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DEM. KARABEROPOULOS
Re cancer knowledge of the ancient Greek doctors 
 
 

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, Archigenes, 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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