{"id":20999,"date":"2020-09-18T09:19:46","date_gmt":"2020-09-18T08:19:46","guid":{"rendered":"https:\/\/research.reading.ac.uk\/research-blog\/?p=20999"},"modified":"2020-10-08T07:18:05","modified_gmt":"2020-10-08T06:18:05","slug":"mastectomies-have-been-performed-for-over-500-years-yet-we-still-cant-talk-about-them","status":"publish","type":"post","link":"https:\/\/research.reading.ac.uk\/research-blog\/2020\/09\/18\/mastectomies-have-been-performed-for-over-500-years-yet-we-still-cant-talk-about-them\/","title":{"rendered":"Mastectomies have been performed for over 500 years \u2013 yet we still can\u2019t talk about them"},"content":{"rendered":"

In the middle of the 17th century, Mrs Townsend found a lump in her breast. Diagnosed with breast cancer by a local physician, she underwent a mastectomy without anaesthetic \u2013 an agonising procedure.<\/p>\n

Her bravery impressed the male surgeons who had gathered to watch the operation. One commented that he \u201chad read that women would endure more than men, but did not believe it \u2018til now\u201d. They stayed in town for several days to inspect her wound and see how it was healing. After this, Mrs Townsend disappears from the historical record. There is no news on how she felt about her changed body, or how others reacted to her.<\/p>\n

While much of Mrs Townsend\u2019s experience is mercifully alien, the silence that surrounds her post-mastectomy experience is eerily familiar. Each year,\u00a055,000 women<\/a>\u00a0in the UK are diagnosed with breast cancer, and up to 40% will choose to undergo a mastectomy. Mastectomy patients are routinely offered\u00a0surgical replacement<\/a>\u00a0of the breast tissue, whether with saline or silicone implants, a tissue transplant from elsewhere on the body, or a combination of the two.<\/p>\n

\"\"
A 17th Century mastectomy, Wellcome Collection, CC BY-SA<\/figcaption><\/figure>\n

<\/p>\n

Reconstruction is an important part of many women\u2019s recovery. Yet it is not without its\u00a0problems<\/a>: 18% of patients return to hospital with post-operative complications such as infection. This, along with other factors, such as time taken off work, means that around\u00a070%<\/a>\u00a0of patients turn down reconstructive surgery.<\/p>\n

<\/figure>\n

Despite these figures, the sight of one- or no-breasted bodies in the media is still rare. Under-representation is a common problem for people with visible bodily difference. But for mastectomy patients, this may be particularly acute: studies<\/a>\u00a0show that breast reconstruction is often presented as a normal and necessary part of restoring bodily \u201cwholeness\u201d.<\/p>\n

What is it about breast cancer that has made mastectomy and its effects so hard to discuss throughout history?<\/p>\n

The gnawing wolf<\/h2>\n

History suggests that our fear of cancer is deep rooted. The disease was first recorded in ancient Greece, where its propensity to \u201cgrip\u201d the body of the sufferer caused it to be named after the crab,\u00a0karkinos<\/em>. In medieval and Renaissance Europe, doctors believed that cancer was caused by a buildup of sluggish melancholy humours in the affected part, behaving like a parasitic worm or a \u201cgnawing wolf\u201d in the way it devoured its victims. Desperate patients put raw meat on the cancerous area in hopes that the disease would eat the meat and not their bodies.<\/p>\n

Throughout, cancer was viewed as primarily a woman\u2019s disease. While physicians occasionally diagnosed testicular or skin cancers, internal cancers were impossible to pinpoint in living patients and often had symptoms similar to infectious diseases rife in the period. Cancers of the female reproductive system were slightly easier to diagnose with a physical examination, but the overwhelming majority of all diagnosed cancers were in the breasts.<\/p>\n

Indeed, medical practitioners agreed that \u201cwhere one has a cancer in any part besides, twenty have them in their breasts\u201d. Noticing that post-menopausal women were the most likely to suffer from cancer, physicians concluded that when menstruation ceased, women were vulnerable to a buildup of bad humours, or fluids, in the womb. Unable to be expelled from the body, this toxic cocktail was, they believed, transported directly to the breasts via a special (now known to be non-existent) vein.<\/p>\n

While medicines of mercury and arsenic might be tried, the\u00a0mastectomy<\/a>\u00a0was the only effective means of treatment. First described in medieval texts, this procedure probably originated in antiquity but went unrecorded for many years. By the 17th century, surgeons \u2013 emboldened by their experience amputating limbs on European battlefields \u2013 started to perform and record more mastectomies.<\/p>\n

Historical mastectomy<\/h2>\n

Based on newspaper reports, diaries and physicians\u2019 handbooks, we can speculate that perhaps ten or 20 mastectomies took place each year during the 1600s, and considerably more in the 1700s.<\/p>\n

Rates of mortality in these operations are hard to calculate. We know that for Daniel Turner, a skilful 17th-century surgeon, nearly\u00a030%<\/a>\u00a0of patients he operated on for tumours died in his care. Considering that most of those operations would have been considerably less invasive than mastectomy, the survival chances of women having a breast removed must have been considerably less than 50%.<\/p>\n

Though mastectomy was an established procedure, its effects were hardly ever discussed outside medical texts. The only place a one-breasted woman could be envisioned was the exotic figure of the Amazon, reported in travel books and histories as living in all-female groups, visiting neighbouring tribesmen for sex as and when they pleased. However, when these warrior women appeared in drama, they did so with \u201cnormal\u201d bodies. Actors (usually male) impersonated all kinds of disabilities, reflecting a culture in which bodily difference was widely, if often negatively, represented in ballads, folk tales and broadsides. But they never impersonated one-breasted women.<\/p>\n

In patriarchal Renaissance society, this reticence makes sense. Women\u2019s primary role was seen to be as wives and mothers. By threatening their perceived sexual attractiveness, and their ability to breastfeed, mastectomy displaced women from this role. Women\u2019s voices went unrecorded, and male writers lacked a framework for talking about women\u2019s bodies that did not focus on their sexual and reproductive value.<\/p>\n

The same should not be true today. Yet modern discussions about cancer take more than we might realise from history. Doctors and scholars alike have noted the dominance of\u00a0combative metaphors<\/a>\u00a0for cancer treatment, in a hangover from its characterisation as a hostile crab, worm or wolf. And we still lack positive language for talking about one-breasted or non-breasted women, beyond the platitudes of \u201ccancer survivor\u201d.<\/p>\n

The invisibility of the unreconstructed post-mastectomy body attests that the breast as a symbol of reproduction still matters most. In this arena, it seems that women are still wives and mothers first.<\/p>\n

Alanna Skuse is a post-doctoral researcher in the Department of English Language and Literature.<\/p>\n

This article is republished from\u00a0The Conversation<\/a>\u00a0under a Creative Commons license.<\/p>\n","protected":false},"excerpt":{"rendered":"

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