Diagnosis and treatment of tumors by physicians in antiquity.

A review of the diagnostic skills and therapeutic acumen of physicians in ancient times requires the availability of written records. One might argue that since the Chinese and the Sumerians introduced writing around 5000 BC, they were probably the first to make medical notes. However, there is general agreement among medical historians that the written history of medicine began in Egypt 3000 years before the Christian era with the Smith papyrus [1,2]. The Smith papyrus is the oldest medical text in existence. It is housed in a vault in the library of the New York Academy of Medicine in New York City. The Smith papyrus contains 48 case reports that are written on a thin roll of papyrus 15 feet long. The medical conditions are arranged systematically from the top of the head down to the pelvis and are discussed according to symptoms, diagnosis, treatment, and prognosis. One of the described cases is a bulging mammary tumor that was attached to the chest wall and was believed to be a malignant swelling (cancer). The report concludes with an admonition that such tumors should not be touched since treatment might prove fatal [3]. A second Egyptian papyrus, the Ebers papyrus written in 1500 BC, was destroyed in Germany during World War II. It contained descriptions of nasal, anal, and uterine polyps, and tumors of the skin, thyroid, pharynx, stomach, anus, and uterine cervix. In addition, the Ebers papyrus gave the first narrative of a soft tissue tumor, “a fatty tumor,” with the recommendation that it should be excised. However, if the tumor was large or livid and was on a limb it should remain untreated [4]. From the writings of ancient Greek and Roman physicians who studied in Alexandria, it is known that in Egypt, operable (superficial) tumors were treated by cautery with a hot iron or by excision with a knife. Ulcerated tumors were treated with mixtures of lead, sulfur, or arsenic compounds. Arsenic paste was in use in Europe and the Americas as “Egyptian ointment” until the 19th century. By 600 BC, Greek physicians, influenced by Egyptian teachings, developed their own medical concepts and made substantial contributions to diagnosis and therapy. The most illustrious Greek physician, Hippocrates (460-375 BC) and his disciples established writing and note-taking as an important part of medicine [1,2]. Hippocrates (Fig. 1), a contemporary of Socrates (469-399 BC) and Plato (427-347 BC), was an astute diagnostician. He separated medicine from superstition and religion and made it a science for the first time. He classified diseases according to their principal symptoms and came to the conclusion that all diseases, including tumors, originate from natural causes [5]. Hippocrates noted that tumors occur mostly in elderly adults and the most aggressive growths reminded him of a moving crab. This observation led to his introduction of the terms carcinos (a tumor), carcinoma (a malignant tumor), and cancer (a nonhealing and ulcerated malignant tumor). In due course, he added another new term, scirrhus (a hard tumor) [6]. Address correspondence to Steven I. Hajdu, M.D., 1759 Drumcliff Court, Westlake Village, CA 91361-1636, USA; tel 805 496 0691; e-mail sih15@aol.com.