Cancer

Prior to the 19th century, cancer had been treatable only by surgical removal or cauterization of the tumor, and even that was seldom possible when a tumor was deep inside the body.¹ From about the 1820s to 1900, three developments set the stage for an oncological revolution: cell theory helped doctors understand cancer better; germ theory made surgical tumor removal eminently more survivable; and the invention of radiotherapy opened up highly effective non-surgical treatment options.

After the Industrial Revolution, microscopes accurate enough to see cells and bacteria became more widely available than ever before.² Working closely with Matthias Schleiden and Theodor Schwann (who are credited with first articulating cell theory, the idea that all living things are composed of autonomous cells), Johannes Muller showed in 1832 that cancerous tumors are also composed of cells; others quickly realized those cells were abnormal.³ This remains the basic foundation of our understanding of cancer as uncontrolled cell division.⁴Surgical tumor ablation grew increasingly safer as antiseptic practices became more widely accepted in the later 19th century. Doctors at the time favored radical operations to remove as much cancerous tissue as possible; William Stewart Halsted's radical mastectomy (removal of the entire breast, some chest muscles, and lymph nodes) was the de rigeur treatment for breast cancer from the 1880's til it fell out of favor in the 1970s.⁵ Many such radical surgeries, like the total hysterectomy, continued to carry high mortality rates well into the early 20th century.⁶ Around that time, oncological radiotherapy started to be regarded as a safer alternative to surgery.⁷ Within a year of the 1896 discovery of naturally-occurring radiation by Henri Becquerel and Marie & Pierre Curie, doctors were using targeted applications of radium to successfully shrink cancerous tumors.⁸ However, the full dangers of exposing healthy tissue to radiation were not yet well understood. In 1910, Paris student Jean Clunet proved in his thesis that overexposure to x-rays can cause cancer.⁹

Des operations que réclament les tumeurs développées dans la region parotidienne

This thesis quotes an 1819 case study describing the difficult removal of a large parotid tumor. The patient survived surgery and healed rapidly.

Parotid tumors in three different patients. Theses from this time tend to classify tumors by their location instead of by their characteristics or even by their malignancy or benignity.

De quelques modifications apportées a l'ablation partielle de l'os maxillaire inférieur

A large carcinoma of the lower maxillary in a 51-year-old farmer, who unfortunately died during surgery to remove it in 1873.

Contribution a l'étude des tumeurs solides du scapulum

A patient after removal of the arm and scapula to treat osteosarcoma there. Sadly, the patient died of lung cancer eighteen months later.

Des fongosités utérines, des kystes de la muqueuse du corps de la matrice, et des polypes fibreaux de l’utérus

Figures from a thesis on assorted cysts, tumors, and fungal infections of the uterus. Figures 1 and 2 show different cross-sections of the same hypertrophic uterine tumor.

Dissertation sur le fongus médullaire de l’oeil

The man in Figure 1 has a large orbital socket tumor, which was successfully removed in surgery (he later died of complications from a tumor in his neck). The girl in Figure 2 suffers from solid tumor that persistently regrows after surgery, ascribed by the doctor to bacterial or parasitic infection.

Étude sur les tumeurs fibro-plastiques de la partie inférieure interne de la cuisse et de la région poplitée

A large fibrous tumor removed from a patient's thigh, partially dissected with some of its blood vessels isolated.

Sur le naevus en général, et sur une modification particulière et non décrite, observée dans un naevus de la paupiére supérieure

Depictions of a raised, pigmented mole, called a nevus. The thesis describes a case in which a nevus on a patient's eyelid grows large enough to interfere with his vision; when moles become hypertrophic and dark in color, they may be malignant.

De quelques productions hétérotopiques de muqueuses a épithélium prismatique cilié

Cross-section of tissue from a skin tumor with a central depression (possibly a carcinoma of some kind); letter a marks an overhead view of the tumor. Figure 2 shows elongated, cilia-bearing epithelial cells like those at 'g' and 'h' in Figure 1, which may be "cancer-initiating" cells.

Définition et classification de l’épithéliome pavimenteux (Cancroïde)

Microscopic examination of a tissue sample from a squamous cell carcinoma on a patient's lip. Figure 2 is a magnification of Figure 1. Areas marked 'a' are cancerous.

Recherches sur les lymphangites pulmonaires

This patient's lung tissues show inflammation of the lymph vessels by a cancerous tumor (pulmonary lymphangitic carcinomatosis).

This 40-year-old patient's (likely benign) facial tumor had been growing for most of her adult life when it was finally successfully removed. Surgery carried a high mortality rate, and removal of ostensibly benign tumors was often delayed as long as possible.

Techniques for surgical removal of carcinomas from the tongue and jaw, circa 1872.

Étude clinique et anatomique sur le sarcome de la choroïde et sur la melanose intra-oculaire

Cancerous tumors, diagnosed as sarcomas, affecting the choroid portion of the eyeball, circa 1873.

Des tumeurs fibreuses du maxillaire inférieur

The subject of this 1854 thesis lived her entire adult life with a non-malignant fibrous tumor disfiguring her lower jaw.

The same patient following surgery to remove the tumor.

Du cancer de la colonne vertébrale et de ses rapports avec la paraplégie douloureuse

Tissue samples from a patient with cancerous tumors on the spine and neck.

La Réaction de Botelho dans le Séro-Diagnostic du Cancer

In the 1920s cancer, was experimentally diagnosed by mixing blood serum with an acid, then using a refractometer to check the density of the precipitate.

De la Rectite proliférante, vénérienne & non vénérienne

Tissue from the site of the tumor in a possible case of rectal cancer, circa 1885.

Des Tumeurs dites cancéreuses primitives des muscles de la vie de relation

A large tumor in a 46-year-old patient's calf muscle, observed by the author in 1860.

Remarque sur une tumeur provenant de la substance grise céphalo-rachidienne

Histologic examination of tissues from cerebrospinal tumors, circa 1865.

Cancer of the larynx, circa 1872.

Notes

Ekmektzoglou, Xanthos, German, and Zografos, "Breast Cancer," 3-5; Rather, Genesis, 8.
Microorganisms and cell structures were first observed through microscopes in the 1670's, but the technology stagnated from roughly the end of the 17th century until the beginning of the 19th. See Hajdu, "First Use of the Microscope in Medicine," 309-310 and Rather, Genesis, 82-3.
Lowy, A Woman's Disease, 30; Rather, Genesis, 83-89, 95. For a detailed account of how microscopy influenced the development of oncology as a clinical discipline, see La Berge, "Dichotomy or Integration?", especially pp. 297-302.
See, for example, the National Cancer Institute (NIH), "What is Cancer?"
Lowy, Woman's Disease, 29; Olson, Bathsheba's Breast, 61-74; Lerner, The Breast Cancer Wars, 32-40, 129ff.
Lowy, Woman's Disease, 27-34.
Lowy, Woman's Disease, 36; Lerner, Breast Cancer Wars, 34.
Ekmektzoglou et al, "Breast Cancer," 6; Badash, "Discovery of Radioactivity," 26.
Mustacci and Shimkin, "Radiation cancer and Jean Clunet," 1073.

Bibliography & Further Reading

Badash, Lawrence. "The Discovery of Radioactivity." Physics Today 49.2 (1996): 21-26.
Ekmektzoglou, Konstantinos A., Theodoros Xanthos, Vasilios German, and Georgios C. Zografos. “Breast Cancer: From the earliest times through to the end of the 20th century.” European Journal of Obstetrics & Gynecology and Reproductive Biology 145.1 (2009): 3-8. DOI:10.1016/j.ejogrb.2009.03.017.
Hajdu, Steven I. "The First Use of the Microscope in Medicine." Annals of Clinical & Laboratory Science 32.3 (2002): 309-310.
Holsti, Lars R. "Development of Clinical Radiotherapy Since 1896." Acta Oncologica 34.8 (1995): 995-1003. DOI: 10.3109/02841869509127225.
La Berge, Ann. "Dichotomy or Integration? Medical Microscopy and the Paris Clinical Tradition" in Constructing Paris Medicine, edited by Caroline Hannaway and Ann La Berge. Rodopi, 1998: 275-312.
Lerner, Barron H. The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. Oxford University Press, 2001.
Lowy, Ilana. A Woman's Disease: The history of cervical cancer. Oxford University Press, 2011.
Mustacchi, Piero and Michael B. Shimkin. "Radiation cancer and Jean Clunet." Cancer 9.6 (1956): 1073-1074. DOI:3.0.CO;2-9>10.1002/1097-0142(195611/12)9:6<1073::aid-cncr2820090602>3.0.CO;2-9.
National Cancer Institute (NCI). "What is Cancer?" Last updated 9 February, 2015. Accessed 4 May 2018. https://www.cancer.gov/about-cancer/understanding/what-is-cancer.
Olson, James S. Bathsheba's Breast: Women, Cancer, and History. Johns Hopkins University Press, 2002.
Rather, L.J. The Genesis of Cancer: A Study in the History of Ideas. The Johns Hopkins University Press, 1978.