a brief history of cancer
Literary evidence collected from antiquity is an immensely valuable tool for classicists and archaeologists, however, great care and knowledge is required to genuinely understand the author’s meaning. Literary evidence consisting of medical knowledge was often limited to external observation of rare cases. Through careful analyses of literary texts, we can begin to understand the particulars of each described disease, the perspectives of the medical professionals at the time, and the manner in which affected individuals were treated (in both social and medical contexts). Ancient written accounts of medical information often included prescriptions for treatments. In some cases of illness that were not well understood by ancient medical practitioners, patients were given magical treatments and/or were given palliative care.
The concept of cancer as a specific disease is a relatively recent development, however, ancient descriptions of illnesses with symptoms strongly correlated with cancer can suggest the presence of malignancy in some cases. The Egyptian Ebers and Edwin Smith papyri are the earliest known records of suspected cancer in the ancient world. They both date to the early Eighteenth Dynasty (1550-1504 BC), but are most likely copies of earlier medical treatises from the Old Kingdom (c. 2600-2190 BC). The Greek scholar, Herodotus, later described a case of breast cancer in Persia that occurred around 520 BC. Other ancient scholars, such as Hippocrates, Aetius, Celsus, Dioscorides, Galen, and Paul of Aegina all wrote small treatises on cancer, containing information ranging from suspected causes of cancer to treatment and prevention strategies. The medical works of these early physicians date from the third century BC to the seventh century AD. Avicenna (980-1037 AD), a prominent Islamic physician of Persian origin, gave a detailed description of cancer symptoms, and treatments and prevention strategies in his work Canon of Medicine, which continued to be an authoritative medical reference until the late eighteenth century. Although these literary works are important sources of information on the history of cancer, they should be consulted within the context of the medical philosophies of the time and region.
Our modern perception is that cancer is caused by external sources such as environmental carcinogens, and internal sources like hereditary elements. In reality, the specific cause of most cancers is still largely a mystery. Hippocrates, also known as the ‘father of medicine’, was the first to publicly dispel the notion that diseases were caused by supernatural elements. Although his understanding of anatomy and physiology was limited, Hippocrates’ detailed descriptions of medical symptoms included observable diagnostic features indicative of some types of cancer. In addition to Hippocrates’ contribution to diagnostic methods, the Hippocratic Oath, a code of medical ethics, is still taken by medical practitioners to this day.
Following Hippocrates’ method for medical observation, ancient physicians made attempts to understand the causes of tumors, swellings, and other abnormal growths by conducting their own research through trial and error. Greek physician, Galen, believed that ‘residues of black bile formed in the liver during hematosis’, and an excess of black bile (one of the four humors, or bodily substances) resulted in the development of cancer. He believed that black bile was created when the liver was weak, and during this process the spleen attracted a large amount of thick black blood. This blood would accumulate in the veins and manifest in the formation of a tumor with projections like the legs of a crab. It is from this description of malignant tumors that malignant neoplastic disease was named after the Latin word for crab, cancer. Later physicians, who largely adopted the concept of humoral imbalance as a cause of disease, adhered to Galen’s philosophy of cancer until the dark ages.
A text in the Hippocratic tradition, ascribed to an unidentified author, suggested that breast cancer was linked to the absence of menstruation after menopause. According to this text, blood that normally flowed free every month stagnated in the body, and migrated to the breast tissue. Stagnated blood was often interpreted as black bile. This account indicates that Hippocratic physicians were aware that breast cancer, much like today, occurred in older women more often than younger women.
There is some question as to whether ancient physicians associated, or confused, injuries with the development of cancer. For example, were injuries involving internal bleeding believed to contribute to cancer? Also, if a person died from such an injury, would this have been attributed to an excess of black bile, and thus cancer? It is possible that some ancient accounts of cancer may, in reality, refer to infection resulting from injury.
A recent study claiming that cancer is primarily a modern disease is based on two major assumptions. The first assumption is that incidence of cancer has risen since antiquity. The second is that modern societies have contributed to a rise in cancer-causing pollution, and have thus made our proverbial ‘bed’ on which we must lie. These assumptions rely on an even more questionable premise that the ancient environment was free of carcinogens, though it has been argued that man-made pollution, and carcinogens, began with the domestication of fire (Nriagu, 1986). Additionally, many carcinogens are found in nature, such as tannins, radon gas, ultraviolet light, and solar radiation, and thus humans have been in regular contact with known carcinogens throughout human history.