Early modern breast cancer: be thankful for modern medicine
To the Institute for Historical Research last week for a seminar,'The Worst of All Her Afflictions': Experiencing Breast Cancer in Early Modern England', presented by Marjo Kaartinen. It almost took me back to my agricultural science days in its goriness - horrible surgical implements and blood-soaked descriptions - one of the younger participants was turning distinctly green as she listened to Fanny Burney's description of her masectomy (carried out of course without anaesthetic) and the picture of a breast dissected by an 18th-century surgeon circulated remarkably quickly ...
Nonetheless it wasn't all gore. There was also an interesting debate on the likely incidence of the disease then compared to now. Of course it will never be possible to get statistics, but it might be possible to get an impression from contemporary accounts, and particularly women's level of fear of the disease (given all of the other deadly dangers around). And the impression was that it was quite high, particularly given that the number of women over 40 in the population was low.
But very few records survive in women's own words. There are a couple of reasons for that. Due to - understandable - fear of the operation, women usually did not approach surgeons, or decide to have it, until the disease was very far advanced (although surgeons did understand that it was important to operate early). So they didn't survive long afterward - usually only a few months. (If, of course, the operation didn't kill them.)
Also some facts (that you might not want to know) about breast cancer. Untreated breast cancer presents as black growth and produces dark, evil-smelling liquid; in 60 per cent of cases it ulcerates. This was a smell that early modern physicians and surgeons recognised. They understood that the disease tended to spread into the lymph nodes (which they would check while performing a masectomy, but metastising was not yet understood). Untreated, the disease usually killed in about three years.
In the early modern era some thought it came from environmental factors, some thought sex life or lack of it - it was well known that nuns were prone to it. Some thought sour milk to blame, others lack of exercise, melancholy, green sickness. Breast-feeding was thought by some to be a cause, and this was one reason for the use of wet-nurses.
"Treatments included all of the usual herbal remedies, usually applied topically, and often caustics, which must have been hugely painful. Books of medicine often contained receipts for "canker in women's breast".
But women victims often seem to have kept their condition secret until it was utterly impossible to hide. By that time, often, surgeons would not operate. The traditional Hippocratic view was that if the cancer did not move - was attached, presumably to the breast bone or ribs? the patient would only die faster if operated on. This may have been the reason why the Machioness of Northhampton, a waiting lady in Elizabeth (I'm not sure which one), went to Antwerp to consult doctors there.
There's one final irony: Fanny Burney survived many years after the operation, so it is likely that her illness was not cancer, and the operation was unnecessary.