From the Dissection Room: An 18th-Century Postmortem of Lung Cancer

Portion of Mrs. Adam’s lung showing several round masses of firm white cancerous tissue embedded in apparently healthy pulmonary tissue, 1792. Specimen from the Hunterian Museum of the Royal College of Surgeons, London.

Definition: Lung cancer is a disease that consists of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and women, is responsible for 1.3 million deathsworldwide annually, as of 2004. The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss. [Wikipedia]

Description: ‘Mrs Ad-m [Adam?], about forty years of age, observed a lump in her right breast, and in about twelve months after, observing it to become of a considerable size, she applied to me in the Autumn 1792. – I ordered Leeches, and the embrocation of Goulard &c, which appeared at first to check its progress. I gave hints of my doubts about the Cure, and endeavoured to lead the mind to an operation. She went into the Country in the month of January 1793, and about the beginning of February she returned to Town; and the progress it had made in that time was very considerable: as also a small gland in the Arm-pit had made its appearance.She also returned with a severe cough, and shortness of breath, which I did not like; for I had often seen such after the disease had made considerable progress towards the source of the Circulation along the Armpit &c, which I conceived arose from the lungs being affected with the absorbed matter from the Tumour; as it must circulate first through them before it got to the common Circulation: but all this was only conjecture, for I had not been able to open such [persons] as had this Symptom and seemed to have died of it.

She now came to the resolution of having it removed, and I now wished to put it off altogether: but it was imagined that her cough and shortness of breathing was nervous, as it had come on so rapidly, and with such violence. The breast and gland were removed; and in the time of removal, the pectoral muscle was found to be contaminated; which parts were removed along with the Tumour. Everything respecting the wound went on well; but the Cough and shortness of Breathing became worse and worse. She felt low, and as if dying: her pulse quick, although not remarkably so; and what was very singular, her tongue always kept clean and moist. All these Symptoms increased upon her, and it was evident she had little or no chance of living; although all this time the sore was going on vastly well. She died about three weeks after the operation, and I wished to examine the body, which was allowed.

The parts leading from the wound towards the Heart in the course of Absorption, viz Arm-pit, & above the Clavicle were to all appearance sound: – the lungs were found to be extremely diseased, and adhered every where to the parietes: not so much disease of their substance, as having every where disease in their substance, particularly in their adhesions: the Mediastinum was particularly so. This disease was every where of one kind, and was in form of Tumours; in largest quantity or masses in the mediastinum and anterior edge of the lungs where they adhered to the Mediastinum; which disease extended laterally and backward in the adhesions. The substance of the lungs every where, was studded with them; some small as peas, others as large as Walnuts &c. These Tumours which were in the adhesions of the lungs were strong; but in the substance of the lungs they could easily be turned out; being attached very slightly. They were pretty firm in consistence, and when torn, they broke into pieces like a Jelly: viz not tough. These substances cannot be called Tubercles or scrofulous swellings; and how to account for this formation (to my own satisfaction,) is to me difficult. To suppose they arose from the absorption of the Cancerous substance, and circulating immediately through the lungs, contaminating them, and producing such effects, does not accord with the effects themselves, or the parts in which they were produced. Parts were affected that seemed to be both out of the way of the course of absorption, and also out of the way of the Circulation in the lungs: for the Mediastinum and anterior edges of the lungs being diseased, one might suppose that the absorption took the route of the internal mammillary artery; but even this is not sufficient for the whole exterior surface of the lungs, not does it accord with the contamination of the lungs from the cancerous absorption circulating through them; for then we should not have expected Tumours, but rather a Consolidation of the lungs. The short period in which these Tumours Adhesions &c, seemed to form, is also uncommon. How far this is reduceable to the case of Mr Bennett the Coach-maker, and of the Duke of Queensberry’s Cook, I will not say; but there is certainly a similarity’. [John Hunter, Casebooks, pp. 609-10].

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