History of Medicine

Concepts of Cancer from Antiquity to the Nineteenth Century

Margaret M. Olszewski, PhD (1T3), Faculty of Medicine, University of Toronto

employed for conditions whose cause was less obvious, like in Abstract the case of headaches, where some scribes recommended rub - Theories about the origins of cancer and potential bing the head with the skull of a catfish, a treatment that fol - treatments for the disease can be traced back to several lowed the magical principle of “similia similibus” or like will be ancient papyri of Egyptian derivation that documented cured by like. 5 Egyptians thus interpreted physical conditions palliative treatment and surgical removal of tumours. within these parameters of belief. In the Greco-Roman period, Hippocrates explained It is generally accepted that the earliest known references to cancer using his humoural theory, arguing that an cancer are found in the Edwin Smith Papyrus, an Egyptian text on excess of black bile produced uncontrollable, crab-like trauma surgery dated to 1600 BCE. Attributed to Imhotep, vizier, cell growths. This theory would dominate explanations architect, physician and astronomer to the Pharaoh Djoser (who of cancer for the next millennia as it was promulgated presumably composed the text in 2500 BCE; the extant text is a by Hippocrates’ successor Galen. While there were copy), the historic collection of medical writings described forty- some additions to the medicinal understanding of can - eighty traumatic surgical cases, eight of which dealt with what cer in the Middle Ages, it was not until the nineteenth modern physicians believe to be incidences of tumours or ulcers 6 century that microscopic work by German pathologists of the breast. The following excerpt, describing the method of including Müller and Virchow, identified the cellular diagnosing tumours of the breast, is taken from the text: origins of cancer. This review considers some of the major contributions to cancer research and care from “... If you examine a man having bulging tumors on his ancient Egypt until the nineteenth century and out - breast, and you find that they have spread over his breast; if you place your hand upon his breast tumors and you find them to be lines the ways in which concepts of the disease have cool, there being no fever at all therein when your hand fells changed with the advancement of medical knowledge. him; they have no granulation, contain no fluid, give rise to no liquid discharge, yet they feel protuberant to your touch, you should say concerning him: ‘This is a case of bulging tumors I Introduction have to content wit h’.” 7 he history of cancer is a long and complicated one; Jacob Wolff’s lengthy volume The Science of Cancerous Disease from This description itself is quite vague and perhaps, not surpris - the Earliest Times to the Present is a testament to the disease’s ingly, it was common practice for a wide assortment of swellings, T 1 enduring and complex presence in medicine. Nonetheless, whether simply inflammatory or cancerous, as well as chronic there are a number of milestones in our current understanding ulcerations, to be classified as tumours during this period of the disease that can be traced from ancient times. This review because of the lack of understanding in human anatomy and article attempts to highlight these milestones, focusing on spe - physiology. 4 There were, however, distinctions made in treat - cific contributions that can be viewed as signposts in our evolv - ment depending on the presentation of the tumour: red, warm ing concept of cancer. As a historical review, this piece is not and pus-oozing masses were removed with cauterization using a intended to provide a complete history of the disease. Notable “fire drill,” while tumours that were cool to the touch and pus- omissions include perspectives on cancer in the Arab world and free were to be left intact. 8 One could also treat tumours with advances in cancer research in the twentieth century, topics that external applications. A number of these treatments are would warrant their own reviews. Instead, this article points out described in the Ebers Papyrus of about 1550 BCE. This text some important historical perspectives on cancer, how they have contained a far more comprehensive collection of medical evolved over time, and how they have set the stage for our mod - remedies – over 876 in total – and mentions some 500 different ern understanding of the disease. substances for the treatment of disease. 9 One such palliative approach for uterine cancer involved inserting a mixture of Ancient Egypt (3000 BCE – 500 BCE) fresh dates into the vagina to ease discomfort. 10 In ancient Egypt, magic and religion were strong influences While frequently cited in the literature on the history of cancer, on medical practice. 2 Priests were considered the ultimate care - these interpretations of cancer in Egyptian texts should be viewed takers of knowledge and it was thought that they received their cautiously, mainly because of the relative absence of tumours in wisdom directly from the heavens. In light of these beliefs, can - examined skeletal remains from the period, although some exam - cer, as well as other diseases, were mainly viewed as direct con - ples, like the discovery of an osteochondroma by Grafton Elliot sequences of the “will of the Gods.” 3,4 Spiritual and mystical ten - Smith and Warren Dawson, do exist. 11 Nonetheless, up until 2006, dencies were especially evident in the disease treatment, which only about thirty-nine malignant tumours had been identified in was based on perceived causes. Conditions were treated accord - Egyptian skeletal remains dating from various periods and places ing to their perceived cause. Pragmatic solutions were devised to in Egypt, although this number has recently been increasing. 12 treat conditions with obvious causes, such as bone setting for Furthermore, scholars such as Leonard Weiss have had trouble fractures and surgery for trauma, while magic was often reconciling the high frequency of male breast cancer in Egyptian

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Concepts of Cancer from Antiquity to the Nineteenth Century texts with modern statistics of the disease’s prevalence, estimated to be less than 1% of all cancer in men and less than 1% of all breast cancer diagnoses worldwide. 13 These scholars have thus tentatively concluded that these textual descriptions of Egyptian cancer cannot be confirmed. 14 On the other side of this argument there are those like Bendix Ebbell, translator of the Ebers Papyrus, who have suggested the word wenemet or “eating,” used frequently when describing swellings, was used unequivocally to describe cancer-like growths. 10 Despite these arguments, the remarkable lack of evidence to support the existence of malignant epithelial tumours is impor - tant when considered in light of recent increases in cancer inci - dence. Why did Egyptians suffer from cancer less frequently than modern society? A shorter life expectancy (thirty-nine years), a different diet and the existence of fewer carcinogenic agents in Egyptian times are a few of the reasons contemporary scholars have offered to explain this discrepancy. 10 The case of cancer in ancient Egypt provides an interesting case study for Figure 1. Hippocrates’s four humours (adapted from Magner, LN. A further epidemiological investigation. history of medicine. New York: Marcel Dekker, Inc.; 1992. 71-74 pp. )

Cancer in the Greco-Roman Period (500 BCE – 500 CE) healthy sexual activity was commonplace. Hippocratic physicians In the Classical Period, the Hippocratic School is thought to also recognized the natural healing process as critical in achiev - be the first to document Greek ideas about cancer. Comprised ing optimum health. Diseases were themselves natural and it was of some seventy books written by Hippocrates of Cos (460 BCE the physician’s responsibility to help nature achieve a cure. 17 – 370 BCE) and other contributing physicians, the Hippocratic How did this approach to medicine influence the way in which corpus was the first text to use the words karkinos and karkinoma the Greeks interpreted cancer? 21 The Hippocratic corpus con - to describe a non-healing swelling or ulceration and malignant tains eleven separate sections that approach the pathogenesis and non-healing tumour respectively. Hippocrates also introduced treatment of cancer. The clearest reference to cancer is found in 4 the word scirrhus to describe hard tumours. These learned the fifth book of Epidemics: “a woman from Abdera developed Hippocratic writings differed considerably from the equivocal carcinoma on the breast, and through the nipple there was sero- descriptions of cancer in the Egyptian period primarily because sanguinous discharge; when the discharge ceased she died.” 22 they were concerned with causation in health and disease and While this excerpt suggests that Hippocrates did not do much were grounded in an Aristotelian framework of rational knowl - about cancer, a number of other references throughout the cor - 15,16 edge acquisition. They adopted a natural philosophical pus indicate he did in fact distinguish between superficial, malig - approach to illness that was driven by a perceptible quest for a nant tumours that he called karkinoma apertus and deep tumours, naturalistic understanding of pathology and not just mystical or karkinoma occlusus , that he considered the overall condition of description . These writings contain a marked decrease in refer - the patient before diagnosis and that he was aware that some can - ences to magical or supernatural exclamations of disease. Belief cers favoured either the male or female gender or the elderly. in gods was still predominant but they were no longer consid - According to Hippocrates, an excess of black bile or atrabilis was 17,18 ered to be the direct cause of disease. the major cause of cancer. Imbalance of internal humours became the dominant expla - If tumours were superficial, Hippocrates advised that they be nation of disease in the Hippocratic era of medicine. The removed by excision; if they were occult or internal, it was best to humoural theory stated that the human body was made up of four leave them alone; “It is better not to apply any treatment in cases basic substances or humours: blood, phlegm, yellow bile and of occult cancer;” wrote Hippocrates, “for, if treated, the patients black bile. Individuals were healthy when these four elements die quickly; but if not treated, they hold out for a long time.” 10 For were balanced but if there was too much of one element and not Hippocrates, cancer was a systemic disease and as such it was best 19 enough of another, persons were ill. Each of the humours was to let the disease take its course without surgery. While some associated with a pair of qualities: hot, cold, wet and dry. Each tumours could be treated with external ointments made from was also associated with a season and this lent many diseases a copper, lead, sulphur or arsenic, this was not the first line of treat - seasonal quality; phlegm was cold and increased in the winter, ment. 5 This limited knowledge of tumorous growths must be blood increased in the spring, yellow bile in the summer, and viewed in light of the taboo surrounding human dissection. For it black bile in the autumn (Figure 1). Physical examination was was not until the third century BCE that human dissection was also emphasized in the Hippocratic writings – physicians were allowed in Alexandria and even then it would soon become illegal encouraged to take detailed case histories that looked for physi - again under Roman law. 23 As was the case in ancient Egypt, a lim - cal signs and symptoms, such as coughing, breathing and the ited understanding of human anatomy hindered research into 20 presence of tumours. the pathophysiology of cancer and the primary explanation of the Treatment of most diseases was aimed at restoring humoural disease was based on superficial observation and conjecture. balance. For example, purging, laxatives, bloodletting, emetics, Little evidence survives about the history of cancer in the cen - diuretics and enemas were employed to rid the body of excess turies that followed the flourish of Hippocratic medicine. humours. Preventive medicine in the form of advice on how to Although there is evidence to suggest that the Hippocratic ensure a complete diet, get adequate exercise and partake in tradition in cancer care persisted. Some recollections of later

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Concepts of Cancer from Antiquity to the Nineteenth Century

Roman medicine were preserved by the medical encyclopaedist rather than locally; cancer should be treated by attempting to Aulus Cornelius Celsus (25 BCE – 50 CE). While not ostensibly balance humours, using the same diet and purges that a physician, Celsus wrote profusely on medical topics and sum - Hippocrates advised, and to remove tumours surgically. 27 An marized advances made in Greek and Alexandrian medicine illustrative description of one such cancer treatment is included during the rise of the Roman Empire in his text De Medicina. in one of Galen’s texts: This work is important as it is one of the only surviving texts to provide a glimpse into medicine during this period. “If you attempt to cure cancer by surgery, begin by cleaning A small portion of Celsus’ encyclopaedia describes cancer and out the melancholic tumor by cathartics. Make accurate inci - its treatment. According to Celsus, the organs most commonly sions surrounding the whole tumor so as not to leave a single affected by cancer were the face, nose, ears, lips, and breasts of root. Let the blood flow and do not check it at once, but make women, as well as the liver and spleen. 24 Tumours were difficult to pressure on the surrounding veins, so as to squeeze out the thick treat and it was advised that as soon as they were perceived, one blood. Then treat as in other wounds.” 28 should use “caustic medicines” to cure them. Celsus was purport - edly the first to classify breast cancer into four stages of progres - A skilled surgeon, Galen is supposedly also the first to have sion: 1) cacoethes (early-stage tumour), 2) carcinoma without skin used surgical sutures to stitch up wounds as well as ligatures to ulceration, 3) carcinoma with ulceration, and, 4) “thymium,” an tie off cut vessels and prevent further bleeding, innovations that advanced exophytic and sometimes bleeding lesion. 25 may have been inspired during his time as the official physician Later in the period the work of Hippocrates was officially for the Roman gladiators. 4 Again, we see the importance of revived and expanded by Galen of Pergamon (129 CE – 199 observation in diagnosing tumours and in classification. Galen CE), the acclaimed physician and philosopher. Throughout his built upon the knowledge base established by Hippocrates in lifetime, he wrote profusely on medical topics as diverse as order to fine tune Roman ideas about cancer. anatomy, physiology, and pathology. The knowledge contained within these texts would dominate medical practice in the West The Middle Ages (500 CE – 1450 CE) and the until the Renaissance. The basis of Galen’s approach was Renaissance (1450 CE – 1600 CE) grounded in the Hippocratic course. Galen added to this by per - A long period of medical stagnation followed the fall of the forming limited anatomical experiments on animals. 17 It has Roman Empire in 476 CE. The Middle Ages witnessed a return been suggested that Galen modelled himself to be a “scientific to the amulets, magical spells and other superstitions that dom - doctor” – that is, he used reason to localize disease. Rational and inated medicine in the time of the Pharaohs. This regression was regional concepts of disease were borne from Galen’s practice. 26 largely due to the fact that before the founding of independent Within this framework, Galen too contributed to knowledge universities in Europe between the tenth and thirteenth cen - about cancer. Galen was the first to describe tumours using the turies, scholarship was restricted to a small array of medieval word “cancer” which derives from the Latin word “cancrum” or monastic orders. However, before the Renaissance, the major crab, because he believed tumours had a characteristic crab-like medicinal text to survive the Middle Ages was the work of Galen, shape. 4 This definition can be gleaned from one of his treatises, which had been transcribed and translated by Arabic scholars. “…and on the breasts we often saw tumours resembling exactly As a result, Galenic-cum-Hippocratic humoural theories were the animal cancer. And just as the animal’s legs are on either resurrected in the Middle Ages and would influence how physi - side of its body, so do the veins stretched by the unnatural cians treated and viewed cancer up until the last part of the sev - tumour resemble (the animal) cancer in shape.” 22 He also intro - enteenth century. 4 duced the term “sarcoma” to describe tumours that exhibited a In the late medieval period, there was a return to using the “fleshy” cross-sectional appearance. 4 term cancer rather broadly to describe a range of afflictions, While remaining faithful to Hippocrates’s humoural theory, including swellings, gangrenes, tumours, abscesses, and herpes Galen extended Hippocrates’ definitions of cancer and classi - sores. A more concrete definition was provided by Guy de fied tumours into three major types (Figure 2). 4,14 Chauliac (1300-1370), the learned French surgeon, who defined He argued that the humoural theory of cancer and argued cancer as “a hard, round, veined, darkish, fast-growing, restless, that the disease was metabolic and should be treated systemical ly warm and painful tumour.” 14,29,30 As Luke Demaitre has observed,

Tumores secondum Tumores supra naturam naturam (tumours Tumores praeter (tumours above nature, according to nature, naturam (tumors e.g., abscesses and e.g., breast growth beyond nature) during pubery) inflammations)

Onkoi (lumps or Karkinos (malignant Karkinomas masses) ulcers) (nonulcerating cancers)

Figure 2. Galen’s classification of tumors

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Concepts of Cancer from Antiquity to the Nineteenth Century de Cauliac’s definition was clearly rooted in Galenic principles Gasparo Aselli (1581-1626), for example, discovered the lym - and Greek ideas of temperature and spreading humours, an phatic system in 1622, while William Harvey (1578-1657) observation that supports the conclusion that older Hippocratic- described the circulation of blood in 1628. 35,36 Galenic ideas still dominated cancer aetiology in the Middle The eighteenth century is particularly interesting for its many Ages. 31 Similarly, Egyptian ideas of cancer “eating” and “gnawing” contributors to cancer epidemiology. In the 1700s, curious the flesh continued to be used by some, such as Henri de physicians and men of science documented numerous links Mondeville (1260-1320), another French surgeon. 31 De between cancer and certain occupational and lifestyle choices. Mondeville did considerable work on concepts of cancer in this In 1713, for example, Bernardini Ramazzini (1633-1714), pro - period. He specified the humoural theory of cancer by differen - fessor of medicine at the University of Padua, wondered about tiating between black bile produced in the liver, which he the high rates of breast cancer and the virtual absence of cervi - thought contributed to hard tumours in the breast, and black cal cancer in nuns. He concluded that the population’s celibate bile produced as the breakdown product of the three other lifestyle must be the cause of the disease, suggesting that lack of humours, which resulted in what he considered true cancer. As sexual intercourse diminishes “disturbances in the uterus. with Galen, de Mondeville recommended diet and purging to Cancerous tumours are [then] very often generated in the redress humoural imbalance, as well as the extirpation of woman’s breast.” 37 In 1761, the English physician John Hill tumours. 25 (1714-1775) observed that snuff users were more prone to devel - A review of the dominant medical texts of the period, including oping nasal cancer, an observation considered by some the first de Chauliac’s and de Mondeville’s, indicates that black bile was acknowledgment of external carcinogenesis. 38,39 In 1775, British still thought to be the primary cause of cancer. The humour surgeon Percival Pott (1714-1788) described an association became problematic when it was improperly cooked or burned, a between scrotal cancer and the chimney sweep occupation, pre - process which made it thick and stagnant and incapable of being sumably the first documented case of occupational cancer. 40 expelled from pores or in the blood. Breast cancer was common With the acceptance of human autopsy, a practice outlawed in in light of this belief because menstruation prevented women earlier times for reasons of religion and decorum, the gross from properly cleansing their blood of black bile. 31 pathology of cancer could for the first time be observed without In the Renaissance, there was efflorescence in all areas of criticism. 41,42 In 1761, Giovanni Battista Morgagni (1682-1771) human life, including the arts, literature and medicine. A laid the foundations of scientific oncology with the publication of renewed interest in the pursuit of intellectual activity and the his On the Sites and Causes of Disease , a landmark text considered opportunity to explore the natural world unhindered by the first example of modern pathology. 16 In this work, Morgagni medieval mores allowed those who studied medicine to rethink described cancers of the breast, stomach, rectum and pancreas accepted traditions. 16 There was also a transition from based on findings compiled from 700 autopsies, a remarkable Aristotelian-Galenic rationalism, based on metaphysical analysis, feat made possible by the loosening of societal strictures on to Baconian-Newtonian empiricism, which took experiment as its human dissection. His observations inspired him to be the first to starting point. The work of Andreas Vesalius (1514-1564), espe - attempt to disprove the Cartesian lymphatic theory with experi - cially his De Humani Corporis Fabrica (1543 ), and the critical mental findings. 32 The study of cancer as an independent disease approach to anatomy contained within it, would throw the long- with its own symptoms and treatments was enforced by the found - revered definitions of Galen into question. Vesalius’s dissections ing of the first institutions set up to treat and research the dis - of human cadavers would for the first time demonstrate the ease. The eighteenth century welcomed the first cancer hospital, errors of Galen’s hypotheses, as these were originally based on LaLutte Contre Le Cancer, which was founded in Rheims, France the anatomy of apes and pigs, not humans. 32 Others too, like the in 1740, and the first cancer institute, where studying the natural alchemist Theophrastus Paracelsus (1493-1541), were brazen history of cancer was the primary cause, which was opened in enough to attempt to overthrow Galen’s humoural theory, even Middlesex, England in 1792. 43 In addition to suggesting the ris - though Paracelsus’ own theory of cancer – that it occurred ing importance of cancer study, the ways in which these institu - because of excess mineral salt in the blood – was itself magical tions were managed illustrates some noteworthy eighteenth-cen - and imprecise. 1 tury cancer concepts. LaLutte Contre Le Cancer, for example, was moved away from the centre of Rheims in 1779 because it was The Seventeenth and Eighteenth Centuries presumed that cancer was a contagious disease. 16 In the Age of Reason, thoughts about the origin of cancer shifted away from the humoural theory toward the lymph node The Nineteenth Century origin of the disease. The French philosopher and physician In the nineteenth century, there was a marked shift away from René Descartes (1596-1650) was the first to propose the lymph the humoural theory of cancer to a cellular theory of the dis - theory of cancer. 16,33 Among the proponents of this idea was ease. This was made possible by improvements in scientific tech - Henry François le Dran (1685-1770), a Parisian surgeon who in nology, namely the light microscope. 44 Invented by H. Jansen in 1757 argued that certain cancers, such as breast cancer, spread the late sixteenth century, and used remarkably by Antony van not by humours but by the lymphatic system. According to le Leeuwenhoek (1632-1723) and Robert Hooke between 1665 Dran, tumours began in localized areas. The disease was then and 1678 to identify microorganisms, the light microscope was transported to regional lymph nodes and eventually produced improved further by Charles Chevalier in 1824 allowing clearer systemic disease throughout the body. 34 In order to prevent visualization of microscopic specimens. 45,46 Johannes Müller spread, le Dran recommended complete excision of tumours as (1801-1858), German physiologist and comparative anatomist, well as nearby lymph nodes. Le Dran’s contributions were made was among the first to observe cancerous tissue under the possible thanks in large part to the incremental discoveries improved achromatic lens of the new microscope. In 1838, he made in the science of the human body. The Italian anatomist verified that tumours were in fact made of cells and not clotted

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Concepts of Cancer from Antiquity to the Nineteenth Century black bile or other unknown substances. 47 While Müller con - details of cancer and highlighted the potential for the disease to firmed the cellular heritage of cancer, from his observations he be diagnosed using microscopic analysis of pathological tissue. 50 extrapolated what became known as the blastema theory of can - He proposed that cancer cells were generated by either one of cer, which stated that tumours originated from a primitive body two methods: 1) a hereditary or constitutional predisposition or fluid or blastema by intracorporeal generation or crystallization 2) from chronic cellular irritation. 16 Despite these revolutionary and not other cells. 48 Blastemas were undifferentiated cell-like claims, Virchow still believed that cancer was spread by a liquid, fluids that originated between tissues that made up an organ, rather than by malignant cells. 51 In 1865, the German surgeon exuded from the blood and could develop into any tissue. 1 This Karl Thiersch (1822-1925) disproved this idea by studying metas - theory clearly echoed the ancient beliefs of Hippocrates’ tasizing epithelial tumours of the skin. Based on serial section - humours, but nonetheless it found its champions in nineteenth- ing techniques, Thiersch concluded that malignant cells in century medical men, including Julius Vogel (1835-1899), who lymph nodes reached secondary sites by cellular embolism; toxic expanded the theory in 1845 by proposing that each tissue had fluids were released from malignant growths but cells were ulti - its own blastema (the law of analogous blastemas). 16 However, mately responsible for spread of the disease. 52 Karl von some were still reluctant to accept that cancer developed from a Rokitansky (1804-1878) identified the two main cellular compo - mysterious component of the blood. nents of cancer to be the cancer mass or parenchyma, composed One of Müller’s students, the German physician and patholo - of nuclei and nucleated cells, and the framework or stroma, gist Rudolf Virchow (1821-1902), would provide the evidence which was not considered neoplastic. The qualities of these two needed to disprove this accepted truth. Using his principle of components determined the type of cancer; if the stroma was cellular pathology, which stipulated that the cell was the smallest predominantly made of fibered trabeculae what was known as a unit in which disease could be located, Virchow conducted fibrous cancer developed while a medullary or gelatinous cancer pathological examinations of histological samples and conclud - formed when the parenchyma predominated. 1 The work of ed that cancer arose in cells and not from body fluids or fibres. 49 Müller, Virchow and Rokitansky would formulate modern classi - Virchow’s revolutionary aphorism omnis cellula a cellula or “all fications of tumours used in cancer pathogenesis, i.e., the type cells are derived from cells” opposed the idea of spontaneous de of cell that composes the tumour, e.g., epithelial or mesenchy - novo generation and asserted that tumours did not develop from mal, and whether the tumour is benign or malignant. 3 As blastemas but from cells. In 1858, Virchow published his seminal George Diamanopoulos has observed, this system of classifica - text Die Cellula Pathologie in which he described the microscopic tion is strikingly similar to the ancient frameworks established by

The Edwin Sm it h Papyrus descr ibes 48 tr aumati c surgica l Galen po pularize s Hippo crates’ Bernard ini Ramazz ini su gges ts a link The first cancer instit ute opens ca ses, 8 of which are hu moura l exp lana tion of canc er. be tween abstinen ce and high rates of in Midd lesex , United Kingdo m. be li eved to be ca ses He class ifies tumours into three br ea st ca nce r/l ow rates of ce rvica l ca nce r of br east tumours . main typ es. based on his observations of nuns .

Hippoc rates explains Galen’s interpretati on of cancer, Giova nni Battista Morga gni canc er us ing his humoura l favo ured since it s introdu cti on , is reco rds anatomical theo ry. He be liev es that an slowly overturned by the work of obse rva ti ons of hu man Rudo lf Vircho w dispr oves the exce ss of black bile or Andreas Vesa lius , who publi shes ca davers. John Hill remarks blas tema theory and conf irms atrab ili s lead s to the De Human i Corpor is Fabr ica, and on the re lati onship be tween that canc er develops from develop ment of tumours. ootthe r RenaissanceRenaissance thinkers.thinkers. snuf f an d nas alal cacance rr.. pre-ep xi sting cell s.

250 0 BCE 150 0 BC E 40 0 B C E 50 CE 19 9 CE 130 0-137 0 154 3 160 0 171 3 174 0 176 1 177 5 179 2 183 8 185 8 186 5

Aulus Cornel ius Cels us Rene Descar tes prop oses Percival Pott describes an Karl Thiersch establi she s that can cer reco mm end s cau stic med icine the lymph theory of cance r. assoc iati on between is sp read by mali gnan t ce lls. and cauterisi zati on as tr ea tment scro tal cance r an d the fro m can cerous tu mours. ch imney sweeps.

The Ebe rs Papyru s Guy de Chau liac defines canc er as “a hard, round, veined , The firs t cancer hosp ital Joha nnes Mülller obs erve s reco mm end s the use of a darki sh, fast-gro wing, rest less, warm and painf ul tu mor” open s in Rheims, France. canc erou s ti ssue unde r a mixture of da tes and other dur ing a period in medica l history when the word was micro sco pe for the fir st ti me. natural substan ce s to trea t used qu it e li berally to des cribe a range of inflamm ati ons. Based on his obse rvations , he tumours in the uterus. Henri de Mondevill e disti ngu ishes betwee n the dif ferent po stulates the blastema theory type s of bile that can produce can cer. of ca ncer .

Figure 3. Timeline of historical concepts of cancer, 2500 BCE – 1865

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Concepts of Cancer from Antiquity to the Nineteenth Century

Hippocrates and Galen, i.e., a classification based on morpholo - 10. Nunn, JF. Ancient Egyptian Medicine. London: British Museum Press; 1996. 4 11. Rowling, JT. Pathological changes in mummies. Proc R Soc Med. 1961 gy and behaviour. May;54(5):409-415. 12. Nerlich, AG, Rohrbach, H, Bachmeier, B, Zink, A. Malignant tumours in two Conclusion ancient populations: an approach to historical tumour epidemiology. Oncol Rep. 2006 Jul;16(1):197-202. This brief look at the history of cancer from ancient Egypt 13. Perkins, GH, Middleton, LP. Breast cancer in men: treatment is based on results until the nineteenth century brings several facets about the extrapolated from trials for women with breast cancer. BMJ. 2003 Aug;327(2):239- 240. evolution of science to the fore (Figure 3 ). For one, it highlights 14. Weiss, L. Early concepts of cancer. Cancer Metast Rev. 2000 Dec;19(3-4): 205-217. how small additions to the overall body of knowledge can have 15. Lindberg, DC. The beginnings of western science: the European scientific tradition in philosophical, religious and institutional context. Chicago: University of Chicago exponential effects on eventual contributions – there is a clear Press; 1992. 113-119pp. advantage to the steady accumulation of medical knowledge 16. Kardinal, CG, Yarbro, JW. A conceptual history of cancer. Semin Oncol. 1979 over the centuries. The ideas of humoural imbalance and circu - Dec;6(4):396-408. 17. Lloyd, GER. The revolutions of wisdom: studies in the claims and practice of ancient lating toxic fluids, introduced by Hippocrates and Thiersch, for Greek science. Berkeley: University of California Press; 1989. 13-21 pp. example, still linger in contemporary theories of cancer. 53 18. Lloyd, GER. Magic, reason and experience: studies in the origins and development ot of Greek science. London: Gerald Duckworth & Co. Ltd., 1999. 15-29 pp. This article also demonstrates how scientific ideas are refined 19. Magner, LN. 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