March 22 1812: Frances Burney's Pre-anesthetic Mastectomy

Frances Burney, 1785

On March 22, 1812, Frances d'Arblay begins to write a letter to her older sister, Esther,  recounting her radical mastectomy that had taken place nine months earlier, performed without anesthetic, in Paris by Baron Dominique Jean Larrey, Chief Surgeon to Napoleon's Grande Army.  Larrey had  learned his skills as Chief Surgeon in Napoleon's battlefields [1].  In March, 1812, he has been given orders by Napoleon to join the Grand Army as it begins to move east to war with Russia. 

Madam d'Arblay was born Frances Burney on June 13, 1752 in England. She was known as Fanny Burney and was an accomplished writer publishing novels and plays. In her youth, she had known Dr. Samuel Johnson and served in the Court of George III. In 1793 she married General Alexandre-Jean-Baptiste Piochard d'Arblay, a French exile who had fled to England after the French Revolution. In 1802, they had moved back to France remaining until 1812.

In 1810, Fanny had discovered a large lump in her right breast. The doctors feared that it was cancerous. After other treatments failed, surgery was recommended. Fanny hesitated but finally agreed in September of 1811. She provided written consent to her doctors. Arrangements were made to keep her husband and son away. Fearing the worse, she also  wrote farewell letters to them and prepared her will [2].

On September 30, 1811, she is waiting in her room and is given some wine by one of her doctors. This will be the only anaesthetic that she is to receive. She again waits. Then suddenly at three o'clock in the afternoon her doctors and assistants, "7 Men in black, Dr Larry, M. Dubois, Dr Moreau, Dr Aumont, Dr Ribe, & a pupil of Dr Larry, and another of M. Dubois", enter her room. There are also two nurses.

The doctors begin to prepare for the operation. Fanny describes how she felt:  

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. I called to my maid - she was crying, & the two Nurses stood, transfixed, at the door. Let those women all go! cried M. Dubois. This order recovered me my Voice - No, I cried, let them stay-! qu'elles restent (“Let them remain!”)!

After further preparations, Fanny places herself on the bed and a "cambric" handkerchief is placed on her face. The handkerchief is transparent so she sees "the glitter of polished steel". Minutes of excruciating silence follow as she again waits. She sees Doctor Dubois use his  forefinger first in a straight line across her breast, then a cross and lastly a circle, indicating the whole breast is to be removed. She waits. Then she feels "torturing pain" as the operation begins:

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 - & 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.

The operation lasts three hours and forty-five minutes. Fanny's right breast was entirely removed. Barron Larrey described his patient as having "un Grand courage." Fanny recovered and will live for twenty-nine more years.

Her complete description of the operation can be found here. It is the bravest thing that I have ever read. I have reproduced some excerpts below:  

"One morning - the last of September, 1811, while I was in Bed, & M. d'A. was arranging some papers for his office, I received a Letter written by M. de Lally to a journalist, in vindication of the honoured memory of his Father against the assertions of Mme du Deffand. I read it aloud to My Alexanders, with tears of admiration & sympathy, & then sent it by Alex: to its excellent Author, as I had promised the preceding evening.

I then dressed, aided, as usual for many months, by my maid, my right arm being condemned to total inaction; but not yet was the grand business over, when another Letter was delivered to me - another, indeed! - 'twas from M. Larrey, to acquaint me that at 10 o'clock he should be with me, properly accompanied, & to exhort me to rely as much upon his sensibility & his prudence, as upon his dexterity & his experience; he charged to secure the absence of M. d'A.- & told me that the young Physician who would deliver me his announce would prepare for the operation, in which he must lend his aid: & also that it had been the decision of the consultation to allow me but two hours' notice. - judge, my Esther, if I read this unmoved! - yet I had to disguise my sensations & intentions from M. d'A!

Dr Aumont, the Messenger & terrible Herald, was in waiting; M. d'A stood by my bedside; I affected to be long reading the Note, to gain time for forming some plan, & such was my terror of involving M. d'A. 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. The detail would be too Wordy, as James says, but the wholesale is - I called Alex to my Bedside, & sent him to inform M. Barbier Neuville, chef du division du Bureau de M. d'A. that the moment was come, & I entreated him to write a summons upon urgent business for M. d'A. & to detain him till all should be over. Speechless & appalled, off went Alex, &, as I have since heard, was forced to sit down & sob in executing his commission.

I then, by the maid, sent word to the young Dr Aumont that I could not be ready till one o'clock: & I finished my breakfast, & - not with much appetite, you will believe! forced down a crust of bread, & hurried off, under various pretences, M. d'A. He was scarcely gone, when M Du Bois arrived: I renewed my request for one o'clock: the rest came; all were fain to consent to the delay, for I had an apartment to prepare for my banished Mate. This arrangement, & those for myself, occupied me completely. Two engaged nurses were out of the way - I had a bed, Curtains, & heaven knows what to prepare - but business was good for my nerves. I was obliged to quit my room to have it put in order- - Dr Aumont would not leave the house; he remained in the Salon, folding linen! - He had demanded 4 or 5 old & fine left off under Garments - I glided to our Book Cabinet: sundry necessary works & orders filled up my time entirely till One O'clock, When all was ready - but Dr Moreau then arrived, with news that M. Dubois could not attend till three. Dr Aumont went away - & the Coast was clear. This, indeed, was a dreadful interval. I had no longer anything to do - I had only to think - TWO Hours thus spent seemed never-ending.

I would fain have written to my dearest Father - to You, my Esther - to Charlotte James - Charles - Amelia Lock - but my arm prohibited me: I strolled to the Salon - 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; - & thus I remained till the Clock struck three.

A sudden spirit of exertion then returned, - I defied my poor arm, no longer worth sparing, & took my long banished pen to write a few words to M. d'A - & a few more for Alex, in case of a fatal result. These short billets I could only deposit safely, when the Cabriolets - one - two - three - four - succeeded rapidly to each other in stopping at the door. Dr Moreau instantly entered my room, to see if I were alive. He gave me a wine cordial, & went to the Salon. I rang for my Maid & Nurses, - but 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.

M. Dubois acted as Commander in Chief. Dr Larry kept out of sight; M. Dubois ordered a Bed stead into the middle of the room. Astonished, I turned to Dr Larry, who had promised that an Arm Chair would suffice; but he hung his head, & would not look at me. Two old mattresses M. Dubois then demanded, & an old Sheet. I now began to tremble violently, more with distaste & horror of the preparations even than of the pain. These arranged to his liking, he desired me to mount the Bed stead. 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. I called to my maid - she was crying, & the two Nurses stood, transfixed, at the door. Let those women all go! cried M. Dubois. This order recovered me my Voice - No, I cried, let them stay-! qu'elles restent (“Let them remain!”)!

This occasioned a little dispute, that re-animated me - The maid, however, & one of the nurses ran off - I charged the other to approach, & she obeyed. M. Dubois now tried to issue his commands en militaire, but I resisted all that were resistable - I was compelled, however, 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 - I regretted that I had refused Mile de Maisonneuve - Mile Chastel - no one upon whom I could rely - my departed Angel! - how did I think of her! - how did I long - long for my Esther - my Charlotte ! -

My 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 - cest peu de chose - mais (“Yes, it is a little thing, 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 showed me he was pale as ashes. I knew not, positively, then, the immediate danger, but every thing convinced me danger was hovering about me, & that this experiment could alone save me from its laws. I mounted, therefore, unbidden, the Bed stead - & M. Dubois placed me upon the mattress, & spread a cambric handkerchief upon my face.

It was transparent, however, & I saw, through it, that the Bedstead 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! - I did not breathe - & M. Dubois tried vainly to find any pulse. This pause, at length, was broken by Dr Larry, who, in a voice of solemn melancholy, said 'Qui me tiendra ce sein? (“Who will hold the centre?”) - ' No one answered; at least not verbally; but this aroused me from my passively submissive state, for I feared they imagined the whole breast infected - feared it too justly, - for, again through the Cambric, I saw the hand of M. Dubois held up, while his forefinger first described a straight line from top to bottom of the breast, secondly a Cross, & thirdly a Circle; intimating that the WHOLE was to be taken off.

Excited by this idea, I started up, threw off my veil, &, in answer to the demand 'Qui me tiendra ce sein? ' cried 'C'est moi, Monsieur! ' & I held my hand under it, & explained the nature of my sufferings, which all sprang from one point, though they darted into every part. I was heard attentively, but in utter silence, & M. Dubois then replaced me as before, &, as before, spread my veil over my face. How vain, alas, my representation! immediately again I saw the fatal finger describe the Cross - & the circle - Hopeless, then, desperate, & self-given up, I closed once more my Eyes, relinquishing all watching, all resistance, all interference, & sadly resolute to be wholly resigned.

My dearest Esther, - & all my dears to whom she communicates this doleful ditty, will rejoice to hear that this resolution once taken, was firmly adhered to, in defiance of a terror that surpasses all description, & the most torturing pain. 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 - & 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.

Notes

1.  Larrey was an extraordinary surgeon. He also developed field hospitals, "flying ambulances" to transport wounded soldiers on battlefield. He also established the principles of triage for casualties. The skills that French surgeons gained were one of the few benefits of Napoleon's butchery on the battlefields of Europe. 
2. This paragraph is based on the information found here.