April 2024 Meeting: Meek’s Reimagining Illness | Literature, Medicine, and Culture Colloquium

Our April 2024 LMCC meeting took place on Wednesday, April 24 at 5:30pm in UNC’s HHIVE Lab (Greenlaw 524) and via Zoom. We discussed Reimagining Illness: Women Writers and Medicine in Eighteenth-Century Britain by Heather Meek (McGill-Queen’s UP, 2023).

Specifically, we explored:

Introduction: “The Discursive Landscape of Women Writers and Medical Ideas in the Long Eighteenth Century” (pp. 3-33)
Chapter 6: “‘This terrible business’: Frances Burney’s Mastectomy Letter and Discourses of Breast Cancer” (pp. 193-214)
Suggested reading: “A Mastectomy” (1812) by Fanny Burney

If you missed the meeting, you can still access the text on the Readings page of this site!

You can also access the recording of our meeting here.

This was our final meeting of the semester and of the academic year! Our regular monthly meetings will resume this fall, most likely in late August. As of now, we plan to continue meeting once at the end of each month in UNC’s HHIVE Lab (Greenlaw 524) with options for people to join via Zoom as well. Stay in touch with us over the summer, and look out for announcements for our meetings to resume this fall!

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Burney, Francis (Fanny). “A Mastectomy.” Henry W. and Albert A. Berg Collection, New York Public Library, 1812.

Meek, Heather. Reimagining Illness: Women Writers and Medicine in Eighteenth-Century Britain. McGill-Queen’s UP, 2023. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/unc/detail.action?docID=30760831.

Some key concepts:

Problematizing older narrative of victim/oppressor; seeing forms of resistance, even the letter itself
Was there a reaction to this letter from Esther?
Fanny “sewed” the medical report into her own account, a physical item
The horror of Burney’s account, what is being described, how it’s worked through the literary nature; description of “pathography”/brutal set of readings/how things are handled and treated, in the context of female medical rights
“Pathography” as a neologism/type of illness narrative, specifically resistant or critical; but does pathography take the same kind of resistance? For instance, acknowledging that medical is helping, but not undercutting the patient’s narrative
A woman stepping into this empirical world of treating the woman’s body; before etiquettes we would expect, a certain familiarity of a familiar room and the revolving door of men in that room, but noticing controls that were there, but also the objectivity/reclaiming of personhood/handling with layers
John Wiltshire’s Frances Burney and the Doctors (argues that she created pathography); his analysis of Burney’s mastectomy and background on the doctors involved, e.g., Dr. Larrey was conceptual inventor of triage
This is well after Thomas Percival’s Code of Medical Ethics (ca. 1803); tending to emotional and mental state on treatment of patients/removing discomfort of the patient
Etiquettes developed in the time of Burney, missed the mark of gender specificity; how doctors in the room were handling the situation, irreconcilable from Burney’s experience
Meek’s intro: so much of the work in the medical sphere, dealt more with men’s illnesses
Francis Burney as understanding her doctors to make ethical decisions/respected their decisions, and great deal of affection for them; the doctors acting well-intentioned; what was sincere, what was satirical? (call to execution, maybe Meek leaned too much into that interpretation)
Wiltshire book may talk about how doctors didn’t want to go through the operation/some reticent on their part because it was so horrible
Meek complicating the narrative of the patient/victim and oppressor/physician; it’s traumatic for the physician, too
Quacks and selling of treatments, but considered less than because of lack of official accreditation/professional sovereignty, which fields were considered seriously; hysteria, for example, not being taken seriously until later 19^th century
Paul Starr, re: professionalization
Looking at Burney’s letter in terms of gendered care that was expressed; Burney’s insistence on her husband not being there; waited 9 months to tell her family as a traumatic experience to recall, how women are expected to move through illness, to take care of themselves and others as well
The traumatic experience from the physicians’ perspective; how care is influenced by relationships in both positive and negative ways, that stand outside of “best practice”
A moment of haze, of seeing her blood on her physician/stigmatization of women’s illnesses, deals with a touchy areas of affected sex organs, what have you been doing/causing? Shroud of shame, how this is handled in early nineteenth-century texts, like Northanger Abbey
Burney’s attendance by several integral physicians, who may have been less phased by the operation; made the process as clinical as possible/Meek’s critique of the pupil’s report on the case/practical considerations of Burney’s position and lying upon the bed, probably wasn’t meant to be humiliating/refusing to tell her was a matter of deciding themselves, how badly it would stress her out beforehand, coming from a place of compassion
Waiting to tell Burney of the operation, as an intended act of kindness
If the clinical as possible is the problem? Not taking into account her grievances, and psychological issues/for Meek, maybe the questions are answered in other places in the book, across other genres
Some fluidity between genres and forms/how has the atmosphere and dynamics of care changed?
Meek and the doctor’s report, how they’re complicated-free/simple, women’s bouncing back; broadly speaking to how surgeries/procedures are minimized, even now (e.g., bariatric surgery, LASIK surgery documentary)
How did they know the tumor was non-malignant? The fact that she survived 29 years after would indicate that it wasn’t malignant
Buy-in for surgery; having to have the conversation now that surgery isn’t a quick fix or devoid of risks
The idea of a quick recovery as dismissing female pain
How much of a build-up in Burney’s letter, getting to the operation, the uncertainty, and the debate back and forth/different terminologies/anticipating that something would happen (the scraping, the vividness), reading alongside Meek and the details as keen as they are for compensating for the gaps that are left
Burney’s claiming her own breast, before it’s removed
What voices are being heard? What we don’t get in the official record, like the doctors showing up, and making decisions
In the context of the letter, how many pages are being dedicated to give context of Burney’s relationship with others
The doctors just entering, without asking—suddenly Burney’s home is the clinic/complicates the narrative that medicine occurred in the home…yes/and—men were coming into the room and asking her to be in a supine position, which Burney seemed to understand, but it’s still problematic
The veiling of Burney, perhaps acknowledging the sacredness of her breast
Jonathan Stern, use of stethoscope to distance the doctor from the body
The use of the veil, maybe for Burney’s comfort, but also physicians not having to see her expression

Some key passages:

“About August, in the year 1810, I began to by annoyed by a small pain in my breast, which went on augmenting from week to week, yet, being rather heavy than acute, without causing me any uneasiness with respect to consequences” (Burney para. 2).

“M. Dubois gave me a prescription to be pursued for a month, during which time he could not undertake to see me again, an pronounced nothing—but uttered so many charges to me to be tranquil, and to suffer no uneasiness, that I could not but suspect there was room for terrible inquietude” (Burney para. 4).

“…his [M. d’Arblay] looks were shocking! his features, his whole face displayed the bitterest woe. I had not, therefore, much difficulty in telling myself what he endeavoured not to tell me that a small operation would be necessary to avert evil consequences!” (Burney para. 5).

“A formal consultation now was held, of Larrey, Ribe, and Moreau—and, in fine, I was formally condemned to an operation by all Three. I was as much astonished as disappointed—for the poor breast was no where discoloured, and not much larger than its healthy neighbour. Yet I felt the evil to be deep, so deep, that I often thought if it could not be dissolved, it could only with life be extirpated” (Burney para. 9).

“I rang for my Maid and 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, and a pupil of Dr Larry, and another of M. Dubois. I was now awakened from my stupor—and by a sort of indignation—Why so many? and without leave?—But I could not utter a syllable” (Burney para. 19).

“I now began to tremble violently, more with distaste and horror of the preparations even than of the pain” (Burney para. 20).

“My dearest Esther,—and 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, and 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—and I almost marvel that it rings not in my Ears still! so excruciating was the agony. 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—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 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” (Burney para. 25).

“…presently the terrible cutting was renewed—and worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it adhered—Again all description would be baffled—yet again all was not over,—Dr Larry rested but his own hand, and—Oh Heaven!—I then felt the Knife rackling against the breast bone—scraping it!” (Burney para. 26).

“My dearest Esther, not for days, not for Weeks, but for Months I could not speak of this terrible business without nearly again going through it! I could not think of it with impunity!” (Burney para. 27).

“To conclude, the evil was so profound, the case so delicate, and the precautions necessary for preventing a return so numerous, that the operation, including the treatment and the dressing, lasted 20 minutes! a time, for sufferings so acute, that was hardly supportable—However, I bore it with all the courage I could exert, and never moved, nor stopt them, nor resisted, nor remonstrated, nor spoke” (Burney para. 28).

“When all was done, and they lifted me up that I might be put to bed, my strength was so totally annihilated, that I was obliged to be carried, and could not even sustain my hands and arms, which hung as if I had been lifeless; while my face, as the Nurse has told me, was utterly colourless. This removal made me open my Eyes—and I then saw my good Dr Larry, pale nearly as myself” (Burney para. 29).

—

“This book considers the literary work of Anne Finch (1661–1720) and five other women – Jane Barker (1652–1732), Lady Mary Wortley Montagu (1689–1762), Hester Lynch Thrale Piozzi (1741–1821), Mary Wollstonecraft (1759–1797), and Frances Burney (1752–1840) – to offer an account of the ways in which this group of major eighteenth-century British women writers engaged with and reimagined the medical concepts and philosophies of their day” (Meek 4).

“A close reading of their works and an examination of their lives reveal that they wrote and lived in a time when disciplinary boundaries were fluid and the domains of literature and medicine were intertwined. Deploying, revising, and generating medical discourse, their discussions of smallpox, consumption, breast cancer, melancholy, hysterical affliction, and the constellation of ailments associated with maternity address and inform prevalent medical theories and provide insight into the experience of suffering” (Meek 4).

“These writers pay particular attention to conceptions of women’s bodies and minds and show how illness might be at once a veritable bodily condition and a malleable construct replete with metaphorical and ideological meaning. The medical ideas these women consider, moreover, shape their work. Their representations of illness often determine or enhance narrative and poetic structure, psychological complexity, political significance, and thematic content” (Meek 4).

“Exploring these women’s narratives of illness, this book contributes to the ongoing work on these accomplished and ambitious literary women, and it helps us to better understand what illness meant and how it was approached and experienced by individuals in this period” (Meek 4).

“While the works of six women writers are the primary focus of the following chapters, the texts of contemporaneous medical men also serve as crucial objects of study. Looking at these two bodies of work alongside each other, this book sees the long eighteenth century not simply as an age in which rationalization and male expertise rose and thrived, but rather as one characterized by a dynamic commotion of ideas shared and debated among a variety of figures. It explores how, as literature and medicine morphed slowly and unevenly into the more unified professional states that would take form in the next century, a multiplicity of views overlapped and collided” (Meek 4-5).

“The book thus resists a simplistic narrative of patriarchal oppression: while women writers are presented as offering a unique window into the medical world of their time, they are not unduly elevated, nor are the medical men dogmatically dismissed, even though, in certain instances, their views are visibly driven by ideas of male superiority” (Meek 5).

“Immersed as they were in the evolving, vibrant, and productively tumultuous discussions of their time, the writers explored in the following chapters participated in a medico-literary conversation driven not merely by a reliance on empirical data, a quest for scientific truth and consensus, and a preoccupation with universal medical cures; they also shared a conviction of the vital importance of heeding informal, idiosyncratic, or unpopular positions, accepting the realities of disease and death, and valuing debate, dissent, dialogue, and the constructive chaos of the creative imagination” (Meek 5).

“The book returns repeatedly, if sometimes only implicitly, to the question of genre, demonstrating how the non-scientific text – in the form of literary fiction and nonfiction, verse, and autobiographical writing – was, for these eighteenth-century women, a crucial platform through which to share and elaborate their medical ideas and to participate in medical debate” (Meek 5).

“The following chapters are preoccupied, moreover, with conceptions of sex and gender; they show how these six women – drawing on their knowledge, experience, and imaginative talents – put forth important positions that scrutinized prevailing eighteenth-century paradigms about women’s minds and bodies. As the book also argues, these very paradigms, as well as others – which generally straddled both older (yet enduring) and emerging epistemologies – took form in the works of medical men and served in turn as foundations for the (sometimes indirect) exchanges of ideas between these men and women” (Meek 5-6).

“…the book shows that the medical ideas with which these women wrestled are entwined with the literary qualities of their works, thus illustrating how illness – then, as it is now – can be understood as a veritable bodily condition, even as it is formed by narrative, and revealing how the development of the woman writer in the eighteenth century was intricately connected to changes in the world of medicine” (Meek 6).

“In the following sections of this introductory chapter, I first survey how women writers in this period were able to both acquire and disseminate medical ideas. From this flows a consideration of the fluidity and contestation that characterized medical knowledge and practice at the time, before the professionalization of medicine had solidified. Indeed, as I then outline, medicine and literature were regarded as intimately intertwined, and in that sense, the women this book features were participants in what was regarded as a normal, even commonplace cross-pollination of knowledge areas and cultures in the eighteenth century” (Meek 6).

“[Jane] Barker, [Anne] Finch, [Lady Mary Wortley] Montagu, [Hester Lynch Thrale] Piozzi, [Mary] Wollstonecraft, and [Frances] Burney have been chosen as the primary subjects of this study because each of them can be understood as at once a major woman of letters and a medical thinker. All of them read widely, moved in intellectual circles, and left a considerable body of written work that displays both literary skill and medical insight. Despite their exceptional accomplishments, they, like most women of their time, did not acquire their learning easily” (Meek 7).

“As [Margaret] Cavendish’s successors, the six women writers explored in the following chapters were perhaps more constrained than she by the growing number of proscriptions and limitations with regards to women’s education and work. Nonetheless, they sought out and acquired knowledge in a variety of areas, including science, medicine, and, of course, literature. None of them enjoyed the educational or professional opportunities of many of their male counterparts, but certain privileges – such as access to exceptional home libraries, the support of erudite family members, friends, and acquaintances, and perhaps the occasional visit to a public lecture – meant that they each became remarkably learned” (Meek 8-9).

“In addition to the knowledge they would have gained through conversation with prominent intellectual figures, these six women writers would have enjoyed the opportunity to learn about medical theories and practices more directly, both by interacting with physicians and by benefiting from the wide accessibility of medical literature in the bourgeoning book trade of their time. Most of these women associated with physicians of their day” (Meek 10).

“Moreover, all these women, as avid readers with access to books, would have been exposed to the growing number of contemporaneous medical texts whose circulation proliferated from the late seventeenth century onward, with the lapse of the Licensing Act in 1695, when censorship laws and restrictions on the number of presses that could operate in Britain were lifted” (Meek 11).

“To some extent, medical practitioners existed in a hierarchy that was determined by prestige, class, skill, and qualification, but even the more established, trained physicians considered in this book were part of a sprawling group of licensed and unlicensed physicians, surgeons, apothecaries, midwives, quacks, and drug peddlers. These figures, which included men and women from a range of social classes who might have been trained at university, by family members, or not at all, contributed to British health, disseminated medical knowledge” (Meek 12).

“The women examined in this book (with the possible exception of Jane Barker) do not seem to have occupied more than fleeting or relatively minor roles in medical care, but they benefited indirectly from the dynamic and supple cultures and economies of medicine in which other women were direct participants. In addition to the women who served as domestic healers in their communities, there were women who published or sold medical-recipe books, or who worked as subordinates in medical settings such as maternity hospitals, infirmaries, or dispensaries” (Meek 13).

“The women authors considered in this book might be aligned with Sterne, Richardson, and Johnson, but they should also be distinguished from them. Like their male counterparts, these women, even though they did not undergo formal medical training or enjoy sustained medical careers, possessed and shared broad medical knowledge and participated in the vibrant, borderless, and heterogeneous medical milieus of their time. Unlike Sterne, Richardson, and Johnson, however, they were denied entrance into many of the male domains in which medical knowledge was produced, shared, and disseminated. Thus, their novels, poems, essays, letters, and journals served as unique vehicles to express their medical knowledge without challenging conventional social mores and risking the likelihood of public reproach” (Meek 16).

“While the obstacles faced by the six socially, intellectually, and economically privileged women who are the central subjects of this book should not be overstated, it is important to remember that they were more restricted than their fellow literary men in the propagation of their medical opinions” (Meek 17).

“These women’s medical erudition was incorporated into their literary works in a variety of ways. They discussed the medical theories they read about in pamphlets and advice manuals directed at lay audiences, as well as in more theoretical treatises written by certified physicians” (Meek 17).

“Even though these women conveyed their medical knowledge through their literary work, this knowledge was neither stagnant nor trapped within the bounds of their texts, and it is clear that their opinions were heard outside a strictly literary context” (Meek 17).

“These women writers thus not only absorbed medical knowledge but produced and shaped it as well…. In a similar way, these women’s literary works can be viewed as sources of medical information as they reproduce and rethink the dominant streams of medical thought, but they also, as the following chapters demonstrate, reveal how such information, as it was presented through literature, fashioned and determined the form of such literature” (Meek 18).

“In the works of these women of letters, illness becomes, variously, structural apparatus, motif, thematic engine, metaphor, muse, and political conduit – a process that forces a reconsideration of illness as a strictly medical category” (Meek 19).

“The medical ideas of the women writers in this book were influenced by similar factors, but these writers provide distinctive perspectives because of their status as critical outsiders to the emerging medical profession and because of their consistent reliance on their own (often productively multi-determined) experiences. Through its examination of these women and their works in conversation with the medical ideas and physician-writers of their time, Reimagining Illness invites readers to regard illness as at once a concrete pathology and a label attached to a range of overlapping and competing narratives” (Meek 19).

“In examining the works of these medically knowledgeable women alongside the texts of their physician-contemporaries, the present book advances new ways of understanding the intersections of eighteenth-century literary and medical cultures and of reading eighteenth-century women’s writing about medicine and illness” (Meek 19).

“This book is indebted to the work of [Susan] Sontag and her successors as each chapter considers both how illness was categorized and quantified in eighteenth-century medical idiom and how it was formed, expanded, and complicated through a proliferation of narratives created by, among others, medical authorities, patients, and women authors. This approach, when applied to the pre-disciplinary, pre-professionalized moment of the eighteenth century, also encourages a realization that medicine and medical culture were still, at that point, highly fluid rather than fixed” (Meek 20).

“Eighteenth-century medical writing, in part because it was produced before the advent of professionalism, was especially variable in its structural, rhetorical, and literary idiosyncrasies. It was not always rigidly scientific, self-consciously impartial, or certain in its conclusions. It assumed a multiplicity of forms and was produced by the diverse group of eighteenth-century figures who presented themselves as medical authorities” (Meek 20).

“Even the medical literature written by trained physicians appeared in an assortment of forms, had a variety of objectives, and was directed at a range of audiences. Some medical men wrote lengthy treatises in which they employed technical language and shared information on the nosology, causation, symptomatology, anatomy, and therapeutics of precise illnesses” (Meek 21).

“This conviction among medical authorities of the value of experience does not mean that physician-patient relationships were without conflict or that patients were not sometimes misrepresented or disregarded” (Meek 23).

“Many physician-writers appear to include patients’ experiences and feelings merely as rhetorical foils, to substantiate their theories and promote their skills. Case histories often conclude predictably, in a way that confirms a successful cure” (Meek 24).

“Many eighteenth-century medical writers relied on sex-based hierarchies that fuelled conceptions of women’s innately disordered bodies and minds. As has been widely noted, women in this era were typically described in medical discourse and beyond as naturally pathological, radically flawed, and even monstrous in comparison to their healthy male counterparts” (Meek 24).

“Into the latter part of the period [the eighteenth century], many physician-writers continued to reproduce Hippocratic and Galenic paradigms of women’s bodies, usually under the guise of the more current terminology of the nerves. The preoccupation with women’s noxious reproductive organs and hysterical lasciviousness was gradually replaced, or sometimes merely complemented, by a growing, equally problematic elevation of women’s natural purity, gentleness, delicacy, and altruism (a tendency also prevalent in the novel of sensibility). Such constructions of femininity meant that women continued to be described, relative to men, as constitutionally weak and more prone to illness” (Meek 25).

“In midwifery texts into the late century we find remnants of the idea that women had the potential, through their wild, inappropriate thoughts or their general tendency toward negligence, to harm their babies both in utero and following birth. Throughout the period, some physicians promoted the idea that women risked passing on the seeds of smallpox to fetuses, while others implied that women’s inclinations toward bodily disorder made them more prone to diseases such as consumption or cancer” (Meek 25).

“Since women did not enjoy the same publication opportunities as men and rarely dared to publish official medical documents, the literary text became a site through which they scrutinized and revised commonplace patriarchal medical ideas. The imaginative text, therefore, allowed these women to describe illness beyond more rigid medical parameters and to shape and produce medical knowledge in ways distinct from their physician contemporaries. While this book strives to consider productive tensions rather than antagonistic disputes between physicians and women writers, it does not ignore instances in which women revealed prevalent medical theories as mere fictions, exposed the ideologically constructed elements in certain accounts of illness, and posited alternative narratives” (Meek 25-26).

“The six women writers explored in the following chapters often demonstrate an ability to grasp and rethink critically the broad outlines of the eighteenth-century medical landscape. Their critiques were at times harsh. They were, after all, part of a tradition in which imaginative writers – even those who were medical enthusiasts – openly condemned certain elements of the medical milieu” (Meek 26).

“As it explores women’s perspectives on eighteenth-century medico-literary landscapes, this book does not seek to advance definitive narratives of medical progress that look forward to what are now perceived as major developments in the nineteenth, twentieth, and twenty-first centuries. Rather, its focus is the long eighteenth century as a period characterized by ferment, innovation, regression, argument, and exchange, a time in which a variety of sometimes conflicting literary and medical narratives burgeoned” (Meek 26-27).

“Eighteenth-century medicine, as it is represented by the women writers and medical authorities explored in the following chapters, appears to us through a variety of overlapping and conflicting perspectives. These writers do not describe a straightforward transition from lingering humoural philosophies to empiricist models in which mechanism and nerve theory paved the way for the supposedly groundbreaking discoveries of the nineteenth century” (Meek 27).

“Like [Margaret] Cavendish, the women writers explored in this book refigure master narratives of the Enlightenment, inviting a reconsideration not only of linear accounts of medical innovation but also of uncomplicated perceptions of literary and feminist progress. The book thus approaches eighteenth-century literature as it approaches eighteenth-century medicine – as fluctuating and multidimensional” (Meek 29).

“The book extends the work of feminist literary historians who are suspicious of notions of fixed gendered hierarchies of knowledge and power and who revisit assumptions that eighteenth-century women writers were continually derided by their male contemporaries or excluded from male circles of learning and literary circulation. Undeniably, the women writers considered in this book struggled to be heard and taken seriously. But they also benefited from a literary world that, like the medical milieu, was open, heterogeneous, and not yet consolidated as a masculine domain” (Meek 30).

“As the pre-professionalized state of eighteenth-century medicine opened up possibilities for women’s contributions, so, too, an emergent, inchoate literary-professional world allowed for women writers to assert and hone their voices” (Meek 30).

“The literary works explored in this book serve as evidence of eighteenth-century women’s important contributions to literary cultures of the period. In their writings about illness, women worked not only in the dominant literary genres of poetry and fiction but also in more marginal ones, notably autobiographical forms. Moreover, they disseminated their writing in a variety of ways, and some of them did not favour commercial publication over other forms of literary distribution. Theirs was a time in which pseudonymous and anonymous publication and coterie circulation were not necessarily devalued or seen as secondary to the more public and commercial forms of publication we now privilege. These women thus produced works that defy a false distinction between categories of so-called public, widely circulated works and private, largely unread writings intended for the authors themselves and perhaps a very small set of intimates” (Meek 30).

“These women’s medically themed works further defy expectation in the sense that they can be remarkably nuanced and unexpected in their feminist sensibilities, often challenging a simplistic opposition between female victim and male oppressor” (Meek 31).

“In their writings about medical issues, the women this book explores occupied a spectrum of authorial roles and political positions and serve as examples of the diversity of textual production and dissemination when it came to women’s literature in the period. Their works point to a period in which medical as well as literary landscapes were characterized by acute variability” (Meek 31).

“Each of the following six chapters considers the heterogeneous medical and literary paradigms of the eighteenth century through the exploration of a woman writer and a corresponding category of illness” (Meek 31).

“Each of these topics is explored in relation to relevant contemporaneous medical literature in an attempt to illustrate how women and doctors, through different sorts of dialectical exchange, constructed assorted narratives of illness. The chapters reveal the ways in which illness in the eighteenth century, much as it is today, could be understood at once as a distinct, easily diagnosed physiological pathology and as a mutable category constructed and reformulated through its encounters with various literary, medical, and cultural factors” (Meek 31).

“The chapters also reveal how, to varying degrees, women and medical authorities surrendered to the baffling, occasionally undiagnosable or incurable nature of illness even as they explored its metaphorical possibilities in ways that were by turns innovative and controversial. Moreover, each chapter shows women not only reproducing but also creating their own medical knowledge and, in so doing, elaborating fresh literary forms and medical approaches” (Meek 32).

“Chapter 6 reads Frances Burney’s epistolary account of mastectomy to argue that Burney at once sets herself apart from male doctors and describes her experiences as intimately intertwined with theirs. In emphasizing conflict as well as consistency between her views and those of contemporaneous physicians, her work captures the psychological complexities of the doctor-patient relationship and implies that the separation between female sufferer and male medical authority was not as hierarchical in the early nineteenth century as it would become in the following decades” (Meek 33).

“In their engagements with medical discourse, the women’s works explored in the following chapters provide unique and imaginative portraits of illness. In so doing, they illustrate a fraught yet constructive intertwinement of medical and literary ideas, capture the diverse medico-literary debates of the period, and show how the eighteenth-century woman writer often donned the cap of medical thinker” (Meek 33).

—

“The mastectomy narrative of Frances Burney (1752–1840) appears in an 1812 letter to her sister Esther and describes in excruciating detail her experience of undergoing the procedure with no more than a ‘wine cordial’ as pain relief” (Meek 193).

“She [Burney] also frames the letter ‘as a warning to [her] dear Esther’ and her other female relatives should they be alarmed by any sensations similar to the small pain Burney first felt in her right breast in August 1810” (Meek 193).

“But the letter, which took three months to complete and is dated nine months post-surgery, offers more than a health update or a mere warning. In its comprehensive descriptions of early symptoms, preliminary medical treatments and consultations, and the operation and its aftermath, as well as in its vivid portrayal of Burney’s physical and psychological turmoil, the letter is an intensely personal yet carefully crafted piece of autobiographical writing and a medical document that offers a rare contribution to our understanding of breast cancer in the long eighteenth century. Burney’s letter is singular, moreover, in relation to the women’s accounts of illness explored in the previous chapters of this book. It is unique as a self-contained narrative devoted entirely to an experience of illness and recovery, thus resembling a modern illness narrative” (Meek 193).

“This chapter demonstrates how Burney’s knowledge and experience of breast disease and mastectomy simultaneously intersect with and diverge from contemporaneous medical wisdom as it appears in late eighteenth-century treatises by prominent surgeons such as Benjamin Bell, Henry Fearon, and Henri-François Le Dran. Burney, who is visibly at odds with medical convention in certain instances in her letter, finds a voice and reinscribes a hierarchal medical encounter in which, as scholars Julia Epstein, Heike Hartung, Heidi Kaye, Kay Torney, and John Wiltshire have variously argued, the (female) patient is silenced and victimized by the (male) practitioner” (Meek 194).

“Extending discussions on Burney’s letter as pathography, this chapter reads her account alongside medical texts on breast cancer to identify precise historical and cultural specificities surrounding her critique of a medical community that misconstrued her experience” (Meek 194).

“Burney’s letter and the aforementioned medical texts are not merely at odds, though, and in fact reveal a complexly ambiguous doctor-patient dynamic particular to Burney’s moment” (Meek 194).

“Medicine was not yet a discrete field made up exclusively of trained physicians, and patients continued to display their considerable medical knowledge. The relationship between patient and physician was not strictly hierarchical and could be quite intimate. As this chapter shows, many breast surgeons treated those under their care attentively and with compassion, and even their most violent methods often seem to have been undertaken out of a genuine belief in their medical efficacy” (Meek 194-195).

“When read next to contemporaneous medical treatises, it becomes part of an elaborate conversation – one unconstrained by the disciplinary boundaries we now know – about the harrowing, painful, and uncertain nature of breast cancer diagnosis, surgery, and recovery in the long eighteenth century” (Meek 195).

“With her [Burney’s] letter as a focal point, the next section [of Chapter 6] illuminates the brutality of some medical practices, describes the range of ideas surrounding breast cancer, and highlights the frequent incongruity between patients’ and physicians’ understandings of physical and psychological pain. This is followed by a consideration of Burney’s resistance to medical authorities in relation to the treatment and surgery she underwent and the way her doctors in certain instances misapprehended her experience as a woman with breast cancer” (Meek 195).

“…it seems many English women, especially those of lower social status, were given no viable alternative to the violent, excruciatingly painful, and often unsuccessful treatment of breast surgery” (Meek 195).

“Nonetheless, it is clear from a reading of contemporaneous medical treatises that even as medical men diverged on the treatment of breast tumours, mastectomy was common. This drastic operation was sometimes driven by an uncertainty as to whether harmless lumps could evolve into more threatening growths” (Meek 196).

“As she [Burney] describes herself here, she has no choice but to submit to the operation, and yet she tries to gain a degree of control by assisting her own surgeons and then by persisting in her attempt to have the surgeons retreat on their decision to amputate” (Meek 198).

“While Burney’s doctors listen to her plea that they abstain from removing the entire breast, which, in her view, is only afflicted in one particular spot, they do not utter a word. Their resolute silence and intimidating mute gestures, which serve as incontestable directives, are set in contrast to Burney’s loquacity, which is presented as desperate in its futility. Burney accentuates her resignation to the doctors’ authority in the final lines of the passage; recognizing that her rebellious agitation is ultimately hopeless, she ceases speaking, watching, or resisting. She does so with resolution, she explains, but also with sadness, thus emphasizing the unfortunate and inevitable nature of her surrender to her surgeons and their attendants” (Meek 198-199).

“Burney’s letter is too complex to be reduced to a narrative of victimhood, however, and, as some critics have noted, there are many ways in which she contests, through writing, the practices of her medical practitioners. At the core of her success in this respect is her skill in literary representation, which was already well developed by the time she began composing this letter in 1811” (Meek 199).

“Certainly, her body of life writing seems crafted, putting on display her novelistic skill and her talent for reproducing dialogue. Especially after 1770 or so, she wrote her journal entries retrospectively” (Meek 199).

“In the 1812 letter to Esther, we see Burney putting to work the skills she had developed as both novelist and letter-writer in her depiction of her arduous experience of mastectomy. She counters her doctors’ objectification of her body by telling her story in a distinctly literary way. Or, to put it another way, she overcomes her mortifications by narrating them” (Meek 200).

“Burney fights her objectification, not only in the letter but also in certain moments during the surgical encounter itself…. Her letter describes, for instance, what many medical treatises ignore or overlook with regards to the patient’s experience and in this way fulfills one of the functions of pathography, which is to record the patient’s words and experiences with the result of criticizing and drawing attention to patriarchal medical practices. Medical case histories of the long eighteenth century are typically far less detailed than Burney’s letter in their accounts of the patient’s physical and emotional reactions to breast cancer diagnosis and treatment” (Meek 200).

“Burney’s first-person account, in contrast to Le Dran’s [referring to Henri-François Le Dran’s fifth edition of The Operations in Surgery of Monsieur Le Dran (1781)] and many other doctor-penned case histories, succeeds in capturing the patient’s psychological distress with an unusual level of detail and intimacy. She repeatedly describes her feelings of terror once it has been determined that she will undergo an operation” (Meek 201).

“Rather than explicitly criticizing her physicians for this extended interval of anxious anticipation, Burney’s focus remains on her own inner torment, and even the surgery is a trial she must endure alone; the doctors’ potential missteps, or her family’s reactions, are ancillary to her solitary anguish. Such intimate detail is enabled by the firsthand account and in contrast to the more objectifying portraits of sufferers presented in treatises like Le Dran’s” (Meek 201-202).

“At the very least, Burney’s version of events suggests that she should have been placed with more sensitivity into this horizontal position or that her surgeons should have explained in advance why she was forced to lie down” (Meek 202).

“The medical men’s tendency to simplify or misunderstand their patient’s suffering is further revealed through an examination of Burney’s letter alongside the official medical report of her surgery [written by the chief pupil of Baron Dominique Jean Larrey], which she sewed to her letter to Esther” (Meek 202).

“Yet elements of the account [from the chief pupil of Baron Dominique Jean Larrey] are visibly short-sighted. The pupil focuses on Burney’s particular sensitivity as a cause for her extended spasm after the operation, a subjective conclusion that ignores another possibility: that the invasive cutting and scraping, the significant blood loss, the intense pain, and the physical and psychological trauma of the experience caused the spasm. When compared with Burney’s account, the report is, in many respects, lacking in detail, notably when it comes to the description of the surgery itself, which is sketched quickly in the first two sentences. The pupil’s declaration of the acute painfulness of the operation and the bravery of the patient is expanded, in Burney’s telling, into a long, affecting letter that explores with detail and subtlety the pain she endured and the courage she exhibited. Perhaps, as the pupil observed her, Burney woke up on the morning after her surgery feeling well, with no fever, no pain, and minimal bleeding, but in her rendition, her post-operative struggles were considerable” (Meek 203-204).

“Burney’s letter implicitly calls into question the descriptions of surgeries within contemporaneous medical treatises, which are, like the pupil’s [the chief pupil of Baron Dominique Jean Larrey], suspiciously concise, especially when we consider that these surgeries took place before the discovery of painkillers and antiseptics” (Meek 204).

“Burney, in her emphasis on the physical and emotional torture of the surgery, mounts a challenge to some physicians’ minimizing of the pain of mastectomy” (Meek 204).

“As this passage suggests, Burney accentuates her pain and resists the surgeons’ objectifications through the use of visual and emotional elements that lend both literary realism and sentiment to the passage. Writing of her need to be carried, her limp arms and legs, and her pallid complexion, she conveys an image that, even as it distances Burney herself from the experience, underscores the horror of the surgery. She dramatizes the pain of the ordeal by describing a patient who is exhausted, physically powerless, entirely dependent upon others, and stripped of vitality, almost to the point of death. And beyond her description of the surgery itself, she announces that she continued to suffer nine months after the operation, thus providing a version of recovery that is in stark contrast to surgeon-writers’ tendencies to underplay the inevitable difficulties that would have followed such operations” (Meek 205).

“In this remarkable passage, Burney’s body is used metonymically to signify her larger response to the surgery: her flesh resists and opposes, much as she, on the page, challenges both the surgical practices to which she is subjected and the medical narratives that erroneously construe and represent her experience” (Meek 205).

“While an exploration of Burney’s letter within the realm of eighteenth-century medical discourse reveals a divergence between lay and medical views, and a struggle between patient and doctor, it also complicates an understanding of the pathography as a text that sets the patient’s and the physician’s perspectives in stark opposition. Burney’s letter, as pathography, engages in productive dialogue with some medical treatises of the day; read together, these works reveal the fluid nature of the boundary between official and lay medical information in this time” (Meek 206).

“Read alongside the medical treatises of [Henry] Fearon, [Benjamin] Bell, and [Henri-François] Le Dran, Burney’s letter reveals a power struggle between doctor and patient, but it also provides a model in which doctors grew attached to their patients, who, in turn, deferred to the knowledge of these doctors, whose practices they viewed as arising from sound medical wisdom and benevolence” (Meek 206).

“Clearly, Burney’s surgeons were not unthinkingly making her suffer by waiting for the operation, but rather, as the letters and the treatises reveal, deliberating the course of her treatment seriously and painstakingly, a process made more difficult by the abundance of contradictory information on the outcomes of breast surgery” (Meek 207).

“The surgical procedure Burney endures, which might initially seem to twenty-first-century readers alarmingly barbarous, appears quite reasonable when read alongside some contemporaneous medical treatises” (Meek 207).

“The scraping of Burney’s bone and muscle, and the dissecting of her breast tissue, was in all likelihood, in the eyes of her surgeons, truly beneficial, which may explain the length of the operation – twenty minutes – a time that Burney describes as ‘hardly supportable’ given ‘sufferings so acute,’ and that to us, in the wake of the discovery of effective surgical anesthesia, is unimaginable” (Meek 208).

“Although fraught with inconsistencies, and revealing both brutality and genuine care, the medical treatises of Benjamin Bell, [Henry] Fearon, and [Henri-François] Le Dran confirm the existence in this period of the compassionate, empathetic surgeon. Interspersed with the hardened scientific descriptions of diagnosis and cure are moments in which the writers of these medical manuals show kindness toward their patients. Most of the surgeons devote a portion of their treatises to the practices of both palliative and post-operative care” (Meek 208).

“The surgeons’ case histories sometimes show an involvement in the sufferer’s experience, even if only briefly, divulging such information as her name, her station in life, her age, her fear of death, and even her resistance to treatment” (Meek 208).

“So while sometimes brutal in their treatments and cold in their descriptions, [Henry] Fearon and other surgeons of the age also seemed to recognize the importance of listening to, showing compassion for, and considering the comfort of their patients, even beyond the surgical encounter. The inconsistent practices and perspectives of these medical men reflect a climate of contradiction in which doctors were finding their way and in which women’s voices were not simply muffled” (Meek 209).

“Burney was alert to such ambiguities in patient care, and, accordingly, her letter sometimes breaks down a doctor-patient hierarchy. This is made clear in her inconsistent characterization of her physicians as well as in her reliably favourable descriptions of Dr Larrey” (Meek 209).

“Hence, it is worthy of note that while Burney’s letter is detailed and piercing in its elaboration of the miseries of breast cancer treatment, the physician-writers of the age, even as they on occasion simplify individual women’s experiences in their case histories, might sometimes be aligned with Burney in their frequent refusal elsewhere in their treatises to gloss over the horrors of breast cancer. As shown above, these men sometimes understate the degree of their patients’ pain in surgery or fail to acknowledge the uncertain success of mastectomy; but they also offer detailed – even passionate – avowals of the horrible nature of breast cancer” (Meek 210).

“Taking an approach similar to these surgeon writers, Burney, though she assures her sister at the outset of her letter of her ‘perfect recovery’ and later remarks that the story ‘end[s] happily,’ nonetheless presents a narrative that refuses an exultant triumph over breast disease. She writes the letter out of a stressful sense of duty to share the news with her family and intimate friends, and, as Epstein [the scholar Julia Epstein] points out, the very act of writing the letter is ‘literally physically painful’ for her and therefore in part a ‘self-inflicted violent act’ (Meek 211).

“In the letter itself, Burney immerses her reader in the trauma of her experience rather than the glory of her cure. The narrative serves not to reassure the reader of her recovery but, rather, through its acute descriptions of pain and anguish leading up to and during surgery, to force a confrontation with the ravages of breast disease. She also refuses to normalize the post-surgical female body” (Meek 211-212).

“Burney’s narrative does not, as pathographies sometimes do, elevate the cathartic possibilities of writing or show how rendering trauma into narrative allows the writer to overcome or reclaim their experience from their aggressors. Her experience was miserable, and so, too, is her account of it, which, she explains, is excruciating not only to write but also to revise. This refusal of a narrative in which she has blossomed or actualized herself through hardship persists in subsequent letters, where there are few if any direct references to the surgery and its aftermath and where all we find are allusions to the lingering pain in her arm; hence her narrative resists a neat and tidy ending and brings to the fore the excruciating nature of breast surgery and recovery” (Meek 212).

“Together, Burney’s letter and late eighteenth-century medical texts on breast cancer thus illustrate the awfulness and complexity of breast cancer diagnosis, surgery, and recovery, as well as the potential intricacies of the relationships between patients and their doctors, and the interwovenness of their often self-contradictory narratives about this horrific disease” (Meek 212-213).

“The dismal portrait of breast cancer elaborated in both Burney’s letter and the medical texts becomes more troubling, and less refreshingly honest and original, when viewed from another perspective. The focus in these texts on the violence of the illness, its ravages to the body, and the faint hope of recovery could also be interpreted as reinforcing prevalent medico-cultural notions – evoked throughout this book – of an unruly female body that is inherently prone to disease. As with contemporaneous discussions of most other illnesses, studies of cancer saw female defect as measured against a standard of male normality” (Meek 213).

“Their [women’s] alleged innate disorder and surplus of passion made women susceptible not only to hysteria, smallpox, gestational problems, consumption, and other medical conditions, but also to breast cancer, a view that is reflected in medical writings on the illness” (Meek 213).

“The female sufferers themselves, because of their disorderly bodies, depraved sexual desires, and troubled minds, were therefore held responsible for their illnesses. These alleged causes are stressed in medical texts, and they are present implicitly in Burney’s letter, in her portrayal of breast cancer as mysterious, violent, and often incurable. Significantly, in another letter, she expresses her despair at having to wean her son from her breast in 1794 due to thrush; she perceived this experience as a failure and, according to [Julia] Epstein, probably understood it as remotely connected to her cancer” (Meek 213).

“Although the group of texts examined in this chapter in some ways reinforce limiting stereotypes of eighteenth-century womanhood and the female body, they also, as I have been suggesting, contain complexities and contradictions that reflect the realities of breast cancer as it was understood, treated, and experienced in this period. Burney’s letter, as much as it might indirectly reinforce notions of feminine unruliness, also rejects such notions, in the sense that it contains no direct speculation of the potential causes of her illness” (Meek 213-214).

“An acknowledgment of such variation, as it is captured in these texts, counters the cultural inscription of a precise, unchanging narrative onto both the female body and the male physician. Together, the letter and the medical treatises at once repeat and challenge enduring notions of defective womanhood and stereotypes of an imposing, patriarchal medical profession” (Meek 214).

“Burney’s ‘miserable account’ is, therefore, not a pathography in the traditional sense of the term; it does not merely set the patient in opposition to the medical community, nor does it present an unequivocal triumph over cancer. Certainly, like a conventional pathography, it provides evidence of the medical value and the therapeutic importance of the patient’s story. Read alongside contemporaneous medical treatises, however, it highlights the uncertain boundaries and ambiguous interactions between breast surgeon and patient. The letter shows how a woman might simultaneously contest and resign herself to medical methods; how doctor and patient alike might be plagued by doubt, hesitation, and the fear of a tragic outcome; and how a so-called ‘perfect recovery’ might be woven through with anxiety, trauma, physical pain, and concern over what comes next. Ultimately, in their literary elements, scientific details, and ambiguous positions, Burney’s account and the medical treatises this chapter has examined enrich our understanding of the ‘terrible business’ of breast cancer” (Meek 214).

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Note: The featured image for this post is a screenshot of the opening of Fanny Burney’s 1812 letter, “A Mastectomy.”