Breast Cancer in the Eighteenth Century

Marjo Kaartinen

• Publisher: Routledge
• Year: 2015
• Edition: 1
• eBook ISBN:
  9781317320289
• Topic: History
• Subtopic: World History
• Index: History

Early modern physicians and surgeons tried desperately to understand breast cancer, testing new medicines and radically improving operating techniques. In this study, the first of its kind, Kaartinen explores the emotional responses of patients and their families to the disease in the long eighteenth century.

1 ‘ONE OF THE MOST GRIEVOUS AND REBELLIOUS DISEASES’: DEFINING, DIAGNOSING AND THE CAUSES OF CANCER

In the long eighteenth century, cancer was considered to be among the most horrible diseases, a misery which one could hardly wish for anyone:

Is there a Man you hate,

Or wish the hardest Fate,

Bid neither Plague, nor Pox,

Nor fam’d Pandora’s Box,

Bid neither Gout, nor Stone,

But (letting these alone)

If wretcheder you’ll make him,

Then bid the Cancer take him.¹

In medical discourse cancer was characterized in intense terms: it was ‘of all the maladies to which human nature is subjected, the most formidable in its appearance’; ‘one of the most loathsome disorders to which the human body is subject’; ‘miserable and deplorable’; ‘the most grievous and rebellious’, ‘horrid’ and ‘cruel’ disease, indeed ‘one of the most excruciating and intractable maladies incident to human nature’.² William Nisbet elaborated on the horrors of cancer:

With a slow, but rooted grasp, it undermines the existence at a more advanced period of age, and under the torments of the most exquisite and lingering pain, as well as a state of the most loathsome putrefaction, it consigns its miserable victims to a late but long wished-for grave, after rendering them, by its ravages, even still more than the former malady [scrofula] hideous spectacles of deformity.³

John Aitken noted that even the slightest sign of cancer was a reason for examination of the situation: ‘Cancer is always full of danger, the slightest degree of it is justly alarming.’⁴ Benjamin Bell considered breast cancer especially threatening: ‘A real cancer is perhaps the most formidable disease to which the human body is liab[le]: Wherever it is seated, its consequences are to be dreaded; but more especially when fixed on one or both of the mammae.’⁵ A Compendium of Physic (1769) characterized cancer, a medical mystery, as the shame of physicians; it was ‘perhaps, the most dreadful malady, to which the human body is subject; is justly called the opprobrium medicorum, as it bids defiance to every method yet attempted, for a radical, compleat cure’.⁶ Henry Fearon wrote that ‘our fellow creatures’ who suffered from cancer were ‘unremittingly tortured with this dreadful disease’, and he noted that the disease was ‘excruciating and loathsome’.⁷ Thomas Frewen considered it ‘the most terrible evil’ that befell the body,⁸ and in a similar vein Benjamin Gooch described it as ‘the most formidable and deplorable disease that human nature is subject to’.⁹

Inevitably, physicians and surgeons putting an effort into curing this horrible disease deserved praise. Human misery caused by cancer is stressed in the declaration of a Society which set out to study the disease and to improve the condition of female cancer patients among the poor:

In the long train of diseases to which human nature is subject, no one is attended with more hopeless misery than that which is denominated cancer, whatever part of the body may be the seat of it. This occurs far more frequently than is generally supposed; and a calamity so pitiable as that of persons afflicted with cancers, in any rank or situation in life (all being alike subject to them) it is hardly possible to imagine; their sufferings being aggravated by the present insufficiency of medicine, to afford any proportionate relief.¹⁰

Cancer was seen not only as cruel but devious as well. Lorenz Heister noted that the tumour could remain in a small state for a considerable period of time, but then suddenly become aggravated and increase dramatically in size.¹¹

Cancer was often given such human attributes as it was thought of as a live beast – this was especially true before the eighteenth century,¹² but this idea can be found in eighteenth-century writings as well. When Daniel Turner turned in his book from the discussion of benign tumours to cancers, he put his rhetorical skills to use to create a dramatic shift. He emphasized the great horror that cancer often was met with: it was a beast, like a lion, deadly dangerous:

But we hasten to the Cancer, which we so lately left as a Lion sleeping, whom finding now provok’d, and rousing up, we shall (however happening to be foil’d) prepare to encounter him the best we can.¹³

This lion was often provoked, and eighteenth-century healers of all sorts were faced with the ravages of the disease. Cancer of the breast was one of its many manifestations, and it is to this I now turn and focus on throughout the following work.

Defining Cancer

Eighteenth-century surgeons and physicians generally made a difference between a benign cyst which they often called schirrus (pl. schirri) and a cancerous tumour, but there were other ways of typology as well. Jean Astruc divided breast cancers into two different types. The first of these began life as ‘a knot in the breast’, which gradually grew into a cancer. The other was a cancer originating as a schirrhus, which ‘occupies all the mammary body’; this again turned into cancer. Both types of breast cancer could be either occult, inward or ulcerous.¹⁴ Pearson noted that ‘[a]ll Schirrhi have a tendency to terminate in Cancer’,¹⁵ an idea which most seem to have shared. Many also admitted that a precise diagnosis was very difficult. Scrofula for instance added to the difficulty, as it could affect both men’s and women’s breasts.¹⁶ In general, however, I would like to argue that cancer in the breast was not an umbrella diagnosis for different breast problems; physicians and surgeons often had a very clear idea of what cancer was like, and were able to differentiate it from other kinds of breast illnesses.¹⁷

Laypersons too were considered to be able to recognize certain kind of growths as being cancerous. In recipe collections and medical self-help books distinction was made between different breast problems. The Queens Closet Opened (1659), for example, listed recipes for sore breasts, promising an excellent and certain cure for all sore ‘paps’ but did not promise to cure either cancer or fistula.¹⁸ A specialist and a well-informed layperson could thus at least in theory assess the degree of malignity of a tumour by interpreting the patient’s symptoms. The widely acknowledged Galenic signs of malignity, ‘itching, heat, shooting pain, and sudden increase of the tumour’,¹⁹ remained much the same through the period studied here. Richard Guy formulated this in clear terms: schirrus was not painful, but cancer usually was.²⁰

The signs of malignity were so vague that it was difficult to recognize the moment when the transformation from schirrus to cancer took place. More generally, however, the process of change could be seen and felt. Joseph Warner’s sixty-four-year-old patient, E.W., had had a small tumour in her breast for seven years, giving only occasional ‘pricking pains’. The tumour started to increase in size very rapidly, and in only eight months grew ‘to a considerable size and extent’. It was then excised, with good success. Rapid growth of a tumour was a grave sign, and cause for immediate extirpation.²¹

There were other signs as well:

An occult Cancer is known to be formed … when, after the Signs of a preceding Schirrus, a Titillation, Itching, Heat, Redness, are gradually perceived; with a shooting, burning, pricking Pain. The Colour of the Skin likewise changes from a Carnation to a deep Red; then it becomes purple, blueish, Livid, and at length Black: The Part feels very hard, unequal and rough; then it rises with an Apex in the middle; the Swelling increases, and the adjacent Veins become tumid, knotty, varicous, thick and black.²²

Benjamin Gooch admitted that it was very difficult to say at which precise point, which specific moment a tumour turned from benign to cancerous. He thought it best to immediately remove all tumours surgically in order to avoid future danger from the growth.²³ Gooch’s suggestion is in line with the prevalent idea that any tumour was potentially hazardous, and could turn into cancer. Therefore any tumour was always bad news, and was often, as we shall see later in more detail, considered a death sentence.

Cancer could be diagnosed from its appearance. Following the ancient tradition it was believed to resemble a crab when it advanced in the breast. The tumour was surrounded by crossing dark veins which resembled the pincers and feet of a crab, and the eighteenth-century authors often reiterated this idea.²⁴ In reporting the appearance of a cancer case in 1815, Samuel Young considered this kind of characterization justified and logical:

In the description of this tumour, the usual attendant characteristic of advanced Cancer, in the instance of large varicose veins, is not to be omitted. These vessels appear in a very marked degree of disease, rising from various parts out of the very substance of the tumour. They crawl down its sides in a tortuous course, affording that appearance of claws, whence, in particular, the ancient name has been attached to the disease.²⁵

There was a tendency to consider a large tumour more malignant than a small one, or rather to assume that malignancy grew with the tumour, but for most authors a cancerous tumour could in practice be of almost any size, from the size of a pea, commonly mentioned as the size of the tumour when it was first discovered, to that of a melon or even a very large melon such as ‘a pompion’, which was the size of an adult’s head.²⁶

It seemed inevitable that in most malignant cases the patient would eventually suffer from ulceration of the tumour.²⁷ It is safe to assume that ulceration was considered common at the later stages because it made a diagnosis quite certain. Pearson pointed out that ulceration was at times very rapid and he called this kind of process very violent.²⁸ In fact, ulceration in advanced cases indeed was common: a systematic study of untreated breast cancer patients in the Middlesex Hospital between 1805 and 1933 shows that 68 per cent of the patients went into ulceration, a stage considered desperate.²⁹

Bryan Cornwell analysed the process of ulceration as follows:

The skin rendered thin by violent straining, is at last burst by the contained matter; hence the ulcer, which by the continuance of the same causes that produced it, increases. While the blood vessels remain unhurt, a ferous ichor only appears in the ulcer; but when they are corroded, blood also issues forth, and as the fungous flesh dissolves, some pus is generated. The stinking sanies is from the heat of the part, and the access of the air putrifying it.³⁰

Ulceration almost became to mean a synonym for the last stage of the disease. According to Richard Brookes, cancer ran an inevitable course first towards ulceration and then, almost inevitably, death:

When it [the tumour] begins to break, the Skin is excoriated, and there transudes through it a thin, sharp Ichor.

After this the sound Vessels on the Edges of the Cancer, being distended by the rising of the Tumour, are broken; hence arises a Putrefaction, which, turns into a subtile, sharp, fetid, cadaverous Sanies, which, corroding and eating away the sound Parts, makes a Progress in Depth as well as in Circumference, and sends forth malignant Roots, by which it takes fast hold; the Lips become tumid, parched, and offensive to the Sight; the Pain is intolerable, with a Sense of burning, pricking and gnawing; the Colour becomes cineritious, livid and black. Afterwards arise occult Cancers communicating with the Glands; Hoemorrhages; Convulsions; a slow Fever; a general Wasting; Loss of Smell; callous Tubercles in the Ears without Pain; fainting Fits. The Parts being thus eaten away and consumed, Death ensues.³¹

Because of this inevitable link between ulceration and death, ulcerated cancers were in general terms not surgically removed until the second half of the eighteenth century. Surgery was considered beneficial only if the tumour was smallish. If it had already ulcerated it was considered too late to be curable, and only palliative treatment was to be applied.³² The progress of the disease was admitted to vary greatly. Many patients suffered for years, whereas others would be dead in months.³³ According to the study of the Middlesex Hospital patients, the median time of survival after first signs of cancer was three years. Ten years after the first appeara...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Preface
• 1 ‘One of the Most Grievous and Rebellious Diseases’: Defining, Diagnosing and the Causes of Cancer
• 2 ‘But Sad Resources’: Treating Cancer in the Eighteenth Century
• 3 Women’s Agency and Role in Choice of Treatment
• 4 ‘So Frightful to the Very Imagination’: Pain, Emotions and Cancer in the Breast
• Epilogue
• Notes
• Works Cited
• Index