Dear Editors,
I read with great interest the historical report written by Kelly and Mahalingam, entitled ‘Surgical treatment of head and neck cancers in the ancient world’, published in your journal in July 2015.Reference Kelly and Mahalingam 1 The discussion of head and neck cancer surgery in the ancient world is welcome, because few papers exist. Nevertheless, I am a little confused with this report. Firstly, the authors omitted the most extensive and complete review about this topic, published in 2013.Reference Pestle, Colvard and Radosevich 2 Secondly, the authors did not discuss ancient Indian and Chinese writings (they also belong to the ancient world). Thirdly, and mainly, some of the references dealing with the Greco-Roman world, essentially the ones considered as primary sources, even if they correspond to author guidelines of the journal, are not clear and are difficult to exploit. Furthermore, they raise the question of whether the authors really did use these original documents in the writing of their paper. Original primary sources are mandatory in historical studies. The risk of inaccuracy is very high when using and compiling secondary references without verifying the primary references mentioned.Reference Mudry 3 – Reference Mudry, Ruben and Pirsig 5 The following text shows two examples extracted from this paper that support this supposition.
In the section on Hippocrates, Kelly and Mahalingam wrote: ‘In Epidemics, … the author describes a pharyngeal carcinoma and suggests that cautery be used, claiming this to have been successful in his experience’. They refer (reference number 20) to ‘Jones W, ed. Hippocrates v. 1. Cambridge, MA: Loeb Classical Library, 1923’. This Hippocrates Volume I contains only a part of Epidemics; that is, Books I and III. Epidemics in the Corpus Hippocraticum is divided into seven Books. Interestingly, the related description of treatment for pharyngeal carcinoma is in Epidemics VII, paragraph 111, transcripted and translated in Hippocrates Volume VII of the Loeb Classical Library. Thus, the reference must be something like: ‘Smith WD, ed. Hippocrates Volume VII. Cambridge, MA: Harvard University Press, 1994, Epidemics VII,111, p.405’. The Loeb Classical Library was founded in 1911 by James Loeb. It is published and distributed by Harvard University Press. It is a registered trademark of the President and Fellows of Harvard College. The exact text is: ‘The one whose cancer in the pharanx [sic, i.e. pharynx] was cauterized was cured by me’.Reference Smith 6 In this passage, no lesion is described, only the treatment, contrary to what Kelly and Mahalingam reported. It will be very entertaining to have all the ‘three references to head and neck cancers' found in the Corpus Hippocraticum and mentioned by the authors. The addition of these related original texts will also facilitate discussion of the validity of head and neck cancer diagnoses, because many descriptions of lesions are vague and may not correspond to a probable cancerous pathology. This is particularly true with the Ebers papyrus.
The presentation of Celsus' references (reference numbers 25 and 26) is not clear. Why mix Latin and English? The reference must be something like: ‘Spencer WG, ed. Celsus: On Medicine, Books VII-VIII. Cambridge, MA: Harvard University Press, 1938, Book VII,9’. Notice that paragraph nine of Book VII deals with mutilations and not with cancer! The exact text (in the reprinted 1994 edition, page 363) is: ‘Mutilations then occur in these three parts and can be treated … But in the case of the lips, if these have become too much contracted, there is also loss of a necessary function, because it becomes less easy both to take food and to speak plainly’.Reference Spencer 7 Furthermore, it does not correspond exactly to the quotation found in Kelly and Mahalingam's paper! Is Kelly and Mahalingam's quotation extracted from another reference or transcripted text? As the 1994 edition is mentioned simply as a reprinted edition, it must correspond to the original 1938 text.
Finally, and concerning Celsus, the authors wrote that Celsus ‘moved to Rome in the middle of the second century BC’. Most historians agree that Celsus lived under the reign of the Roman Emperor Augustus (63 BC to AD 13), and the accepted dates for Celsus are approximatively 30–25 BC to AD 38–50. Further, the authors stated that Celsus ‘made Latin the new language of medicine’. On which facts is this statement based? Celsus' De re medicina was almost never mentioned in medical writings until the fifteenth century, when Pope Nicholas rediscovered it. Galen's most influential writings were in Greek!
It would be very useful for interested readers if the authors would improve and complete all these primary references, notably those of Hippocrates, Celsus and particularly Galen. Thank you for your attention to this letter.
