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The interesting book of Professor and Academian Aristotle Kousis, (1872-1961),
"Cancer by ancient Greek doctors", which was published a hundred years
ago and which we have recently republished so that, it would be easily
accessable to anyone, who would want to have the knowledge of ancient
Greek doctors about cancer: Hippocrates, Galen, Areteos, Rufus of Ephessos,
Dioscuridis, Arcigenes, Philoxenos, Antyllos, Oribasios, Palladios, Aetios,
Paul of Aegina, Theophanos Nonnos, Michael Psellos, Symeon Sethes and
John Actuarios.
Within the bounds of information about this republication, a few points
will be cited further, which should give to the reader a sense of their
rich knowledge regarding cancer.
Information on cancer, has been available since the time of the first
medical texts, meaning from the epoch of Hippocrates and after. Even though
medical texts had been previously written, as Socrates informs us "Many
texts of doctors exist" "Πολλά γαρ των ιατρών εστι συγγράμματα΄΄-
(Xenophon, Memoirs D, b, 10).
It is interesting to mention that the ancient doctors gave the name
"cancer", due to the exterior appearance. Specifically Galen
(Ed. G.C. Kuehn, Galenus Opera Omnia, Leipzig 1828, vol. XI, p. 140) writes
that, as the crab's feet are on both sides of its body in the same manner
the veins on woman's breasts are dilated and evident from tumor and thus
were compared to the crab's feet. From that time this terminology became
common for all the body's neoplasm and was used by all ancient Greek doctors,
whereas the term "carcinoma" was also in use. These terms continued
on into our time and were established in the international medical terminology.
In relation to the types of cancer, it is noticed that they are distinguished
by different terminology: hidden "εν τω βάθει" and superficial "επιπολής",
without ulcer "ανέλκωτος" and with ulcer "ηλκωμένος", inherent "σύμφυτος"
and non inherent or acquired "μη σύμφυτος" i. e.
As for the cause of cancer this is according to the ideas of that epoch
about humour "περί χυμών" . Specifically the ancient Greek doctors claimed
that cancer was produced by "black bile" "μέλαινα χολή" and "melancholic
humour" "μελαγχολικό χυμό". If their clearance, which was done in the
spleen, was abnormal, then their excess would produce cancer and according
to the pungency of the "melancholic humour" cancer would be produced with
or without ulcer. Moreover contributing factors in the formation of cancer
are noticed "bad humour" (κακοχυμία), "dyscrasia, bad temperament" (δυσκρασία)
and diet.
According to ancient Greek writers cancer size varies "from the size
of a fishes' eye to the one of a melon" as it is written by Orevasius
(ed. Daremberg, vol. IV, p. 18), with abnormal and rough like surface,
hard structure and darker in color from the inflamed parts, as Galen points
(G. C. Kuehn, Galenus Opera Omnia, vol. VII, p. 720). A particular interest
presents, the fact that ancient Greek doctors had noticed the big development
of vessels in tumors, which " the veins had around them expanded like
varices" as characteristically is noted by all the other doctors and esppecially
Aetios in the 16th speeches (ed. Skevos Zervos, Leipzing 1902, p. 60).
About the cancer's location they mark that it is possible to be developed
in any part of the body, but it is mentioned that the most frequent location
of cancer is woman's breast and uterus, as Galen relatively writes "cancerous
tumors develop in all the parts of body, especially in women' breasts"
(Οι καρκινώδεις όγκοι εν άπασι τοις μορίοις γίνονται. Μάλιστα δε τοις
τιτθοίς των γυναικών), (G. C. Kuehn, Galenus Opera Omnia, vol. XV, p.
331).
The symptoms of cancer, which are interesting, are those, that the ancient
doctors have written about in their texts. Cancer's outbreak is possible
to be dormant, to produce mild symptoms, but also strong, intense and
clear symptoms, as Galen notes (ed. G.C. Kuehn, vol. X, p. 976). Hippocrates,
especially, had noted that at the beginning of cancer patients have a
taste of bitterness in their mouths, "καρκίνου γενομένου το στόμα πικραίνεται"
and it is accompanied by lack of appetite, (ed. G.C. Kuehn, Galenus Opera
Omnia, vol. III, p. 466).
The ancient Greek doctors had remarked during patient's examination
that cancerous tumors, when palpable, were rough to the touch, not warm
and was of irregular size, adhesive to the surrounding tissues with expansion
of the veins, and often with ulcers. It induces swelling and stiffness
to the surrounding glands and is not accompanied by fever. Pain was another
characteristic symptom of cancer for ancient doctors as Paul of Aegina
notes "cancer is tumor with pain" (ed. Briau, p. 210) and bleeding.
We point out that Prof. Arist. Kousis in his interesting study for ancient
Greek doctors' ideas on cancer makes a specific distinction between the
term "σκίρρος" "scirrhus" , which occurs in the ancient medical texts,
and contemporary term "scirrhus". He notes that the ancient doctors with
the term "scirrhus" characterized the chronic inflammation with hardening
of the tissues, cirrhosis of viscera and the mild tumors.
According to ancient doctors prognosis of cancer was the worst. "devastating
cancer" "ολέθρια τα καρκινώδεα" noted Areteus as also Aetios that cancer
is "hard to cure or incurable" "δυσίατος ή ανίατος" with the final result
being death.
As for the treatment of cancer that the ancient physicians followed,
what we note is that at its first stages of development they applied various
therapeutic forms and medicines and in case of failure they followed surgical
treatment. The medications, which they applied, were according to them
that the cause of the cancer, being the melancholic humour of blood, and
which produced the cancer. That's why they followed practices which would
decrease the surplus humour by purgation, phlebotomy and medicines. As
the writers note these therapeutic practices had good results especially
on the first stages of cancer. Characteristically Orivasius notes that
"the incipient cancer could be prevented by clearing the melancholic humour
before going into the affected part of the body" "δυνατόν μην τους αρχομένους
καρκίνους κωλύειν αύξεσθαι καθαίροντας τον μελαγχολικόν χυμόν πριν εν
τω πεπονθότι μορίω στηριχθήναι".
A lot of pharmaceutical substances, and therapeutic forms were used
for cancer, a point that suggested uncurable cancer. Lets mention some
of them such as the herbs "swallow-wort, Vincetoxicum officinale" (Ασκληπιάς),
"stinging-nettle" (ακαλήφη ή κνίδη), "birthwort, Aristolochia" (αριστολοχία),
"adder-wort, Arum dracunculus" (δρακοντία), "hedge-mustard, Sisymbrium
polyceratium" (ερύσιμον), "chick-pea, Cicerarietinum" (ερέβινθος), "hellebore"
(ελλέβορος), "heath, Erica rborea" (Ερείκη), "squirting cucumber, Ecballium
Alaterium" (ελατήριον ή σίκυς άγριος), "Cuscuta epithymum" (επίθυμον).
Also as anticancer medicines were used "river crabs" (ποτάμιοι καρκίνοι),
"cadmia, calamine" (καδμεία), "litarge, lead monoxide" (λιθάργυρος), "lead"
(μόλυβδος), "rock-alum" (χαλκίτις).
In cases where the treatment of cancer was not possible with pharmaceutical
substances and additional substances, the ancient Greek physicians applied
surgical operations. Nevertheless in "hidden" cancers they followed Hippocrates
advise, who in his "Aphorismi", part 6, 38, notes that it is better not
to cure these types of cancer because with the starting of the treatment
the patients soon die. Galen advised the surgical therapy be applied only
to "επιπολής καρκίνους" superficial cancers, in which he tried to cut
it from its roots all the way to the healthy tissues, "πάσης μεν χειρουργίας
εκκοπτούσης όγκον παρά φύσιν ο σκοπός εστιν εν κύκλω πάντα ογκον περικόψαι,
καθ' α τω κατά φύσιν έχοντι πλησιάζει" "in every operation cutting a tumor
the aim is to cut the whole tumor circularly far enough so as to have
access to the healthy tissue" ( ed. G.C. Kuehn, Galenus Opera Omnia, vol.
XVII, A' , p. 60 and vol. XI, p. 141).
Before the surgical operation appropriate medication was given in order
to clear the melancholic humour and after that the tumour was removed
"ξυραφιοις πεπυρωμένοις ομού τέμνουσι και διακαίουσιν" "with the aid of
glowing razors would cut and burn" a type of searing-iron, so as to avoid
bleeding from the vessels. After the operation followed healthy tonic
nutrition along with physical exercise to reinstate the body humours to
a healthy condition.
In conclusion we can ascertain that the ancient Greek doctors not only
gave the name "cancer" to that nosologic entity but moreover they distinguished
the cause and determined cancer' symptoms, localization, morphology, signs,
prognosis and therapeutic treatment, pharmaceutical and surgical.
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