Mastectomy #5: How it was done in the 18th Century (warning: gory descriptions)

18CenturyMastectomyInstruments

No, it’s not a turkey carving set. These are 18th Century Mastectomy Instruments. image credit: cancerculturenow.blogspot.com

For all my fears about surgery and mastectomy, I am grateful to modern medicine for making a barbaric procedure less torturous.

Today we have general anaesthesia, antibiotics, sterile operating theatres, super-duper painkillers.  Chemotherapy and other treatments offer the hope of remission if not cure, and an extension of life.

Not so for the women of the 18th Century.

I came across this account of breast cancer surgery as it was performed then, on Abigail “Nabby” Adams Smith, the first born child of the second President of the USA, John Adams.  Abigail Adams was diagnosed with breast cancer at the age of 45.

This account was taken from James Olson’s Essay on Abigail Adams in his book, Bathsheba’s Breast: Women, Cancer & History (available from Amazon – click on link) and reads more like the dissection of a steak dinner than a delicate surgical procedure.

My heart goes out to the women who suffered so much at the hands of an incomplete medical science – they were, after all, getting what was considered top quality treatment of the day – and the courage and bravery that they showed.

And who knows … perhaps some day in the future, when breast cancer treatments have evolved beyond surgery, other people will look back on my mastectomy and wonder at how crude the treatments were today, and how quaint and primitive our medical knowledge was.

[WARNING:  contains graphic descriptions.  Do not read if you are thinking of having a mastectomy or about to have surgery]

Jim Olson’s Essay on Abigail Adams

“The surgery took place in an upstairs bedroom of the Adams home in Quincy, Massachusetts. It was as bad as they had all feared. John Warren was assisted by his son Joseph, who was destined to become a leading physician in his own right, and several other physicians. Exact details of the operation are not available, but it was certainly typical of early nineteenth surgery. Warren’s surgical instruments, lying in a wooden box on a table, were quite simple–a large fork with two, six-inch prongs sharpened to a needle point, a wooden-handled razor, and a pile of compress bandages. In the corner of the room a small oven, full of red-hot coals, heated a flat, thick, heavy iron spatula.

AbigailAdams

Abigail Adams

Nabby entered into the room as if dressed for a Sunday service. She was a proper woman and acted the part. The doctors were professionally attired in frock coats, with shirts and ties. Modesty demanded that Nabby unbutton only the top of her dress and slip it off her left shoulder, exposing the diseased breast but little else. She remained fully clothed. Since they knew nothing of bacteria in the early 1800s, there were no gloves or surgical masks, no need for Warren to scrub his hands or disinfect Nabby’s chest before the operation or cover his own hair. Warren had her sit down and lean back in a reclining chair. He belted her waist, legs, feet, and right arm to the chair and had her raise her left arm above her head so that the pectoralis major muscle would push the breast up. A physician took Nabby’s raised arm by the elbow and held it, while another stood behind her, pressing her shoulders and neck to the chair.

breastfork

Breast Fork mid-18th century. Image credit: http://collectmedicalantiques.com/

Warren then straddled Nabby’s knees, leaned over her semi-reclined body, and went to work. He took the two-pronged fork and thrust it deep into the breast. With his left hand, he held onto the fork and raised up on it, lifting the breast from the chest wall. He reached over for the large razor and started slicing into the base of the breast, moving from the middle of her chest toward her left side. When the breast was completely severed, Warren lifted it away from Nabby’s chest with the fork. But the tumor was larger and more widespread then he had anticipated. Hard knots of tumor could be felt in the lymph nodes under her left arm. He razored in there as well and pulled out nodes and tumor. Nabby grimaced and groaned, flinching and twisting in the chair, with blood staining her dress and Warren’s shirt and pants. Her hair matted in sweat. Abigail, William, and Caroline turned away from the gruesome struggle. To stop the bleeding, Warren pulled a red-hot spatula from the oven and applied it several times to the wound, cauterizing the worst bleeding points. With each touch, steamy wisps of smoke hissed into the air and filled the room with the distinct smell of burning flesh. Warren then sutured the wounds, bandaged them, stepped back from Nabby, and mercifully told her that it was over. The whole procedure had taken less than twenty-five minutes, but it took more than an hour to dress the wounds. Abigail and Caroline then went to the surgical chair and helped Nabby pull her dress back over her left shoulder as modesty demanded. The four surgeons remained astonished that she had endured pain so stoically.

BathshebaBreast

Nabby endured a long recovery. She did not suffer from post-surgical infections, but for months after the operation she was weak and feeble, barely able to get around. She kept her limp left arm resting in a sling. Going back to the wilds of western New York was out of the question, so she stayed in Quincy with her mother, hoping to regain strength. What sustained all of them during the ordeal was the faith that the operation had cured the cancer. Within two weeks of the surgery, Dr. Rush wrote John Adams congratulating him “in the happy issue of the operation performed upon Mrs. Smith’s breast…her cure will be radical and durable. I consider her as rescued from a premature grave.” Abigail wrote to a friend that although the operation had been a “furnace of affliction…what a blessing it was to have extirpated so terrible an enemy.” In May 1812, seven months after the surgery, Nabby Smith felt well again. She returned home to the small farm along the Chenango River.”

*********

Abigail Adams Smith died of breast cancer in 1813.

After Nabby’s radical mastectomy, John Adams wrote to Dr. Rush:

“Oh! that a vaccine Inoculation could be discovered for this opprobrium of Philosophy and Mi[. . .]. The Cancer, This Physical [disgrow] of human Nature!”

My sentiments precisely.

Please God, soon, send a vaccine for bresat cancer that is effective, affordable and available commercially for everyone.  And God bless you, Abigail Adams for what you went through and to all the other courageous women who went through the same.

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Due to nerve damage from a mastectomy, I am now fundraising for cancer treatment in Germany.  Please help if you can!

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I am fundraising for my cancer treatments in Germany. Please help if you can!

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