title: Mastectomy with tears: breast cancer surgery in the early nineteenth century.
abstract: BACKGROUND
  By the early nineteenth century, breast cancer was better understood and surgical treatment was emerging as a more favoured option although anaesthesia had yet to be discovered. Many questions would have arisen for a woman advised to have surgery, including possible alternatives, what the operation would entail, pain and risks involved and the competence, ethical and professional behaviour of the surgeon. This paper addresses these questions in the context of the contemporary environment, focusing in particular on the personal experiences of the women involved.
  
  
  METHODS
  A review of the surviving personal letters and information regarding three women who had breast surgery, and of the contemporary surgical writings on breast cancer, training of surgeons, ethical and professional expectations and the concurrent status of women in society.
  
  
  RESULTS
  Surgical training was in its infancy and the first pronouncements on medical ethics had just been published. Pain, bleeding and infection presented formidable challenges and carried significant risks. Women were frequently devoid of information, suffered a loss of their dignity and were progressively stripped of their authority.
  
  
  CONCLUSIONS
  Breast cancer surgery was accompanied by enormous emotional and physical distress and significant risks from bleeding and infection. Although efforts were being made to give women a greater voice and autonomy in society, their position when receiving health care remained largely a submissive one. Lack of information, feelings of vulnerability, helplessness and loss of control occurred. The public perception of detachment most likely accounted for the occasional negative stigma then associated with the surgical profession.
authors.affiliation: Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.
authors.forename: John P
authors.initials: JP
authors.lastname: Collins
mesh_terms: D001943:Breast Neoplasms / Q000266:history* / Q000601:surgery; D005260:Female; D049672:History, 19th Century; D006801:Humans; D008408:Mastectomy / Q000266:history* / Q000379:methods
keywords: breast cancer; mastectomy; nineteenth century; pain; professionalism