(ORDO NEWS) — How did the people of antiquity relate to such a difficult and complex disease, known today as cancer?
In recent years, an increasing number of scientists have paid attention to the prevalence of cancer diagnoses in antiquity.
Although there is not much evidence for the diagnosis of cancer in antiquity, there is enough evidence to discuss possible approaches to the treatment of this disease before the advent of modern medicine.
History of Cancer Treatment: From Hippocrates to Oribasius
According to Papavramidou et al., the earliest mention of cancer in the history of medicine dates back to 1600 BC. At that time, the term “carkinoma” was used to describe incurable tumors that occur in some patients.
Hippocrates, a Greek physician known as the father of medicine (460 – 370 BC), was the first to record observations of these tumors and give them a name.
Other doctors of that time believed in the humoral theory of Hippocrates, which said that various diseases are caused by an excess of different amounts of bile.
According to Hippocrates and his entourage, cancer, in particular, was caused by “an excess of black bile.” Common treatments included bloodletting, laxatives, or dietary changes. At this stage in history, there is no evidence of surgical methods for removing tumors.
The works of Aulus Cornelius Celsus, a Roman physician and encyclopedist, appeared after Hippocrates between 25 BC. and 50 AD Celsus took the Hippocratic term for the disease, carcinoma, and translated it into the Latin term crab, which we now know as cancer.
He was the first to record his observations of the spread of cancer, even once describing how breast cancer can spread from the breast to the armpit in some patients.
He also created a classification of different types of cancer based on their severity and physical characteristics. He described finding cancer on all parts of the body, including the face, mouth, throat, chest, liver, colon, and more.
Progress in cancer treatment did not occur until several decades after Hippocrates and Celsus. Archigenes of Apamea, a Greek-Syriac physician of the 1st and 2nd centuries AD, became the first recorded physician to attempt to surgically remove cancer from his patients.
Oribasius, who described this method, emphasized the importance of early diagnosis and that all nerves surrounding the tumor should be removed. He also described early methods of cauterization in cases of bleeding, as well as postoperative treatments to prevent infection, including poultices, salt, leeks, and other astringents.
Doctors and their cancer treatments: From Galen to Aeginetus
Claudius Galen, a Greek physician of the 2nd century AD, continued the teachings and methods of treatment of Hippocrates and the Archigen of Apamea. Basing his ideas on the humoral theory of Hippocrates, he also agreed that cancer was caused by an excess of black bile.
In particular, he believed that black bile was produced by the liver and ignored by the spleen, leading to its accumulation. Galen also originally believed that black bile led to incurable cancers and yellow bile to curable ones. This may be one of the earliest records of ancient physicians distinguishing between malignant and benign tumors.
Galen claimed to have observed a significant number of cases where “excess black bile” caused cancer in the breast tissue in premenopausal women. He details the process of removing these tumors, indicating that he cuts out the tumor and some of the surrounding area, and then cauterizes the roots of the tumor in an attempt to prevent it from growing back.
However, he also notes the importance of early treatment of these tumors. At first, patients with tumors were treated with cleaning products in an attempt to rid them of black bile. Only if all other forms of treatment had been exhausted would Galen resort to surgical removal as the final form of treatment.
Leonidas of Alexandria, a Greek physician, lived in the same century as Galen. He frequently referred to Galen’s work in his own notes, and went on to analyze and treat various cases of breast cancer.
More open to surgical methods than Galen, he believed in early surgery, as opposed to the latter surgery that Galen performed after other forms of treatment. His notes describe some of the earliest total mastectomies in response to extensive breast cancer, usually in women.
However, Leonides also describes some of the rarer cases of male breast cancer, as well as the different ways breast cancer manifests in different patients. He was the first to identify nipple inversion as a sign of breast cancer.
Cauterization in his surgeries was done mainly to prevent bleeding, but is also described as a method of removing the last traces of cancer on the torso after a mastectomy. By completely cauterizing the area where the tumor and mammary gland had been removed from the torso, he believed that this would eliminate the disease so that it would not return later.
Finally, Paulus Aegineta, physician and encyclopedist of the 7th century AD, described further findings regarding the treatment of cancer. Aegineth basically followed the teachings of Galen, believing that cauterizing the entire site causes more harm to the patient in the long run due to an increased chance of infection and a longer healing time
He believed that cancerous tumors that ulcerate (protrude from the skin) should be surgically removed, but cauterization should only be used to easily destroy the roots of the tumor.
Even with hemorrhages, cauterization was used as sparingly as possible in his surgical methods. Non-ulcerated tumors (under the skin or presumably inside an organ such as the uterus) were too dangerous to work with and had too high a mortality risk for Aegineth to justify surgical treatment. He, like Hippocrates and Galen, turned to therapies aimed at expelling “black bile” to treat these patients.
As we can see, doctors in the following centuries after Hippocrates, Archigen of Apamea and Galen continued to work using their methods. They continued to believe that black bile was the cause of cancer (sometimes using secretions from malodorous tumors as evidence) and generally worked to improve surgical techniques for removing tumors from various parts of the body.
Most operations were performed only on those tumors that were close to the surface and therefore visible to the naked eye. Because deeper surgeries were considered too dangerous and had a high mortality rate, treatment for deeper or more advanced cancers has only become common in the last few centuries.
Understanding progress in cancer treatment throughout history
Ultimately, the progress in cancer treatment in ancient times is exciting to watch. Internal procedures aimed at curing the patient of “excess black bile” became surgical as ancient physicians continued to observe and analyze patients with various types of cancer.
The focus on breast cancer is particularly notable, probably due to the importance of the breast in ancient times for the nutrition of infants and its alleged connection with childbirth and child rearing.
It is also interesting to note the difference in views on the problem over time. Hippocrates and Celsus were the first to describe the physical characteristics of tumors, such as their color, shape, and the presence of dark veins running from them (which eventually led to the term “cancer” due to their physical resemblance to crabs).
Whereas Archigenes of Apamea initially paid special attention to the angiogenesis and vascularization of growing tumors (which was marked by his need to remove the “roots” of the tumor during surgery), Galen and Aeginet turned to cauterization of these “roots” to prevent the re-growth of the cancer.
Leonidas of Alexandria took it one step further by deciding to cauterize the entire area affected by the tumor to prevent it from growing, rather than focusing on specific locations.
While we now know, thanks to modern medicine, that cancer is not caused by “excess black bile,” we also know that all of these early doctors were not completely wrong when it came to treating cancer.
Excising a tumor and preventing its recurrence are integral aspects of cancer treatment today, although they have now become more precise and sometimes less invasive.
Even those who recommended improved diets weren’t completely wrong – while dietary changes are not a cure for cancer, maintaining a balanced diet and a healthy weight over time reduces cancer risk.
Prevalence of cancer in history
The number of cases of cancer during this time was not specifically recorded. There is also little evidence of cancer found in early human remains. Although research is ongoing, an article in the journal Science explains that of the tens of thousands of ancient remains found, few malignant tumors have been found.
This has led some researchers to believe that cancer in ancient times was not as common as it is today. Potential reasons for this include increased exposure to carcinogens, poorer diets, and reduced physical activity in society in recent years.
Another reason is that the risk of cancer increases with age, which means ancient people might not have lived long enough to get cancer in the first place.
However, not all researchers are convinced of this. As noted in the CNN article, many believe that cancer was as common in the past as it is today.
Carcinogens certainly existed at that time, and exposure to various chemicals used in construction likely led to the development of cancer. There is also the fact that surgery was often used as a last resort. Cancers that did not “ulcerate” and were not visible to the naked eye often went unnoticed by both patients and doctors.
Without modern diagnostic tools to detect these deeper cancers, doctors remained unaware of their existence until they were large enough to ulcerate, or until an autopsy was performed. However, autopsies were rarely performed in ancient times due to religious opposition. They believed that an autopsy unnecessarily disfigures the body and can prevent the deceased from entering the afterlife.
The belief that cancer was not so common in ancient times also fails to take into account the number of human remains that can no longer be found or verified due to decomposition and/or destruction.
Human remains that have not been mummified or otherwise preserved are either impossible to find or in such poor condition that testing for cancer is not possible. Due to the inability to determine a diagnosis of cancer during life and the inability to test the body after death, the true number of cases of cancer in ancient times may never be known.
Fortunately, with modern scanning capabilities for tumors in all parts of the body, cancer diagnosis is more accurate than ever before. Cultural and societal attitudes towards autopsies have also changed in many areas, leading to a greater willingness to determine the causes of death of the deceased.
With better medical tools and disease analysis, doctors can now learn more about the causes, behaviors, and consequences of various types of cancer. In the future, we can only hope that new diagnostic technologies will also lead us to more effective treatments and cures for this complex disease.
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