The dangers of delaying treatment in oral cancer: A seventeenth-century perspective.

Dear Editor,

In the seventeenth century, the only cancers that were recognised were those which could be seen [1]. Oral cancer was one of them. A rare and poignant account of this disease can be found in the published surgical treatises of the eminent royal military surgeon Richard Wiseman (bap.1620–1676) [2]. Although written over three hundred years ago, its central message is one which holds true today: oral cancer must be diagnosed early if it is to be treated successfully [3].

Wiseman’s patient was a sixty-year-old man, who had been ‘long diseased with a Cancer on the left side of his Tongue’. The cancer ‘corrupted’ half this organ, ‘from the Root to the Tip’, and also affected the ranula and ‘salivals’. Being ‘at a loss what to doe’, the man travelled to London, where he consulted several well-known surgeons and physicians, including Wiseman. In view of the advanced state of the cancer, the practitioners initially advised a palliative, rather than a curative, course of treatment. The patient, however, ‘persisted earnestly’ in his wish for a complete cure, so that eventually Wiseman agreed to ‘cut off that part of the Tongue, and to cauterize the sordid Ulcer that lay on that side of his Mouth’. This was an unusual course of action in the seventeenth century, especially in ‘old’ cancer cases, where the chance of survival was deemed slim. A far more common treatment was the so-called ‘meat cure’, which involved applying slices of freshly killed poultry to the affected body parts, in the hope that the cancer – which was conceived as a sort of ravenous animal – would be tempted to devour the meat rather than the patient’s flesh [4].

Wiseman recounted the stages of the operation in detail. With the use of a ‘raspatory’ (file), he ‘pulled away the corrupt Flesh’ between the ‘Root of the Tongue and the edge of the Tonsil’, and then cauterised this part ‘to a crust’. Having, as he hoped, ‘consumed the Cancer’, he inserted a probe with a ligature into the ulcer under the tongue, and brought it out above’. Pulling the tongue forward, ‘I cut off the cancerated part’, recorded the surgeon, and cauterized the area. While what remained of the tongue began to heal, a ‘hard Swelling arose’ in the man’s right thigh, which became ‘so painfull, that he was forced to keep to his Bed’. At the same time, ‘apostumations’ (abscesses) developed in the ‘salival Glands’ and ‘under the Jaws’, of which ‘together he languished and died’. In an era before anaesthetics, the agony experienced by this patient during and after his operation can only be imagined [5].

Wiseman was aware this procedure might seem ‘extream cruel’ or hazardous, but insisted that given ‘the misery those poor creatures suffer with Cancers in their Mouths’, it is ‘not to be wondered [at] if they try a doubtfull Remedy, though painfull’. He described with great compassion what this misery entailed. The patient feels the cancer ‘eating and gnawing the Flesh, Nerves and Bones’, a pain which in this era was commonly likened to the sensation of being bitten by a wolf or crab [6]. These patients also ‘suffer hunger and thirst’, owing to the difficulty of swallowing, and if they are able to eat and drink, ‘yet it is with an unsavoury taste, by reason of its passing through such sore corrupt Parts’. Getting to sleep was almost impossible, as indeed it was for many seriously ill people in the seventeenth century [7], [8]. In Wiseman’s words, ‘Sleep is a stranger to their eyes, their Slumber very troublesome, and Death is their onely desire’.

Thankfully, modern advances in surgery and medicine have transformed the experience and treatment of oral cancer, but Wiseman’s concluding remarks still resonate powerfully today. He hoped that the case would ‘teach others how dangerous it is to neglect’ oral cancer ‘while the Disease is recent, and easie to be eradicated’. One of the anticipated repercussions of COVID-19 is a delay in the diagnosis and treatment of oral cancer [9]. Wiseman’s lesson is thus especially relevant now.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.