life of the English aristocracy and addressed the issue of women’s rights.
At the age of 41, Frances Burney married the French general Alexandre d'Arblay and became Madame d’Arblay. Together, they had a son named Alexander and in 1797, the family moved to Surrey, where a house had been built thanks to the proceeds of Fanny’s third novel: Camilla; or, A Picture of Youth. Four years later, the whole family relocated to Paris, where Alexandre had been offered a temporary position in Bonaparte’s government. Unfortunately, the outbreak of the Napoleonic Wars prevented the d’Arblays from going back to England, and what was meant to be a one-year expatriation became a 10-year exile ^{11, 12, 13}.

Portrait of Frances Burney, after a painting by E. F. Burney (source: The Morgan Library & Museum)

It is during her time in France, at the age of 58, that Fanny started complaining of “a small pain in [her] breast”¹⁴. After the visit of one doctor, followed by a second, a third and then a fourth, her hopes grew dim. The year was 1810, and the dreadful shadow of an operation was lurking; an operation which would be performed — as we know by now — without anaesthesia.
For several months, Fanny and her doctors did everything in their power to avoid surgery. Despite their best efforts, she was forced to undergo radical mastectomy (complete ablation of the right breast) on Monday, the 30th of September, 1811.
A year later, Fanny summoned up all her courage to write to her sister, Esther, in order to relate the whole gruesome affair. Determined at first to keep it a secret for fear of causing distress to her family, she was obliged to break her silence due to the rapid spreading of rumours about her health. Entitled ‘Account from Paris of a Terrible Operation — 1812’, her letter is one of the great legacies of History, recounting in vivid details the day of her operation but also the anxious wait that preceded it.

After several months of increasing pain in her breast, and to the insistence of her husband and friends, Fanny had finally accepted to see her first doctor, monsieur Jouart. She summarises his intervention in two condemning lines:

Thinking but slightly of my statement, he gave me some directions that produced no fruit – on the contrary, I grew worse

Following this ineffectual visit, M. d’Arblay urged his wife to see M. Dubois: “the most celebrated surgeon of France, […] accoucheur to the Empress”, first surgeon of the Imperial Guard and “created a Baron [in 1812] for his eminent services!’”. This second visit marked a turn in the novelist’s attitude towards her health:

It was now I began to perceive my real danger, M. Dubois [...] uttered so many charges to me to be tranquil, & to suffer no uneasiness, that I could not but suspect there was room for terrible inquietude. My alarm was encreased by the non-appearance of M. d’A[rblay] after his departure. They had remained together some time in the Book room, & M. d’A[rblay] did not return – till, unable to bear the suspence, I begged him to come back. He, also, sought then to tranquilize me – but in words only; his looks were shocking! his features, his whole face displayed the bitterest woe. I had not, therefore, much difficulty in telling myself what he endeavoured not to tell me – that a small operation would be necessary to avert evil consequences!

Distraught by their telling silence, Fanny saw her symptoms worsen over the following days. She points out in her letter: "for this [operation] I felt no courage – my dread & repugnance, from a thousand reasons besides the pain, almost shook my faculties".

Until the middle of the 18th century, surgery had often fallen in the hands of barber-surgeons, trained in both the arts of moustache trimming and bloodletting ¹⁵. It is only in the 1740s that France and England witnessed the separation of surgeons and barbers by royal decree ¹⁶, leading to the emergence of a stronger, more regulated and altogether more ‘scientific’ body of surgeons. Nevertheless, the discipline was still in its infancy, and unskilled perambulating operators kept casting an aura of disrepute over the surgical community, feeding the public’s disgust and distrust ¹⁷.
Spectacular operations held by qualified practitioners – who were often encouraged to create a great effusion of blood to assert their authority – showed only their manual skills and failed to highlight their ethics and the extensive care provided to the patient before the operation ¹⁸. When a bill to establish a College of Surgeons was put before the Parliament in 1797, only a few years before the d’Arblays moved to France, it was virulently opposed in the House of Lords by Lord Thurlow, who exclaimed: "there is no more science in surgery than in butchery." ¹⁹

Fanny, however, was not a stranger to the medical world. She had encountered several surgeons during her time at the Royal Court ²⁰, and had done extensive research for the writing of Camilla, in which the sister of the heroin contracts smallpox. Within her family, she had been tending to the health of her only son, who was of a weak constitution ²¹, and even had a brother-in-law who practised as a trained surgeon ²².
Nonetheless, this knowledge might also have been the very reason for her concern. An article from the 1790 Encyclopédie méthodique states that “a true Surgeon, a learned and experienced man, seeks to count his successes only by the Operations he has known how to prevent“ ²³. As Fanny’s narration illustrates repeatedly, her surgeons knew all too well the pain and the dangers associated with her operation. Such foreboding on their behalf could not have been of much encouragement for the patient who would have to stand still under their knife.
Aside from the obvious physical challenges tied to the surgery, there were also psychological ones, namely mutilation and loss of bodily integrity. Later in the letter, minutes before the operation, we read these gripping lines:

Let those women all go! cried M. Dubois. This order recovered me my Voice – No, I cried, let them stay [...] I was compelled [to] submit to taking off my long robe de Chambre, which I had meant to retain – Ah, then, how did I think of My Sisters! – not one, at so dreadful an instant, at hand, to protect – adjust – guard me

"Le Tableau de l'Opération de la Taille". In 1725, the French virtuoso Marin Marais composed a musical piece describing the removal of a bladder stone - or lithotomy -, a painful operation he had himself undergone at the age of 64.

Soon after the visit of M. Dubois, afflicted with pains that grew “quicker and more violent”, Fanny was advised by one of her friends to have recourse to Dr. Larrey, “a Surgeon of great eminence” who had cured a woman of a “similar malady” — presumably without resorting to surgery. Dominique Jean Larrey had served as Chief Surgeon to Napoleon’s Grand Army since 1804 and had been made a Baron in 1809. Responsible for our current system of triage and the modern ambulance, he is remembered today as the first military surgeon, and earned in his time a reputation as a skilled, pragmatic, and empathetic practitioner ¹⁷.

Fanny “thankfully caught at any hope” and was able, with the help of her influential network, to secure his services. The evolution of her relationship with Dr. Larrey constitues one of the most touching aspects of the letter.

M. Larrey has proved one of the worthiest, most disinterested, & singularly excellent of men, endowed with real Genius in his profession, though with an ignorance of the World & its usages that induces a naiveté that leads those who do not see him thoroughly to think him not alone simple, but weak. They are mistaken

Fanny was put on a new prescription by “[her] good Dr. Larrey” and soon “was much better, & every symptom of alarm abated”. Despite these improvements, the surgeon remained anxious and called in Dr François Ribe, first anatomist of France, for a second opinion. Ribe however “confirmed [their] best hopes” and, for a while, things seemed to be turning out for the best.

“Here, my dearest Esther, I must grow brief, for my theme becomes less pleasant”. Unfortunately, during the course of her remission, Fanny received a series of distressing news, among which the death of two of her close friends. Upon his next visit, Larrey “was quite thrown into a consternation, so changed he found all for the worse[. He] sadly, announced his hope[s] of dissolving the hardness were nearly extinguished” — a prognosis that was rapidly confirmed by Ribe.

A Physician was now called in, Dr Moreau, to hear if he could suggest any new means: but Dr Larrey had left him no resources untried. A formal consultation now was held, of Larrey, Ribe, & Moreau – and, in fine, I was formally condemned to an operation by all Three. [...] I called up, however, all the reason I possessed, or could assume, & told them that – if they saw no other alternative, I would not resist their opinion & experience: – the good Dr. Larrey, who, during his long attendance had conceived for me the warmest friendship, had now tears in his Eyes

Larrey’s grief is an unexpected but telling illustration of the dread inspired by surgery at the time, even among the medical body; it is one of several instances encountered in Fanny’s narration. Mme d’Arblay’s celebrity was another cause for anxiety, as any mistake would put the doctors’ reputation at risk ¹⁷; Larrey himself expressed this concern to his patient and called in Dubois one last time: “You are so esteemed here Madam, that the public would be discontented should you not get all the succour available” (quoted in French in Fanny’s letter).

After a final examination, Dubois consulted with his peers, and Fanny was summoned to hear their verdict:

I came back, & took my seat, with what calmness I was able. All were silent, & Dr Larrey, I saw, hid himself nearly behind my Sofa. My heart beat fast: I saw all hope was over. I called upon them to speak. M. Dubois then, after a long & unintelligible harangue, from his own disturbance, pronounced my doom.

Was it because their patient displayed such strength and determination that they next decided to be thoroughly honest with her, or was it simply that the doctors lacked in tact? There is probably a fragment of truth in both assumptions. Regardless of their true motivation, here was the substance of their warning:

M. Dubois had pronounced “il faut s’attendre à souffrir, Je ne veux pas vous tromper – Vous Souffrirez – vous souffrirez beaucoup! –” [you should expect pain, I do not want to lie to you – You will suffer – you will suffer a lot]. M. Ribe had charged me to cry! to withhold or restrain myself might have seriously bad consequences, he said. M. Moreau, in echoing this injunction, enquired whether I had cried or screamed at the birth of Alexander – Alas, I told him, it had not been possible to do otherwise; Oh then, he answered, there is no fear! – What terrible inferences were here to be drawn!

Despite this rather abrupt discourse, the doctors wished at all price to save their patient any further anguish and thought it best to keep the date of her surgery undisclosed. Together, they agreed on a four hours’ notice that would allow Fanny to settle matters before the operation and to send her unsuspecting husband away for the day.

Thus began a difficult wait for Fanny, during which she drew up her will and secretly entrusted it to one of her acquaintances.

I was in hourly expectation of a summons to execution; judge, then to my surprise to be suffered to on full 3 Weeks in the same state! M. Larrey from time to time visited me, but pronounced nothing, & was always melancholy.

Unnerved by the absence of information, Fanny’s husband asked that the operation be performed without any further delay. Yet the doctors kept shunning their responsibility. Only two months later did Fanny learn that:

M. Dubois had given his opinion that the evil was too far advanced for any remedy; that the cancer was already internally declared; that I was inevitably destined to that most frightful of deaths, & that an operation would but accellerate my dissolution. Poor M. Larrey was so deeply affected by this sentence, that – as he has lately told me, – he regretted to his Soul ever having known me, & was upon the point of demanding a commission to the furthest end of France in order to force me into other hands.

Instruments used to perform breast surgery

Illustration of a woman having a breast operation, accompanied by a close up of the surgical instruments used (17th century)

(source: Wellcome collection)

Instruments used to perform breast ablation

The tenaculum helvetianum was a type of forceps used to excise the breast. Engraving with etching by A.J. Defehrt after L.-J. Goussier (mid-18th century)

(source: Wellcome Collection)

Mastectomy, by a Dutch artist

Mastectomy performed with a tenaculum helvetianum, attributed to a Dutch artist (18th century)

(source: Wellcome Collection)

Tumour removal performed on a man, 1817

A surgical operation to remove a malignant tumour from a man's left breast and armpit in a Dublin drawing room, 1817.

(source: Wellcome Collection)

Breast surgery, 1830s-1840s

Plate illustrating breast sugery. From Traité complet de l'anatomie de l'homme (published between 1831-1845)

(source: U.S. National Library of Medicine)

The Gout, J. Gillaray (1799)

Though mastectomy had been practised and improved over centuries, no solution had yet been found to suppress the pain caused by the operation.
Caricature using a devil figure to illustrate the pain caused by gout, by James Gillaray (1799).

(source: Wikimedia Commons)

Surgeon's set, late 18th c.

Late 18th century amputation set by Savigny of London, the premier British instrument manufacturer at the time and maker of instruments for the King.

(source: collectmedicalantiques.com)

Nonetheless, remembering that Fanny had once declared she "would far rather suffer a quick end without, than a lingering life with this dreadfullest of maladies", Larrey and his colleagues finally settled on a date. On the morning of September 30th, 1811, she received a letter from her "good doctor", giving her a two hours’ notice. With remarkable composure and efficiency, Fanny sent word to her husband’s superior “that the moment was come, & I entreated him to write a summons upon urgent business for M. d’A[rblay]& to detain him till all should be over.” As she explains to her sister: “such was my terror of involving M. d’A[rblay]in the unavailing wretchedness of witnessing what I must go through, that it conquered every other, & gave me the force to act as if I were directing some third person.”

After negotiating a delay with her doctors in order to make all the necessary arrangements, Fanny took care of the preparation of her operation, despite the pain occasioned by the tumour which, by then, had spread to her upper arm. When at last all was ready, by the time one o’clock struck, she was faced with another obstacle.

Dr. Moreau then arrived, with news that M. Dubois could not attend till three. [...] This, indeed, was a dreadful interval. I had no longer any thing to do – I had only to think – Two Hours thus spent seemed never-ending. [...]
I strolled to the Sallon – I saw it fitted with preparations, & I recoiled – But I soon returned; to what effect disguise from myself what I must so soon know? – yet the sight of the immense quantity of bandages, compresses, sponges, Lint – made me a little sick: – I walked backwards & forwards till I quieted all emotion, & became, by degrees, nearly stupid – torpid, without sentiment or consciousness [...] I defied my poor arm, no longer worth sparing, & took my long banished pen to write a few words to M. d’A[rblay] and a few more for Alex, in case of a fatal result.

No sooner had she put the billets in a safe place than “the Cabriolets – one – two – three – four – succeeded rapidly to each other in stopping at the door” and Dr Moreau entered the room. She was given a wine cordial — possibly laced with laudanum ²¹ — as a sedative, after which she rang for her maids and nurses.

[...] before I could speak to them, my room, without previous message, was entered by 7 Men in black, Dr Larry, M. Dubois, Dr Moreau, Dr Aumont, Dr Ribe, & a pupil of Dr Larry, & another of M. Dubois. I was now awakened from my stupor – & by a sort of indignation – Why so many? & without leave? – But I could not utter a syllable.

A bedstead was placed in the middle of the room and fitted with a pair of old mattresses and an old sheet, to the astonishment of the authoress, who had been told that an armchair would be sufficient. “I now began to tremble violently, more with distaste & horror of the preparations even than of the pain.” When asked authoritatively by Dubois to get onto the bed:

I stood suspended, for a moment, whether I should not abruptly escape – I looked at the door, the windows – I felt desperate – but it was only for a moment, my reason then took the command, & my fears & feelings struggled vainly against it. [...] My distress distress was, I suppose, apparent, though not my Wishes, for M. Dubois himself now softened, & spoke soothingly. Can You, I cried, feel for an operation that, to You, must seem so trivial? – Trivial? he repeated – taking up a bit of paper, which he tore, unconsciously, into a million of pieces, oui – c’est peu de chose – mais – [indeed, it isn't much – but –]” he stammered, & could not go on. No one else attempted to speak, but I was softened myself, when I saw even M. Dubois grow agitated, while Dr Larry kept always aloof, yet a glance shewed me he was pale as ashes.

Extract from Fanny’s letter, describing the operation (source: British Library). (Click for full view.)

Hardly heartened by the obvious uneasiness of her doctors — but conscious that this operation might be her best chance to escape the jaws of the danger that hovered above her — Fanny climbed onto the bed and lied down without any further exhortation. A handkerchief was placed upon her face to hide from her sight the gruesome proceedings. Unfortunately, the fabric proved too thin to conceal anything and “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.”

Several minutes of silence ensued, during which the patient presumed her doctors to be exchanging instructions through gestures. This moment of suspension was finally broken by the voice of Larrey asking who would hold her breast to steady it. Fanny’s next action does not only vouch for her tremendous courage but is also a powerful symbol of a woman reclaiming ownership and control over her body.

No one answered; at least not verbally; but this aroused me from my passively submissive state [...] I started up, threw off my veil, &, in answer to the demand “Qui me tiendra ce sein?” [Who will hold that breast for me?] cried “C’est moi, Monsieur!” [I will, sir!] & I held My hand under it

She was then prompted to lie down again, and through the fabric, saw with horror Dubois intimating to his peers that the whole breast was to be cut out. Fanny describes in bloodcurdling details the 20 minutes of operation that followed, during which she fainted on at least two occasions. This account, reported here in its entirety, is not for the faint-hearted; nonetheless the raw quality of Fanny’s words makes each of them feel essential, and an artificial cut in the text would only betray its gripping sincerity, and the painful efforts of her author to put it on paper.

[W]hen 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 – & 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 – but when again I felt the instrument – describing a curve – cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator, who was forced to change from the right to the left – then, indeed, I thought I must have expired. I attempted no more to open my Eyes, – they felt as if hermetically shut, & so firmly closed, that the Eyelids seemed indented into the Cheeks. The instrument this second time withdrawn, I concluded the operation over – Oh no! presently the terrible cutting was renewed – & worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it adhered – Again all description would be baffled – yet again all was not over, – Dr Larry rested but his own hand, & – Oh Heaven! – I then felt the Knife rackling against the breast bone – scraping it! – This performed, while I yet remained in utterly speechless torture, I heard the Voice of Mr Larry, – (all others guarded a dead silence) in a tone nearly tragic, desire everyone present to pronounce if any thing more remained to be done; or if they thought the operation complete. The general voice was Yes, – but the finger of Mr Dubois – which I literally felt elevated over the wound, though I saw nothing, & though he touched nothing, so indescribably sensitive was the spot – pointed to some further requisition – & again began the scraping! – and, after this, Dr Moreau thought he discerned a peccant attom – and still, & still, M. Dubois demanded attom after attom. – My dearest Esther, not for days, not for Weeks, but for Months I could not speak of this terrible business without nearly again going through it! I could not think of it with impunity! I was sick, I was disordered by a single question – even now, 9 months after it is over, I have a head ache from going on with the account! & this miserable account, which I began 3 Months ago, at least, I dare not revise, nor read, the recollection is still so painful.

Frances Burney, madame d’Arblay, aged 59, endured this procedure with a strength and a dignity that command respect: “I bore it with all the courage I could exert, & never moved, nor stopt them, nor resisted, nor remonstrated, nor spoke”. Even more admirable is her compassion towards her doctors. While the men, distressed by the pain they were subjecting her to, were dressing her breast, she exclaimed: “Ah Messieurs! que je vous plains!” [Ah sirs! How much I pity you!].
Later, when her exhausted body was carried to the bedroom she opened her eyes to see “my good Dr Larry, pale nearly as myself, his face streaked with blood, & its expression depicting grief, apprehension, & almost horrour.” Her husband was called to her, followed by their son. The next paragraph, written in M. d’Arblay’s hand and addressed to Esther, is a moving testimony of the love that united Fanny and her “tenderest Partner”:

I must own to you, that those details which were, till just now, quite unknown to me, have almost killed me; & I am only able to thank God that this more than half Angel has had the Sublime courage to deny herself the comfort I might have afforded her, to spare me, not the sharing of her excruciating pains, that was impossible, but the witnessing so terrific a Scare, & perhaps the remorse to have rendered it more tragic. For I don’t flatter myself I could have got through it – I must confess it.

Fanny went on to live another 29 years, and passed away at the ripe age of 87. To this day, researchers are unable to tell whether the breast removed was indeed cancerous or whether Madame d’Arblay was suffering from mastopathy, a benign autoimmune disease that sometimes mimics carcinoma ²⁴.

Despite her jarring experience, it must be remembered that Fanny was in fact one in a small group of lucky few: she was placed in the care of the most eminent surgeons in Paris. Neither Dubois nor Larrey had a practice that was open to the public, and it is only through her influence and a powerful social network that she was able to access their services ²¹.

Though being operated at home was not uncommon for people sharing her social rank, for many individuals in the lower classes, surgery could become a rather public spectacle. In several hospitals, the operation was performed in a amphitheatre for the benefit of a large audience of medical students and practitioners ²⁵, and while some surgeons illustrated themselves by their speedy and efficient procedures, others apparently thought it a good opportunity to discuss the patient’s state while the sentient man, woman or child was lying on the table with their belly opened.
In a letter addressed to The Lancet in 1826 ²⁶, a man describes the case of a surgeon who :

having exposed the intestine of an incarcerated hernia, and having divided the stricture, addressed the pupils upon some little irregularities of the case, during two or three minutes, (indeed, it seemed to me a much longer time,) with the exposed intestine smoking in his face; instead of returning it instantly to the abdomen. The patient died [, though no parts of the hernia were gangrenous] at the time of their exposure.

In the end, Fanny Burney’s letter to Esther constitues a treasurable legacy, opening a window on History and on the universality of our human experience. With it, she wished to offer a cautionary tale to the female members of her family. Despite the pain augmenting in her breast from week to week, and the concern of her loving husband and friends, she waited months before she finally, “most painfully and reluctantly”, accepted to see a surgeon:

I thought their fears groundless, and could not make so great a conquest over my repugnance. I relate this false confidence, now, as a warning to my dear Esther – my Sisters & Nieces, should any similar sensations excite similar alarm.

In spite of the latest medical advances, 627.000 women died of breast cancer in 2018. The same year, 2.1 million new cases were diagnosed, and the numbers keep growing ²⁷ . Fanny’s story is one for the ages.

Adieu, adieu, my beloved Esther (source:British Library)

Emma Hollen

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