Medieval Notions of Cancer: Malignancy and Metaphor

Nearly a thousand years ago, Avicenna declared that “leprosy is cancer of the whole body.” ¹ This link between the most “medieval” of scourges and the most “typically twentieth-century” disease is food for thought. In more immediate terms, Avicenna’s equation calls for inquiry because it was quoted by Latin authors with such reverence that one cannot hope to comprehend medieval views of leprosy—my ulterior goal—without having a sense of the early notions of cancer. ² These notions will be explored here with an eye on their medical implications for the time: on the attitudes evoked in definitions and analogies, rather than on their closeness to the latest scientific insights. Nevertheless, a secondary benefit of the exploration may be some perspective for modern mentalités and “mythologies” of cancer. ³ Without the goal of proving continuity or discontinuity, or of arguing any set thesis, this paper is simply aimed at gleaning the observations of medieval physicians. It is drawn from two dozen texts, and it follows the division of scholastic medicine into theorica, which was constructed around pathology, and practica, which covered diagnosis, prognosis, and therapeutics. ⁴

Theorica

In medieval medicine, “pathology” meant the recognition of disease. It consisted of a definition, a classification, an identification of causes, and a description of their effects.

Definition

Opening definitions presented the framework for recognition, and they were almost standardized. This near-uniformity contrasted sharply with the inconsistent nomenclature of nosology: one ailment could have several names, and one term could refer to widely varying conditions. Inconsistency, redundancy, and overlap were most pervasive in the area of dermal phenomena. The particular problems with terminology for our subject were illustrated by Lanfranc of Milan when, after a description of gangrene (“cancrena”), he concluded that “some people call this disease ‘cancer,’ some ‘lupus,’ some as in France ‘Our Lady’s Evil,’ while some Lombards call it ‘St. Anthony’s fire,’ and others ‘eating erysipelas.’ But you should not be concerned with the diverse names.” ⁵

The word cancer covered an increasing variety of swellings anywhere in the body, although a wide range of evidence attests to both its etymological origin and its primary significance as referring to breast cancer. Against this background, it seems puzzling that in the medical sources closest to the concerns of women, including the Gynaecia of Soranus of Ephesus (early second century c.e.) and the compendium associated with Trotula of Salerno (twelfth century c.e.), the term cancer did not designate lesions of the breast but, generally, any festering ulcers—particularly cankers of the nose and mouth—and, almost in passing, uterine growths. ⁶ Indeed, over time the label was applied more and more indiscriminately to gangrenes (“corroding a whole arm in one night”), tumors (“every cold tumor”), penetrating abscesses (“cancers or fistulas or ficus of the pudenda”) and herpes sores (“often occurring in the palate or gums”). ⁷

It fell to the learned surgeon Henri de Mondeville to observe in 1318 that the nomenclature was particularly fluid outside the schools:

Whatever authors, practitioners, and the common people call cancer, including abrasions, inflammations, light ulcers of the gums or penis, and the like, is not true cancer but should properly be called corrosions: indeed, the stated definition of cancer is not appropriate for these, nor is, consequently, the treatment of cancer. ⁸

Guy de Chauliac, Henri’s successor in the role of learned surgeon, emphasized that a “definition fixes what a thing is, and makes it differ from anything else.” ⁹ At the same time he believed that “for the surgeon, it is enough to know that the words tumor, apostema, inflacio, ingrossacio, eminencia, elevacio, excrescencia, are synonyms that signify more or less the same thing, as Henri says.” ¹⁰

Guy de Chauliac stood out by defining cancer in the least conceptual and most concrete terms, as “a hard, round, veined, darkish, fast-growing, restless, warm, and painful tumor.” ¹¹ This semiological definition was clearly rooted in Galenic nosology, and it faintly echoed the inclusion of factors such as color and heat in classical diagnoses. ¹² Most other...