The first accurate description of uterine carcinoma by Aretaeus of Cappadocia

Uterine cancer had been known since antiquity. The earliest documentation, even tenuous in the extreme, comes from the ancient Egyptian Kahun papyrus (c. 2000 BC). A small passage from another Egyptian papyrus, the Ebers, written in 1500 BC, that was mentioning: “woman gnawed in her uterus and in the vagina where ulcers develop” led some authors to conclude that the disease described was uterine cancer. Support for this hypothesis comes only from the genital malignancy discovered in a Ptolemaic mummy by the eminent physician Augustus Bozzi Granville (1783-1872) who in 1825 performed the first autopsy on an Ancient Egyptian mummy. However, in 2009 the molecular re-examination of the mummy revealed that she died from tuberculosis.

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Uterine cancer is mentioned centuries later in Hippocratic writings where for the first time the terms karkinos and karkinoma (ancient Greek for “crab”) were applied to designate cancer.

The first accurate description of cancer of the uterus is credited to Aretaeus of Cappadocia who described the malignancies of the uterus and distinguished between malignant ulcerations and malignant tumors.

Aretaeus of Cappadocia was born in Cappadocia, a region in eastern Asia Minor, studied medicine in Alexandria and practised in Rome.

His two treatises, De causis et signis morborum acutorum et diuturnorum (On the causes and symptoms of acute and chronic diseases) in four books and De curatione morborum acutorum et diuturnorum (On the cure of acute and chronic diseases) also in four books, are written in Ionic Greek, a dialect which had not been in use for centuries and Aretaeus chose it to imitate Hippocrates who also wrote in that dialect.

Aretaeus’s work is characterized by the accuracy and simplicity of his descriptions, showing him to be an excellent observer who was concerned more for his patient than the theory itself.

His accounts are summarized in the following categories: anatomy, physiology, symptomatology (description of several diseases as diabetes, leprosy, asthma, cancer), neurology, psychiatry, surgery and therapeutics. Furthermore, he was the earliest medical author to distinguish between conveyance of the disease by actual contact (contagion) and transmission of disease from a distance (infection).

In the chapter entitled “On uterine affections” of his book “On the causes and symptoms of acute and chronic diseases”, Aretaeus begins by stating:

The orifice of the womb in the female is appropriated to menstruation and child bearing, but is conducive to many bad diseases”.

Concerning the uterine carcinoma, he attributed it to an excess of black bile and distinguished two types: the ulcerated one which could be broad, itching and painful and the non ulcerated which was firm.

The ulcerated uterine carcinoma could be superficial or deep. For the deep one, he masterfully wrote:

The purulent discharge is large …the lips of the ulcer are harsh and rough, there is certain offensive ichor and the pain is severe. The ulcer corrodes the uterus and sometimes a loose fleshy substance protrudes which does not cicatrize for a long time but occasions death….the veins in the uterus become swollen with tension of the surrounding parts”.

He continuous his description by stating that the women suffering from that kind of ulcers are in an incurable state, have fever and experience severe pain making any medicinal application difficult. He believes that these ulcers are fatal and names them cancerous.

In his work Aretaeus described another type of cancer, which does not present ulcers, but is rather a growth in the uterus:

In another variety of cancer there is no ulceration, but a hard, unyielding lump that extends through the wall of the uterus”.

Concerning the pain and other symptoms are the same as in the ulcerative form.
Aretaeus believes that both forms are of a cancerous nature, both chronic and fatal, but the ulcerated one is worse than the no ulcerated.

(Source: “Aretaeus of Cappadocia and the first accurate description of uterine carcinoma”, by Gregory Tsoucalas et al.)

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Research-Selection for NovoScriptorium: Maximus E. Niles

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