Anatomists & surgeons

1775 · Understanding · Foundations

Pott links chimney sweeps' scrotal cancer to soot

In 1775 the London surgeon Percivall Pott described scrotal cancer in chimney sweeps, many of them young, and attributed it to soot. It is generally counted as the first described occupational cancer, and later laboratory work on coal tar and soot built on it.

In Chirurgical Observations (1775), Pott described scrotal cancer in chimney sweeps and attributed it to soot, making scrotal cancer the first described occupational cancer; Bassius had described the disease in 1731. Doll writes that Pott's observation began the chain leading to the first experimental production of cancer, the first synthesis of a carcinogen and the first isolation of one from a natural substance. Experimental evidence of carcinogens in soot came from Passey in 1922.

1832 · Origin · Hodgkin lymphoma

Hodgkin describes enlarged lymph nodes and spleen (1832)

In 1832 the London pathologist Thomas Hodgkin described seven people whose lymph nodes and spleen were enlarged, based on what he found at autopsy. Later reviews of his cases disagree on how many were Hodgkin lymphoma; at least one was a different lymphoma, so the disease carrying his name was only part of what he reported.

Hodgkin's paper in Med Chir Trans, read to the Medical and Chirurgical Society on 10 and 24 January 1832, gave gross autopsy findings in seven patients with enlarged lymph nodes and spleen: six his own, one from Carswell. Later examination of preserved specimens found Hodgkin lymphoma in some and at least one non-Hodgkin lymphoma. On treatment he wrote that he had nothing to offer; most patients had reached hospital at an advanced stage.

1838 · Understanding · Foundations

Johannes Müller applies the microscope to tumours (1838)

In 1838 Johannes Müller published in Berlin the first part of a book on the fine structure of tumours. Using a microscope, he described cells, nuclei and nucleoli in cancers and told tumour types apart. A catalogue note says he saw that cell theory was needed to understand cancer.

Müller's Ueber den feinern Bau und die Formen der krankhaften Geschwülste (Berlin: G. Reimer, 1838) applied the microscope to tumours; only the first part (Lieferung 1) appeared, and C. West translated it into English in 1840. The translation describes cells, nuclei and nucleoli in tumours and cites Schwann's cell theory; Garrison-Morton adds that he distinguished tumour types microscopically. Virchow was among his students.

1842 · Understanding · Foundations

Rigoni-Stern compares cancer deaths by marital status (1842)

In 1842 the Italian surgeon Domenico Rigoni-Stern used death registers from the Verona region to compare cancer deaths in married and unmarried women. He found more breast cancer deaths in nuns and fewer uterine cancer deaths in nuns and other unmarried women. Historians see an early clue to infection in cervical cancer, though the nun finding has been questioned.

Per Horn and Vatten, Rigoni-Stern (1842) used death registers in the Verona region to compare uterine and breast cancer mortality in married and unmarried women. Nuns had higher breast cancer mortality; nuns and other unmarried women had lower uterine cancer risk (cervix and corpus not yet separated). Griffiths questions a very low cervical cancer risk in nuns, estimating their risk of death is little different from the general female population.

1844 · Origin · Multiple myeloma

Mollities ossium cases of the 1840s: Solly, Macintyre, Bence Jones

In the 1840s doctors described patients whose bones had softened and broke easily, then called mollities ossium. In one man, seen from October 1845, the urine reacted oddly to nitric acid and heat, and microscopy of his bones showed soft, cell-filled material. The urinary protein was later named after Henry Bence Jones and is linked today with myeloma.

Solly (1844) published cases of mollities ossium. Macintyre (1850) described a 45-year-old man first seen on 30 October 1845 with bone pain and urine rich in albumin-like animal matter that behaved atypically with nitric acid and heat; at autopsy the ribs were soft and brittle. Dalrymple (1846) examined a rib and two lumbar vertebrae. Bence Jones's urine paper was read in April 1847 and printed in 1848. Macintyre's text does not use the word myeloma.

1845 · Origin · Chronic myeloid leukemia

1845: Early case reports later recognised as leukemia

In October 1845 an Edinburgh medical journal printed two case reports, by David Craigie and John Hughes Bennett, of men with very large spleens and pus-like material in the blood. Later historical accounts count these among the early descriptions of leukemia, alongside observations by Rudolf Virchow the same year.

Two autopsy-based case reports (Craigie case 1, Bennett case 2) of men with very large spleens and purulent-looking venous blood. Case 2 also had a greatly enlarged liver and enlarged lymph nodes; Bennett judged the corpuscles to be pus. No blood count is given; the article does not use the word leukemia. The leukemia reading, leucocythemia (Bennett, 1845) and leukämie (Virchow, 1847) come from Kampen 2012.

1846 · Treatment · Foundations

Ether anaesthesia at Massachusetts General Hospital (1846)

On 16 October 1846 in Boston a dentist, William Morton, gave ether during an operation by surgeon John Collins Warren, a demonstration seen as the first public demonstration of anaesthesia. Surgical volume at the hospital rose afterwards. The patient's swelling was a vascular malformation, not a cancer, but later cancer surgery relied on anaesthesia.

On 16 October 1846 at Massachusetts General Hospital, Morton administered ether during Warren's operation on Edward Gilbert Abbott. Firth's review of the hospital records finds a congenital vascular malformation treated by attempted ligation under incomplete anaesthesia, not the tumour removal described on the commemorative plaque. Andrew and colleagues report that surgical volume rose after ether and the share of female patients doubled. Wyld and colleagues state that before anaesthesia and antisepsis cancer surgery carried high morbidity and mortality.

1858 · Understanding · Foundations

Virchow's Cellular Pathology applies cell theory to disease

In 1858 Rudolf Virchow published Cellular Pathology, arguing that disease arises in cells and that every cell comes from another cell. This turned pathology toward the microscope and shaped how tumours were studied. He also held that chronic irritation or inflammation could predispose to cancer, an idea later tested in animal experiments.

Virchow's Die Cellularpathologie (1858) gave Schwann's cell theory clinical significance; Breathnach describes his aim of a pathological physiology founded on omnis cellula e cellula, and notes that advances in microscopy dictated the growth of histopathology. Schmidt and Weber call it the basis of his oncology; he recognised inflammation as predisposing to tumours. Fujiki dates his irritation theory (Reiztheorie) of cancer to 1858.

1865 · Origin · Hodgkin lymphoma

Wilks attaches Hodgkin's name to the disease (1865)

In 1865 the Guy's Hospital physician Samuel Wilks published fifteen cases of enlarged lymph glands and spleen under a title that gave the condition as Hodgkin's disease, noting that Hodgkin had been first to draw attention to it more than thirty years before. The name has stayed in use; Wilks also favoured the term anaemia lymphatica.

Wilks's paper in Guy's Hospital Reports (vol. XI, pp. 56-67), 'Cases of enlargement of the lymphatic glands and spleen (or Hodgkin's disease) with remarks', reports fifteen cases, reviews Hodgkin's 1832 cases and says Hodgkin was first, as far as Wilks knew, to call attention to the disease. Stone (2005) cites it as the first use of the name Hodgkin's disease. Wilks preferred 'anaemia' to 'leucocythaemia lymphatica'.

1867 · Treatment · Foundations

Lister publishes the antiseptic principle in surgery (1867)

In 1867 the surgeon Joseph Lister published his antiseptic method, using carbolic acid to prevent wound infection, drawing on Pasteur's work on germs. A biography says that as many as 80 in 100 operations of that era led to infection. His results were debated for years, but reviews date the growth of cancer surgery from anaesthesia and antisepsis.

From 1867 Lister published a series of papers in the Lancet and British Medical Journal on carbolic acid treatment of wounds, drawing on Pasteur; the BMJ paper cited here is 'On the Antiseptic Principle in the Practice of Surgery'. Tröhler: the first paper reported 11 patients with compound fractures, two of whom died; the effect of Listerism was controversial for over a decade in Britain. Jessney: as many as 80% of 1800s operations resulted in infection.

1884 · Origin · Glioblastoma

Glioma surgery since 1884: a historical review of outcomes

A 2021 historical review of surgical series in glioblastoma starts from the introduction of craniotomy for glioma in 1884. It reports that the earliest operation was followed by the patient's death within a month, and that early deaths after surgery fell from 50% to 6% in Harvey Cushing's series after better management of pressure inside the skull.

McCutcheon and Preul (World Neurosurg 2021), review of major glioblastoma surgical series from 1884 to 2020: the earliest reported craniotomy was followed by death within a month; early postoperative mortality fell from 50% to 6% in Cushing's series after improved intracranial pressure management; mean survival in the first major surgical series (1912) was 10.1 months. These are the reviewers' figures, not checked against the original series.

1894 · Treatment · Breast cancer

Halsted's radical mastectomy and its published results

In 1894 the surgeon William Halsted published results of breast cancer operations carried out at the Johns Hopkins Hospital. The radical mastectomy he pioneered removes the breast, the chest muscles and the lymph nodes in the armpit. It remained the standard operation until the late twentieth century, when randomised trials tested less extensive surgery.

Case-series report (Ann Surg 1894) of operations for breast cancer at Johns Hopkins Hospital from June 1889 to January 1894, per its title. Its opening sentence states that in fifty cases operated on by what Halsted calls the complete method, only three local recurrences could be traced. Historians describe the operation as removal of breast, pectoral muscles and axillary nodes. Other counts and survival figures were not extracted.