ON 30 SEPTEMBER 1811, in Paris, Frances Burney d’Arblay (1752-1840) underwent a simple mastectomy of the right breast to remove a growth her surgeons believed to be a cancerous tumor. A wine cordial, possibly containing laudanum, served as anesthetic. During the months that followed, Burney painfully composed a detailed narrative of her illness and operation for her family and friends in England. While its wealth of detail makes it a significant document in the history of surgical technique, its intimate confessions and elaborately fictive staging, persona-building, and framing make it likewise a powerful and courageous work of literature in which the imagination confronts and translates the body. Can this story be told? Fanny Burney’s letter asks. By questioning the narratability of her medical experience and bodily violation, Burney’s mastectomy document also questions the nature of representation in the highly codified genre of the medical case history. The formal, stylized operation retold in Burney’s letter and her intimately encoded response constitute two approaches to the same timeless human need-the need to avoid pain and suffering-and demonstrate the complex ways in which the act of writing, like the act of surgery, can be simultaneously wounding and therapeutic.

Fanny Burney’s mastectomy narrative imaginatively reenacts the anatomization of the author’s body, a private body violated and made public through the experience of surgery. In doing so, it creates the author’s very selfhood as a response to violence. Long before 1811, however, Burney’s writings had depicted physical and mental pain to satirize the cruelty of social behavioral strictures, especially for women, and to pillory the sentimental conventions of eighteenth century fiction. Burney showcased moments of endured violence in the three novels that predated her mastectomy, and these moments serve as frameworks for her analyses of female fear and the forced loss of control that constantly lurks beneath society’s polite forms and coerces women into self-suppression. Whether as medical catastrophe, social embarrassment, or criminal brutality, violence cracks the surface of polite and acceptable social engagement and raises the specter of exposure.

This silencing power of violence-its capacity to render language inaccessible and thereby to make narration impossible-particularly controls the plot of Camilla. In the novel’s final cataclysm, Camilla has a paradigmatic nightmare in which the figure of Death forces her to write an account of herself. First struck mute, she then picks up a “pen of iron” and scribbles dementedly, her words burning into the page (Cam 874-78). In Camilla’s nightmare, in which the writing implement represents a weapon to deploy against madness and death, words embody a commitment to a finished and sealed self that terrorizes her. “Write with thy own hand thy claims,” calls a voice, to which Camilla replies, “O, no! no! no!… let me not sign my own miserable insufficiency!” She “involuntarily” takes up the pen and writes “with a velocity uncontroulable” words that become “illuminated with burning sulphur” everywhere she looks. She cannot narrate, but she must; ultimately, she cannot stop narrating. Camilla’s nightmare story, her entry in the “Records of Eternity,” parallels the author’s story years later when Burney, in a frenzied need to write her body’s experience and turn it into history, composed her mastectomy letter.

The compositional history of the narrative describing Burney’s breast disease illuminates part of the matrix of violence in her writing. For Burney, the physical act of writing, both before and after her mastectomy, was not only an act of social defiance but a self-inflicted violent act, literally physically painful. It had become extremely uncomfortable for her to write long before the mastectomy itself. Immediately before the surgeons arrive, she takes up a pen with effort to make a will and to write notes to her husband and son, but she writes later that “my arm prohibited me” from writing to others to exorcise her dread while the surgery was in preparation. Holding and using a pen remained painful and difficult for her until at least 1815. She refers to being “still but convalescente” from “a dangerous & almost desperate illness” a year later, in a letter to Dr. Burney dated 18 September 1812, and in the winter of 1813 she complained of the effects of nasty English weather and inappropriate activity on her health. “I have cruel fears,” she wrote to her brother in January, “as I am a slave to care & precaution, or an instant sufferer: for the least cold-damp-extension of the right arm, bending down the chest,-quick exertion of any kind,-strong emotion, or any mental uneasiness, bring on either short, acute pangs, or tolerable, yet wearing & heavy sensations.

Now begins the operation itself- “The dreadful steel was plunged into the breast-cutting through veins-arteries-flesh-nerves,” and although Burney says her terror “surpasses all description,” she gives us a marvel of detail. The ability so closely to observe, habitual with her, may itself have been a defense mechanism, an absorption into the trauma in order to control it, to become the historian during the making of the history. An eighteenth-century American patient, undergoing an amputation, remarked on that quality of surgical experience: “During the operation, in spite of the pain it occasioned, my senses were preternaturally acute, as I have been told they generally are in patients under such circumstances…. I still recall with unwelcome vividness the spreading out of the instruments, the twisting of the tourniquet, the first incision, the fingering of the sawed bone, the sponge pressed on the flap, the tying of the blood-vessels, the stitching of the skin, and the bloody dismembered limb lying on the floor.” Burney remains resolute; she defies her own fear and pain and does not resist, though she obeys the injunction to cry out with “a scream that lasted unintermittingly during the whole time of the incision-& I almost marvel that it rings not in my Ears still! so excruciating was the agony.” The explicit description that follows is one of the most astonishing, and bravest, medical passages in literature. TURN PAGE >>