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TitleDaniel de Moulin. A Short History of Breast Cancer 1989
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A short history of breast cancer

presented with the
-----compliments of -----

U ~~~~~I~o~!~E~~,~ ERSR

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DANIEL DE MOULIN
Institute of the History of Medicine

Catholic University, Nijmegen, The Netherlands

A short history of
breast cancer

KLUWER ACADEMIC PUBLISHERS
DORDRECHT / BOSTON! LONDON

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Fig. 21. Fanny Burney.

yet exist - and making a will, the anxiousness caused by a delay of three whole weeks
after she had given her consent, the excruciating agony of the intervention itself
together form a moving, subjective account of what patients had to endure in the days
of pre-anaesthetic surgery. It may have been common practice to postpone the
scheduled operation for an unspecified time, meanwhile leaving the patient uncertain
as to the precise date. In 1751, Madame de Bonnac was taken by surprise in the same
way by her surgeon Morand.138 The exact mode of the operation does not, of course,
become clear from Mrs. Burney's account, but it seems to have been a traditional
mastectomy, without additional removal of axillary nodes. The fact that she did not
contract a sepsis may be attributed to her being operated upon in her own house,
rather than in a hospital, the latter being a reservoir of infection. Since she survived
her operation for about thirty years, we may have some doubt as to the malignant
character of her affliction.

It is clear that the ever-present danger of septic infection and the lack of anaesthesia
prohibited the development of better methods of operative surgery than those that
had been in use for a thousand years. It is easy to understand, therefore, why quite
different approaches were tried. In Great Britain, a certain Samuel Young divulged a
method of treating tumours of the breast by continued compression. Before long,
compression was considered the treatment of choice for breast cancer in England. In

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France, the method was propagated by 10seph-Claude-Anthelme Recamier (1774~
1856), physician to the Hotel-Dieu in Paris. In his Recherches sur Ie traitement du
cancer par la compression ml!thodique simple ou combinee (Paris, 1829), he reported
on his results in one hundred cases. Thirty patients had recovered completely by
compression alone, twenty-one had shown considerable improvement, fifteen of
whom had been treated by compression followed by operation, and six by com-
pression in combination with cauterisation. Twelve patients did not respond
favourably.

After initial enthusiasm, critical voices were heard. A serious objection was that
compression was difficult to apply evenly without leading to pain or even causing
necrosis. Dr. Neil Arnott (1788~ 1874) of London therefore devised an apparatus in
which pressure was exerted on the breast by means of an air-cushion (Fig. 22). Still
more serious was the objection raised by such authorities as Alfred Velpeau (1835)
and Hermann Lebert (1851), two prominent mid-century oncologists to whom we will
presently turn our attention. They concluded that no definite cure of cancer had ever
been obtained by the method and that alleged cures had actually no bearing on cancer
cases. Compression treatment thereupon fell into disuse.164

In the early years of the nineteenth century, less progress was made regarding the
treatment of tumours than in the knowledge of their minute structure. The latter
development was initiated by Marie-Fran~ois-Xavier Bichat (1771 ~ 1802), a pupil
of Desault and the founder of histology. In his Anatomie generale appliquee a la
physiologie et a la medecine, which appeared for the first time in ! 80 1, he wrote that
the different kinds of cancer consist more or less distinctly of connective tissue. Such
tissue is the general base for the nourishing parenchyma. 'Tous les tumeurs sont
cellulaires, c'est leur caractere commun', he emphasised.165 Once again, 'cells' are not

Fig. 22. Compression apparatus, designed by N. Arnott and described by W.H. Walshe.

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Sappey, MPhC 94
Schelling, F 52
Schinzinger, A 102
Schleiden, MJ 58
Schrage, A 36,44
Schuh, F 72, 73
Schwann, Th 58,59
Scotto, J 75
Scribonius Largus 9
Scultetus, J 18
Seguin, P 25
Sjobring, H 106
Slooten, EA van 97
Slye, M 92
Stein thaI, C 96
Stevenson, THC 89
Stoerck, von 43
Stone, WS 100
Swieten, G van 32,34,35,41,42
Sylvius, F de Ie Boe 21,22,23,35,36
Syme, J 52, 79

Tabor, G 46
Temkin, 0 III
Teodorico Borgognoni 14, 19, 24
Thales 1
Thiersch, C
Thornton, M
TiUmans, H

124

68, 70
53

69

Tulp, N 24, 26

Ulhoorn, H 29,32,46,47
Ulrich, P 103
Urban, JA 97

Vallot, A 25
Velpeau, AALM 52, 57, 62-64, 66,

72,73,74,76,79,80,85
Vesalius, A 17
Virchow, R 37, 64, 67-68, 69, 70,

78,105,107
Vogel, J 62,66
Volkmann, R von 81,85

Waldeyer-Hartz, W von 68, 70
Wangensteen, OH 97
Ward, J 26-27
Welch, WH 83, 93
Westerman, CWJ 94-95
Whitbread, S 50
White, WC 95
Winiwarter, A von 76, 85
Wiseman, R 29
Wolff, J III, 92
Wij, GJ van 4

Yamagiwa, K 93
Young, S 56

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Also available by the same author:

A History of Surgery
With Emphasis on the Netherlands

By Dr. D. De Moulin, Institute for the History of Medicine, Catholic University,
Nijmegen, The Netherlands.

After a career as an active surgeon, the author of this volume switched to medical
history and became Professor of the History of Medicine at the Catholic University,
Nijmegen, The Netherlands.

A History of Surgery consists of original research into the development of surgery
through the ages and provides a chronological survey of the events which have led to
the modem achievements in surgery.
Furthermore, the book contains many historical illustrations not previously published.
There is an emphasis on surgical practice within the Netherlands. Dutch surgery,
however, has by no means been taken as an isolated phenomenon: it is considered in
its context within European Surgery as a whole, whilst contemporary medical thinking
is set against a cultural and political background.
As a result of this unique approach, this volume will be of great interest to practicing
surgeons and physicians, as well as to medical historians and the public at large.

Hardbound, 432 pp. ISBN 0--89838-968-2
1988 KLUWER ACADEMIC PUBLISHERS

This is no chauvinistic or narrowly national history. In the compass of its 400 pages, it
provides a lovely review of the history of surgery, in which an emphasis on the
development of surgery and those who contributed to it is combined with a humanistic,
social, and historical approach uncommon in histories of surgery. The book is
necessarily brief in every section, yet the author's skill is such that the treatment of
each phase is satisfyingly unhurried ... The illustrations are well chosen ... Two
splendid chapters, "The beginning of Modern Surgery" and "Surgery in the Past 75
years", provide fine accounts of specific developments of surgery in the Western
world during the 19th and 20th centuries. Obviously, a single chapter on 20th-century
surgery can only hit the high points. The author's intention was to present a 'survey of
the earlier events which led to these modern achievements ... for practicing surgeons
and interns' .
He has succeeded very well.

Mark M. Ravitch, M.D.
Montefiore Hospital

Pittsburgh, PA, U.S.A.

Review in: New England J. of Medicine,
September 1988

125

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