Friday, March 17, 2017

XI - A Mastectomy Performed Painlessly on Madame Plantin in Paris in 1829

The following narration, found in one of Dr. John Elliotson’s writings, describes the amputation of Madame Plantin’s breast. Under usual conditions in the time period, a mastectomy was a horrible procedure to undergo - as you might very well imagine. You can read about one done on Nabby, the daughter of President John and Abigail Adams, in 1811:  Elliotson adds further commentary on other patients treated painlessly with magnetism - mesmerism.

I shall now detail a case which occurred many years ago in Paris; the mesmeric operator—Dr. Chapelain, and the surgical operator—M. Jules Cloquet, are now both alive in that city. "Madame Plantin, aged 64, living at No. 151, Rue Saint Denis, consulted M. Cloquet, April 8th, 1829, respecting an open cancer which had existed for several years in her breast, and which was complicated with a considerable enlargement of the right axillary ganglions. M. Chapelain, her physician, who had mesmerised her for some months, with the view of dissipating the disease, could effect only a profound sleep, in which sensation appeared suspended, but intellect remained perfect. He suggested to M. Cloquet to operate upon her in the mesmeric sleep-waking. M. Cloquet, having judged the operation indispensable, consented, and it was fixed for the following Sunday, April 1st. The previous two days, she was mesmerised several times by Dr. Chapelain, who prevailed upon her when in the state of sleep-waking to bear the operation without fear, and brought her even to converse about it calmly; although, when she was awake, she could not listen to the proposal for horror.

"On the day fixed, M. Cloquet arrived at half-past ten in the morning, and found the lady dressed in an arm-chair, in the attitude of a person calmly asleep. She had returned about an hour from mass, which she habitually attended at that time of the day. Dr. Chapelain had thrown her into the mesmeric sleep on her return. She spoke with perfect calmness of the operation which she was about to undergo. All being ready she undressed herself, and sat upon a common chair.

"Dr. Chapelain supported her right arm. The left was allowed to hang at her side. M. Pailloux, internal student of the Hospital Saint Louis, had the charge of presenting the instruments and applying the ligatures. The first incision was begun at the arm-pit, and carried above the breast as far as the inner side of the nipple. The second was begun at the same point, and carried under the breast till it met the first. M. Cloquet dissected out the enlarged ganglions with care, on account of their proximity to the axillary arteries, and removed the breast. The operation lasted ten or twelve minutes.

"During all this time, the patient conversed calmly with the operator, and gave not the least sign of sensibility; no movement occurred in the limbs or FEATURES, no change in the RESPIRATION or VOICE, no emotion EVEN IN THE PULSE, was discernible; this patient remained uninterruptedly in the same state of automatic indifference and passiveness, (état d’abandon et d’impassibilité automiques, or, as Mr. Topham says of his patient, 'uncontrolled, in perfect stillness and repose,' 'like a statue!') in which she was some minutes before the operation. There was no necessity to restrain her, we had only to support her. A ligature was applied to the lateral thoracic artery, which was opened in removing the ganglions. The wound was closed with sticking plaster and dressed, and the patient was put to bed, still in the same state of sleepwaking; and was left in this state for eight and forty hours. An hour after the operation a slight haemorrhage occurred, which proved of no importance.

“The first dressing was removed on Tuesday the 14th; the wound was washed and dressed afresh; the patient shewed no sign of pain; the pulse was undisturbed. After this dressing, Dr. Chapelain awoke the patient whose sleep-waking had lasted from one hour before the operation, i. e. two days. The lady seemed to have no idea, no conception, of what had passed; but, on learning that she had been operated upon, and seeing her children around her, she experienced a very strong emotion, to which the mesmeriser put an end by im
mediately sending her to sleep again."

Some of the surgeons of Paris scouted this case just as the London Medical Society, in imitation, scouted that of the amputation [of Wombell]. Lisfranc explained it somehow or other, and Baron Larrey accused the poor lady of being an “accomplice of the mesmerisers." The latter should have remembered that there was once a soldier named Blanchard, who refused all his advice to part with his right leg on account of fistulous ulcers of the foot, tumefaction of the cellular membrane, a white swelling of the inner ankle, disease of the ligaments, and caries of the tarsal bones, and who was pronounced incurable by the certificates of six physicians and surgeons; that, when the Marquis de Puysegur mentioned to him that by means of mesmerism the poor man was greatly relieved, he burst into a laugh, said the patient would never be cured because the bones were diseased and the periosteum gone, and that amputation would be indispensable. By mesmerism the poor soldier was completely cured.

I have extracted the case of the lady from the highly-favourable report, in 1831, of the Committee appointed by the French Academy of Medicine to report upon mesmerism, and to be found in Dr. Foissac's excellent work. The committee continues thus:—

"The committee sees in this case the most evident proof of the suspension of sensibility during sleep-waking, and declares that, though it did not witness the case, they find it so stamped with the character of truth, it has been attested and reported to them by so good an observer who had communicated it to the surgical section, that they do not fear to present it to you as a most unquestionable proof of the state of torpor and stupefaction produced by mesmerism."

I may mention that the case is related as perfectly genuine in the Penny Cyclopaedia, published by our Society for the Diffusion of Useful Knowledge, article Somnambulism, in which the truth of mesmerism is admitted to the extent even of clair-voyance; Lord Brougham being president of the society, and the Bishop of Durham, several peers, several Fellows of the Royal Society, men of the first distinction in science and literature, and several professors of University College, where a general stand was made against mesmerism, being my colleagues on this committee. In the Hermès it is stated likewise, that M. Cloquet attests not only that there was complete absence of pain, but that, while he was washing the surface around the wound with a sponge, the patient felt tickled, and several times said merrily, "Come, leave off, —don't tickle me." Her laughter, thus occasioned, was heard by M. Plantin—the patient's son, and by Madame Granier, who were outside the door.

This remarkable circumstance must be viewed side by side with the uneasiness felt from the blood in the mouth of my patient who had no sensation from the extraction of her tooth, and whose case I have related at p. 66; and with the exquisite sensation she always had both of heat and cold in parts perfectly insensible to pinching, &c.—a fact noticed by me in several other cases, and by Mr. Prideaux in regard to heat in one of his patients, spoken of at p. 71; and in regard to cold in the Spanish Lady mentioned at p. 49, who was comatose without mesmerism.

No man who has a heart can read the narration without being affected and earnestly hoping it is true. But, though its truth is equally certain as that there is such a surgeon as M. Cloquet, it has lately been denied in England and the parties have been vilely traduced.

In the London Medical Gazette for the 2nd of last December, immediately after an imperfect and incorrect account of the discussion in the Royal Medical and Chirurgical Society on the paper which detailed the case of amputation [of Wombell] in the mesmeric state, is an anonymous letter of three paragraphs,—signed "a member of the Medical and Chirurgical Society," who is ashamed to give his name, and there fore does the deed in darkness,—the first styling the account "very silly" and unfit for the society, the second heartlessly accusing the poor patient of deception, and the third as follows:

''It is rather remarkable that it should have occurred to no one present to mention the case of a woman whose breast was amputated, some years ago in Paris, by M. Cloquet, while she was (as it is supposed) in a state of mesmeric stupor. This woman was believed to have been insensible to pain during the operation; and was a better actor than the man mesmerised by Mr. Topham, as she did not even moan. Some considerable time afterwards, however, while dying of an internal complaint in another hospital, she confessed to the nurse that the whole had been a cheat; that she had experienced pain like other persons, but had sufficient command over herself not to shew it."

The Nottingham surgeon, to whose letters I have already twice referred, writes,—"some years ago in France the breast of a female was removed while she was professedly in the mesmeric sleep. She died a few days afterwards; an operation which in other cases rarely indeed proves fatal. Is it not too probable that the attempt to bury the anguish in her own bosom proved too much for nature to sustain? Another mesmeric operation case succeeded better, but the patient subsequently confessed that her insensibility was all feigned."

"Many similar cases have occurred, &c." Now the statements of both writers are altogether untrue. Madame Plantin was never in an hospital, but the wife of a wealthy merchant of Paris; resided in a country house which she could hardly be prevailed upon to leave in the fine season of spring to take up her abode in Paris for the purpose of being mesmerised, for she disliked mesmerism because it had been tried upon her at different times unsuccessfully, and she was unwilling to submit to the restraint of mesmeric treatment; and she was terrified at the thought of a surgical operation under any circumstances, and declared she would rather die, and had indeed suffered severely from
refusing even to be bled in one of her pregnancies.

M. Cloquet testified to the Academy that she was pious, modest, and incapable of any collusion; and Dr. Caldwell of America, hearing a rumour in London that this surgeon confessed he had operated upon other patients in an ordinary state who bore the pain as unmoved, called upon M. Cloquet, in Paris, to ask the question, and told me that he received for answer, "Jamais! jamais! jamais!” [Never! never! never!] However, Dr. Davison, a friend of mine, called upon M. Cloquet at my request in January, to make enquiries respecting the case; and the following is an extract from his reply,— "The letter to which you allude in the Medical Gazette is false in every particular, save the death of the patient. The lady was never the inmate of an hospital. She was the wife of a rich negotiant, an excellent person, respected by all who knew her. She died above a fortnight after the operation, of a pleurisy; the wound having done well, and she having taken a drive some days previously. Cloquet saw her and is quite sure that she never made the confession alluded to."

As to the other case, spoken of by the Nottingham surgeon, Dr. Davison has made every enquiry in Paris, and cannot learn that it ever occurred. "Many similar cases have occurred!" I call upon him to make good all his assertions. He knows that Mr. Wood flatly contradicted him in The Nottingham Journal in regard to the one, and pointed out that he gave no authority whatever for the others: yet, though two months have elapsed, this candid person has never replied or ventured to recur to the subject.

The next post will be on Dr. Elliotson's mesmeric treatment of a patient with breast cancer which did not lead to surgery and produced cure.

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