July 18, 1813 – August 14, 1813
John Adams to Thomas Jefferson: “Your Friend, my only Daughter, expired Yesterday Morning in the Arms of Her Husband her Son, her Daughter, her Father and Mother, her Husbands two Sisters and two of her Nieces in the 49th. Year of her Age, 46 of which She was the healthiest and firmest of Us all: Since which, She has been a monument to Suffering and to Patience.”
John and Abigail’s eldest child, Abigail Adams Smith (known as Nabby), died on August 13, 14, or 15, 1813 of breast cancer. Dates always bug me, because was it the 13th, 14th, or 15th, and why don’t we know? This letter from John Adams as transcribed by Lester J. Cappon is dated “Quincy August [14?] 1813,” which would mean Nabby died on the 13th if Cappon correctly deciphered the date (and if JA, in his grief, wrote the correct date). The PBS website, “American Experience: John & Abigail Adams,” lists her death date as August 14. Wikipedia claims August 15, and I’m willing to bet that about 90% of every other source on the internet is simply recycling that entry. I consult David McCullough’s John Adams, and he assures us that it was August 15. Like a good armchair historian, I weigh the sources and pick the best one. PBS claims Nabby died at the age of 48, contrary to both John Adams’s and David McCullough’s claim of 49, so let’s just dismiss PBS right now. I would tend to trust Mr. Cappon and his original source, but then I must assume that Mr. McCullough read these letters as well and must have additional sources to back his conclusion. And I trust McCullough because of his fame and influence and because I’ve read his book and therefore have an automatic sympathetic bias. We’ll go with the 15th. You have to trust someone.
Not that it matters.
An internet search reveals that I’m one of many who were moved, pained, and astounded by the account of Nabby Adams’s ordeal with breast cancer, her mastectomy in 1811, and her death in 1813. A 25-minute surgery and a one-hour post-operative dressing, conducted without the profound benefit of anesthesia, is an ordeal that I cannot imagine, whether as a patient or as the mother standing beside her daughter or as the father waiting downstairs (as it was for Abigail and John). An essay by Jim Olson, from his Pulitzer Prize-nominated book, Bathsheba’s Breast: Women, Cancer, and History, describes the scene in detail.
The surgery itself was horrific, but what is heartbreaking is that it ultimately failed to cure Mrs. Smith’s cancer. I’m reading McCullough’s The Greater Journey: Americans in Paris, in which an American medical student in Paris (home to the finest surgeons in Europe) in the 1830s estimated that two-thirds of all surgery patients died afterwards. McCullough concurs that “most patients who survived surgery of any kind at the hands of the most skilled surgeons later died and nearly all of infection.” No anesthesia, no understanding of bacteria, no disinfecting of surgical tools. It is incredible that Mrs. Smith survived. The heartbreaking injustice—if there were any justice when it comes to disease—is that less than two years later the cancer killed her anyway. Considering what I assume was a long and painful recovery after her mastectomy, an obvious question is whether the surgery was worth it.
It’s an impossible question. How often did Nabby Smith ask herself? How many nights did John and Abigail lay awake at night asking themselves? Her husband? Her children? The doctor?
“Will it be worth it?”
“Is this worth it?”
“Was it worth it?”
They decided that it was, so it was. All I can do is sit in awe at Courage, Heartbreak, and Survival.
I like the portrait of Ms. Adams above, capturing a memory of her at the age of nineteen: young, unmarried, fashionable, pretty, a “lady in London” with her parents when John Adams was Minister to Great Britain. Of the painting, she wrote to her brother that “Pappa is much pleased with it, and says he has got my character, a Mixture of Drolery and Modesty.” I love that, and it’s right on. There’s a touch of teenage sarcasm around the edges of her lips and in her raised eyebrows. Whether this portrait brought comfort or pain to her parents after 1813 I don’t know, but it seems like a good way to be remembered.