Breast Cancer and Parish Poor Relief in the Eighteenth Century

In Breast Cancer in the Eighteenth Century (which I recently reviewed) Marjo Kaartinen notes that this disease was a great equaliser which afflicted rich and poor women alike. First-hand accounts of the experience of breast cancer are rare, and those that do exist are typically from more well-off women. Rarer still are reports which discuss the diagnosis and treatment of women from the lower ranks of early modern society, however I was fortunate enough uncover a brief but revealing case on a recent research trip to Powys Archives. 

Prior to poor law reforms in the nineteenth century those who were not able to provide for themselves could appeal to their parish of legal settlement for support. This support was in cash or kind and provided the basic necessities of life including food, clothing and shelter as well as medical care. As such records kept by parish overseers of the poor can provide evidence of diseases and their treatments.

The case which I discovered is tragically and frustratingly short, accounting only for what the parish spent on one woman’s care, but it does provide a glimpse into life of someone who likely suffered and ultimately died from the disease.

In 1792 the overseers of the poor in the parish of Meifod, Montgomeryshire (now in modern-day Powys) made seven separate payments relating to the care of one Elizabeth Humphreys,  a poor widow who was likely under the age of 45 and who most probably had breast cancer.

Record of parish support of Elizabeth Humphreys
Reproduced with permission from Powys County Archives (M/EP/41/O/RT/3 unsorted)

Either through the course of her illness or her financial circumstances or both Elizabeth was no longer able to financially support herself. From this record we know she suffered for at least 11 weeks before succumbing to her illness as this was the duration of the support provided, but she was likely ill for some time before this. This payment of 16 shillings and 6 pence was paid directly to Elizabeth, which indicates that she was still physically able to care for herself, as at this point there is no mention of another parishioner being paid to care for her. What her circumstances were prior to her receipt of parish support, and just how sick she was we don’t know, however she does not appear to have been in receipt of parish support prior to this. 

Over the course of her illness Elizabeth was provided with at least two medical treatments, one of which was a salve, which could have been the popular ‘goose dung and celandine’ treatment discussed by Kaartinen (p. 59), or something more aggressive and caustic such as mercury, hemlock or carbonic acid (pp. 32-34). The second treatment is described only as a cure by vestry, which suggests parish officials acquired the services of a professional medical practitioner who may have even operated on Elizabeth, as lumpectomies and mastectomies were seen as options in all but the most advanced of cases. 

Following this treatment Elizabeth was cared for by a Mary Davies, which suggests that she could have been further incapacitated by an invasive procedure.

Prior to this treatment an expense was incurred for the movement of Elizabeth’s goods. This could have been part of the preparations made in advance of an invasive surgical procedure which would have necessitate a lengthy recovery period in the home of Mary Davies, or it was because it was clear that her illness was terminal and the parish was making arrangements for the provision of palliative care. 

 Whatever the treatment was we know it was not successful, as the following entry is for funeral expenses for Elizabeth, and she was either buried in January or June 1792 (the burial register lists two Elizabeth Humphreys in that year, both of whom were widows and both were paupers). Sadly, Elizabeth left behind a young daughter who was likely under the age of 12 as she was subsequently placed in an apprenticeship, which gives us a clue to Elizabeth’s age range. As an apprentice Elizabeth’s daughter would have learned practical skills in housewifery rather than one of the trades associated with professional apprentices, and the apprenticeship would have served as a foster home for the orphaned girl. Unfortunately her indenture does not appear to have survived.

Although at presentit is not possible to know any more about Elizabeth Humphreys and her illness, it is clear that when individuals were inflicted by diseases such as cancer but were not able to support themselves certain measures were in place to ensure that they did receive whatever care was reasonably available and within the means of the parish. 

(with thanks to Kerry and Roz at Powys County Archives) 

 Further Reading

Lorie Charlesworth, Welfare’s Forgotten Past (London: Routledge, 2010) 

 David W. Howell, The Rural Poor in Eighteenth-Century Wales (Cardiff: Cardiff University Press, 2000)

 Marjo Kaartinen, Breast Cancer in the Eighteenth-Century (London: Pickering Chatto, 2013)

Book Review – Breast Cancer in the Eighteenth Century

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.