Graphic description of mastectomy sans anesthesia in 1855

From Letters of Note, this incredible letter written in 1855 by Lucy Thurston, a 60-year-old missionary in Hawaii who had breast cancer. She underwent a mastectomy (and lymph node removal) with no anesthesia, no blood transfusion.

She wrote the following letter to her daughter a month later and described the unimaginably harrowing experience. The procedure was a success. Lucy Thurston lived for another 21 years.

[WARNING: not for the squeamish]: Letters of Note: "Deep sickness seized me".

(thanks, @scanman)

Boing Boing editor/partner and tech culture journalist Xeni Jardin hosts and produces Boing Boing's in-flight TV channel on Virgin America airlines (#10 on the dial), and writes about living with breast cancer. Diagnosed in 2011. @xeni on Twitter. email: xeni@boingboing.net.

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Melinda9

An amazing story. And she didn’t even have a blood transfusion. (Also amazing that the letter survived.)
Mitchell Glaser

This sort of testimony makes me question my entire world view. I cannot picture myself enduring such a harrowing trial of my composure, and yet this brave woman took it quietly with no more than friendship and faith to sustain her. At moments like these I feel myself to be the weakest man on the planet.
arp

and I thought I did well not crying having an impacted wisdom tooth removed without anesthetic.
millie fink

Nope, can’t do it, won’t be reading that, thanks anyway, thanks again, nope nope nope.
Paul Renault

I’ve heard and read other people who underwent surgery hundreds of years ago.

Yes, we are such wimps nowadays. And no, I complain less now.
- EH
  
  Back when “it could be worse” really meant something!
Lyle Hopwood

That must have been hell, the poor woman. One great thing is she lived so long afterwards that it mustn’t have been any recurrence of the cancer that carried her off. The doctor did a good job. I’ve sometimes read accounts of leg amputations and similar pre-anesthetic operations with awed wonder that the human spirit can stand so much pain in the interests of continuing to live afterwards.

I don’t have that much fortitude. After my double mastectomy, I woke up from the anesthetic on the operating table, before they gave me pain-killers. I remember that it felt like, if you’ll pardon the expression, someone had cut both my tits off with a knife. Then I remembered they had. ”It hurts,” I said rather peevishly to a nurse, who said, “Hang on – I’m starting the pain control now.” And she did, so within fifteen minutes I was fine.

I told the surgeon this when we next met a few days later and he said, “It’s okay – patients don’t remember that.” I was a little taken aback. When we were ready to do the implants for the reconstruction, which involves anesthesia, I told the anesthesiologist for the new operation what happened the last time. “That’s all right,” he said, “you don’t remember what happens to you on the operating table.” By this point I was beginning to wonder if this was a psychological ploy, or whether they really didn’t understand that I could remember the pain. I note, however, that at this second operation I didn’t wake up until half an hour after I got into the recovery room – and I was woozy all day. I’m guessing he got the message.

My solution is not to have any more operations under general anesthesia. That should be the end of the less/more anesthesia problem.
- awjt
  
  Not to throw your surgical team under the bus, but they dropped the ball. My knee surgery was under general and I woke up high as a friggin kite for about 4 hours on fentanyl, which they pushed right after the wake-up drug. No delay like you experienced. Ouch!
  
  One marvel we have to be thankful for in our modern age is painkillers. Sure, you can get snowed. That’s not what I’m talking about. Far short of total inebriation, we can now control pain, keep the patient lucid, for as long as we need to. We still do a lot of stupid stuff in medicine, but THAT is a wonderful thing.
  - blueelm
    
    They did, but also some people do not go under as well. I know because I’m one, and have woken up quite a lot. Mercifully for me it has been the opposite though. I’m fully awake, but not in pain. Frankly, I’d be fine if they just didn’t bother with trying to put me under and focused on managing the pain. I’m fine to sit through it, but I’d rather not hurt.
    - ocker3
      
      Some people metabolise anesthetics at different rates, that’s why the anesthesiologist is paid almost as much as the surgeon, it’s their job to ride that thin rail between being aware and being dead.
- Antinous / Moderator
  
  It’s called Versed. It’s an amnesiac. That way, if they don’t adequately control your pain, you won’t show up for your post-op visit with a sawed-off shotgun.
  - Lyle Hopwood
    
    It seems I didn’t get the Versed. :( I haven’t blown away the surgical team though, so that’s all right. I’m still here six years after a diagnosis of breast cancer, so I don’t have many quibbles.
    
    It’s not possible to tell what the surgical team used in terms of drugs, though, because the bill looks a bit like this:
    
    Anesthesiologist $3000
    Surgeon $4000
    Operating room $1000
    Sundries $20,000
    
    And yeah, that’s it. No itemization to speak of.
  - retchdog
    
    Well, if that doesn’t chill the blood…
  - http://boingboing.net/ The Life Of Bryan
    
    I’ve had that stuff twice. It messed my head up for a week each time. Never again.
    - Antinous / Moderator
      
      The doctors love it. I had to switch my colonoscopy appointment because the first doctor wouldn’t do the procedure without it. He actually refused to do a routine procedure without using a relatively useless drug that’s only been in common use for about 25 years.
http://sarahlovesfabric.com/ SarahLovesFabric

This is why, no matter how much I love history and historical novels/ movies, I am perfectly happy to live in the here and now. The present has its problems, but it also has anesthesia, antibiotics, and tampons. And I really enjoyed not dying in childbirth last year, that was awesome. Hooray for the present!
blueelm

What a badass. I can’t imagine. I guess if my other choice was dying a painful death though…

I think it’s amazing that it worked. I truly love reading historic medical texts, and it actually I think gives you a respect for at least *some* people in the field. Medicine has come a long way, but it is amazing how sincere the effort has been.
- phisrow
  
  The fog of cluelessness takes a lot of dispelling; but the fact that, at every point in history, medicine was the subtle art of ‘hopefully preventing people from really dying’ has always attracted a great deal of focused attention…
  
  And, some genuinely clever people. I remember reading(in one chapter sandwiched between sections on assorted ghastly pre-Harvey accounts of haemostasis through cauterization and the like) of a very clever mechanism for minimzing facial scarring:
  
  To deal with facial wounds large enough to require suturing, which the author recognized would cause some pretty hairy looking scars, this medieval surgeon was gluing little strips of vellum to each side of the wound and then using stitches made in the vellum to pull the wound closed and keep it that way. Given today’s vastly superior adhesives, I’m a bit surprised that that one isn’t still in use, for surface work…
Antinous / Moderator

http://en.wikipedia.org/wiki/Ether_Monument
- awjt
  
  Nice, I never stopped to look at that thing. Now I will.
RedShirt77

Let me first say, what a strong brave woman to undergo that. Second, let me say, I find it a little funny that she wrote that experience up and sent it to her daughter. I mean her daughter must not have seen/talked to her mother for months after the incident and feared constantly for her mother’s life the whole time after reading that macabre. If this isnt’t the all time greatest mother guilt trip I really don’t want to know what takes the cake.
- blueelm
  
  Hmmm… I don’t know. I’d like my mother to tell me all that. Because I’d want to know what happened! I’d probably tell her as much too.
  
  Also: why is it when women brag about their war wounds it’s “guilt tripping” man? Maybe her daughter was like “damn, that’s awesome!” If my mom wrote me a letter like that I’d be thinking “If anyone can kick cancer’s ass it’s mom.”
  - RedShirt77
    
    Maybe I would think that because I wouldn’t think it was awesome that my mother suffered what sounds like a fate worse than death. Also, because my parents would just send me an email that mentioned BTW they had an operation, with no detail.
Lewis Duffy

The fascinating history of the discovery of ether, and the unfortunate fact that its’ value as an anaesthetic was not seized upon earlier, is well told by Richard Holmes in his marvelous history of Enlightenment science, ‘The Age of Wonder’. Just one of the many heroic lives Holmes documents is that of the novelist and playwright Fanny Burney, who in 1811 survived a mastectomy without anaesthetic and wrote a harrowing account of it as well.
EarthtoGeoff

As a reader, frankly, the scariest part about it was that the tumor was basically reaching the skin surface so as to be visible externally. WTF!? Goodness gracious. The rest was more inspiring than it was graphic, IMO.
- phisrow
  
  This scienceblogs page links to the tragic story of somebody whose enthusiasm for alt-med prevented their tumor from stopping at ‘basically reaching’ and allowed it to progress to full on “funginating”.
  
  The pictures are not for the weak of stomach; but do serve to remind one why some pretty aggressive surgical and chemical procedures are considered preferable to the alternative…
  - http://twitter.com/james4765 Jim Nelson
    
    Well, that’s fairly horrifying.
  - chgoliz
    
    For some reason your link didn’t work. Maybe this one will:
    
    http://scienceblogs.com/insolence/2006/11/a_different_kind_of_testimonial.php
MsAnon

Fanny Burney’s account of hers is at this link: http://www.mytimemachine.co.uk/operation.htm
cstatman

i sure as hell hope Xeni’s aint this rough, but if it is? we ought to send her to hawaii afterwards, for recovery.
Jonathan Roberts

“I have hitherto forborne to write respecting the surgical operation I experienced in September, from an expectation that you would be with us so soon. That is now given up; so I proceed to give a circumstantial account of those days of peculiar discipline. ”
TL;DR. Sorry for not coming this autumn, I met some great friends in Maui on the way over. BTW Mom, I need some money…
Mister44

My Gawd that was hard core. Let’s hear it for modern anesthesia.
juepucta

MI
ER
DA
That was some read. Heavy heavy shit. I want to grow up to be that lady.

-G.
Digilante

An excellent and inspiring read during breakfast :) Question: Do you think that pain, or to be more specific, the experience of pain, could be relative and undergo change over time? Do we adapt to handling pain when pain is all around us? Do we get soft when our life involves no pain? Not to take away anything from her, but it was a tougher time, and she was naturally more man than ten of us office workers in this day. She also had her faith – that’s probably the only case where religion has a/any benefit that manifests itself physically. What do we believe in these days?
cmholm

In addition to her strong constitution, Ms. Thurston had the advantage of being no stranger to pain, having previously borne five children. I found the prose not particularly graphic. She relates her general sensations of pain, but doesn’t (and was in fact unable to) follow each cut in loving detail. That she didn’t succumb to infection was indeed fortuitous.
- chgoliz
  
  However, pain endured in childbirth is different: it’s a known cause, with a known progression and eagerly-hoped-for outcome.
  
  Speaking from experience (what was probably an ovarian cyst blowing up….no insurance meant negligent medical care), I would argue that pain from a harmful source with no known timeline for when (or if) it will cease is a very different kind of pain. And I would include pain from an operation that probably had a 5% success rate (if you include after effects such as infection) in that category.
Andrew Moody

So many friends, and Jesus Christ besides. His left hand is underneath my head, His right hand sustains and embraces me. I am willing to suffer. I am willing to die. I am not afraid of death. I am not afraid of hell. I anticipate a blessed immortality. Tell Mr. Thurston my peace flows like a river.”Upward I lift mine eyes.From God is all my aid:The God that built the skies,And earth and nature made.

Wow.
Kludgegrrl

The British author Frances Burney also endured a mastectomy without pain-killers, and wrote about it in, apparently, harrowing detail. It is easy to simply think that people in the past were tougher. I think that the truth is, people who do not have a lot of choices find that they are tougher than they thought. Nevertheless, thank heaven for anesthesia (as well as antisepsis, which didn’t take off until the second half of the 19th century).
- Kludgegrrl
  
  MsAnon linked to Burney’s account above. Harrowing, and moving, reading.
http://www.butifandthat.com/ Aaron Geiger

Xeni and Co., for further reading you should consult Samuel Pepys’ diary, where he recalls his kidney stone surgery and recovery (as well as much tomfoolery). Also, I don’t recall if Ms. Thurston was the subject in Bill Bryson’s book “The Home,” but I remember him talking about a most gruesome mastectomy sans anesthesia.
http://twitter.com/PACSCL_CLIR Holly Mengel

The PACSCL/CLIR Hidden Collections Processing Project worked on the Dillwyn and Emlen family correspondence (housed at the Library Company of Philadelphia) in which Susanna Dillwyn Emlen describes her own experience with a mastectomy without anesthesia. Check out the project’s blog post http://clir.pacscl.org/2010/10/27/ladies-of-courage-breast-cancer-survivors-then-and-now/ on this collection as well as the finding aid so you can read the letters http://dla.library.upenn.edu/dla/pacscl/detail.html?id=PACSCL_LCP_LCPDillwyn . Unquestionably one of the most amazing collection with which I have ever worked!
ocker3

Perhaps it’s because my Mum, Step-Mum and Father all work in the medical field, but that description wasn’t that horrifying. Perhaps it’s also because I’m a guy, and this is talking about a mastectomy, not a treatment of testicular cancer.