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Breast Cancer : Patient Narratives and Treatment Methods

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Breast Cancer : Patient Narratives and Treatment Methods Whitman, Birgit (2004) Breast cancer : patient narratives and treatment methods. PhD thesis. http://theses.gla.ac.uk/2969/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Glasgow Theses Service http://theses.gla.ac.uk/ [email protected] BREAST CANCER: PATIENT NARRATIVES AND TREATMENT METHODS BIRGIT WHITMAN BA (HONS) Well come Unit for the History of Medicine and Gloucestershire Royal Hospital SUBMITTED FOR THE DEGREE OF PhD TO GLASGOW UNIVERSITY MEDICAL FACULTY February 2004 1 ACKNOWLEDGEMENTS I would like to thank the many people who made this thesis possible. My colleagues at the Gloucestershire Royal Hospital for allowing me the time for this project and for their never-ending practical support and enthusiasm; Consultant Nurse and wonderful friend Donna Parkin; medical secretaries Charlotte Sainsbury, Linda Mallett, Amanda Cresswell; Sam Evans from Medical Illustrations; Consultant Surgeon Brian Heather; Chloe George and Alison Hicks from the Medical Library. Staff at the Wellcome Unit for the History of Medicine in Glasgow and London for making me welcome and supporting me; Ann Mullholland, Ray Mcbain, Malcolm Nicolson, Anne Crowther and particularly my advisor Marguerite Dupree; Fiona McDonald for her invaluable comments and reference material; the staff in the Library and Medical Photographic Library. Staff from Cancer Relief Macmillan Fund in Glasgow and London. In particular I am extremely grateful to Tom Scott, who supported this thesis from the beginning. He sadly died before he was able to see it completed. His colleagues, Gaye McPhail, Macmillan Lecturer/Practitioner in Cancer Nursing Glasgow, and Alison Timey, Department of Nursing Studies, University of Edinburgh, shared their insight into breast cancer treatment during the initial phase of this thesis. Staff in London allowed me access to their archive and invited me to the launch of the first breast cancer directory. 2 Staff and volunteers of Breast Cancer Care in Glasgow, particularly the Scottish Co­ ordinator, Fiona Sandford, and the volunteers who participated in focus groups to provide an insight into the patient's perspective of breast cancer treatment. Samantha Farhall, Assistant Archivist for the Archives & Museum, St Bartholomew's Hospital, London I would like to acknowledge the financial support from the Gloucestershire Royal NHS Trust and The Wellcome Unit. Most of all I would like to thank my two supervisors for their fantastic support. Johanna Geyer-Kordesch very kindly encouraged me to set out on the journey to write a PhD in the History of Medicine, therefore combining my skills as a research co-ordinator in surgery and my degree in history. Jonothan Earnshaw, Consultant Surgeon, was always there when I needed inspiration or encouragement and never failed to believe in my abilities. I wish to say a personal thank you to my family and extended family. To my grandmother, Lisbeth Tackenberg, who came over from Germany to look after my son Sebastian, and to my husband, Nigel Whitman, for his loving care and patience. I would like to dedicate this thesis to Karen Ferry, who was our medical secretary when I started. She provided invaluable practical support and managed to get me organised until the day she herself became a patient. Her courage in the face of such a vicious attack deserves my utmost admiration. 3 TABLE OF CONTENTS INTRODUCTION ............................................................................13 METHOD ................ "............................ ., ............................. "........ 0 ••• 28 RESULTS ................ "..................................................................... 37 1 Breast cancer treatment in the 19th century .......................... 37 1.1 First case report of the amputation of a cancerous breast Lorenz Heister (1683-1758) ................................................ 37 1.2 The patient's perspective ................................................... .46 1.2.1 Fanny Burney (1752 - 1840) ............................................... .46 1.2.1.1 Napoleon's chief surgeon Dominique Jean Larrey (1766 - 1842) Amputation technique and wound care management. .................. 54 1.2.1.2 The mastectomy (1811) ..................................................... 60 1.2.2 Emily Gosse (1806 - 1857) ................................................. 68 1.2.2.1 Alternative treatment for breast cancer J Weldon Fell (1857) ........................................................ 72 1.2.2.2 Treatment for breast cancer with caustic paste Henry T Butlin (1887) ............ , ......................................... 77 1.2.3 Death from breast cancer without treatment Zelie Martin (1877) .......................... '" ............................. 81 2 The debate at the turn of the century: radical mastectomy vs. conservative surgery ......................... 88 2.1 Major scientific developments in surgery improving short-term survival of the patient. ............................ 90 2.1.1 The control of pain with anaesthesia (1846) .............................. 92 2.1.2 Increased survival rates after the introduction of infection control (1864) ................................................. 101 4 2.2 Major scientific developments improving long term survival. .......................................................... 105 2.2.1 The publication of 'Cellular Pathology' by RudolfVirchow in 1858 ............................................... 106 2.2.2 The discovery of x-ray treatment in 1895 by Willhelm Conrad Rontgen (1845-1923) ................................. 110 2.3 The view of the medical profession and the patient. .. , .. , .......... , .113 2.3.1 A pioneer in breast surgery Theodor Billroth (1829-1894) ................... , ......................... 114 2.3.2 The establishment ofa standard operation for breast cancer by William Stewart Halsted (1852-1922) .......... 119 2.3.3 The argument for less disfiguring breast cancer surgery by Geoffrey Keynes (1887 - 1982) ......... , .. 126 2.3.4 A move from qualitative to quantitative data and the disappearance of the patient's narrative ............. '" . " ...... " .. 133 2.3.5 Patient support networks and palliative care. The example of the first patient support charity CRMF and Breast Cancer Care .................................................... 138 3 Breast cancer treatment in the 20th century ........................ 142 3.1 The increased choice of treatment with the development of new surgical techniques and adjuvant therapy ......................................................... 142 3.1.1 First trials evaluating lumpectomy and radiotherapy vs. radical mastectomy ............................................. , ....... 142 3.1.2 The development of chemotherapy ....................... " .............. 145 3.1.3 The development of endocrine therapy .............................. '" .. 148 3.1.4 Complementary and alternative medicine (CAM) ..................... .152 3,1.5 The importance of early detection ..................... , .................. 157 3.2 Women's perception of different surgical techniques and adjuvant therapy since 1970 .......................................... 162 3.2.1 Audre Lorde 'The Cancer Journals' and 'A Burst of Light' US 1973 ................................................... ,." .............. 168 3.2.2 Rose Kushner 'Breast Cancer - A Personal History and Investigative Report' US 1975 ...................................................................... 182 5 3.2.3 Maxie Wander 'Leben war' eine prima Alternative' Germany 1976 ............................................................... 189 3.2.4 Barbara Rosenblum and Sandra Butler 'Cancer in two voices' US 1985 ..................................................................... 198 3.2.5 Angelila Mechtel 'Jeden Tag will ich leben Germany 1987 .............................. , ............... , ...... '" ....... 206 3.2.6 Joyce Wadler 'My Breast' US 1992 ..................................................................... 212 3.2.7 Elisa Segrave 'The Diary of a Breast' UK 1994 ..................................................................... 222 DISCUSSION ................................................................................ 233 CONCLUSION ...............................................................................256 REFERENCES ................................................................................260 6 LIST OF FIGURES Lorenz Heister. ................................................................................. 43 Breast tumour of farmer's wife ............................................................... 44 Instruments for the amputation of a breast. .......................................... , ..... .45 Fanny Burney ................................................................................... 53 Dominique Larrey ............................................................................... 58 Larrey's ambulance ............................................................................. 59 Henry
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