But John Adams, then the U.S. minister to the Kingdom of Great Britain, eagerly called for his wife and daughter to join him in London.

[4] Shortly afterward Adams met Colonel William Stephens Smith, who was serving as her father's secretary and was 10 years her senior.

[7] On October 8, 1811, a mastectomy was performed by John Warren and several assistants without any anesthesia in an upstairs room of the Adams home.

[7] The instruments used during the surgery consisted of a large fork with a pair of six-inch prongs sharpened to a needle point, a wooden-handled razor, a small oven filled with heated coals, and a thick iron spatula.

[7] To stop Smith's bleeding, Warren applied the heated spatula to cauterize the open cuts, and then sutured the wounds.

[8] Warren and his assistants later expressed astonishment that Smith endured the pain of the surgery and cauterization without crying out, despite the gruesomeness of the operation, which was so horrifying it caused her mother, husband, and daughter to turn away.

[7] At first a local doctor in New York said that the pain was from rheumatism, but later that year new tumors began to appear in the scar tissue as well as on her skin.