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From the ancient Greeks to modern medicine (part 1)

Ken Burns’ PBS documentary on cancer features U-M medical historian

A depiction of ancient Greek physician Galen treating a patient, by 20th century artist Robert Thom

A depiction of ancient Greek physician Galen treating a patient, by 20th century artist Robert Thom

If you look in the night sky at this time of year, you might see a constellation called Cancer. To the ancient Greeks, who gave it that name, the collection of stars looked like a crab. So they gave it the Greek name for crab: carcinos.

Later, the Romans kept that name for the same constellation, but used the Latin word for crab: cancer.

Both cultures also used those words for something else: a terrible disease that formed growths as hard as crab shells inside the body, and sent spindly legs out from a central body.

Even though we now know that “cancer” is actually many diseases, we still use that ancient word. And the history of cancer is as fascinating as the incredible progress now being made in fighting it in all its forms.

Here’s more about the history of cancer from Howard Markel, a University of Michigan medical historian who will appear as one of many internationally known experts in in “Ken Burns’ Cancer: The Emperor of All Maladies”, a major PBS television special airing March 30 through April 1 on most PBS stations.

Howard Markel, M.D., Ph.D.

Howard Markel, M.D., Ph.D.

Q: So the ancient Greeks and Romans knew about cancer?

A: Yes, though in those days they believed that all illness was a product of an imbalance between the four humors, or basic substances. They called these humors black bile, yellow bile, phlegm and blood. Cancer, which they didn’t know very much about at all, was considered to be the result of too much black bile in the body.

And the fact that both cultures called it the “crab” in some ways makes sense — cancerous tumors can be surprisingly hard, and if you dissect out a malignant tumor you can see little projections coming out like a crab’s legs. Yet, for several millennia, doctors really didn’t understand the disease’s cause, let alone its treatment, and couldn’t do anything about it.

But in the 1500s, Andreas Vesalius, who literally wrote the book on human anatomy, could not find any evidence of any of the four humors in the body, nor could he find evidence that black bile caused cancer. This was the beginning of the realization that cancer did not come from an imbalance of humors or from God or from being bad or immoral – instead, several doctors began to realize that something went wrong inside the body to cause cancer.

Q: But it wasn’t until the mid- to late 1800s that the modern concept of cancer and treating cancer began?

A: That’s right. One of the key ideas was formulated by Rudolf Virchow, a German physician who basically invented the field of cell pathology, or studying the role of cells in disease. He hypothesized that something inside normal cells went awry, causing them to become cancerous.

That set off a scientific quest that’s still going on to this day, to determine just what the process of carcinogenesis involves and how to block or prevent it.

William Stewart Halsted, pioneering breast cancer surgeon

William Stewart Halsted, pioneering breast cancer surgeon

Another name to know in the history of cancer is William Stewart Halsted, The pioneering Johns Hopkins surgeon and tragic personal figure who I wrote about in my book “An Anatomy of Addiction”. He developed the first major operation for breast cancer, the radical mastectomy, to treat women who would come to him with full-blown, rock-hard, and widely advanced malignant tumors — a condition tantamount to a death sentence.

Cancer surgery in those days – the very late 1800s – was all about amputation, about taking out as much as you could to reduce the risk that the cancer would come back–which, invariably, it did. For the women who had the procedure Halsted developed, which removed the breast, the muscle and the lymph nodes beneath it, right down to the chest wall, it was terribly marring – but for some, it gave them a few more years of life.

And in fact, a modified version of Halsted’s operation, but with reconstruction, was still being done even into the late 20th century. Fortunately, we also got much better at diagnosing women earlier, and offering less-radical options like lumpectomy as well as many other treatment modalities.

Q: How did the history of the discovery of radiation and radioactivity affect cancer diagnosis and treatment?

Emil Grubbe, age 21

Emil Grubbe, age 21

A: It mattered tremendously. The development of radiation therapy for cancer came about because of Emil Grubbe, a pioneer in the field of radiology and radiation oncology. In 1895, while still a homeopathic medical student, he began to use X rays to try to kill cancerous cells.

He was using doses far higher than what’s used today, of course. And in those days, he and other radiologists did not leave the room or wear a lead apron when treating a patient – so unfortunately the early radiologists were exposed to extremely high, ultimately cancer-causing doses even while they were working to treat patients.

One particular chapter in the history of how we learned that radiation can cause mutations in DNA that can lead to cancer has a University of Michigan connection. James Neel, a top geneticist who helped found U-M’s Human Genetics department, led efforts to study the people of Hiroshima and Nagasaki, Japan after the atomic bombs were dropped on those cities in World War II, to understand the effect it had on their bodies. That allowed doctors to refine the use of radiation as therapy, to target and reduce doses.

Keep reading:

Part 2 of the interview with Dr. Markel, including more about the modern era of cancer research, and the experience of taking part in the Ken Burns film.

 

Take the next step:

Simpson Memorial InstituteThe U-M Center for the History of Medicine, part of the U-M Medical School, conducts research and collaborations that place contemporary medical dilemmas in context with past events to help inform public health and medical policies. It also serves as consulting historians to the Medical School, and fosters appreciation of the medical humanities among U-M medical students. It is housed in the Simpson Memorial Institute, a 1926 building on the U-M medical campus shown at left.

 

Cancer-center-informal-vertical-sig-150x150The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.