For
most of its three hundred pages, Bathsheba’s Breast utilizes biographical
sketches, primarily of well-known historical figures, to illustrate the
millennia old struggle of women against a disease that is uniquely theirs:
breast cancer. Bathsheba’s Breast
concentrates on several themes central to the disease: the pervasiveness of the
disease through the centuries, the progress in and barbarity of treatments, and
the social problems associated with treatment and research.
The pervasiveness and impartiality of breast cancer pervades
almost the entire text of Bathsheba’s Breast. This theme is introduced with the example of
Atossa, Queen of the Persian Empire in 490 B.C.
Atossa found a lump, which she feared was cancerous and kept hidden
until forced to seek help. She ultimately
sought treatment from a Greek slave, who lanced the lesion on her breast. Luckily for Atossa, the sore was merely an
abscess, not a tumor. It falls to other unfortunates to supply Bathsheba’s
Breast with more concrete examples of the fear and horror experience by
women actually afflicted by breast cancer.
The Byzantine Empress Theodora provides an excellent
backdrop for the discussion of ancient techniques of treating breast cancer,
though she refused the recommended treatment of mastectomy, and used
painkillers to maintain her dignity while dying. Anne of Austria, the wife of Louis XIII of
France, and late Renaissance nuns show the pervasiveness of the disease and
that it crossed all social strata. After
spending many years visiting convents and witnessing the full effects of breast
cancer in the nuns there, including a nun whose cancer had destroyed a large
portion of her torso, Anne knew exactly what might lay in store for her when
she found a lump in her breast. However,
understanding the course of treatment and denial also kept her from seeking
medical help for months. Anne suffered
through a long and painful course of treatment that had little chance of
success due to the medical technology of the age.
The second major theme of Bathsheba’s Breast is of
the progress made in the fight against the disease over the millennia, as well
as the horror of the treatments inflicted upon women by their male doctors.
Reading the text gives the distinct impression that in many ways the conception
of breast cancer has run full circle from systemic disorder to localized
disorder and back again. This process is well documented by Olson and runs
throughout. Beginning with the humoral
theory advanced by Hippocrates in the 5th century B.C., physicians
believed that breast cancer and other ailments were caused by imbalances of
forces within the body. Interestingly
enough, although not really germane to the discussion at hand, Hippocrates is
responsible for the modern name of cancer, which he called karkinos
after its crab-like appearance.
Clarissimus Galen, who further categorized different lesions and
cancers, took up the torch of humoral theory in the ancient world. After an interlude caused by the breakup of
the Roman Empire, Galen’s theory was taken up again during the Renaissance and
help sway into the 18th century.
Galen’s humoral theories were responsible for the practices of
bloodletting and purging performed by European doctors at the time Anne of
Austria was stricken with breast cancer.
One prominent physician blamed her condition on her hedonistic
lifestyle, in which she studiously avoided bleeding. Humoral theory ultimately fell into disuse
and surgical procedures began to dominate treatment.
Despite the portrayal of humoral theory being in the
ascendant during this time, however, Bathsheba’s Breast also seems to
indicate that one of the first options suggested for Anne of Austria was
surgical. This option was rejected in
her case due to the advanced state of her disease when she sought help. Perhaps this was the beginning of the sea
change in medical practice that would soon occur. Olson uses the cases of Mary Washington and
Nabby Adams to show that the change in practice from bleeding and humoral
theory to one of surgery was not long incoming.
By the beginning of the 19th century, surgery was the
preferred solution among learned medical practicians. In Bathsheba’s Breast this also
signals the change from a systemic approach to a more localized one. This change represents another major theme in
the work, as it is emphasized repeatedly, that even in the latter half of the
20th century most doctors treated breast cancer as if the disease
was strictly restricted to the breast until it started to metastasize to other
parts of the body.
When the surgical method reached its height after the
introduction of the radical mastectomy in 1890, so too did the fear of
treatment among women. Bathsheba’s
Breast not only delivers graphic descriptions of both the radical
mastectomy and the super radical mastectomy, which removed the breast, lymph
nodes, and much of the chest muscle in an attempt to remove all possible cancer
cells, but it describes the surgeons who performed the procedure as only
concerned with preserving the lives of their patients. The emphasis on saving or extending lives at any
cost prevented the surgeons from understanding the emotional and physical
damage they were causing their patients.
The philosophy of maiming women, as Olson describes it, continued to
dominate American breast cancer treatment into the late 20th
century, when it was at last challenged by simple mastectomy or lumpectomy
combined with radiation and chemical therapies.
Interestingly, success rates for the less drastic surgery are not much
different from far more invasive procedures.
One of the most important issues discussed regarding
treatment of breast cancer, both ancient and modern, is that most of the
doctors are male, while most of the patients are female. An interesting correlation between the ratios
of surgical oncologists of each gender and the preferred treatment method is
suggested. According to the text, in the
United States, where surgeons continued to favor aggressive surgery as the
primary breast cancer treatment, more practitioners are male. This is in contrast with European nations,
where a larger ratio of practitioners is female, and where less invasive and
damaging treatments were adopted earlier.
This implies that the greater “cruelty” of American treatments compared
to European ones (for little difference in success rates) is due to a lack of
empathy by the health provider for the emotional damage caused by drastic
procedures. Whether this is due to
gender or economics is open to debate, which Bathsheba’s Breast readily
illustrates.
These issues are hardly the only ones raised in Bathsheba’s
Breast, they are just the most important ones. A more thorough analysis would also discuss
social factors that prevent women from seeking early treatment, or political
factors that aid or hinder research into cures.
Other topics presented also include the current state of research and
the impact on both research and society resulting from the publicity
surrounding high profile breast cancer cases such as Betty Ford and Nancy
Reagan.
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