Dr. Osborn doesn’t mention cancer anywhere in his vade mecum. This is most unusual. A typical doctor witnesses many cases that he will have to determine whether each is cancer or not. The ability for a physician to successfully make the correct decision however is questionable.
The differences between cancer and other diseases are obvious to us today, but not so much during colonial times. A number of conditions that appear like cancer are witnessed by doctors every year. When residing in a farming community, such incidents could take place on a monthly basis perhaps. When residing in the wilderness setting of New York during the colonial period, this is less so the cases but nevertheless frequent when compared with other medical conditions. I say it this because during the colonial years the most common “cancers” are in fact not cancers as we think of them today. Many of the diseases called cancer back then were not at all deadly, some were curable, and many in fact resolved on their own. Some of the cases left unresolved took a few weeks or months to take a life if left untreated. Others could linger on for years, causing all sorts of problems other than cancer that ultimately take a life.
In some ways, this still doesn’t sound that different from the cancer or tumour as we know these to exist today. However, the numbers of different types of cancer that were known about back then are not a diverse as the lengthy more modern list. To colonial doctors, cancer and tumor were simply one condition, a malady in its own right that differed in behaviors due to its inner makings, not the consequence of the place where it was first diagnosed. If a colonial doctor were to be around today when someone first had a cancer or tumor diagnosed, that doctor might wonder why the person is so emotional about the discovery. To him, this was a disease that needed to be aggressively treated and monitored to see if it would subside. Without such treatment, this condition could begin to grow further in size and express itself in different ways, such as by changing its color or changing its means for expressing the humours. This doctor might even tell the patient and the other more modern doctor treating that condition to ‘be careful, or else it could get away from you and spread to other parts of the body, then you’ll have a great problem finding where it is getting its strength and stamina’. To the colonial physician, this is the truth for most diseases that go untreated, they can progress to other parts of the body. To the regular doctor, this can be an ultimate outcome whether or not they have been aggressively treated, but usually some kinds of “cancer” thoe modern doctor will know can be completely healed, whereas other forms of “cancer” cannot. Due to this mixed meeting of the minds, the currently trained doctor would only look at this colonial physician and blurt out to him ‘of course that is the case… we know cancers will metastasize and spread to other tissues and organs. The question is where do we go from here?!’ The colonial doctor might think and ask ‘metastasize?’, and then reply “oh, you means how the humours might be spread.”
The same could be said for Osborn’s thinking that cancer somehow relates to what we consider infectious diseases like small pox and measles, or perhaps abscessed tooth and the mumps. Both of these form an abscess or tumor in the cheeks. Osborn might hear a modern immunologist say that some of these “tumors” are due to this stuff that flows about the blood, protecting the body from disease and at times, creating a redirection to the problem causing many other such maladies to arise. Osborn’s words to an immunologist in turn might be ‘these are due to humours flowing in different ways, but very wrong ways, causing them to sequester at times in some places, and so causing the disease to grow.’ [Across the river, Cadwallader Colden around this same time claimed the same, or used a similar line of reasoning, relating measles and small pox to the sore throat epidemics that occured in Kingston (diphtheria?), the latter being a less aggressive form, utilizing less fire.]
During colonial times, “cancer” was anything that resulted in significant swelling and significant changes in gross appearance. Even during Hippocrates time, it was known that there was this kind of condition called “cancer” that could be quite different from other conditions assigned this same name due to the similar appearance. There were some conditions called cancer that could have in fact have been cancer. The name itself helped to define the characteristic looks of cancer. Derived from cancrorum or cancer, referring to the crab, there was something about how a cancer crept through the body, spreading into nearby tissues, that made anatomists and others who actually took a close look at a cancer. They knew there was something very different for this particular disease. At the clinical level, the main ways a physician might have been able to tell the difference between the traditional cancer and all these other conditions they called cancer, is in how long it took for the disease to take someone’s life. During colonial times, some cancers were deadly, others were not.
The treatment plan is often what gave the physician the impression as to what type of cancer was occuring–acute and shortly lived or chronic and deadly to the patient. If it was a simple tumor that could be treated, then a compress would be laid, and few cuts made of its head or center, and in a few days the cause would simply emerge and make the tumor go away. If it was a complex tumor, then it needed more agrgressively applied compresses, a more aggressive knife be handled, followed by some blood-letting to diminish the bad blood perhaps causing it, and the administration of medicines meant to enhance the body’s strength, like a tonic or beer. If it is the case that it has invades the liver, we will know, for the tumor will manifest a condition of the body in which it becomes yellow, a symptom of the gall being generated by this condition. If it is approaching its most deadly state, the humour being discharged directly from the tumor will turn black. The best tumor to have is one that is small, whitish, expressing just phlegm, an one that needs to be simply lanced. Ignoring the humoural concepts just mentioned, this still sounds much like how we picture and describe the makings and methods for generation and treatments of tumors today–there are good tumors with well defined edges and borders, that can be removed through simple surgery, and bad tumors that are most aggressive and not nearly as treatable.
Unlike the alternative forms of cancer, a true cancer did more to the body than the simple tumor. ,The vitality, spirit, and to some, the soul of the body are what suffer the most from the more aggressive forms of cancers and tumours. They used this fate of the disease to differentiate true cancer from the other conditions that today we do not even relate to cancer, but which colonial physicians thought were cancer—the sores cankers and abscesses growning beneath the skin, and the most deadly of all conditions–consumption. The closest thing to cancer in terms of a patient’s future outlook and mortality was the other slowly evolving disease capable of dissolving the body a little bit at a time–consumption. At least doctors could tell the differences between cancer and consumption, or so they thought, so long as a cancer of the lung didn’t some into play to cause the emaciated patient to cough up his black bile mash of decaying lung tissue, this time coming out as some sort of other color due to its cancrorum heritage, a lung with too much phlegm or too little fire perhaps is what they’d think. A state of decay resulting in no vitality to allow it to succeed in what this disease is trying to accomplish.
Based on Osborn’s disease interpretations, we can put cancer under St. Anthony’s Fire, along with the accompanying discussion of Shingles. This is because Osborn’s theory for the St. Anthony’s Fire also known as Erysipelas, as well as his theory for the Shingles, are the closest thing he has to a possible cancer experience and philosophy he might have witnessed in his patients. These conditions are all considered to be engaged in as disorders of the fire. This provides us with a duality that Osborn has just defined as part of his practice, perhaps one of his primary aphorisms–along with the balance of humors that must exist, there is a balance between the humours and the fire that drives them and causes them to migrate, progress, become less active, or find their new way to new tissues or body parts. It is the humours that cause a disease, and the fire that defines its energy and types of severity. Only the routes that are taken need to be discovered by a physician, if he wants to prevent a condition from becoming worse.
The only other option for thinking about cancer in view of Osborn’s essays within the vade mecum is to relate cancer to pleurisy, in which pain in the chest commences as the pleura becomes so attached to the tissue next to it that some form of fire erupts. Pleurisy however is not fatal like cancer. Osborn would have also known that. More than likely, pleurisy is not cancer because it does not grow and get larger, and there is no humour to be ejected from the unhealthy tissue or some sort of tumor to be excised. Only consumption is close to cancer for some of these attributes, but the Shingles and St. Anthony’s Fire more like cancer visually, as external growths on the body indicative of some sort of unhealthy balance existing beneath the skin.
There is a third option about Osborn’s take on cancer and why it doesn’t appear in the vade mecum, one that only can be implied by a brief sentence in his vade mecum. On one account in his book he refers us to his knowledge and experience as a chirurgeon (surgeon), which he claims to have written up, or planned to write up, in another book. Unfortunately for us that book was never found.
So, to begin with Osborn’s take on cancer, we need to first review what his apparent philosophy is regarding disease pathology. As this understanding of Osborn’s writings become more and more apparent to me, his philosophy is added to the section I have on Dr. Osborn’s knowledge base–his aphorisms so to speak–taking this name from the same sort of writing Hippocrates and the locally favored Hermann Boerhaave is know to have produced, something for Osborn to be able to read if he would. So too, for us, Osborn’s aphorisms provide us with insights into his personal philosophy about disease, as this review of cancer and Osborn should provide as well.
Osborn believed in a four humours balance, with emphasis on the fire as a unique element capable of generating disease and damages to tissues throughout the body. Osborn also had a liking of the metaphysics, like any scientist would once he reaches a certain stage in his life. We know this about Osborn because he refers to the ens veneris to treat feminine conditions, a recipe created by Harvard Alchemist and Christian George Starkey only a century before Osborn got to write down this term on his own (perhaps even the first time this term has ever been linked to a doctor in America). So Osborn could have combined his theories on the flowing of humours, beginning with phlegm throughout the body, agitating and causing other parts within to release their own illful humours, like the liver releasing its yellow bile, the gall its black bile, and the blood, its bad blood and excess amounts of heat it can help to cause, take away, dilute, or agitate.
Osborn may have thought the cancer was an illness that like others began as phlegm, turned into some more colorful biliary form, caused blood to be released from the site in the more acute cases, even before the bile is generated, but finally leading to the formation of its worst product–the black bile. And were the cancer to be severely life threatening, its victim will know this. There are only two paths one might take with cancer, experience the same fate as having the consumption for too long, thus becoming yet another example of that state of decay Osborn is so much into treating, or take a course along another path, losing your vitality, losing your temperament or personality, and ultimately follow the same route to your fate as you would any other time such an illness turned you into a mortal, regardless of your ens primum.
If we look at Hippocrates theory for cancer for a moment, we find that Osborn’s theory of the humours travelling about, like the ens of the uterus losing its way in the body, could very well be much like the theory for cancer defined by Hippocrates. Even though Osborn never mentions a thing about what to do when treating something like an abscess, he must have had that experience, so much that he would know this problem more than any others he probably had to treat on a regular basis. Osborn had to have been treating people for cuts that were infected, open fractures that failed to heal, sores on the skin, ulcers, abscesses, warts, impetigo, and even severe cases of acne, measles and small pox. All of these diseases resembled each other in some manner. Although some were acutely fatal, and others capable of sequestering in a bed of tissue for weeks or months, both must have had similar reasons they were given for their initial onset. It is only after this onset that the various different reasons were needed to define their own separate route that had to be taken, be it fatal or simply the principal cause for one’s morbidity. Maybe Osborn does not mention cancer or its similars like abscesses, tumors, cankers and warts in his vade mecum because he considered this knowledge common sense, nothing he needed to teach his sons.
Osborn does covers two “scabbed” forms of skin problems like those that Hippocrates may have noted to be associated with cancer–St. Anthony’s Fire and Shingles. These two diseases he discusses in his vade mecum because he knows they are different from cancer, because they are engaged more in the disorders of fire. If we place Osborn’s writings about the St. Anthony’s Fire and Shingles into my illustration of Hippocrates idea on cancer, we find there are three more steps preceding that Inflamed Red Lump stage from too much blood, and perhaps fire. We find the progress of the “cancers” as Osborn might have seen them as follows:
First the body develops a sore, perhaps with some fire, and sting, and a little pain. Then this sore develops and begins to become very big and inflamed. Be it white, then it consists of too much phlegm, be it red and we are back to the blood and fire. Once this object becomes so big it is something like a boil or abscess, of perhaps a blister, or even a swelling from a severe poison ivy case, we find the phlegm is being exchanged for yellow bile, and so purulence forms and is discharged by itself, or when we open it. In some cases this discharge helps to clean it out of bad humours, and so the cancer recedes. In other cases, these humours have penetrated the entire body, and so this cancer becomes fatal.
I should add at this point that when you read the older books, from 1850 on back, and then review these theories as to these disorders in a forward direction time wise, you see something that just stands out about “cancer.” For a while there, “cancer” is the same thing as “Canker” of “Chancre”, and their treatments are interchangable. One is the other, or one precedes the other, or they are both one and the same, only with different avenues taken and different outcomes in the body. This appears a lot in 1830s and 1840s writings by “irregular” physicians–people who did not go to medical school or undergo apprenticeship under a regular MD, but people who did receive some training informal or formal from another practitioner with matching metaphysical and practical beliefs as a practitioner. Since medicine did very little to cut a body into pieces, or dissect the latest grandparent who died, very little was known about the differences between these two entities as inner and outer problems. Cancer and canker were diagnosed primarily due to their external appearances. Only later did anatomy, and the bravery of physicians to go beyond the state of shyness of searching for a cancer of the breast, ovary, or other private part, were doctors really able to begin to understand that cancer was not only different due to its manner and shape of growing, but also due to its ability to form in many different parts of the body, for seemingly inconceivable ways and in illogical manners. Cancer was different from canker in that the latter was understandable and predictable, true cancer was not. Canker could be treated and a life could be spared, with cancer this was not the case.
With this in mind, we can how Osborn’s treatment for cancer, when he could see it protruding the body’s surface, was probably quite obvious. He treated it according to its state. Was it simply a sore? an abscess? does it bleed? did it produce an ulcer? was its outer presentation like the shingles? the St. Anthony’s Fire? Was it overly choleric? (yellow bile) was it decaying? (black bile) Was it of the acute phlegmatic kind that others need to avoid? (mumps, measles, small pox). Could it travel from one place to the next, or from one tissue or organ to the next, like the consumption?
We can tell from his vade mecum recipes and theories that Osborn knew what to do. Aside from surgery he knew about the caustic medicines, capable of dissolving a cancer type of condition which we today call a wart. He made use of mineral remedies, the only way to produce an agent ten to twenty times more powerful than any plant drugs or recipes. There were also the proprietary agents out there he could order. Foments, packs, plasters, and other external applications would be the first test to perform, to see if it erupts and then goes away. This could be followed by some of his beer to tonify the decaying body unable to fight the condition effectively, in its early state. But if it were late in the progress of such a decay, perhaps the only thing left to do was the same thing already discussed for consumption. A decay of the breast, skin, torso, joint, or lower belly seemed no different from a decay of the lungs due to something as simple as pleurisy or something as complex as the consumption.
Like Hippocrates and Thomas Sydenham, one of Dr. Osborn’s most respected authors on the fevers, Osborn was what another of his cited authors (Daniel Turner) called ‘a doctor who likes to work from the skin out’ (extracorporeal). According to Turner, there were plenty of doctors out there who didn’t learn as much about anatomy as they learned about diseases and the medicines. Osborn is very much on of these types. He likes to physically cure what he can touch and see, but only metaphysically try to resolve problems erupting from within the corpus, in some form of fire, entia, energy or change in vitality.
Brian Altonen, MPH, MS 