How did ancient people handle the challenging and intricate ailment known as cancer? A growing number of academics have recently examined the frequency of cancer diagnosis in ancient times. Even if there isn’t much data on ancient cancer diagnoses, there is still enough to talk about potential treatments for the condition before the advent 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
The first time cancer is mentioned in recorded medical history is, according to Papavramidou et al., sometime about 1600 BC. The term “karkinoma” was then used to refer to certain patients’ developing incurable tumors. The first person to observe and name these tumors was the Greek physician Hippocrates (460–370 BC), who is regarded as the father of medicine.
Hippocrates’ humoral theory, which held that various ailments were brought on by an excess of varying amounts of bile, was accepted by other doctors at the time. Hippocrates and the physicians around him believed that an “excess of black bile” in particular was the cause of cancer. Bloodletting, laxatives, or dietary changes were common therapies. At this time in history, there is no evidence of any surgical procedures to eliminate tumors.
After Hippocrates, between 25 BC and 50 AD, the works of Aulus Cornelius Celsus, a Roman physician and encyclopedian, appeared. Celsus translated the condition’s name from Hippocrates, carcinoma, into the Latin word for crab, which is now known as “cancer.” He was the first to document his findings on the spread of cancer, once going so far as to explain how, in some people, breast cancer can move from the breast to below the armpit. Additionally, he created classifications for various cancers based on their physical traits and severity. He talks of discovering malignancies on every area of the body, including the breast, liver, colon, face, mouth, and more.
After Hippocrates and Celsus, advancements in the treatment of cancer did not occur for some decades. In the first and second centuries AD, a Greco-Syrian physician named Archigenes of Apamea made history as the first doctor to try surgical eradication of cancer from his patients. Oribasius, who described this procedure, emphasized the significance of an early diagnosis and the need to clear any obstructions from any nearby nerves. He also discussed early cauterization techniques for bleeding situations, as well as post-operative care that included poultices, salt, leeks, and other astringents to prevent infection.
Line engraving of Hippocrates. ( Wellcome Images )
Physicians and their Cancer Cures: From Galen to Aegineta
A Greek physician named Claudius Galen advanced the theories and medical practices of Hippocrates and Archigenes of Apamea in the second century AD. Based on Hippocrates’ humoral hypothesis, he concurred that an excess of black bile was the cause of cancer. In particular, he thought that the spleen ignored the black bile, which was being created by the liver and causing it to build up. Galen initially held the view that yellow bile caused curable tumors whereas black bile caused incurable tumors. This may be one of the oldest examples of ancient doctors distinguishing between benign and malignant tumors.
Galen asserted to have seen numerous instances of “excess black bile”-induced breast cancer in non-menopausal women. He describes how to remove these tumors, saying that he would first cut off the tumor and some of the surrounding tissue before trying to stop it from coming back by cauterizing the tumor’s roots. He does emphasize the significance of early therapy for these malignancies though. To try to get rid of the patient’s black bile, purgatives were first used to treat those with malignancies. Galen would only resort to surgical removal as a last resort after trying every other therapy option.
Galen and the Greek physician Leonides of Alexandria both flourished in the same century. He regularly used Galen’s writings in his own records and continued to investigate and treat numerous breast cancer cases. He was more receptive to surgical techniques than Galen and advocated early surgery as opposed to Galen’s last-ditch surgeries used as a final resort. In reaction to excessive breast cancer, typically in women, his records detail some of the early full mastectomies.
Portrait of Galen ( CC by SA 4.0 )
However, Leonides also discusses a few more uncommon examples of breast cancer in males as well as the numerous symptoms that different people with breast cancer may have. He was the first to recognize nipple inversion as a breast cancer warning sign. Cauterization was mostly used to stop bleeding during his operations, but it was also presented as a way to get rid of any remaining cancer following a mastectomy on the torso. He believed that by completely cauterizing the region where the tumor and breast were removed from the torso, the sickness would be eradicated and would not subsequently recur.
Last but not least, Paulus Aegineta, a physician and encyclopaedist who lived in the 7th century AD, provided additional information on cancer therapy findings. Aegineta mostly adhered to Galen’s beliefs, choosing to think that cauterizing the entire area really did more long-term injury to the patient because it raised the risk of infection and prolonged the healing process. He believed that cauterization should only be used to sparingly eliminate the tumor’s roots and that surgery was necessary to remove cancerous tumors that ulcerated (bulged out from the skin).
His surgical techniques used cauterization as little as possible, even in cases of hemorrhaging. The risk of mortality was too great for Aegineta to justify surgical treatment for tumors that were not ulcerated, under the skin, or thought to be inside an organ, such as the uterus. In order to treat these patients, he, like Hippocrates and Galen, turned to therapies that centered on releasing “black bile.”
As we can see, physicians carried on employing their techniques centuries after Hippocrates, Archigenes of Apamea, and Galen. They persisted in their belief that these cancers were caused by black bile (sometimes citing the unpleasant excretions from the tumors as proof) and usually strived to improve their surgical methods to remove tumors from various regions of the body. The majority of operations were only performed on tumors that were visible to the human eye and were consequently near to the surface. Treatment for deeper or more widespread cancers did not become widely used until the previous few centuries because surgery deeper than this was thought to be excessively risky and had high death rates.
12th-century mural painting showing both Galen and Hippocrates in Anagni, Italy. (Nina Aldin Thune / CC BY-SA 2.5 )
Understand Progress in Cancer Treatment Throughout History
The development of cancer treatment in antiquity is ultimately fascinating to observe. As ancient doctors continued to examine and study patients with various types of cancer, internal remedies to relieve a patient of “an excess of black bile” gave way to surgical treatments. There is a particular focus on breast cancer, maybe as a result of the perception that breasts are associated with birthing and raising children as well as their historical significance as a source of nutrition for infants.
It’s also interesting to examine how perspectives change throughout time. The physical characteristics of tumors, such as their color, shape, and the existence of dark veins emanating from them, were first described by Hippocrates and Celsus. This description later gave rise to the term “cancer” because of the tumors’ resemblance to crabs.
While Archigenes of Apamea was the first to make a special note of the angiogenesis and vascularization of developing tumors (noted by his need to surgically remove the tumor’s “roots”), Galen and Aegineta both turned to cauterization of these “roots” to stop cancer from returning. In order to prevent regrowth, Leonides of Alexandria went one step further and decided to cauterize the entire tumor-affected area rather than just a few selected places.
Even though modern medicine has taught us that cancer is not brought on by a “excess of black bile,” we also know that these early doctors were not entirely mistaken when it comes to cancer treatment. Today’s cancer treatments are more targeted and occasionally less invasive, but tumor excision and regrowth prevention are still crucial components. Even those who advocated for better diets weren’t entirely off the mark; while dietary modifications cannot cure cancer, they can lower the risk over time by helping people to maintain a well-balanced diet and a healthy weight.
17th-century illustration of a mastectomy. ( Public domain )
The Prevalence of Cancer in History
There was no particular count of cancer cases during this time period. Early human remains have very occasionally been found to have cancerous tissue. Though study is ongoing, a Science article revealed that just a small number of cancers have been discovered out of the tens of thousands of retrieved ancient remains. Because of this, some academics now think that cancer was less common in ancient times than it is now. Increased exposure to carcinogens, worse diets, and a decline in exercise in recent years are some possible causes of this. Another factor to take into account is the fact that cancer risk rises with aging, suggesting that ancient peoples may not have lived long enough to develop the disease in the first place.
Not all scientists, though, are certain about this. According to a CNN report, many people think that cancer was formerly as common as it is now. There were undoubtedly still carcinogens around at the time, and exposure to the various chemicals used in construction probably contributed to the development of some cancers. Additionally, surgery was frequently reserved for last-resort situations in medical care. Patients and doctors are likely to have missed cancers that did not “ulcerate” or become evident to the unaided eye.
Doctors were ignorant of the existence of these deeper tumors until they ultimately got large enough to ulcerate or until a postmortem autopsy was carried out. However, due to religious hostility to them, autopsies were rarely carried out in the past. They held that autopsies unnecessarily dismembered the body and might keep the departed from entering the afterlife.
The number of human remains that can no longer be located or examined owing to decomposition and/or destruction is also not taken into account by the notion that cancer was less common in ancient times. It is either impossible to locate unmummified human remains or they are in such bad state that testing for the presence of cancer is impossible. The real number of cancer cases in ancient times may never be known due to the difficulty to diagnose cancer while still alive and the impossibility to examine the body after death.
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.
