Nabby Adams: The Mastectomy

John and Abigail Adams’ daughter underwent a mastectomy when she was forty-four.

The Oldest Adams Offspring

abigail and john

Nabby Adams’ illustrious parents: John and Abigail.

The eldest of the four surviving children of John and Abigail Adams was a daughter, named Abigail (1765-1813) and forever nicknamed “Nabby.”   Somewhat withdrawn and shy by nature, she was bright enough, but never displayed the brilliance or intellect of either of her illustrious parents.

Nevertheless, she learned the domestic virtues and skills of a colonial woman and at twelve, had assumed substantive household activities. By this time, her father had been dispatched to Europe as diplomatic minister by a fledgling United States government.  John Quincy, Nabby’s younger brother and close companion, went with him. The long separations that John and Abigail suffered throughout the 1770s drew mother and daughter closer together.

When Nabby was in her mid-teens, she caught the eye of Royall Tyler, a local young man, recently graduated from Harvard. In those early days, romance and courtship was under the eye of everyone, and there was no such thing as a “casual date.” From the start, inquiries were made, and it seems that Mr. Tyler appeared unsatisfactory. There is some indication that Abigail’s sister Mary Cranch vented her disapproval. There is some indication that Abigail herself put the kibosh on it. There is definite indication that John Adams, far off in Paris, left the matter in his wife’s capable hands.  There is little indication, however, that either Royall Tyler or Nabby Adams had much to say about it, or that Nabby’s heart was broken past perhaps the slight wound stage.

Nabby Adams Smith


Nabby Adams was a stylish young woman in her late teens when she went to Europe with her mother. (from the Adams. Natl Historical Park)

In part to soothe whatever slight wounds she may have felt from the romantic breakup, and in greater part to be her mother’s companion, when John sent for his wife and she agreed to meet him in Paris, Nabby went with her. By that time, she was a young woman of pleasing looks and marriageable age.

Col. William Smith (one of a handful of “William Smiths” who pepper and confuse the Adams’ family tree) had been graduated from the College of New Jersey (Princeton) and had served as one of George Washington’s adjutants during the Revolution. Now he served as John Adams’ secretary. Ten years older than Nabby, he wooed and won her. Both John and Abigail were pleased with the match – a decision they would come to regret.

nabby husband wm smith

Col. William Smith was John Adams’ secretary while he was in Europe. He became the Adams’ only son-in-law.

Within a year of their marriage, the Smiths were now parents of an infant. There would be three more. They returned to the United States and settled in New York City, at that time  the capital of the new United States.  All went well. Then the capital was moved to Philadelphia, and William Smith was hard pressed to find stable and/or satisfying employment. Inclined toward the “quick deal,” he was always on the lookout for a speculative venture, and the couple spent many months apart while Smith set out to seek his fortune, which was never forthcoming. Nabby was hard pressed to keep food on the table. Her parents and her brother John Quincy helped where they could.

Despite the senior Adams’ change of heart toward their son-in-law, Nabby seems to have remained supportive, never speaking ill of him, and disdaining those who did. Eventually Abigail took two of their daughters to live with them in Quincy, Massachusetts – to spare her daughter the additional expense.

Nabby Becomes Ill


An engraving of the young Abigail Smith (nee Adams)

In 1811, when she was only forty-four and living in the “frontier” of upstate New York, Nabby Adams Smith discovered a lump in her left breast, along with a general malaise. Doctors were summoned, but medical knowledge was still in its infancy, especially in remote locations. They recognized the cancerous tumor easily enough, but were at odds as to how to treat it. When she finally told her parents, they insisted she come to Boston for better treatment.

benj rush

Dr. Benjamin Rush, a Signer of the Declaration of Independence and close friend of John Adams, was the one who insisted that Nabby Adams Smith undergo an immediate mastectomy.It bought her a little time.

It was Dr. Benjamin Rush, one of the best known physicians in the country, and a close friend of John Adams, who insisted that Nabby undergo immediate surgery. She would not survive otherwise.

Very little actual and factual documentation exists regarding Nabby’s surgery, other than that it was done on the kitchen table of John and Abigail’s house. She was also fully clothed for modesty, required only to expose her left breast. One can only surmise the event from similar experiences and procedures of that time.

To wit. The likelihood was that every spare piece of linen or cloth was brought to make her “bed” comfortable, and to provide dressings. It is also probable that every candle they had was brought to provide the best possible lighting. There was no anesthesia. Nabby may have had strong whiskey forced down her throat, if anything at all. If she was fortunate, she might faint and be spared excruciating pain. There was no antisepsis. Doctors were casual in washing their hands and instruments; more likely a wipe-swipe on their aprons. When the breast was completely removed, the doctors noticed that the tumor appeared larger and more widespread than originally believed, but they had done their best. According to Jim Olson’s excellent article on Nabby Adams’ Mastectomy, it took longer to dress the wound than it did to remove the breast.

Nabby’s recovery was long, mostly due to her weakened condition. She stayed in Quincy with her parents, and the family sustained themselves hoping that the operation had been successful. It was seven months before she was well enough to return to upstate New York.

But she was not cured. The cancer had metastasized even before her operation. Within weeks, Nabby’s brief remission-of-sorts had ended and she began experiencing assorted aches and pains, that at first were regarded as “rheumatism.” But it was not. It was the cancer returning with avengance.   In spring 1813, she returned to Quincy once more “to die in her parents’ home.” It was her choice. When she arrived, after an excruciating trip, she was a shadow of her former self.

Nabby died on August 9, 1813, a few weeks after she arrived. And, just she had wished, with her family around her.


Gelles, Edith B. – Abigail and John: Portrait of a Marriage – William Morrow, 2009

Levin, Phyllis Lee – Abigail Adams – St. Martin’s Press, 1987

About Feather Schwartz Foster

Feather Schwartz Foster is an author-historian who has made more than 500 appearances discussing presidential history. She teaches adult education at the Christopher Wren Association (affiliated with William and; Mary College), and adult Education programs at Christopher Newport University. She has been a guest on the C-SPAN "First Ladies" program. She has written five books.
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3 Responses to Nabby Adams: The Mastectomy

  1. energywriter says:

    Amazing! I had no idea that they did mastectomies back then. sd

  2. Pingback: Healthcare is Hard, part two: How We Got Here (and Why)? | The View from the Cheap Seats

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