How did people of ancient times treat the difficult and complex condition known today as cancer? In recent years, a rising number of scholars have taken a look at the prevalence of cancer diagnoses in ancient times. Though there is not much evidence to observe regarding ancient cancer diagnostics, there is enough to discuss potential approaches to curing the disease before the days of modern medicine.
16th century illustration of the four humors. Hippocrates believed that cancer was caused by an excess of black bile, one of the four. ( Public domain )
A History of Cancer Treatment: From Hippocrates to Oribasius
According to Papavramidou et al., the earliest mention of cancer in medical history occurs sometime around 1600 BC. At the time, the term karkinoma was used to describe incurable tumors that would arise in some patients. Hippocrates, the 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 physicians at that time believed in Hippocrates’ humoral theory, which stated that various diseases were caused by an excess of different amounts of bile. To Hippocrates and his surrounding physicians, cancer was caused by an “excess of black bile” in particular. Common treatments included bloodletting, laxatives, or a change in diet. There is no evidence of any surgical techniques to remove tumors at this point in history.
The works of Aulus Cornelius Celsus, a Roman physician and encyclopedist, came after Hippocrates between 25 BC and 50 AD. Celsus took Hippocrates’ term for the condition, carcinoma, and translated it into the Latin term for 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 below the armpit in some patients. He also established classification for different cancers based on their severity and their physical characteristics. He describes finding cancers on all parts of the body, including the face, mouth, throat, breast, liver, colon, and more.
Advancements in cancer treatment did not happen for several decades after Hippocrates and Celsus. Archigenes of Apamea, a Greco-Syrian physician in the 1st and 2nd Century AD, became the first recorded physician to attempt surgical removal of cancer on his patients. Oribasius, who described this method, stressed the importance of early diagnosis and how any nerves surrounding the tumor had to be moved out of the way. He also described early methods of cauterization in cases of hemorrhaging, as well as post-operative treatment to prevent infection including poultices, salt, leek, and other astringents.
Line engraving of Hippocrates. ( Wellcome Images )
Physicians and their Cancer Cures: From Galen to Aegineta
Claudius Galen, a Greek physician in the 2nd Century AD, furthered the mentality and treatments of Hippocrates and Archigenes of Apamea. Basing his ideas on Hippocrates’ humoral theory, he too agreed that cancer was caused by an excess of black bile. Specifically, he believed the black bile was being produced by the liver and ignored by the spleen, causing it to accumulate. Galen also originally believed that black bile led to incurable cancers while yellow bile led to curable cancers. This may be one of the earliest records of ancient physicians identifying differences between malignant and benign tumors.
Galen claimed to observe a significant number of cases of “excess black bile” causing cancer in the breast tissues of non-menopausal women. He details the removal process for these tumors, stating that he would excise the tumor and a bit of the surrounding area before cauterizing the roots of the tumor in an attempt to prevent it from growing back. However, he also notes the importance of early treatment with these tumors. Individuals with tumors would first be treated with purgatives in an attempt to rid the patient of black bile. Only if all other forms of treatment were exhausted would Galen turn to surgical removal as a final form of treatment.
Leonides of Alexandria, a Greek physician, lived in the same century as Galen. He frequently referenced Galen’s works in his own records and worked further with analyzing and treating various cases of breast cancer. More open to surgical methods than Galen, he believed in early operation as opposed to the last-ditch operations provided by Galen after other forms of treatment. His records describe some of the earliest full mastectomies in response to excessive breast cancer, usually in women.
Portrait of Galen ( CC by SA 4.0 )
However, Leonides also describes some more rare cases of breast cancer in men, as well as the various ways breast cancer may exhibit in different patients. He was the first to identify nipple inversion as a sign of breast cancer. Cauterization in his surgeries was mostly for preventing hemorrhaging but is also described as a method of eliminating any last traces of cancer on the torso after mastectomy. By fully cauterizing the area where the tumor and breast were removed from the torso, he believed this would eliminate the illness so it would not later return.
Finally, Paulus Aegineta, a 7th Century AD physician and encyclopaedist, further described findings in regards to cancer treatment. Aegineta mostly followed the teachings of Galen, choosing to believe that cauterization of the entire area caused more harm to the patient in the long term due to increased chances for infection and longer healing time. He believed that cancerous tumors that ulcerated (bulged out from the skin) needed to be removed via surgery, but that cauterization should only be used to lightly destroy the roots of the tumor.
Even in hemorrhaging, cauterization was used as little as possible in his surgical methods. Tumors that were not ulcerated (under the skin, or believed to be inside an organ such as the uterus) were too dangerous to be worked on and had too high of a mortality risk for Aegineta to justify surgical treatment. He, like Hippocrates and Galen, turned towards treatments that focused on expelling “black bile” to treat these patients.
As we can see, physicians in the centuries after Hippocrates, Archigenes of Apamea, and Galen continued to work using their methods. They continued to believe that black bile was the cause of these cancers (sometimes using foul-smelling excretions from the tumors as proof) and typically worked to advance their surgical techniques to remove tumors from different parts of the body. Most surgeries occurred only on tumors that were close to the surface and could therefore be seen with the naked eye. Because surgery deeper than this was deemed too dangerous and had high fatality rates, treatment for deeper or more widespread cancers did not become prevalent until the last few centuries.
12th century m ural painting showing both Galen and Hippocrates in Anagni, Italy. (Nina Aldin Thune / CC BY-SA 2.5 )
Understand Progress in Cancer Treatment Throughout History
Ultimately, the advancements in cancer treatment in ancient times are fascinating to observe. Internal treatments to cure a patient of “an excess of black bile” evolved into surgical treatments as physicians of ancient times continued to observe and analyze patients with different types of cancer. A focus on breast cancer is especially seen, likely because of the importance of breasts in ancient times to provide nourishment for babies and their perceived connection to childbirth and child-rearing.
The differences in perspectives over time are also interesting to note. Hippocrates and Celsus were the first to describe physical characteristics of tumors, such as their color, shape, and the presence of dark veins stemming from them (eventually leading to the term “cancer” due to the physical resemblance of crabs).
While Archigenes of Apamea originally made special note of the angiogenesis and vascularization of growing tumors (noted by his need to remove the “roots” of the tumor in surgery), Galen and Aegineta both turned to cauterization of these “roots” to prevent cancer regrowth. Leonides of Alexandria took this a step further, choosing to cauterize the entire area affected by the tumor to prevent regrowth, rather than focusing on specific spots.
Though we now know due to modern medicine that cancer is not caused by an “excess of black bile,” we also know that all of these early physicians were not completely wrong when it came to cancer treatment. Tumor excision and regrowth prevention are both essential aspects of treatment for cancer in modern times, though they are now more precise and at times less invasive. Even those that recommended improved diets were not completely wrong – though dietary changes are not a cure for cancer, maintaining a well-balanced diet and a healthy weight over time does reduce risks for developing cancer.
17th century illustration of a mastectomy. ( Public domain )
The Prevalence of Cancer in History
The number of cancer cases around this time was not specifically recorded. There is also little evidence of cancer found in early human remains. Though research continues, an article in Science explained that there have been few findings of malignancies out of tens of thousands of recovered ancient remains. This has led to some researchers believing that cancer was not as prevalent in ancient times as it is today. Potential reasons for this include increased carcinogen exposure, poorer diets, and decreased exercise in society in more recent years. Another consideration is that risk for cancer increases with age, meaning ancient peoples may not have lived long enough to get cancer in the first place.
However, not all researchers are convinced of this. As highlighted in a CNN article, many believe that cancer was just as prevalent in the past as it is today. Carcinogens certainly still existed back then, and exposure from various chemicals involved in building likely led to some cancer development. There is also the fact that surgery was often saved as a last resort in medical treatment. Cancers that did not “ulcerate” or become visible to the naked eye likely often went unnoticed by both patients and physicians.
Without modern diagnostic tools able to detect these deeper cancers, physicians went unaware of their existence unless they eventually grew large enough to ulcerate or an autopsy was later performed. However, autopsies were seldom performed in ancient times due to religious opposition towards them. Autopsies, they believed, unnecessarily mutilated the body and may prevent the deceased from reaching the afterlife.
The belief that cancer was not as prevalent in ancient times also does not take into consideration the number of human remains that are no longer able to be found or tested due to decomposition and/or destruction. Human remains that were not mummified or otherwise preserved are either unable to be found or are in so poor condition that testing for cancer presence is impossible. Between an inability to determine cancer diagnosis during life and an inability to test the body after death, the true number of cancer cases in ancient times may never be known.
Luckily, with modern abilities to scan for tumors in all parts of the body, cancer diagnoses are more accurate than ever before. Cultural and societal perception towards autopsies has also changed in many areas, leading to more willingness to determine causes of death in the deceased. With more medical tools and disease analysis, physicians can now learn more about the causes, behaviors, and effects of different types of cancers. In the future, we can only hope that this new diagnostic technology can also lead us to more efficient treatments and cures for this complex disease.
Top image: Common treatments for cancer included bloodletting. Source: Public domain
By Lex Leigh
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