Background

Although cancer was known to the ancient Egyptians and the symptoms of what can be assumed to be malignant disease were described in Chinese and Arabic medical writings, nothing was known of its causes or geographical distribution. Cancer was first mentioned as a cause of death in 1629 in the annual Bills of Mortality produced in London. Scattered reports also came from Paris and from some other European countries. The fact that few individuals survived into their 50s probably explains its apparent rareness. The majority of reports on cancer were essentially clinical observations and concepts of etiology were rudimentary.

While Hippocrates had emphasized the role of environmental factors in human disease causation, little real data was available about such exogenous factors. With developments in microbiology in the late nineteenth century, the situation changed as the major communicable diseases began to be identified and controlled. However, for noncommunicable chronic diseases, including cancer, knowledge remained inadequate although theories, often far-fetched, abounded. In 1775, Percival Pott demonstrated the relationship between scrotal cancer in chimney sweeps and soot, raising the possibility of prevention. Recognized as a milestone today, Pott's work had relatively little impact during the following century. Clemmesen (1965) provides an excellent introductory review to this early period.