Seven Men in Black, a Wine Cordial, and Twenty Minutes of Screaming

Frances Burney's Letter about 30 September 1811 and a First-Person Account of Surgery without Anesthesia

Novelist, Servant at the Queen's Court, an Englishwoman in Napoleonic France

Frances Burney was born on 13 June 1752 in King's Lynn, in Norfolk, England. Her father, Charles Burney, was one of the leading musicologists and physicians of the period; a contemporary of Bach, Handel, Haydn, and Mozart, he had written the first major general narrative of European music history. Her mother, Esther Sleepe, died when Frances was only ten. Frances grew up amid the conversations of central figures of the 18th-century English Enlightenment, such as Samuel Johnson, Joshua Reynolds, and David Garrick, who visited their home as family friends. She began writing at a young age, starting her diary at sixteen — a diary she would keep for seventy years until her death, and which would become one of the most detailed historical sources on late 18th- and early 19th-century English life for modern readers.

Her first novel, Evelina, was published anonymously in 1778, when she was 26; it was a great success, and was followed by Cecilia (1782) and Camilla (1796). Jane Austen took the title of her own Pride and Prejudicefrom Burney's Cecilia; Austen's letters refer to Burney as "my favorite author." For five years, between 1786-1791, she served at court as Queen Charlotte's (wife of George III) Keeper of the Robes — there she closely observed the royal illness that lasted for years and George III's mental health crisis.

In 1793, she married a French exile and former officer in Napoleon's army, Alexandre-Jean-Baptiste Piochard d'Arblay . She would subsequently also be known as "Madame d'Arblay." In 1801, they returned to Napoleonic France; Frances made a life in Paris with their son Alexander. In the autumn of 1810 — when she was 58 — she began to feel pain in her right breast. This was the beginning of the story.

From Autumn 1810 to September 1811: Diagnosis, Denial, Acceptance

In her letter, Burney describes the first signs of the illness in detail: "In August 1810, a small pain in my breast began to trouble me." At first the pain was mild and intermittent; it intensified over the following weeks, but she describes it as "not sharp, but heavy". Her husband Alexandre had persistently urged her to call a physician, but Burney initially resisted. "I thought his fears groundless," she writes in the letter — "I now recount this false confidence so that it may serve as a warning, my dear Esther, to my sisters and nieces, should similar sensations arouse a similar alarm." These sentences were written in 1812, yet they carry an insight that could still be used in 21st-century breast cancer awareness campaigns.

Throughout the autumn, at her husband's insistence, Burney consulted physicians. First the family friend Dr. Jouart, then her husband's old friend Antoine Dubois — one of the most famous surgeons in Paris at the time, the physician overseeing the pregnancy of Emperor Napoleon's second wife, Empress Marie-Louise . Dubois examined Burney and proposed a treatment protocol, but the symptoms continued to progress. Dubois's court duties (Marie-Louise gave birth to Napoleon's son Napoleon II on 20 March 1811) prevented him from attending to Burney for an extended period. Her husband therefore called in another specialist: Baron Dominique-Jean Larrey.

Larrey followed Burney's condition from March 1811 onward. For months, he tried to postpone the decision to operate; he recommended medical treatments, diet, and bed rest. Unable to decide on surgery by himself, he called in France's foremost anatomist, Dr. Ribe, and another specialist, Dr. Moreau, for second and third opinions. The three physicians assessed Burney together and reached a consensus in September 1811: surgery was necessary. When Larrey brought the decision to Burney — according to her account — he told her "with tears in his eyes".

"Seven Men in Black" and Twenty Minutes

Burney's letter recounts, in extraordinary detail, the hours before the day of the operation, the physicians' arrival, the preparation of the room, and everything that happened afterward. On the morning of the operation, Larrey knocked at the door; Burney understood immediately.

22 March 1812 – Summer 1812: A Letter Begun Six Months Later

After the operation, Burney waited six months to recover. The date on which she began writing the letter was 22 March 1812. She did not write it in a single sitting; over the next four months, she repeatedly continued, stopped, reviewed, erased, and rewrote it. When she finished, she had a manuscript of approximately 12 pages — about 7.000 (seven thousand) words in a modern edition. At the beginning of the letter, she added the note: "Account from Paris of a terrible operation — 1812" ("An Account of a Terrible Operation from Paris — 1812").

The letter was not published during her lifetime. Burney intended it as a private family document, available to her sister Esther and within the family. But when Burney died in 1840 at the age of 87, her diary and letters remained; the edition published between 1842-1846, Diary and Letters of Madame d'Arblay (7 volumes), included selected passages, but the full text of the mastectomy letter was not published until 1975 in the scholarly critical edition prepared by Joyce Hemlow.

Today, the original letter is preserved in the Berg Collection of the New York Public Library, among Burney's other papers. In 2018, the British Library published selected passages from the letter in its publicly accessible online collection. Anyone who reads it can hear what happened on Rue de Miromesnil in Paris 213 years ago directly in the voice of the woman who lived through that day.

The Birth Certificate of Patient Testimony

Burney's letter is unique in medical history in several respects:

First, it is the first detailed account of surgery without anesthesia documented by a patient . Before modern surgery began with William Morton's ether anesthesia in Boston in 1846, all major operations in European and American hospitals were performed under the conditions Burney experienced. Surgeons' records (speed, technique, outcome) were plentiful; patients' records were almost nonexistent. Burney's letter is the only substantial answer to the modern patient's question, "What is it like to experience an operation?". In medical history, this is the birth certificate of the patient's voice.

Second, it offers an early portrait of the asymmetry in the patient–physician relationship. In her letter, Burney describes in detail how the physicians intervened in her decision-making, how they downplayed her fears, but also how they treated her with affection and patience. Larrey conveying the decision to operate "with tears in his eyes," Dubois's statement, "You must expect to suffer; I do not wish to deceive you", and Ribe's strange attempts at encouragement, such as "Do not be afraid to scream; your husband told me about the woman screaming in childbirth, and I am glad" — all let us see early examples of modern patient communication pedagogy .

Third, it reveals the limits of a female patient's bodily agency (that is, her right to make decisions about her own body). Burney is 59, an adult woman, a writer, and famous worldwide — yet she does not agree to surgery without the insistence of her husband, physicians, and sister; the decision-making process takes months; on the day of surgery she is given approximately two hours' notice. In the absence of the 21st-century concept of informed consent, a female patient's decisions about her body were the product of collective negotiation between family and physicians.

Fourth, when read clinically, the letter sheds light on the technical details of breast cancer surgery at the time. As modern historian Zoe Copeman has shown, Dubois's "line – cross – circle" sign was a silent signaling system used in Parisian surgery of the period for extirpation (wide excision) — to allow surgeons to communicate without frightening the patient. Larrey and Dubois were contemporary practitioners, 54 years later, of Le Dran's 1757 surgical algorithm, which we discussed yesterday: Le Dran's principle of a "stepwise approach"was being applied in real life to a female patient by Paris's most famous surgeons in 1811.

From 1811 to 1840: Continuing to Write

Burney recovered quickly after the operation. Bed rest throughout 1812 was followed by a gradual return to her former life at home; in the autumn of the same year, the Napoleonic wars forced her to return from France to England with her husband and son. In 1814, she published her fifth and final novel, The Wanderer; critics received it coolly, but sales were good. Her husband Alexandre died in 1818. In 1832 — when she was 80 — she published a three-volume biography of her father, Memoirs of Doctor Burney. Her only son, Alexander, died in 1837 at the age of 43.

Frances Burney died in Bath on 6 January 1840 at the age of 87. The cause of death was recorded as "old age" — no breast cancer recurrence, no other cancer. Her grave is in Walcot Cemetery in Bath; she lies with her husband Alexandre and son Alexander.

The period from the 1811 operation to her death, 28 years and 3 months, is extraordinary for breast cancer surgery of the time. For comparison: in the early 19th century, the great majority of women undergoing breast cancer surgery died within 5 years of recurrence or postoperative complications. Burney lived far beyond that statistic — and continued writing throughout those 29 years.

The First Voice of Patient Advocacy in the 19th Century

After its publication in 1975, Burney's letter became a turning point for modern feminist medical historians. Audre Lorde's The Cancer Journals (1980), Rose Kushner's breast cancer activism in the 1970s, Susan Sontag's Illness as Metaphor(1978), Christopher Hitchens's Mortality(2012), Paul Kalanithi's When Breath Becomes Air(2016) — all are continuations of the tradition Frances Burney opened in 1812: the patient speaks in their own words. This tradition is one of the philosophical foundations of modern oncology ethics (informed consent, shared decision-making, and patient-centered care).

There are signs of this line of development in Turkey, too. In Turkish literature, Hüsamettin Bozok's cancer narratives (1980s), Tezer Özlü's illness diaries, the cancer-related passages in Oğuz Atay's Tutunamayanlar, and Cemil Meriç's diaries from his final years offer Turkish-speaking readers examples of their own tradition of patient testimony. Beyond its words, the spirit of Burney's letter is universal.

This article is day 71 of The History of Cancer in 365 Days Series. The end of surgery without anesthesia will be covered on days 82 (Crawford Long, 1842) and 83 (William Morton, 16 October 1846, "Ether Day"); the modern tradition of patient testimony will return in the context of day 116 (Tolstoy, The Death of Ivan Ilyich, 1886), day 169 (Rose Kushner), day 234 (Susan Sontag), and day 235 (a thematic dossier on modern cancer literature). Frances Burney's letter about 1811 is the founding link of this long chain in the early 19th century. The article was prepared from a historical perspective for a general audience; it contains no medical treatment guidance.