Did Breast Cancer Exist In Medieval Times? The Bizarre History Of Breast Medicine Will Make You Very Grateful That We Live In 2017
Many of us are familiar with self-exams for unusual breast shapes and lumps, and the necessity of getting mammograms after a certain age, as recommended by a doctor, among other techniques to detect breast problems. As we've learned in other areas of medical history, women have often faced fairly grim or just plain disgusting treatment when they've sought help for their health woes — and the history of breast health is no exception. From deer hearts to bull bile and extremely uncomfortable surgery, women in history with mammary issues, from breast tenderness to cancer, have had to face an onslaught of very bizarre solutions.
Looking at the history of breast medicine is important. For one, it makes us appreciate the wonders of the modern age, complete with its anesthesia, genetic testing, and total lack of strange botanical remedies. (If your doctor is giving you that, you probably want to find a different one.) But it also shows the development of medical concepts about breast health, and the many ways in which sexism has influenced incorrect beliefs about how female bodies operate. In many ways, medicine continues to battle against sexist preconceptions about female bodies and pain, and breasts are only one aspect of a very long-running problem.
Breast Medicine In Ancient Egypt
There's considerable argument about whether the numerous medical papyri that survive from ancient Egypt describe breast cancer, or other kinds of breast-related illness. We do know that breast cancer likely existed in ancient Egypt because skeletons have surfaced with signs of it; but what could women with breast problems look forward to when they went to a doctor under the Pharaohs? Weirdness, to be honest.
The Edwin Smith medical papyrus, from around the 17th century BCE, describes treatment of prominent tumors on the breast area of a man with a "fire-drill," which involved burning into the tumor in an attempt at healing, similar to how one might cauterize a wound. (In case you need reminding, no, there was no anesthesia.) If your breasts hurt from hormonal issues or bruising, you might be prescribed an ointment that combined bull bile, fly droppings, and ochre, or another involving natron, which was used in the embalming process, according to a medical text from around 1300 BCE known as the Greater Berlin Papyrus. The Ebers papyrus of 1500 BCE, meanwhile, describes a situation in which a breast swells "like an unripe pear," and notes that this is a situation in which the physician can do nothing at all; whether this was breast cancer or not remains unknown.
Breast Medicine In Ancient Greece
The Greeks believed in the idea of humoral theory, in which the body's health was largely determined by the levels of black bile, yellow bile, phlegm, and blood. Cancers were thought to be produced by an excess of black bile, and the great physician Hippocrates, writing around 400 BCE, believed that breast tumors that were left untreated would eventually leak black bile into the remainder of the body and cause further issues. The other authority of the age, Galen, thought this too, noting that tumors seemed to appear in the breasts of women who weren't menstruating and whose livers were "weak" and unable to cope with rich blood. He thought these should be removed surgically if they were detected early enough, but that the body should be "purged" of black bile first using a concoction made of a plant called "devil's guts" and cheese whey. After the surgery, he noted, the wound should be cauterized. Yep.
The ancient Greek historian Herodotus is also responsible for one of the most uncomfortable pieces of breast medical history: the story of Atossa, the wife of Persian emperor Darius I. Herodotus reports that Atossa “had a tumor on her breast ... after some time it burst; and spread considerably. As long as it was small she concealed it, and from delicacy informed no one of it; when it became dangerous, she sent for Democedes — a famous doctor of medicine — and showed it to him [sic]." Democedes cured her, likely by removing it surgically without any pain relief, and Atossa lived — which is likely why the anecdote was worthy of repeating, because many women who went through that procedure probably didn't.
Breast Medicine In The Ancient Middle East
Ancient Arabic medicine often drew on the writings of earlier Greek and Byzantine writers, and we can find many of their ideas about how to treat breast issues in places like the work of Paul of Aegina, a 7th-century Greek author. According to his writings, Paul erroneously believed that women were more likely to get cancer because they were "weaker," and that if cancer showed up in the breasts it should be dressed with damp cloth imbued with black nightshade or a poultice made of lettuce. How this was meant to help is unclear.
We do know that Byzantine and Greek writers of the time were seriously worried about how to treat tumors in breasts. One, Aetius of Amida, wrote in the sixth century CE that "cancers in the breast must invariably be abandoned," because the risks of surgery were huge. He did, however, think that tumors that appeared only in the nipple could be targeted without loss of life, so that was at least some comfort.
Breast Medicine In Medieval Europe
Medieval Europeans faced with breast issues often found inventive methods of treatment. One common one, inspired by a similar Roman practice, involved taking clay or wax molds of breasts to the shrines of saints and leaving there with prayers for recovery. They would also place holy relics and sacred garments on the breasts themselves to pray for a holy cure. Saint Agatha, above, was a Christian martyr who had had her breast cut off as part of her martyrdom, and was the patron saint of breast issues. If the breast tissue had hardened, they were treated with asphodel and caustic ointments, but richer patients often found they were expected to take incredibly expensive treatments. One treatment, from a German physician in the 1400s, advocates that a woman with an ulcerated breast tumor take a lozenge made up of dyed silk, ivory, emerald and sapphire chips, gold and silver filings, purple dye and the "bone from the heart of a deer", among other ingredients, and constantly wear sapphires and rubies to help her health.
A lot of the theories about women's breasts in European medicine in the medieval period were based around the idea that menstrual blood and milk were basically the same thing. Blood was meant to "convert" to the milk when breastfeeding, and in so doing become "pure," and if it didn't, or if blood "built up" and caused issues, breast problems resulted. To remove a breast, surgeons had two options: surgery using forceps and knives, and "cautery", where a breast was burnt off over months using corrosive materials like arsenic.
Outside of Europe, a 12th century Buddhist monk in China proposed a shift in the way Chinese medicine defined breast tumors. Instead of "rock", he advocated for ai, which means "three mouths over the volcano", and is meant to indicate just how intense and dangerous tumors of the breast can be.
Renaissance To The 19th Century: Limes, Wine & New Therapies
As we approached the Renaissance, European medicine of the breast remains a mix of arguments about surgery and home remedies like "lime drinks" and poultices. One recipe for a cancer treatment from the 17th century goes like this:
"Take three pounds of new burnt lime, unslacked, and put it to a gallon of spring water and let it stand four days, then pour the water off as clear as may be. Then take half a pound of sassafras wood and half a pound of licorice and half a pound of anise seeds and half a pound of currants; shave the wood very thin and bruise all the rest and put them in the water and let it stand four days longer. Then drink thereof every morning and about four in the afternoon, a small sack glass full."
This is also the period in which the author Fanny Burney wrote perhaps the most brutal personal account of a mastectomy in history. In 1812, she required the surgery in Paris and detailed the excruciating procedure in a letter, including having to be held down by seven men and the use of a wine cordial as the sole source of pain relief. A hundred years earlier, the mastectomy pioneer Lorenz Heister had written that while some women could bear the pain of the surgery admirably, some "make such a clamor that they may dishearten even the most undaunted surgeon and hinder the operation." Wonder why.
This was also the beginning of some of the recognizable "modern" treatments for breast ailments. A woman named Rose Lee was treated with radiation therapy way back in 1896, and anesthesia came along in the late 1800s to help women endure surgery. 1896 was also the year in which ovary removal for breast cancer debuted, laying the foundations for the idea of hormonal therapy in the future.
Today's Advances In Medicine
These days, breast cancer is the most concerning of all breast problems. And the 20th and 21st centuries have heralded big breakthroughs in how we understand and treat it: mammography first became popular in the 1930s, discoveries about exposure to nitrogen mustard in WWII led to new therapies like fluorinated pyrimidines, and surgery has developed with a focus on avoiding mastectomy if possible. We also now know a lot more about how the role that genetics plays in breast cancer, and genetic testing for problematic genes is now becoming widely available. Beyond cancer, we also have better ways to treat blocked milk ducts, breast cysts, and other issues.
So what's next? It's recently been reported that a company called Hologic is working on a more comfortable mammogram system that doesn't involve crushing the breast between flat surfaces, a process that is widely regarded as painful. And a new drug combination just tested by U.S. researchers seems to lead to good outcomes in a particularly aggressive form of breast cancer. A cure for all breast-related maladies might not be a realistic aim for this century, but it certainly seems like a vast improvement from being told to eat bull bile.