Harmony Hunter: Hi, welcome to the podcast. I’m Harmony Hunter. Today our guest is Medical Historian Sharon Cotner, who is here to talk to us about something that we think of as a modern plague, but it’s actually one that stretches back for centuries: cancer. Sharon has spent some time studying the understanding and the treatments and the causes of cancer in the 18th century, and she is here to share some of that history with us. Sharon, thank you for being here today.

Sharon Cotner: Hello.

Harmony: Well, I think the first thing that we would want to talk about is, "What is cancer?" How do we understand cancer?

Sharon: In the 18th century, cancer is identified as a tumor. The tumor would be small originally, but growing, hard, painful, immovable. It would turn black or leaden in color. There would be swelled or crooked vessels, or vesicles, as they called them, growing from or around the cancer. That’s actually where the tumor gets its name, because all of these extra vessels growing off the cancer reminded the ancients of the crab, all of the little appendages coming off a crab. And cancer is the ancient Latin term for crab.

Harmony: So in the 18th century, we also need to think about causes of cancer. They think about it as causes of cancer and influences; sort of two subsets.

Sharon:  Right, because in their mind, cause is not something they really understand the way we do today. They think about it as the fluids in the body vitiating or thickening up, and causing a tumor, not from cells or cell division. And then this tumor could stay dormant for a long period, but if something triggered or influenced the tumor, it would start to grow.  And in that growing process, it would become a cancer. And the influences could be a blow or contusion.

It could be, for women and breast cancer, what they called milk breast, and we call mastitis. It could be something about your lifestyle like eating lard and pork meats were thought to influence cancer -- or a lot of stress and fear and anxiety. External applications, something they would call an acrimony or acrimonious being an external influence.

But they also thought of cancer as something that could come internally. Women who did not have children, or they never bred, especially women who were like nuns, were thought to get breast cancer more often than women who bore children or were pregnant at some point.

Harmony: Two things you’ve said have kind of made my ears prick up. First is, "the fluids in the body.” This makes me think of the theory of the four humors. What’s happening in medical theory right now in the 18th century? They are experiencing sort of a turning in the prevailing medical theory.

Sharon: Absolutely. We are no longer looking at the old Galenic theory of medicine based on four humors. Now, we are looking at the body as being composed of multiple humors or fluids in the body and their relationship to the solid parts or fibers of the body, and the influence of these two substances on each other, the quality of these substances, the movement of the fluids within the solid parts of the body. All of these things are influenced by the physical properties of these substances.

That influence came out of the enlightenment and the scientific revolution which at this point in time, physics, as a science, was really the only well developed science. And that’s where a lot of this is coming from, the science of physics, not the science of chemistry or biology.

Harmony: And I’ve read this change as sort of understanding the body almost as a machine, understanding the physical workings.

Sharon: Absolutely. This system was referred to as iatromechanism, or like a machine.

Harmony: The other thing you talked about when you touched on the influences of cancer, it sounds very familiar to today: lifestyle choices, diet, reproductive cancers. Some of these things really haven’t changed much. We might think of them a little bit differently, but they are noticing some of the same things that we’re noticing now.

Sharon:  Absolutely. Through observation of centuries really, they knew a lot more about what was happening in the body in relation to cancer and influences of cancer without having to study this in a laboratory and do some kind of test.

Harmony: So when we talk about the cancers that you’re seeing, you’ve described them as sort of tumors, which is interesting because it seems like they're probably leaving a lot of other cancers behind, if cancer is only tumors. They’re overlooking some things that we can see now.

Sharon: Absolutely. In order to identify a cancer, it has to be sensed. Touch, smell, sight, taste. You have to use your senses, and that’s true of diagnosing any medical condition of this time period. There were what are referred to as occult, or hidden cancers, that you could feel the tumor, but you couldn’t feel anything else.

The only way to identify cancer truly as it being cancer versus a nonmalignant tumor would be when it ulcerated. When ulcerates, it would change color, an ichorous, stenchy material would kind of come forth from the cancer, and it would eat away from the flesh surrounding it. And it would grow and spread and eventually, of course, would kill you.

Harmony:  My goodness. It just seems like by the time you notice one of these cancers, it’s probably too late.

Sharon:  Well that was often a problem for medical doctors at this time period. They talk about women waiting, for example, with breast cancer until it was too late, and the doctor then by the time he saw the patient, could no longer treat them.

Harmony:  Let’s talk about treatment. There are a few classifications of treatments, sort of your home remedies, and your formal medical remedies.

Sharon: Well, home treatments are kind of interesting, because people were often trying those first, hoping that it wasn’t cancer. So they were applying a lot of topicals to try and break down the tumor and make the tumor go away. Common plant materials, like herb Robert and Common Nightshade, a lot of bathing with cold water. Materials like doc root, and scraped parsnips and carrot poultices. There was a doctor who was writing a home medicine book who recommended using bread and milk, which was a common poultice for all kinds of wounds and contusions of the time.

Harmony: So those are your home remedies. What other types of practitioners do we have out there who are claiming to treat cancer?

Sharon:  Well your professional treatments of cancer included both surgical and non-surgical methods. Trying to treat it non-surgically would have been almost impossible at this time. And most doctors recognized that, but they still tried to do so. They were trying poisonous materials to treat the cancer like mercury. They were trying external applications like arsenic.

In the mid 1760s, there was a doctor over in Europe who comes up with the use of hemlock, and that was to apply both topically, and to take it internally in a pill form. He would start with slow amounts of the material and increase it to try and work it up in the body and kill the cancer. Unfortunately, most of these treatments have absolutely no affect whatsoever. Some doctors were trying to things just to build up the system and make it more bearable.

There was a gentleman named Dr. Justamond, who is going to try using various iron treatments to try and help the condition. What they basically discover is that it just basically boosted up the system.

In the end, probably the only successful way of dealing with the cancer was going to be surgical removal. And surgical removal could have meant trying to extract the entire tumor or the entire body part. Breast cancer would have been one of the most commonly identified and written about cancers of the day.

So the majority of texts writing about how to deal with it talk about how to deal with breast cancer, and in many of those cases they refer to removing the whole breast. They also talk about being able to, if you cannot remove the whole breast, then you can try and just cut the tumor itself and preserve as much of the breast, or the skin around the breast, as possible. The problem with cancer is that it can spread. We refer to the idea of metastasis, John Burrows, in 1767, is writing an essay on cancer and he actually uses the term “metastasis.” If you cannot remove the matter, root, branch, and seed, that it will strike inwards and possibly return on the same body part or move to another body part.

Harmony: It’s interesting now to hear you say these things because it’s similar to the struggles we face today. So many things remain the same with treatment and just facing these cancers.

Sharon:  Absolutely. With treatment today, we’re still using poisons. The use of things like mercury, arsenic, hemlock in the 18th century, they were the wrong poisons, but they were still using poisons. An interesting point about using poisons, there are some references to Native Americans using a plant called pokeweed to treat cancer. And in modern times, we generally talk about pokeweed as a poison. But there is study of a chemical found in pokeweed that appears on animals to have anti-tumor and anti-cancer properties. So it’s being looked at as a possibility of treating humans.

I think what’s important to recognize about cancer is much like today: you have to catch it early for treatment to be successful.  Doctors in the 18th century were really trying to get people to recognize that. “Come to us! Let us examine it. Let us figure out what needs to be done as quickly as possible, because if you wait too long, we’re not going to be able to take care of it.” Well, that’s pretty much true today. When it gets to that stage where you can no longer care for it, then the only thing you can is try and make your life bearable till you die. They do have opium for the relief of pain, but that can only do so much.

Harmony: I think we need to understand these people as scientists, and as scholars. Much as the medicine we practice today 200 years from now might seem like the Dark Ages, but we feel like we’re at the cutting edge. How do we think about 18th century medicine and really respect the science that’s being done at the time?

Sharon: We are definitely viewing ourselves as new and improved. There are texts that compare the 18th century and medical practices to the Middle Ages. So definitely we’re past the Middle Ages. We are trying to use science. This is the age of enlightenment. Unfortunately, the problem is the state of science itself. Yes, physics is a well-developed science by this point in time, but chemistry is still in its infancy. That’s when men like Boyle, Priestly, Lavoisier, that’s what they’re doing through the 18th century is developing the science of chemistry. And it won’t be until the 19th century that biology really gets developed as a science.

So we’re limited to what we can use, but we are trying to use science. And we are trying to use some of the scientific principles. There is experimentation going on in medicine, even if it’s not in certain areas. Like cancer, there is experimentation of developing new medicines.  Withering in England is going to start working with foxglove, which we know as digitalis, for the heart. And he experimented for approximately nine years before he introduces his medicine.

Harmony: What a fascinating conversation that we’ve had with you today. Thank you so much for being our guest. I hope that when people come and visit Colonial Williamsburg, they’ll drop in at the apothecary and talk to you and your colleagues about all the facets of 18th century medicine. Thank you so much.

Sharon: Thank you!