Women of the Enlightenment taking charge of their Breast Cancer Awareness—The Case of Frances Burney

Written by Zoe Copeman |
Frances “Fanny” Burney by Charles Turner, published by Paul and Dominic Colnaghi & Co, after Edward Francisco Burney, mezzotint, published 16 May 1840, NPG D13846 © National Portrait Gallery London

Frances Burney’s breast operation took place on 30 September 1811 in Paris under the supervision of some of the most distinguished surgeons of Napoleonic France, including Dominique Jean Larrey and Antoine Dubois. Burney’s harrowing depiction of her “mastectomy” [1], which she recorded in a letter to her sister dated 22 March 1812, has been analyzed numerous times for its historical and literary merits. 

In honour of Breast Cancer Awareness month, Kress Fellow Zoe Copeman introduces a contemporary source that Burney may have used to make sense of her diagnosis and the events that followed—a source accessible at the Warburg Institute. 

If you have not yet encountered the British novelist Frances Burney (also known as “Fanny” or by her married name Madame d’Arblay), Virginia Woolf once called her "the mother of English fiction" and her work was said to have heavily influenced Jane Austen. Publishing her first novel anonymously in 1778 at the age of twenty-six, Burney was exalted in her time for her wit and vivid descriptions. Living in both Britain and France, her novels and diaries offer insight into the everyday social milieu of these nations.

“the terrible operation”

Burney’s letter recounting her breast cancer diagnosis, prognosis, and cure is often discussed for its singularity as it provides a rare patient perspective for this period [2]. In an article for the Guardian, Jenni Murray classified Burney’s letter as “one of the most courageous pieces of work I’ve ever encountered” [3]. Though Burney’s operation was performed in 1811, it took her six months before she felt that she could revisit the procedure to inform her family and friends what had happened to her.

In this letter, Burney describes the tense buildup to the operation, in which—after months of convincing Burney that she needed the procedure—her surgeons suddenly appear hesitant to continue. Their resolve shattered, it is Burney who takes charge of her operation:

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 this breast for me?—”] 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, and thirdly a circle; intimating that the Whole was to be taken off. Excited by this idea, I started up, threw off my veil, and, in answer to the demand “Qui me tiendra ce sein?” cried “C’est moi, Monsieur!” [“I will, Sir!”] and I held My hand under it, and explained the nature of my sufferings, which all sprang from one point, though they darted into every part.[4]

Not only does Burney’s holding of her breast imply that she will act as a surgical hand (n.b. she does not end up serving this role), her explanation of “the nature of my sufferings” also exhibits her knowledge of eighteenth-century theories on cancer. She holds her breast knowing that it is infected and spreading from its initial lump. And though Burney’s earlier recollections belabor the fact that she is “condemned to an operation” (her own words), it is her voice that allows that very operation to continue—not simply as an “extirpation” (the cutting out of just a tumor) but as a “full amputation” (the removal of all breast tissue).

Knowing the procedure

Throughout the letter, Burney is apt to showcase her knowledge of such surgeries: “M. D’Arblay filled a Closet with Charpie, compresses, and bandages—All that was owned, as wanting, was an arm Chair and some Towels”. She had prepared for her operation to occur at a moment's notice, as it would. She was told she only had two hours before the attendant would arrive to prep her Salon (n.b. it was common for someone of Burney’s class to have operations at home). On the day, Burney was horrified to learn that she would not have her operation strapped to an armchair as was also customary in the eighteenth century. Instead, they unexpectedly drew together “[t]wo old mattresses” in her Salon. This was one of many shocks that defied her expectations that day.

What is most striking is Burney’s switch from hesitancy to resolve occurs only after she catches through the thin veil placed over her head those signs that the surgeon Antoine Dubois renders above her breast (emphasized in italics in the above quote). Burney went into the operation expecting an extirpation and came out with an amputation. The way that she was able to see a line, a cross, then a circle and know that that meant the latter is curious, as the delineation between performing an extirpation and amputation was not something agreed upon even in the medical literature. 

The following table provides examples of eighteenth- and nineteenth-century surgeons and their favoured incisions for breast operations.

SurgeonFavoured first incisionReferenced in (n.b. surgeon in the author):
Lorenz Heister (German)longitudinal (extirpation) ; no incision for amputation, whole breast taken offInstitutiones chirurgicae in quibus quicquid ad rem chirurgicam pertinet (1740)
Henri François le Dran (French)latitudinal (both extirpation and amputation)Traité des opérations de chirurgie (1742)
Antoine Louis (French)longitudinal (extirpation) ; cross or T-shape (amputation)L’Encyclopédie, tome 2 (1751)
Percivall Pott (English)circular (both extirpation and amputation)The chirurgical works of Percivall Pott (1779)
Henry Fearon (English)longitudinal (both extirpation and amputation)A treatise on cancers (1784)
John Syng Dorsey (American)semi-elliptical (extirpation) ; unclear on full amputationin his unpublished surgical notebooks under the supervision of Philip Syng Physick (1800)
Jean-Baptiste Marc Bourgery (French)elliptical (both extirpation and amputation)Traité de petite chirurgie (1837)
Guillaume Dupuytren (French)longitudinal (extirpation) ; cross or T-shape (amputation)Leçons orales de clinique chirurgical: faires à l'Hôtel-Dieu de Paris (1839)

This list is by no means exhaustive, but the intent here is to illustrate that there was no one way to perform breast operations. Surgery was considered an art, and how one performed that art varied greatly. Yet, it is interesting that two of the French surgeons in this table used a line as a sign for  “extirpation” and a cross for “amputation”, and that Dubois would replicate that sign system during Burney’s surgery. It comes as no surprise that Guillaume Dupuytren would follow a similar model as Antoine Louis decades prior. Throughout his lectures at the Hôtel-Dieu in Paris, Dupuytren referred to Louis’s various practices with much esteem, holding him as well as Burney’s surgeons Dubois and Larrey in the highest regard. One may infer that Dubois could have operated similarly, and indeed may have employed his signs of line—cross—circle above Burney to silently inform his fellow surgeons the new course of operation without distressing the patient. And yet, to his surprise, Frances Burney was also aware of this discrete surgical lingo. How?

Her source material

Title page for L’Encyclopédie, volume 2, edited by Denis Diderot and Jean le Rond d’Alembert, published 1751-1772 in Paris and Geneva in several volumes © Photograph taken by the author.

Antoine Louis described his unique style of incisions (line—cross) in his article on “Cancer” for the iconic Enlightenment text L’Encyclopédie edited by Denis Diderot and Jean le Rond d’Alembert. The first volume of the Encyclopédie was published in 1751 to great enthusiasm both in France and abroad. The massive undertaking was meant to function as a French counterpart to Ephraim Chambers’s English Cyclopedia (1728-1753), bringing erudite knowledge to the French public [5].

Although the Encyclopédie was expensive and thus not as accessible as its editors had intended, Frances Burney’s father (the musical historian Charles Burney) was one of its first subscribers and eagerly snatched up the full set. Burney grew up with its volumes, even referencing in her letters and journals times others had studied them in her presence [6]. The Burneys also owned the illustrative plates. The illustrations for “Chirurgie” [Surgery] offer some of the most striking imagery. With Louis’s article on “Cancer” in volume 2 and his other article “Chirurgie” in volume 3, one can consult these two articles at the same time while simultaneously referring also to their accompanying plates. When one does so, the “line” as a symbol for extirpation on plate 28, figure 4 is immediately apparent.

“Chirurgie” [“Surgery”], plates 28 in volume 2, drawn by Louis Jacques Goussier and engraved by B.L. Prevost for L’Encyclopédie, edited by Denis Diderot and Jean le Rond d’Alembert, published 1751-1772 in Paris and Geneva. © Wellcome Collection, public domain.

Taken together, the text and images are meant to demonstrate how eighteenth-century surgeons created less painful operations and better postoperative care for their patients (n.b. the type of anesthesia we have today was not available). Looking back as twenty-first century viewers, the terror for us lies in the fact that Burney’s only form of anesthetic was a wine cordial. Eighteenth-century patients shared that terror. Yet, for Burney the Encyclopédie at the very least provided an idea on how these surgeries may be performed, allowing her to construct a vision on what to expect and to know that when she saw her surgeon sign a “cross” that meant a change to the procedure she had originally agreed upon.

While some scholars have questioned the veracity of Burney’s letter because of its latency, her knack for storytelling, and the fact that she even rewrote it years later with amendments (n.b. the amended letter is the version that most have read) [7], Burney clearly demonstrates that she was knowledgeable of surgical practices and the ways in which breast cancer was discussed amongst medical men. Whether she actually recognized Dubois’s symbols in that moment, sat up, and clutched her breast to demand more from her surgeons, we may never know. But she recorded herself as possessing this knowledge and having the agency to act upon it, and that is what we will remember.

Volumes 2 and 3 of the text alongside volume 2 of the plates, from L’Encyclopédie, shown here in the stacks of the Warburg Institute © Photograph taken by the author.

You too can consult the Encyclopédie by heading to the second floor of the Warburg Library. A late eighteenth-century copy of Chambers’s Cyclopedia (labeled as Chambers’s Dictionary) is on the same shelf.

Zoe Copeman is a doctoral candidate studying at the University of Maryland, College Park. She currently holds the Samuel H. Kress History of Art Predoctoral Fellowship to complete her dissertation “Cankerous Femme: The European Mastectomy and the Semiotics of Surgery” at the Warburg Institute and Courtauld Institute of Art. She has generously also been funded for this project by the Cosmos Club in Washington, DC, the Swann Foundation at the Library of Congress, as well as departmental, college, and university grants provided by the University of Maryland. You can read more on her work on the Encyclopédie in her article “Deviating from Monstrosity” for the Journal of Literary & Cultural Disability Studies.

References

[1] The term mastectomy was not used by Burney, nor was it used by eighteenth-century surgeons. Burney referred to her procedure as a “breast operation”, marking her letter to her sister with the note “account from Paris of a terrible operation - 1812”. To avoid confusion, I consciously do not use the term “mastectomy” here.

[2] John Wiltshire has written extensively on the history of “pathography”. For Burney’s place in that discourse, see: John Wiltshire, "Frances Burney: Pioneer of Pathography," The Burney Journal 9 (2007): 7-19.

[3] https://www.theguardian.com/books/2016/oct/07/fanny-burney-courageous-writing-jenni-murray 

[4] The full letter is accessible online through the New York Public Library: https://archives.nypl.org/brg/19312#overview 

[5] For a brief history on the Encyclopédie, click here for the Victoria & Albert Museum’s write-up: https://www.vam.ac.uk/articles/the-encyclop%C3%A9die#:~:text=The%20aim%20of%20the%20Encyclop%C3%A9die,publication%20took%20over%2040%20years 

[6] Many of Burney’s journals and letters are available through Oxford Scholarly Editions Online. Information on the Burney’s relationship with the Encyclopédie can be found primarily in The Early Journals and Letters of Fanny Burney, volume 1, edited by Lars E. Troide. 

[7] Julia Epstein, The Iron Pen (Bedminster: Bristol Classical Press, 1989).