In 2018, a mastectomy – an operation to remove one or both breasts, to treat and prevent the spread of breast cancer – is always carried out under general anaesthetic. That doesn’t stop the procedure being frightening: having to undergo any kind of surgery is unnerving, and becomes even more so when it’s related to cancer. But most people who undergo mastectomies recover well, and – if they haven’t also had breast reconstruction surgery – are usually able to leave hospital the day after the operation.

Things were very different in the early 19th century. While one Japanese surgeon is reported to have developed a form of general anaesthetic in 1689, anaesthesia was not yet widely used in the West until the mid-19th century. As a result, surgeries were relatively rare, and took place without any pain relief when they were carried out.

The British Library recently published a letter from the English writer Frances ‘Fanny’ Burney, who wrote several popular novels about the trials and tribulations of upper-class women, including Evelina, Camilla and Cecilia. In the letter, which Burney wrote to her sister Esther, she provides an emotional account of being diagnosed with breast cancer and undergoing a mastectomy in Paris in 1811. It offers a shocking insight into what women with breast cancer went through at that time in history.

“About August, in the year 1810 I began to be annoyed by a small pain in my breast,” Burney writes. Although the pain grew more significant “from week to week”, she says it felt “heavy rather than acute”, and she wasn’t overly concerned about what it might mean. 

Burney recounts how her husband, a well-connected French former military officer named Alexandre Piochard D’Arblay, entreated her to have her breast examined. She resisted, hoping that the pain would go away on its own with the help of “care and warmth”, until a close female friend also encouraged her to get checked out by a doctor.

“I thought their fears groundless,” Burney writes. But she adds that she is relating “this false confidence, now, as a warning to my dear Esther, my sisters and nieces, should any similar sensations excite similar alarm.”

D’Arblay’s noble connections meant that Burney was able to be seen be two of the most celebrated surgeons in Paris, who also treated the pregnant Empress Marie-Louise and Napoleon. But the surgeons’ glittering credentials couldn’t make the mastectomy less of a horrifying experience, and Burney reports feeling “a terror that surpasses all description, and the most torturing pain”.

“When the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves – I needed no injunctions not to restrain my cries,” she writes. “I began a scream that lasted unintermittingly during the whole time of the incision – and I almost marvel that it rings not in my ears still! so excruciating was the agony.”

After the surgeon stopped cutting, Burney says she felt a pain that was different, but still agonising. “When the wound was made, and 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 and forked poniards, that were tearing the edges of the wound,” she writes.

The surgeon seemed to struggle to cut through her flesh, Burney continues, and at one point she thought she might die from the pain.

“When again I felt the instrument … cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and 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.”

Remarkably, Burney made a full recovery from the mastectomy, and went on to live for another 29 years. She published her fifth and final novel, The Wanderer, three years after her surgery, and released a three-volume biography of her father in 1832.

She passed away in 1840 at the age of 87, and is buried with her husband and son (both of whom died before her) in Walcot cemetery in Bath.

Her letter offers a fascinating window into what women with breast cancer went through in the 19th century; you can read it in full here.

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