In Recognition of Breast Cancer Awareness Month this post recounts the experience of Abigail Adams Smith with breast cancer. Nabby, as she was called (featured in the last post), developed a tumor in her breast at the age of 45. She journeyed, from upstate New York where she was living, to her parents’ home in Massachusetts. She wrote a letter to the famous doctor Benjamin Rush describing her condition and requesting his advice. Her letter was enclosed with one from her father to Rush on September 12, 1811. She wrote:
… about May 1810 I first perceived a hardness in my right Breast just above the nipple which occasioned me an uneasy sensation, like a burning some times an itching & at time a deep darting pain through the Breast, but without any discolouration at all. it has continued to Contract and the Breast has become much smaller than it was. the tumor appears now about the size of a Cap, and does not appear to adhere but it be loose.… I applied to a Physician and he recommended me to apply a Plaister of the cicuta*.… I have also taken a considerable of cicuta in Pills, but I thought they produced a heaviness in my head…. I have consulted several Physicians upon the Subject they have all advised me not to make any outward application to it…. Still I am uneasy upon the Subject—for I think I observe it becoming harder and a little redness at times on the skin…. Dr Warren who has seen it told me that in its present state he would not advise me to do anything for it….
* Hemlock: a poultice prepared with the leaves of the plant was applied topically to treat tumours.
Doctor Rush chose to reply to his old friend John Adams, rather than writing to Nabby herself about such a sensitive topic. Below are excerpts from Rush’s letter to John Adams:
… After the experience of more than 50 years in cases similar to hers, I must protest against all local applications and internal medicines for her relief. They now and then cure, but in 19 cases out of 20 in tumors in the breast they do harm or suspend the disease until it passes beyond that time in which the only radical remedy is ineffectual. The remedy is the knife. From her account of the moving state of the tumor, it is now in a proper situation for the operation. Should she wait till it suppurates or even inflames much, it may be too late. The pain of the operation is much less than her fears represent it to be …. I repeat again, let there be no delay in flying to the knife. Her time of life calls for expedition in this business, for tumors such as hers tend much more rapidly to cancer after 45 than in more early life. I sincerely sympathize with her and with you and your dear Mrs. Adams in this family affliction, but it will be but for a few minutes if she submit to have it extirpated, and if not, it will probably be a source of distress and pain to you all for years to come. It shocks me to think of the consequences of procrastination in her case.
Following the reply from Rush, dated September 20, Nabby had the breast removed. Read the distressing account of the surgery performed on Nabby in James Olson’s book, Bathsheba’s Breast, (Johns Hopkins University Press, 2002) Nabby hoped she had been cured. But her mother wrote to her brother John Quincy on October 22, 1813:
we are all well, except your Sister Smith, who has had a very sick winter, she has so far recovered, as I hope, to be upon her journey here again, John has undertaken to get her here at her most earnest request. I fear it will be, to be laid by her Ancestors. Such are her complaints; that I fear I shall have one of the distressing and trying scenes of my Life to go through To heaven I submit, trusting that as my trials are, so will my strength be—
Nabby died in 1813 from a recurrence and spread of the cancer.
For Nabby’s description of her problem and her mother’s comments see a presentation made on November 4, 2013 at the South Shore Hospital on Long Island, New York, sponsored by the Abigail Adams Historical Society. For Rush’s reply see “Benjamin Rush on Cancer,” by Michael Shimkin in Cancer Research, 1976; 36:2117-2118.