History of Medicine
Concepts of Cancer from Antiquity to the Nineteenth Century
Margaret M. Olszewski, PhD (1T3), Faculty of Medicine, University of Toronto
Abstract
Theories about the origins of cancer and potential
treatments for the disease can be traced back to several
ancient papyri of Egyptian derivation that documented
palliative treatment and surgical removal of tumours.
In the Greco-Roman period, Hippocrates explained
cancer using his humoural theory, arguing that an
excess of black bile produced uncontrollable, crab-like
cell growths. This theory would dominate explanations
of cancer for the next millennia as it was promulgated
by Hippocrates’ successor Galen. While there were
some additions to the medicinal understanding of cancer in the Middle Ages, it was not until the nineteenth
century that microscopic work by German pathologists
including Müller and Virchow, identified the cellular
origins of cancer. This review considers some of the
major contributions to cancer research and care from
ancient Egypt until the nineteenth century and outlines the ways in which concepts of the disease have
changed with the advancement of medical knowledge.
Introduction
T
he history of cancer is a long and complicated one; Jacob
Wolff’s lengthy volume The Science of Cancerous Disease from
the Earliest Times to the Present is a testament to the disease’s
enduring and complex presence in medicine.1 Nonetheless,
there are a number of milestones in our current understanding
of the disease that can be traced from ancient times. This review
article attempts to highlight these milestones, focusing on specific contributions that can be viewed as signposts in our evolving concept of cancer. As a historical review, this piece is not
intended to provide a complete history of the disease. Notable
omissions include perspectives on cancer in the Arab world and
advances in cancer research in the twentieth century, topics that
would warrant their own reviews. Instead, this article points out
some important historical perspectives on cancer, how they have
evolved over time, and how they have set the stage for our modern understanding of the disease.
Ancient Egypt (3000 BCE – 500 BCE)
In ancient Egypt, magic and religion were strong influences
on medical practice.2 Priests were considered the ultimate caretakers of knowledge and it was thought that they received their
wisdom directly from the heavens. In light of these beliefs, cancer, as well as other diseases, were mainly viewed as direct consequences of the “will of the Gods.”3,4 Spiritual and mystical tendencies were especially evident in the disease treatment, which
was based on perceived causes. Conditions were treated according to their perceived cause. Pragmatic solutions were devised to
treat conditions with obvious causes, such as bone setting for
fractures and surgery for trauma, while magic was often
UTMJ • Volume 87, Number 3, May 2010
employed for conditions whose cause was less obvious, like in
the case of headaches, where some scribes recommended rubbing the head with the skull of a catfish, a treatment that followed the magical principle of “similia similibus” or like will be
cured by like.5 Egyptians thus interpreted physical conditions
within these parameters of belief.
It is generally accepted that the earliest known references to
cancer are found in the Edwin Smith Papyrus, an Egyptian text on
trauma surgery dated to 1600 BCE. Attributed to Imhotep, vizier,
architect, physician and astronomer to the Pharaoh Djoser (who
presumably composed the text in 2500 BCE; the extant text is a
copy), the historic collection of medical writings described fortyeighty traumatic surgical cases, eight of which dealt with what
modern physicians believe to be incidences of tumours or ulcers
of the breast.6 The following excerpt, describing the method of
diagnosing tumours of the breast, is taken from the text:
“... If you examine a man having bulging tumors on his
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
cool, there being no fever at all therein when your hand fells
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
have to content with’.” 7
This description itself is quite vague and perhaps, not surprisingly, it was common practice for a wide assortment of swellings,
whether simply inflammatory or cancerous, as well as chronic
ulcerations, to be classified as tumours during this period
because of the lack of understanding in human anatomy and
physiology.4 There were, however, distinctions made in treatment depending on the presentation of the tumour: red, warm
and pus-oozing masses were removed with cauterization using a
“fire drill,” while tumours that were cool to the touch and pusfree were to be left intact.8 One could also treat tumours with
external applications. A number of these treatments are
described in the Ebers Papyrus of about 1550 BCE. This text
contained a far more comprehensive collection of medical
remedies – over 876 in total – and mentions some 500 different
substances for the treatment of disease.9 One such palliative
approach for uterine cancer involved inserting a mixture of
fresh dates into the vagina to ease discomfort.10
While frequently cited in the literature on the history of cancer,
these interpretations of cancer in Egyptian texts should be viewed
cautiously, mainly because of the relative absence of tumours in
examined skeletal remains from the period, although some examples, like the discovery of an osteochondroma by Grafton Elliot
Smith and Warren Dawson, do exist.11 Nonetheless, up until 2006,
only about thirty-nine malignant tumours had been identified in
Egyptian skeletal remains dating from various periods and places
in Egypt, although this number has recently been increasing.12
Furthermore, scholars such as Leonard Weiss have had trouble
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 important when considered in light of recent increases in cancer incidence. 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
further epidemiological investigation.
Cancer in the Greco-Roman Period (500 BCE – 500 CE)
In the Classical Period, the Hippocratic School is thought to
be the first to document Greek ideas about cancer. Comprised
of some seventy books written by Hippocrates of Cos (460 BCE
– 370 BCE) and other contributing physicians, the Hippocratic
corpus was the first text to use the words karkinos and karkinoma
to describe a non-healing swelling or ulceration and malignant
non-healing tumour respectively. Hippocrates also introduced
the word scirrhus to describe hard tumours.4 These learned
Hippocratic writings differed considerably from the equivocal
descriptions of cancer in the Egyptian period primarily because
they were concerned with causation in health and disease and
were grounded in an Aristotelian framework of rational knowledge acquisition.15,16 They adopted a natural philosophical
approach to illness that was driven by a perceptible quest for a
naturalistic understanding of pathology and not just mystical
description. These writings contain a marked decrease in references to magical or supernatural exclamations of disease. Belief
in gods was still predominant but they were no longer considered to be the direct cause of disease.17,18
Imbalance of internal humours became the dominant explanation of disease in the Hippocratic era of medicine. The
humoural theory stated that the human body was made up of four
basic substances or humours: blood, phlegm, yellow bile and
black bile. Individuals were healthy when these four elements
were balanced but if there was too much of one element and not
enough of another, persons were ill.19 Each of the humours was
associated with a pair of qualities: hot, cold, wet and dry. Each
was also associated with a season and this lent many diseases a
seasonal quality; phlegm was cold and increased in the winter,
blood increased in the spring, yellow bile in the summer, and
black bile in the autumn (Figure 1). Physical examination was
also emphasized in the Hippocratic writings – physicians were
encouraged to take detailed case histories that looked for physical signs and symptoms, such as coughing, breathing and the
presence of tumours.20
Treatment of most diseases was aimed at restoring humoural
balance. For example, purging, laxatives, bloodletting, emetics,
diuretics and enemas were employed to rid the body of excess
humours. Preventive medicine in the form of advice on how to
ensure a complete diet, get adequate exercise and partake in
182
Figure 1. Hippocrates’s four humours (adapted from Magner, LN. A
history of medicine. New York: Marcel Dekker, Inc.; 1992. 71-74 pp.)
healthy sexual activity was commonplace. Hippocratic physicians
also recognized the natural healing process as critical in achieving optimum health. Diseases were themselves natural and it was
the physician’s responsibility to help nature achieve a cure.17
How did this approach to medicine influence the way in which
the Greeks interpreted cancer?21 The Hippocratic corpus contains eleven separate sections that approach the pathogenesis and
treatment of cancer. The clearest reference to cancer is found in
the fifth book of Epidemics: “a woman from Abdera developed
carcinoma on the breast, and through the nipple there was serosanguinous discharge; when the discharge ceased she died.”22
While this excerpt suggests that Hippocrates did not do much
about cancer, a number of other references throughout the corpus indicate he did in fact distinguish between superficial, malignant tumours that he called karkinoma apertus and deep tumours,
or karkinoma occlusus, that he considered the overall condition of
the patient before diagnosis and that he was aware that some cancers favoured either the male or female gender or the elderly.
According to Hippocrates, an excess of black bile or atrabilis was
the major cause of cancer.
If tumours were superficial, Hippocrates advised that they be
removed by excision; if they were occult or internal, it was best to
leave them alone; “It is better not to apply any treatment in cases
of occult cancer;” wrote Hippocrates, “for, if treated, the patients
die quickly; but if not treated, they hold out for a long time.”10 For
Hippocrates, cancer was a systemic disease and as such it was best
to let the disease take its course without surgery. While some
tumours could be treated with external ointments made from
copper, lead, sulphur or arsenic, this was not the first line of treatment.5 This limited knowledge of tumorous growths must be
viewed in light of the taboo surrounding human dissection. For it
was not until the third century BCE that human dissection was
allowed in Alexandria and even then it would soon become illegal
again under Roman law.23 As was the case in ancient Egypt, a limited understanding of human anatomy hindered research into
the pathophysiology of cancer and the primary explanation of the
disease was based on superficial observation and conjecture.
Little evidence survives about the history of cancer in the centuries that followed the flourish of Hippocratic medicine.
Although there is evidence to suggest that the Hippocratic
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
Aulus Cornelius Celsus (25 BCE – 50 CE). While not ostensibly
a physician, Celsus wrote profusely on medical topics and summarized advances made in Greek and Alexandrian medicine
during the rise of the Roman Empire in his text De Medicina.
This work is important as it is one of the only surviving texts to
provide a glimpse into medicine during this period.
A small portion of Celsus’ encyclopaedia describes cancer and
its treatment. According to Celsus, the organs most commonly
affected by cancer were the face, nose, ears, lips, and breasts of
women, as well as the liver and spleen.24 Tumours were difficult to
treat and it was advised that as soon as they were perceived, one
should use “caustic medicines” to cure them. Celsus was purportedly the first to classify breast cancer into four stages of progression: 1) cacoethes (early-stage tumour), 2) carcinoma without skin
ulceration, 3) carcinoma with ulceration, and, 4) “thymium,” an
advanced exophytic and sometimes bleeding lesion.25
Later in the period the work of Hippocrates was officially
revived and expanded by Galen of Pergamon (129 CE – 199
CE), the acclaimed physician and philosopher. Throughout his
lifetime, he wrote profusely on medical topics as diverse as
anatomy, physiology, and pathology. The knowledge contained
within these texts would dominate medical practice in the West
until the Renaissance. The basis of Galen’s approach was
grounded in the Hippocratic course. Galen added to this by performing limited anatomical experiments on animals.17 It has
been suggested that Galen modelled himself to be a “scientific
doctor” – that is, he used reason to localize disease. Rational and
regional concepts of disease were borne from Galen’s practice.26
Within this framework, Galen too contributed to knowledge
about cancer. Galen was the first to describe tumours using the
word “cancer” which derives from the Latin word “cancrum” or
crab, because he believed tumours had a characteristic crab-like
shape.4 This definition can be gleaned from one of his treatises,
“…and on the breasts we often saw tumours resembling exactly
the animal cancer. And just as the animal’s legs are on either
side of its body, so do the veins stretched by the unnatural
tumour resemble (the animal) cancer in shape.”22 He also introduced the term “sarcoma” to describe tumours that exhibited a
“fleshy” cross-sectional appearance.4
While remaining faithful to Hippocrates’s humoural theory,
Galen extended Hippocrates’ definitions of cancer and classified tumours into three major types (Figure 2).4,14
He argued that the humoural theory of cancer and argued
that the disease was metabolic and should be treated systemically
Tumores secondum
naturam (tumours
according to nature,
e.g., breast growth
during pubery)
rather than locally; cancer should be treated by attempting to
balance humours, using the same diet and purges that
Hippocrates advised, and to remove tumours surgically.27 An
illustrative description of one such cancer treatment is included
in one of Galen’s texts:
“If you attempt to cure cancer by surgery, begin by cleaning
out the melancholic tumor by cathartics. Make accurate incisions surrounding the whole tumor so as not to leave a single
root. Let the blood flow and do not check it at once, but make
pressure on the surrounding veins, so as to squeeze out the thick
blood. Then treat as in other wounds.”28
A skilled surgeon, Galen is supposedly also the first to have
used surgical sutures to stitch up wounds as well as ligatures to
tie off cut vessels and prevent further bleeding, innovations that
may have been inspired during his time as the official physician
for the Roman gladiators.4 Again, we see the importance of
observation in diagnosing tumours and in classification. Galen
built upon the knowledge base established by Hippocrates in
order to fine tune Roman ideas about cancer.
The Middle Ages (500 CE – 1450 CE) and the
Renaissance (1450 CE – 1600 CE)
A long period of medical stagnation followed the fall of the
Roman Empire in 476 CE. The Middle Ages witnessed a return
to the amulets, magical spells and other superstitions that dominated medicine in the time of the Pharaohs. This regression was
largely due to the fact that before the founding of independent
universities in Europe between the tenth and thirteenth centuries, scholarship was restricted to a small array of medieval
monastic orders. However, before the Renaissance, the major
medicinal text to survive the Middle Ages was the work of Galen,
which had been transcribed and translated by Arabic scholars.
As a result, Galenic-cum-Hippocratic humoural theories were
resurrected in the Middle Ages and would influence how physicians treated and viewed cancer up until the last part of the seventeenth century.4
In the late medieval period, there was a return to using the
term cancer rather broadly to describe a range of afflictions,
including swellings, gangrenes, tumours, abscesses, and herpes
sores. A more concrete definition was provided by Guy de
Chauliac (1300-1370), the learned French surgeon, who defined
cancer as “a hard, round, veined, darkish, fast-growing, restless,
warm and painful tumour.”14,29,30 As Luke Demaitre has observed,
Tumores supra naturam
(tumours above nature,
e.g., abscesses and
inflammations)
Tumores praeter
naturam (tumors
beyond nature)
Onkoi (lumps or
masses)
Karkinos (malignant
ulcers)
Karkinomas
(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
and Greek ideas of temperature and spreading humours, an
observation that supports the conclusion that older HippocraticGalenic ideas still dominated cancer aetiology in the Middle
Ages.31 Similarly, Egyptian ideas of cancer “eating” and “gnawing”
the flesh continued to be used by some, such as Henri de
Mondeville (1260-1320), another French surgeon.31 De
Mondeville did considerable work on concepts of cancer in this
period. He specified the humoural theory of cancer by differentiating between black bile produced in the liver, which he
thought contributed to hard tumours in the breast, and black
bile produced as the breakdown product of the three other
humours, which resulted in what he considered true cancer. As
with Galen, de Mondeville recommended diet and purging to
redress humoural imbalance, as well as the extirpation of
tumours.25
A review of the dominant medical texts of the period, including
de Chauliac’s and de Mondeville’s, indicates that black bile was
still thought to be the primary cause of cancer. The humour
became problematic when it was improperly cooked or burned, a
process which made it thick and stagnant and incapable of being
expelled from pores or in the blood. Breast cancer was common
in light of this belief because menstruation prevented women
from properly cleansing their blood of black bile.31
In the Renaissance, there was efflorescence in all areas of
human life, including the arts, literature and medicine. A
renewed interest in the pursuit of intellectual activity and the
opportunity to explore the natural world unhindered by
medieval mores allowed those who studied medicine to rethink
accepted traditions.16 There was also a transition from
Aristotelian-Galenic rationalism, based on metaphysical analysis,
to Baconian-Newtonian empiricism, which took experiment as its
starting point. The work of Andreas Vesalius (1514-1564), especially his De Humani Corporis Fabrica (1543), and the critical
approach to anatomy contained within it, would throw the longrevered definitions of Galen into question. Vesalius’s dissections
of human cadavers would for the first time demonstrate the
errors of Galen’s hypotheses, as these were originally based on
the anatomy of apes and pigs, not humans.32 Others too, like the
alchemist Theophrastus Paracelsus (1493-1541), were brazen
enough to attempt to overthrow Galen’s humoural theory, even
though Paracelsus’ own theory of cancer – that it occurred
because of excess mineral salt in the blood – was itself magical
and imprecise.1
The Seventeenth and Eighteenth Centuries
In the Age of Reason, thoughts about the origin of cancer
shifted away from the humoural theory toward the lymph node
origin of the disease. The French philosopher and physician
René Descartes (1596-1650) was the first to propose the lymph
theory of cancer.16,33 Among the proponents of this idea was
Henry François le Dran (1685-1770), a Parisian surgeon who in
1757 argued that certain cancers, such as breast cancer, spread
not by humours but by the lymphatic system. According to le
Dran, tumours began in localized areas. The disease was then
transported to regional lymph nodes and eventually produced
systemic disease throughout the body.34 In order to prevent
spread, le Dran recommended complete excision of tumours as
well as nearby lymph nodes. Le Dran’s contributions were made
possible thanks in large part to the incremental discoveries
made in the science of the human body. The Italian anatomist
184
Gasparo Aselli (1581-1626), for example, discovered the lymphatic system in 1622, while William Harvey (1578-1657)
described the circulation of blood in 1628.35,36
The eighteenth century is particularly interesting for its many
contributors to cancer epidemiology. In the 1700s, curious
physicians and men of science documented numerous links
between cancer and certain occupational and lifestyle choices.
In 1713, for example, Bernardini Ramazzini (1633-1714), professor of medicine at the University of Padua, wondered about
the high rates of breast cancer and the virtual absence of cervical cancer in nuns. He concluded that the population’s celibate
lifestyle must be the cause of the disease, suggesting that lack of
sexual intercourse diminishes “disturbances in the uterus.
Cancerous tumours are [then] very often generated in the
woman’s breast.”37 In 1761, the English physician John Hill
(1714-1775) observed that snuff users were more prone to developing nasal cancer, an observation considered by some the first
acknowledgment of external carcinogenesis.38,39 In 1775, British
surgeon Percival Pott (1714-1788) described an association
between scrotal cancer and the chimney sweep occupation, presumably the first documented case of occupational cancer.40
With the acceptance of human autopsy, a practice outlawed in
earlier times for reasons of religion and decorum, the gross
pathology of cancer could for the first time be observed without
criticism.41,42 In 1761, Giovanni Battista Morgagni (1682-1771)
laid the foundations of scientific oncology with the publication of
his On the Sites and Causes of Disease, a landmark text considered
the first example of modern pathology.16 In this work, Morgagni
described cancers of the breast, stomach, rectum and pancreas
based on findings compiled from 700 autopsies, a remarkable
feat made possible by the loosening of societal strictures on
human dissection. His observations inspired him to be the first to
attempt to disprove the Cartesian lymphatic theory with experimental findings.32 The study of cancer as an independent disease
with its own symptoms and treatments was enforced by the founding of the first institutions set up to treat and research the disease. The eighteenth century welcomed the first cancer hospital,
LaLutte Contre Le Cancer, which was founded in Rheims, France
in 1740, and the first cancer institute, where studying the natural
history of cancer was the primary cause, which was opened in
Middlesex, England in 1792.43 In addition to suggesting the rising importance of cancer study, the ways in which these institutions were managed illustrates some noteworthy eighteenth-century cancer concepts. LaLutte Contre Le Cancer, for example,
was moved away from the centre of Rheims in 1779 because it was
presumed that cancer was a contagious disease.16
The Nineteenth Century
In the nineteenth century, there was a marked shift away from
the humoural theory of cancer to a cellular theory of the disease. This was made possible by improvements in scientific technology, namely the light microscope.44 Invented by H. Jansen in
the late sixteenth century, and used remarkably by Antony van
Leeuwenhoek (1632-1723) and Robert Hooke between 1665
and 1678 to identify microorganisms, the light microscope was
improved further by Charles Chevalier in 1824 allowing clearer
visualization of microscopic specimens.45,46 Johannes Müller
(1801-1858), German physiologist and comparative anatomist,
was among the first to observe cancerous tissue under the
improved achromatic lens of the new microscope. In 1838, he
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 confirmed the cellular heritage of cancer, from his observations he
extrapolated what became known as the blastema theory of cancer, which stated that tumours originated from a primitive body
fluid or blastema by intracorporeal generation or crystallization
and not other cells.48 Blastemas were undifferentiated cell-like
fluids that originated between tissues that made up an organ,
exuded from the blood and could develop into any tissue.1 This
theory clearly echoed the ancient beliefs of Hippocrates’
humours, but nonetheless it found its champions in nineteenthcentury medical men, including Julius Vogel (1835-1899), who
expanded the theory in 1845 by proposing that each tissue had
its own blastema (the law of analogous blastemas).16 However,
some were still reluctant to accept that cancer developed from a
mysterious component of the blood.
One of Müller’s students, the German physician and pathologist Rudolf Virchow (1821-1902), would provide the evidence
needed to disprove this accepted truth. Using his principle of
cellular pathology, which stipulated that the cell was the smallest
unit in which disease could be located, Virchow conducted
pathological examinations of histological samples and concluded that cancer arose in cells and not from body fluids or fibres.49
Virchow’s revolutionary aphorism omnis cellula a cellula or “all
cells are derived from cells” opposed the idea of spontaneous de
novo generation and asserted that tumours did not develop from
blastemas but from cells. In 1858, Virchow published his seminal
text Die Cellula Pathologie in which he described the microscopic
The Edwin Smith
Papyrus describes 48
traumatic surgical
cases, 8 of which are
believed to be cases
of breast tumours.
Galen popularizes Hippocrates’
humoural explanation of cancer.
He classifies tumours into three
main types.
Hippocrates explains
cancer using his humoural
theory. He believes that an
excess of black bile or
atrabilis leads to the
development
of tumours.
p
2500 BCE 1500 BCE 400 BCE 50 CE
Bernardini Ramazzini suggests a link
between abstinence and high rates of
breast cancer/low rates of cervical cancer
based on his observations of nuns.
Galen’s interpretation of cancer,
favoured since its introduction, is
slowly overturned by the work of
Andreas Vesalius, who publishes
De Humani Corporis Fabrica, and
other Renaissance thinkers.
199 CE
Aulus Cornelius Celsus
recommends caustic medicine
and cauterisization as treatment
from cancerous tumours.
The Ebers Papyrus
recommends the use of a
mixture of dates and other
natural substances to treat
tumours in the uterus.
details of cancer and highlighted the potential for the disease to
be diagnosed using microscopic analysis of pathological tissue.50
He proposed that cancer cells were generated by either one of
two methods: 1) a hereditary or constitutional predisposition or
2) from chronic cellular irritation.16 Despite these revolutionary
claims, Virchow still believed that cancer was spread by a liquid,
rather than by malignant cells.51 In 1865, the German surgeon
Karl Thiersch (1822-1925) disproved this idea by studying metastasizing epithelial tumours of the skin. Based on serial sectioning techniques, Thiersch concluded that malignant cells in
lymph nodes reached secondary sites by cellular embolism; toxic
fluids were released from malignant growths but cells were ultimately responsible for spread of the disease.52 Karl von
Rokitansky (1804-1878) identified the two main cellular components of cancer to be the cancer mass or parenchyma, composed
of nuclei and nucleated cells, and the framework or stroma,
which was not considered neoplastic. The qualities of these two
components determined the type of cancer; if the stroma was
predominantly made of fibered trabeculae what was known as a
fibrous cancer developed while a medullary or gelatinous cancer
formed when the parenchyma predominated.1 The work of
Müller, Virchow and Rokitansky would formulate modern classifications of tumours used in cancer pathogenesis, i.e., the type
of cell that composes the tumour, e.g., epithelial or mesenchymal, and whether the tumour is benign or malignant.3 As
George Diamanopoulos has observed, this system of classification is strikingly similar to the ancient frameworks established by
1300-1370
1543
1600
Giovanni Battista Morgagni
records anatomical
observations of human
cadavers. John Hill remarks
on the relationship between
f and nasal cancer.
snuff
1713
Rene Descartes proposes
the lymph theory of cancer.
Guy de Chauliac defines cancer as “a hard, round, veined,
darkish, fast-growing, restless, warm and painful tumor”
during a period in medical history when the word was
used quite liberally to describe a range of inflammations.
Henri de Mondeville distinguishes between the different
types of bile that can produce cancer.
The first cancer institute opens
in Middlesex, United Kingdom.
1740
1761
1775
Rudolf Virchow disproves the
blastema theory and confirms
that cancer develops from
pre-existin
p
g cells.
1792
Percival Pott describes an
association between
scrotal cancer and the
chimney sweeps.
The first cancer hospital
opens in Rheims, France.
1838
1858
1865
Karl Thiersch establishes that cancer
is spread by malignant cells.
Johannes Mülller observes
cancerous tissue under a
microscope for the first time.
Based on his observations, he
postulates the blastema theory
of cancer.
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 morphology and behaviour.4
Conclusion
This brief look at the history of cancer from ancient Egypt
until the nineteenth century brings several facets about the
evolution of science to the fore (Figure 3). For one, it highlights
how small additions to the overall body of knowledge can have
exponential effects on eventual contributions – there is a clear
advantage to the steady accumulation of medical knowledge
over the centuries. The ideas of humoural imbalance and circulating toxic fluids, introduced by Hippocrates and Thiersch, for
example, still linger in contemporary theories of cancer.53
This article also demonstrates how scientific ideas are refined
by improvements in scientific method and scientific technology.
Revolutions in thought following the stagnancy of the Middle
Ages facilitated a greater emphasis on observing the human
body at the gross anatomical level. This allowed individuals like
Paracelsus and Descartes to propose alternative theories of cancer origin that opposed the long accepted humoural theory
established by Hippocrates and Galen. Enhancing the human
senses to be able to visualize the microscopic transformed
understanding of cancer pathology. In the nineteenth century,
the improvement of the microscope, for example, allowed scientists like Müller and Virchow to conclude that tumours were
in fact made of cells and not lymph or bile.
A number of common themes weave throughout these earlier
concepts of cancer. The idea that cancer was transported in the
body within some sort of fluid, be it black bile, lymph or Virchow’s
toxic liquid, is one such theme. The humoural theory, lymph theory and blastema theory share this tenet. This belief facilitated the
notion that cancer was a systemic disease because the fluid
allowed it to be transmitted to the entire body. Similarly, there are
themes in cancer treatment. Surgical removal of cancer was common in all periods from ancient Egypt to the nineteenth century.
We also see how social norms, such as the prohibition of human
dissection, have shaped the ways in which science is made.
Modern cancer research too has been affected by accretions
in knowledge, advances in practice and technology and these
common themes. In the twentieth century, these preliminary
advances have been taken even further with the ability to see
beyond the cell and into the genome. Thus, we can conclude
that modern theories of cancer and our current understanding
of the disease have benefitted from these past theories by building on the knowledge they embodied and by using them as the
foundations for contemporary concepts of cancer.
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