Keeping Abreast

 A historical overview of breast cancer causes and treatments from ancient history to the Middle Ages....who knew?!

Beginning in ancient Egypt and well into the sixteenth century, physicians engaged in an unrelenting struggle to explain the root causes of cancer. The assortment of “cures” and causes implicated in the discussion of one of history’s oldest malaises displays the complex and multifaceted assumptions regarding carcinoma of the breast.

Ancient teachings of Greek, Roman and Hebrew physicians state that “cancer was caused by sin, violation of religious rules, and the wrath of Gods.”[1] This description of cancer persisted until Hippocrates of Cos (460-370 B.C.) and his disciples declared their opposition to any reason that exclusively upheld a superstitious nature. Instead, Hippocrates attempted to explain disease through the practice of natural philosophy and the four humors: blood, phlegm, yellow bile, and black bile.   Ideas about the etiology of cancer that arose from the Hippocratic period persisted throughout the rise of Roman physician Galen of Pergamum (129-200 A.D.). Galen believed that breast cancer could be explained by the build up of black bile, sometimes called melancholia. In retrospect, the influx of black bile could be considered one of the earliest notions of carcinogenic matter. Galen’s humoral theory posited that cancer of the breast occurred when “black bile, improperly cooked or burned, became corrupted and thick, and resisted natural expulsion through the pores or with the blood.”[2] The bile would eventually harden within the soft tissues of the woman’s body and, upon menstruation, rotting black bile would accumulate in the uterus, eventually moving to the breast and ultimately forming cancer.[3]    Galen applied a character to the appearance of malignant tumours, stating that the “size and shape closely resembl[ed] the animal known as the crab...the limbs protrude from either side...the swollen veins radiate from its edges and give a perfect picture of the crab.”[4] Aetios of Amida (~6th c. A.D.) was a distinguished Byzantine physician who also utilized the crab metaphor. He explained cancer’s crab-like tendency of using its pincers to grab hold of someone and the difficult task of detaching the creature/cancer afterwards. Aetios believed that the reason women were more susceptible to breast cancer than men, is because “their breasts are bigger and fleshier.”[5] It was not until the time of Paracelsus (1493-1541) that a completely oppositional notion of cancer was posited. Paracelsus contested the work of Galenists, and instead conceived that cancer was caused by “deposits of salt of sulphur and arsenic in blood.”[6] With this, Paracelsus made the first link between cancer and chemicals—a presumption that would eventually lead to less conceptual ideas of causation.    The woman’s breast was seen as the “feeding organ of the maternal body.”[7] Breasts were a sacred and precious part of the woman’s body and therefore “received symbolic and...religious significance.”[8] According to Roman Catholic martyrologies, Agatha (3rd c. A.D.) had pledged her virginity to Jesus. Quintinian fell in love with her but she ignored his many advances, and in a fit of jealousy he condemned her to life in a brothel.[9] Her refusal to revoke her vow to Jesus, led Quintinian to resort to a number of horrific tortures including “burning her at the stake” and “cut[ting] off her breasts.”[10] By divine and miraculous forces, she was healed and her breasts were restored by Saint Peter. As a result she was declared the patron saint of women suffering from breast cancer and was regarded as a martyr against breast disease. Agatha has since been publicized in religious paintings presenting her breasts on a platter. Jean of Tournemire (1380) was a papal physician who taught at the University of Montpellier in France. In 1387, he diagnosed his daughter Marguerite with breast cancer. Jean of Tournemire believed that both surgery and medicine were useless. Instead, he sought a miraculous cure through prayer and religious artefacts. Jean acquired a piece of thread from the belt of Saint Peter of Luxembourg and “ordered his wife to rub [Marguerite’s] breast with the relic.”[11]  He was not only interested in curing her breast cancer through divine practice, but also believed “it was the doing of God”[12] that caused Marguerite’s cancer to develop.   Several other unorthodox practices developed during the Middle Ages. During the early fifteenth century, Parisian physician Guillaume Boucher provided documentation of his therapeutic regimen. In addition to cleansing and purifying the breast cavity with herbs, he recommended that a “chicken or hen, or the lung of a freshly killed pig or sheep” be applied to the growth two or three times daily[13]. William Clowes (1560-1643) was Her Majesty, Queen Elizabeth’s trusted physician in Britain. He believed that the royal touch could heal cases of mammary carcinoma. The results of such unusual practices are not recorded because these customs did not extend past the Middle Ages, and were disproved and deemed ineffective in curing breast cancer.    Prescriptions of natural remedies appear throughout historical records of cancer as one of the earliest treatment regimens. The Ebers medical papyrus of ancient Egypt appeared around 1500 B.C. One of the remedies cited for treatment of cancer by the papyrus was “calamine, gall of ox, fly’s dirt, [and] yellow ochre.”[14] This formula was to be massaged into the ill breast for four days.    Over history, physicians have not been lacking in fervour with regards to surgery. The Edwin Smith papyrus of ancient Egypt, discusses the use of extirpation and cautery in the treatment of cancerous growths.[15] This text dates back to 2000 B.C. making surgery one of the oldest traditions used in treating breast cancer, “yet enthusiasm for it has waxed and waned over time.”[16] Galen (131-203 A.D.) recognized, with regards to humoral theory, that recurrence of the disease would likely take place if any bad humors remained in the woman’s breast. His ideas were therefore similar to modern notions of pathology whereby a healthy organ becomes diseased via transmission from a diseased organ.    By the twelfth century, surgical methods were becoming more precise. Physicians during this time began differentiating between the effectiveness of diverse types of incisions. A major advancement in surgical treatments of breast cancer occurred with Ambroise Paré (1510-1566). His technique most closely resembles today’s modern mastectomy as Paré was “among the first to note the importance of axillary involvement in breast cancer.”[17]    Dating as far back as 1500 B.C., breast cancer has been regarded as a plaguing disease among women. Ancient and medieval physicians, though thousands of years apart from modern day ones, share a major understanding—that breast cancer is not a contained disease, but rather a systemic one.
[1] Steven I. Hajdu, “Thoughts about the Cause of Cancer,” Cancer 106.8 (2006): 1643. [2] Demaitre, “Medieval Notions of Cancer,” 617. [3] Carl M. Mansfield, Early Breast Cancer: Its History and Results of Treatment. (New York, New York: Karger, 1976), 3. [4]Roswell Park, “An Epitome of the History of Carcinoma,” Medical Library and Historical Journal 4 (1903): 241. [5] Andreas Skarpelos, Stavros Peroukides, Pavlos Goudas and Athanasios Diamandopolous, “Oncology in Byzantium: Breast Cancer Fifteen Centuries Ago,” ISHM (2006): 2. http://www.ishm2006.hu/abstracts/files/ishmpaper_117.doc [6] Hajdu, “Thoughts About Cancer,” 1643. [7] Skarpelos et al., “Oncology in Byzantium,” 1. [8]Ibid. [9] James S. Olson, Bathsheba’s Breast: Women, Cancer, and History (Baltimore, Maryland: The Johns Hopkins University Press, 2002), 23. [10] Ibid. [11] Ibid., 637. [12]Jean Jacme, “Metaphor and Malignancy: the difficult case of cancer 1: Jean of Tournemire diagnoses his daughter’s breast cancer and receives divine medical aid,” Acta Sanctorum. Trans. Faith Wallis. (Paris, France: Victor Pale, 1387) 526. [13]Guillaume Boucher, “Metaphor and Malignancy: the difficult case of cancer 2: Guillaume Boucher,” Secreta et concilia Carnificis et Danszon. Trans. Faith Wallis. (Paris, France: 1400) 90. [14] Mansfield, Early Breast Cancer, 2. [15] William L. Donegan and John S. Spratt, Cancer of the Breast. 5th ed. (St. Louis, Missouri: Saunders, 2002), 2. [16]Ibid., 1. [17]Ibid., 5.