When do you think the first evidence of cancer in humans was recorded?
The earliest written observation of cancer in humans comes from Egypt, although the word cancer was first used by Hippocrates much later. The Edwin Smith Papyrus, the oldest known surgical treatise on trauma, is a collection of 48 medical cases of injuries. The Papyrus, which is presumed to have been written by the architect-physician-statesman Imhotep, dates back to the Pyramid Age (around 3000 – 2500 BC) and provides the earliest description of human tumor. The historic two-volume translation of the Papyrus by James Henry Breasted in 1929 offers a fascinating window into the practice of medicine and early evidence of tumor in ancient Egypt.
The Papyrus provides case studies of several breast tumors.
The ancient physician used ocular and tactile approaches to methodically examine and diagnose the tumors. The clinical texts of the cases, written in hieratic, describe several visual characteristics of tumors – swelling with pus spread over the breast, redness, penetration to the bone, inflammation, bulging tumor, and abscess in the breast. They also describe diverse tactile characteristics – hot tumors, cold tumors, oily tumors, solid tumors, patient with fever, lack of fever, and patient that shudders when the tumor is touched.
These accounts are astonishingly akin to descriptive data that a modern physician might summarize in their clinical text today.
The ancient physician used the visual and tactile characteristics of tumors to pursue treatment. The Papyrus provides the earliest reference to cauterization as surgical treatment for tumor. The ancient Egyptians were adept at bandaging and made effective use of this skill as a medical tool to cover the tumors and keep therapeutics (such as leaves or herbs) in place and as a surgical tool to mechanically retain the patient in a particular position for better healing.
The Papyrus also refers to a treatment involving binding the tumor with fresh meat (potentially for hemostasis) on the first day, followed by application of grease, honey, and lint every day (potentially as an ointment) until the patient recovers. While such treatment is likely to humor a modern physician, it suggests that the ancient physicians very likely understood the critical role of hemostasis, the importance of emollience, and the need to protect the tumor area from the environment for successful treatment delivery to the tumors.
The ancient physicians also used astringent to dry the wounds in the tumor. However, an interesting case is a bulging tumor with swellings spread over the breast and cool to the touch, for which the physician does not prescribe any treatment, possibly because this was an untreatable tumor at that time.
Numeric data are foundational to modern medicine.
Today’s clinical text would include the size of the tumor or abscess, a patient’s anthropometric measurements, treatment dosage and measures of outcomes. The examination, diagnosis, and treatment summaries in the Papyrus are largely non-numeric. This cannot be due to lack of numeracy. The ancient Egyptians were skilled in numbers – after all it was the Pyramid Age; whole numbers and fractions were fundamental to planning and constructing the pyramids that stand to this day. Perhaps numeracy was not an essential part of ancient Egyptian medicine or clinical texts.
The ancient physician, however, knew the concept of a fever and could distinguish between hot and cold tumors. Clearly, they knew that temperature was a valuable diagnostic sign of ailments and resorted to palpable approaches for feeling the temperature. The thermometer as we know it today was only invented in 1709 AD by Daniel Fahrenheit.
The ancient physician also prepared treatment compounds via trituration, which very likely required the understanding and careful use of fractions. Clinical texts, as inscribed in ancient Egyptian medicine, appears to have been more qualitative than quantitative.