Breast Cancer in the Eighteenth-Century by Marjo Kaartinen
(London: Pickering Chatto, 2013), 256 pp Print: £60 eBook: £24
Breast Cancer in the Eighteenth Century is a compelling and compassionate investigation of both contemporary medical understandings of cancer and the lived experience of what is still a horrific disease.
By dividing the book logically into four thematic sections (definition and diagnosis, treatments, women’s agency, and the emotional and physical experience of pain) Kaartinen is able to effectively intertwine narratives of medical knowledge, popular beliefs, and experiences without creating an hierarchy which champions empirical advancements and subordinates the role of women in their diagnosis and treatment. Instead, what she has created is an accessible and engaging work of medical and cultural history which captures the humanity of the women who suffered from breast cancer, their family networks and the practitioners who attempted with the best of intentions treated them.
This book’s two strongest features are the quantity and diversity of evidence it draws upon, and the author’s skillful balancing of objectivity and empathy in a study of a problem which many women still face today. The extent of the research which went into producing this book is evident in the range of rich sources such as medical treatises, recipe collections, receipts books, diaries, letters and popular literature. These sources are drawn primarily from England, with some reference to cases in continental Europe and in Scotland.
As much as possible Kaartinen attempts to incorporate the voices of the women who experienced breast cancer themselves, which is rarely in their own words but rather as recorded by the medical practitioners who treated them, or by family members such as husbands and fathers. Despite this the author makes it clear that women played an active role in their diagnosis and treatment. Sometimes this results in problematic assumptions which are, perhaps, beyond the limits of evidence and which many historians would steer clear of, such as when she suggested that a patient, ‘probably thought that it was her stubbornness, her keeping her own mind that saved her breast.’ (p. 75), or speculating about Jane T’s motives in going against doctor’s orders when she was discovered mending her dress shortly after her surgery (p. 112). However such instances are infrequent, and more often than not Kaartinen’s analysis of the sources is measured and pragmatic.
Moreover, Kaartinen’s discussion of the role of women in their diagnosis and treatment is a valuable contribution to our understanding of gender and disease in early modern Europe. Throughout the book she effectively demonstrates women’s agency in how they understood the disease, sought various diagnoses and treatment opinions, utilised networks of female knowledge, shared and expressed their experiences, and ultimately decided for themselves whether or not they would subject themselves to invasive surgeries, which at that time would have been conducted without anaesthetic.
Breast Cancer in the Eighteenth Century uncovers many interesting issues which provide insight into early modern beliefs, such as understandings of the causes of breast cancer, which were linked to problems with women’s reproductive capabilities including breastfeeding (pp. 14-16) and childbearing (pp. 16-17), or the paradoxical notion that women were both the weaker sex and as such more susceptible to suffer from cancer, but also, because of their ability to endure childbirth, women were better able to withstand the pain of the disease and aggressive treatments such as mastectomies, which was seen as the worst pain any patient could endure (p 110).
This work may have benefited from a discussion of some of the diseases which could have presented as cancer, but which may not have been diagnosed as such by modern standards, particularly those cases with patients or practitioners who reported a positive outcome from what we now know would not have been a cure. However the author never set this out as a purpose, and her work does not suffer without this. Furthermore such retrospective diagnoses may themselves be problematic, if not impossible.
Kaartinen’s prose can at times be abrupt, with some sections reading as bullet points reassembled into paragraphs, however this does not detract from its readability, and it succeeds in achieving the difficult balance of being suitable for both a general and an academic audience.
This work is by no means lacking in detailed descriptions and discussions, and the deeper Kaartinen delves into the experience of the disease the richer her work becomes. The most notable and brutal account is that of Fanny Burney as captured in a difficult letter written to her sister several months after mastectomy, which clearly was both physically and emotionally excruciating (pp. 101-107).
Kaartinen closes her work with a reminder that what modern readers may interpret as brutal and barbaric treatments are by no means worse than the drastic and invasive treatments for the disease today. In the eighteenth century as in today such heavy-handed treatments arise from a genuine desire on the part of patients and medical practitioners to restore health and eliminate the pain and suffering caused by breast cancer.