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Treating the incurables: Cancer asylums in 18 th and 19 th century

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  • Salamina Medical Center

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For centuries several hypotheses were formulated on can-cer's pathogenesis such as contagiousness, melancholy, heredity and sexuality. In the 18 th and 19 th century, despite the advent of medical thought and practice, cancer was considered an incurable and contagious disease. Hospitals were refusing to treat cancer patients while the social stigma which followed the disease made primordial the need for the establishment of special institutions. In our article we will present the cancer asylums which counterbalanced the prejudices of the time and contributed to the establishment of modern cancer hospitals.
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JBUON 2017; 22(5): 1367-1371
ISSN: 1107-0625, online ISSN: 2241-6293 • www.jbuon.com
E-mail: editorial_oce@jbuon.com
HISTORY OF ONCOLOGY
Correspondence to: Marianna Karamanou MD, PhD. 4, Themidos str, Kissia, 14564, Athens, Greece. Tel: +30 6973606804,
E-mail: mariannakaramanou@yahoo.com
Treating the incurables: Cancer asylums in 18th and 19th
century
Marianna Karamanou1, Theodora Psaltopoulou2, Kostas Markatos3, Georgios Karaoglanis4,
George Androutsos3
1University Institute of History of Medicine, Faculty of Medicine, Claude Bernard Lyon 1 University, Lyon, France; 2Department
of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece; 3Biomedical
Research Foundation, Academy of Athens, Athens, Greece; 4Henry Dunant Hospital, Athens, Greece
Summary
For centuries several hypotheses were formulated on can-
cer’s pathogenesis such as contagiousness, melancholy, he-
redity and sexuality. In the 18th and 19th century, despite
the advent of medical thought and practice, cancer was
considered an incurable and contagious disease. Hospitals
were refusing to treat cancer patients while the social stig-
ma which followed the disease made primordial the need for
the establishment of special institutions. In our article we
will present the cancer asylums which counterbalanced the
prejudices of the time and contributed to the establishment
of modern cancer hospitals.
Key words: cancer hospital, cancer stigma, Dame du Cal-
vaire, history of oncology
In 19th century while the medical identity of
cancer was transformed, its social representation
was still that of an incurable and deadly disease.
That period, the Larousse dictionary in the word
cancer was mentioning: “to talk about treatment
means assuming curability of the disease…cancer
is and remains incurable” [1]. The enigma that
surrounded its origin contributed to several hy-
potheses on its pathogenesis such as hereditary
transmission, melancholy and contagiousness
[2-4], while the macroscopic similarity of genital
carcinoma and syphilitic gummas reinforced the
belief that cancer could be transmitted sexually
and it was a result of punishment for the sin of
the esh [5].
When tumors began to ulcerate and disgure
the face or body, patients became a burden for their
families and the medical system. Hospitals were
refusing to treat them believing that their disease
was incurable and contagious. On the other hand
the number of cancer patients seemed to increase
making primordial the need for the establishment
of special institutions. Since the 16th century, in
Warsaw, the Saint-Lazare Hospital was the rst to
hospitalize male cancer patients who were named
“putreed” or “rotten” and a century later a special
department for female cancer patients was inaugu-
rated with a capacity to hospitalize 70 women [6].
In France, cardinal’s François de La Roche-
foucauld (1558–1645) idea to create asylums for
the incurables “that their condition makes them
unable to earn a living by working or begging”
was approved by the King Louis XIII (1601–1643).
It was indeed an urgent need for such facilities
to emerge in order to counterbalance the preju-
dices of the time [7]. Two royal ordinances, one of
Francis II (1544-1560) and the other of Charles IX
(1550-1574), were stretching the importance for
Cancer asylums1368
JBUON 2017; 22(5): 1368
the admission of cancer patients in Hôtel Dieu hos-
pital of Reims as a measure to decrease the risk of
infesting the air, a popular belief of cancer’s trans-
mission based in miasma’s theory [8]. Worried for
the fate of “the poor of this city who are suering
from the disease that we call cancer and they are
not suciently cared”, Jean Godinot (1661-1749),
a religious man from Reims, excluded from the
monastic order to which he belonged because of
his Jansenist beliefs and devoted to the cultiva-
tion of his vineyard, decided in 1742 to found a
hospital for cancer patients aiming to relieve their
physical and psychical suering [6] (Figure 1). The
hospital named Saint-Louis was located on Saint-
Denis street and according to the statute it also
provided support in patients’ individual and social
problems. In 1786, it had 12 beds funded with en-
dowments, 8 for women and 4 for men. The medi-
cal care was delivered by the physicians of the
Hôtel Dieu whereas 3 nurses were caring daily for
the patients. However, the citizens, terried by the
fear of contagion, decided to transfer the hospital
out from the city; it remained there till 1846 [7].
Reims’s hospital is considered the oldest known
hospital serving cancer patients exclusively and
the Jean Godinot Institute, which was developed
out of it, remains active in Reims till nowadays.
In 1792, the London surgeon John Howard (?
-1811), ex-pupil of the distinguished surgeon Per-
civall Pott (1714-1788), informed the governors
of Middlesex Hospital that a friend of his who
wished to remain anonymous (later known to be
Samuel Whitbread (1720-1796), brewer and mem-
ber of Parliament would like to make an important
donation for the establishment of a cancer depart-
ment [9]. He mentioned that a spacious ward in
the Middlesex Hospital should be devoted to this
specic disease and to this disease only, stating
also: “The most serious and deplorable cases of
cancer can be divided into two groups: in the rst
group the symptoms rapidly evolve into a fatal
outcome; in the second one they slowly progress”
[10]. He also pointed out that patients belonging in
the second group could be treated as outpatients
and they would be admitted when their symptoms
would become severe, requiring a daily medical
support. The cancer ward was inaugurated on 19
June 1792. Patients with ulcerating tumors, those
requiring surgical operation and those whose can-
cer relapsed aer operation were allowed to re-
main in the hospital for an unlimited time. None-
theless, the treatment of patients was not the only
aim of Middlesex Hospital. It was also focusing
on research and it was oering training of medical
students in this eld. For this reason, they were
keeping a detailed record of each patient’s history
along with the eects of drugs administration and
surgical procedures. New therapeutic approaches
were also tested, such as the famous localized
pressure treatment in cancerous ulcers which was
tested in 18 patients, in 1816 without a positive
result. In 1853, almost 60 years aer its founda-
tion, the cancer ward had 26 beds and thanks to
another endowment the number increased to 36
in 1870 [10] (Figure 2).
In a similar way, the “Dames du Calvaire
(Ladies of Calvary) in France were focusing on a
specic patient category: women suering from
cancer presenting ulcerous lesions [11]. The deci-
sion for the care of women was reecting a per-
ception of the time that cancer was a “female”
disease. This view had a long history and was re-
inforced in the 19th century, based on the obser-
vation that women were especially liable to can-
cer of the breast and uterus [12]. The Association
was founded in 1842 in Lyon, France, by Jeanne
Garnier-Chabot (1811-1853), a young woman aris-
ing from a family of Lyon traders who within few
months she lost her husband and two children [13]
(Figure 3). That period she met an “unfortunate
woman” aicted by cancer, living alone in a slum.
She treated her, taking care of her physical and
mental suering. That experience was a turning
Figure 1. Jean Godinot (1661-1749): the founder of the
cancer hospital of Reims.
Cancer asylums 1369
JBUON 2017; 22(5): 1369
point in her life as she decided to dedicate to the
care of women aected by cancer whom the hospi-
tal and their relatives had abandoned [13]. Thanks
to the support of the archbishop of Lyon, cardinal
Louis Jacques Maurice de Bonald (1787-1870), she
succeeded to obtain the necessary funds to buy
a house in Saint-Irénée district which was used
for accommodation [7]. Her initiative received a
favorable response among women in bourgeois
circles and several hundred widows joined the as-
sociation. Widowhood was a compulsory condi-
tion to become member as “only the woman who
has suered is prepared for this task. Only those
for whom the love of material things is no longer
important will be given the task” [7]. According
to the statute the widows should not be attached
to any religious order, should be able to pay their
pension and their only attachment to the Calvaire
must be their love of God and the sick person [11].
Furthermore, there were four distinguished cat-
egories of benevolents: resident ladies who were
managing the house; associated widows who were
living outside and they were visiting regularly
the patients caring them and changing the wound
dressings; devotees responsible for the organiza-
tion of charity events; and associates who were
helping with the maintenance of the house. Be-
fore their admission in the Association the ladies
were trained for one year and once accepted they
were receiving a silver cross engraved with the
words: prayer, humility, charity, sacrice [7]. The
work of Calvary, taking care of indigent cancer pa-
tients, lled a gap in the medical-social system of
the time and created a reversal in the 19th century
social conceptions: it was equalizing the ranks,
making the wealthy woman, for whom the world
Figure 2. Middlesex Hospital: view of the entrance, 1837.
Cancer asylums1370
JBUON 2017; 22(5): 1370
seemed to be a place of enjoyment, the servant of
the most poor. Thanks to the continuous nancial
support from new members and charities, the as-
sociation established a large property in Fourvière
hill and soon aerwards new branches were cre-
ated in Paris (1874), Marseille (1881), Bruxelles
(1886), Rouen (1891), New York (1899), Bordeaux
(1909) and Bethlehem (1920) [7]. Nowadays, the
name of “Dames du Calvaire” and Jeanne Garnier-
Chabot continues to be associated with palliative
care services in France.
Almost 10 years aer the foundation of
“Dames du Calvaire” in Lyon, the surgeon William
Marsden (1796–1867), known also for the estab-
lishment of Royal Free hospital in London (1828)
for the care of the poor, founded in 1851 the rst
hospital dedicated for the research and treatment
of cancer, the London Cancer Hospital, renamed
the Royal Marsden hospital (Figure 4). Cancer
patients were admitted without a letter of intro-
duction and they were treated free of charge until
their death. The main goal of the hospital was to
treat the poor cancer patients without charge and
to make research for the disease [14]. However,
Queen Victoria (1819-1901) denied the patronage
as she was opposed to the idea for the creation of
a hospital devoted exclusively to a single disease
when those who suered from it they were not
excluded from the general hospitals. Finally she
Figure 3. Jeanne Garnier-Chabot (1811-1853): the founder
of “Dame du Calvaire”, Lyon.
Figure 4. The Royal Marsden Hospital in the 19th century, known as London Cancer Hospital.
Cancer asylums 1371
JBUON 2017; 22(5): 1371
was persuaded to give an amount of money and
in the following years she was annually donating
“pheasants and cast-o linen” [14]. In the eld of
research and mainly that of anatomical pathology,
Robert Knox (1791-1862) was appointed in 1856.
Knox was a brilliant anatomist from Edinburgh
whose career was damaged when it revealed that
the murderers Burke and Hare sold to him the
bodies of their victims [15]. In 1909, the Cancer
Hospital Research Institute was founded promot-
ing research. It was said that the hospital served
around 50,000 patients till 1900 and in 1909 the
Cancer Hospital Research Institute was founded
[14]. Similar institutions were founded in other
cities and countries, such as the Liverpool Cancer
Hospital (1862), the Memorial Sloan-Kettering
Cancer Center of New York (1884), Glasgow Can-
cer Hospital (1890) and the Roswell Park Cancer
Institute (1898) [7].
Aer the refusal of Hospitals to take care of
cancer patients, cancer asylums in the 18th and
19th century provided palliative care and psychi-
cal support to patients, in a period that cancer was
considered an incurable and contagious disease.
However, the social stigma of cancer was so strong
and long lasting that almost two centuries later, in
1939 according to a survey in France, 41% of the
respondents believed that cancer was contagious
[16]. Professor Maurice Tubiana (1920-2013), pio-
neer of modern radiotherapy mentioned: “When
I moved to the apartment where I lived in 1953,
the inhabitants of the building, including lawyers,
writers, and art critics, protested against my arriv-
al. They were afraid of crossing cancer patients on
the stairs” [16]. Even today that cancer could be
curable and cancer hospitals provide quality care,
combating cancer related stigma still remains a
challenge for both the society and physicians.
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... For this reason, Jean Godinot (1661-1739), canon of the cathedral in the French city of Rheims, accepted, in 1740, to transform his cathedral in the first cancer hospital for the poor for a considerable amount of money. It was called "Hôpital des cancers"; however, after few years, in 1779, the hospital was dislocated outside city to avoid multiples infections [26]. ...
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