Is cancer a contagious disease? In the late nineteenth century this idea, and attending efforts to identify a cancer “germ,” inspired fear and ignited controversy. Yet speculation that cancer might be contagious also contained a kernel of hope that the strategies used against infectious diseases, especially vaccination, might be able to subdue this dread disease. Today, nearly one in six cancers are thought to have an infectious cause, but the path to that understanding was twisting and turbulent. A Contagious Cause is the first book to trace the century-long hunt for a human cancer virus in America, an effort whose scale exceeded that of the Human Genome Project. The government’s campaign merged the worlds of molecular biology, public health, and military planning in the name of translating laboratory discoveries into useful medical therapies. However, its expansion into biomedical research sparked fierce conflict. Many biologists dismissed the suggestion that research should be planned and the idea of curing cancer by a vaccine or any other means as unrealistic, if not dangerous. Although the American hunt was ultimately fruitless, this effort nonetheless profoundly shaped our understanding of life at its most fundamental levels. A Contagious Cause links laboratory and legislature as has rarely been done before, creating a new chapter in the histories of science and American politics.
|Publisher:||University of Chicago Press|
|Edition description:||First Edition|
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About the Author
Robin Wolfe Scheffler is the Leo Marx Career Development Chair in the History and Culture of Science and Technology at the Program in Science, Technology, and Society at the Massachusetts Institute of Technology.
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Cancer and Contagion
In 1911 Peyton Rous, a researcher at the Manhattan-based Rockefeller Institute for Medical Research, observed a "non-filterable" agent capable of transmitting tumors in chickens. Rous struggled to characterize the ambiguous nature of the agent, which appeared to be neither microbial nor chemical; but with the advantage of considerable hindsight the Nobel Foundation recognized his observations in 1966 as the discovery of the first tumor virus. Two years after his observations, the Rockefeller Institute's front office passed Rous an inquiry from Richard Boardman, a lawyer across the Hudson River in Jersey City. Boardman had read in the newspaper about Rous's discovery of a "cancer parasite" and was moved to write in the hope that Rous might settle an ongoing dispute between him and his wife, Dorcas Boardman.
Both Richard and Dorcas were concerned that there were cancer "germs" in the mattress that the couple had inherited after caring for Dorcas's aunt, who had died a decade earlier after a "long illness"— a common euphemism for cancer. Richard sought an answer for what he presented as his wife's concern that there was "the danger of communication of the disease of cancer lurking in the use of" a mattress that had been "stained by the drain from the cancer." Richard was inclined to believe that the mattress was safe, not because he denied that cancer was infectious, but because he doubted that cancer "germs" could survive for so long in the mattress. Dorcas maintained that they might have survived. Yet her concerns were not so great as to prevent the couple from offering the mattress to members of their household staff. With Rous's guidance, the institute's business manager sent a reply, sympathizing with the "tyranny that germ theory may exercise over the imagination" and assuring Richard that while "it is usually impossible to prove a negative," in this instance there was no "danger of infection whatsoever."
In approaching the history of biomedical objects such as viruses, we may feel a strong temptation, rooted in our present understanding of these objects, to identify with the views of physicians and scientists. Rous's contributions to the virus theory of cancer, discussed in chapter 2, are well known to historians of science and medicine, but the Boardmans' concerns are not. Our first instinct is to regard the Boardmans' fears of cancer germs lurking in a mattress as misplaced, because they fall so far from the attitudes we have been trained to cultivate toward cancer. As one early twentieth-century textbook on cancer noted, although the idea that cancer might be contagious was "the oldest hypothesis of the origin of cancer," it was a hypothesis that "few competent observers" credited in the wake of advances in microbiology. From the perspective of later scientific observers, cancer viruses fit the mold of a classic "unpopular" theory later redeemed by new experimental methods. As Rous accepted the Nobel Prize in 1966, he attributed the record-setting fifty-five-year delay between his findings and his award to the "downright disbelief" that other cancer researchers directed toward his theories of viral carcinogenesis. Only the diligent work of a small number of experimentalists exorcised the theory's unpopularity.
However, taking the skepticism expressed by a small number of doctors and scientists as our guide to the associations between cancer and contagion throughout history can be misleading, no matter how much such views resonate with our own. Scientists, physicians, and laypeople addressed the larger problem of cancer through different "regimes of perceptibility," combinations of scientific and social practices that they used to make sense of the disease and its causes. Identifying, or failing to identify, a cancer virus using new experimental methods becomes meaningful only in reference to the importance ascribed to these results by others — the technology does not speak for itself. Moreover, different social and scientific factors can align to create moments of imperceptibility, where particular causes of disease are harder to study.
As the Boardmans' debate over their mattress indicates, the theory that cancer was a viral disease drew upon a deep reserve of public belief in cancer as contagious disease. That reserve exerted a powerful influence on how the public received scientific research on cancer viruses and tinged how cancer specialists approached the question of cancer's potential infectious causes. Although the laboratory techniques that Rous borrowed from microbiology struggled with the nature of viruses, the vehemence of the skepticism expressed by members of the oncology community was less about Rous's theory itself than about broader questions of how medicine would relate to laboratory science and public concern about cancer.
The association between cancer and contagion proved enduring and controversial precisely because it existed at the intersection of the different regimes of perceptibility created by the techniques of the laboratory, the practices of physicians, and the customs of the public. Preserving the tension between these perspectives is vital for understanding how cancer viruses traveled through early twentieth-century American society. We should follow the ways in which different individuals and institutions brought cancer viruses into being through their actions and habits rather than defaulting to one of those perspectives. Cancer viruses became tangible to different groups through perceptual regimes instantiated in personal habits, architecture, fundraising, legislation, and education. These regimes were shaped not only by clinical practice, hygiene, and laboratory analysis, but also by fears of death, concerns about professional authority, and hopes for a cure. Approaching the history of cancer viruses with the full range of these regimes in mind underscores that the development of our present understanding of cancer, contagion, and viruses was far from inevitable.
This chapter examines different communities as they approached the question of viral carcinogenesis — both before Rous's discoveries and afterward, as the hunt for cancer viruses continued — in the context of the expansion of laboratory-based microbial theories of disease associated with the so-called bacteriological revolution. In addition, it highlights how popular ideas about cancer as a contagious disease shaped the reception of cancer virus research by both communities of professionals and the public. Centuries-old beliefs, habits, and practices coexisted with new efforts to identify the agents of disease in the laboratory. Nor were physicians and biologists unified in their approach to cancer and contagion. At different moments they contended with the interests and concerns of many other groups regarding the problem of cancer as a contagious disease. Cancer specialists struggled not only with concerns regarding standards of proof but also with the implications of their new theories for the social status of the medical profession. In fact, during the years of its eclipse as a credible scientific theory, cancer specialists spent considerable time and energy campaigning against the idea that cancer viruses existed. Their actions strongly suggest that technical debates concerning cancer viruses were haunted by the continuing resonance in the public mind between cancer and contagion.
Contagion and Cancer
In 1741 the inhabitants of the Saint-Denis neighborhood in Reims, France, gathered to defeat a great danger to their community: the first hospital in Europe dedicated exclusively to the treatment of cancer. The wealthy Maillefer family had planned their hospital on the model of institutions for the treatment of consumption, and the hospital's organizers had identified what they thought was an ideal site within Saint-Denis: a large building on a quiet street with extensive gardens that would console patients. For the hospital's prospective neighbors, however, the possibility of such a dense concentration of patients with cancer raised the terrifying concern that it could spread into the community — particularly that the odors associated with the rot of advanced tumors would carry the disease beyond the hospital walls. The residents of Saint-Denis strenuously protested, petitioning King Louis XIV to demand that the hospital be either closed or moved far outside the city walls. The hospital's final location, far from the center of Reims, bears vivid witness to the power of popular fears of contagious cancer.
In eighteenth-century Europe, the association between cancer and contagion thrived because both ideas were much more loosely bounded than their twentieth-century counterparts. Cancer was capable of manifesting itself in numerous terrifying forms. Ulcerating tumors stank, and individuals stricken with cancer suffered from vomiting or convulsions in the late stages of the disease. Rot and corruption dominated descriptions of the illness. Cancer "ate" its way into surrounding healthy flesh and "dissolved" ligaments, bones, and tissue. Surgeons who attempted to amputate external tumors were confounded by the apparent ability of "seeds" of tumors to spread into other parts of the body. The grisly deaths caused by cancer and the limited treatments available fostered the sense of taboo and fear that followed the disease well into the twentieth century.
Meanwhile, the doctrine of contagionism, which developed during the fifteenth century to explain the spread of plague and other diseases, readily encompassed cancer. Contagionism called attention to the transmission of disease through contact with a wide range of objects. The idea of tumor "seeds" within the body merged easily with the general idea of seeds of contagion. Moreover, the classification of disease under humoral theory grouped cancer with other potentially contagious inflammatory diseases, such as syphilis and tuberculosis. Writings from Babylonian, Persian, Indian, Greek, Arabic, Roman, and European sources all described instances of "tumors," which included lumps, cysts, inflamed masses, and other kinds of swelling, and their occasional treatment. Seventeenth- and eighteenth-century observers reported numerous cases in which cancer passed from one person to another by different mechanisms varying from sexual intercourse to sharing a pipe or a cup.
Further study of cancer in the nineteenth century did nothing to dispel the fear of contagion, especially the chance of transmission through sexual activity. The first deliberate efforts to collect statistics on the incidence of cancer strengthened its association with sexually transmitted infections. In 1842 Domenico Antonio Rigoni-Stern, the provincial surgeon of Verona, Italy, published a paper reporting the results of his effort to establish relative rates of cancer deaths. He claimed that cancer was eight times as common in women as in men, a finding likely explained by the relatively greater ease of diagnosing cancers of the breast and women's reproductive organs. Rigoni-Stern became infamous for the claim that married or widowed women, who had presumably been sexually active, were far more likely to die of "uterine cancer" than nuns, who were presumably celibate. This finding fit well into the views of female sexuality and health common among male European medical authorities. Cancer, like syphilis and other venereal diseases, was a disease best prevented by avoiding promiscuous sexual behavior. Associations between sex and cancer infection endured into the twentieth century. The life insurance actuary Frederick Hoffman, whose own compilations of statistics played a prominent role in the discussion of cancer as a public health problem, addressed the chances of the transmission of the disease via "marital infection" in 1915, albeit with the aim of assuring his readers it was not a possibility.
Other efforts to collect systematic epidemiological data about cancer also deepened the sense that cancer was contagious. In the late nineteenth century, the British physician Alfred Haviland collected detailed statistics regarding deaths from cancer, heart disease, and other diseases throughout England. Haviland used these statistics to argue for the importance of local geography to the incidence of cancer. He explained that higher rates of cancer in valleys were due to a lack of ventilation by winds, creating conditions similar to those where the "malarial air of rheumatism lurks." This suggestion, which drew on the miasmic theory that disease might spread through contact with unhealthy odors, recalled the potential connections between cancer transmission and odor that had concerned the denizens of Saint-Denis. A contemporary of Haviland speculated that the smell of advanced cancer could spread the disease by traveling throughout a house and down into the stomachs of healthy residents. Drinking brandy was considered an effective way to ward off those dangerous odors. This recommendation spoke to the expansive understanding of contagion and cancer before the advent of germ theory: while the means of cancer's transmission might be particulate, as in the case of the passage of cancer seeds, it could also draw on broader associations of disease transmission with miasma, odor, and rot.
Shifts in the classification of cancer associated with tissue and cell theory did not displace its associations with contagion. At the start of the nineteenth century, medical theorists focused on the outer symptoms of tumors, which they placed alongside other forms of inflammation. Since many cancers developed within the body and techniques of surgery were limited, the physiological structures associated with the disease remained obscure. At best, surgeons might examine tumors in the course of an autopsy. In the 1840s the development of the compound microscope and the expansion of physician training at sites such as the Paris clinics allowed the study of tumor cells by anatomists and pathologists. Cell theory provided a new approach to the study of disease, one that sought to determine the structural differences between "normal" and "pathological" tissues. However, even with the microscope, pathologists continued to engage in heated debate regarding the classification of cancer cells and the degree to which malignancy could be determined from cell structure alone. Techniques attending the use of the microscope — such as tissue staining to highlight cell structures — remained contentious. These points of controversy and confusion left cell theory on the margins of medical approaches to cancer.
Even after the microscope and cell theory gained greater acceptance, observers debated whether cancer was in fact different from other diseases of inflammation such as tuberculosis or syphilis. One British surgeon saw all three of these diseases as part of a pathological progression. He maintained, based on advances in the microscopic examination of diseased tissues, "it is now thoroughly well established that there exists every possible gradation between simple glandular enlargement and cancer of the glands. It is impossible to say where one begins and the other ends." A generation later, another British physician emphasized the striking resemblance between the "chronic swelling" produced by tuberculosis or syphilis and the tumors of "malignant disease."
Cancer after Germ Theory
The advent of germ theory, discussed further in chapter 2, dramatically redefined the effort to identify the causes of disease. Germ theorists promised that they could isolate and guard against agents of illness that could not be perceived through sight, touch, or smell, ushering in what historians have identified as a quintessentially "modern" view of disease grounded in the laboratory rather than in the clinic. Public concern about intangible germs reshaped everyday practices ranging from toilet design to the taking of Communion. Germ theory also implied relationships between the laboratory and clinic and between the laboratory and the natural world that were the topic of impassioned debate. As different communities became embroiled in these controversies, the range of appropriate applications of germ theory remained far broader than in its later incarnations.
The protean nature of germ theory as it moved among these different communities permitted the search for a cancer microbe to coexist alongside the search for the microbial causes of numerous other diseases. Suggestively, cancer bore similarities to certain kinds of tuberculosis and syphilis. All three diseases killed slowly, produced strange growths, and seemed to be caused by a complex mixture of environmental, hereditary, and behavioral factors. To some medical practitioners, the behavior of tumors within the body, including their ability to distribute "seeds" in the blood, seemed remarkably like the behavior of microbial infections. "From a surgical point of view cancer is a spreading infective process, and the cancer cell contains elements of infection," one paper explained. Anecdotal evidence suggested that transmission occurred. In several circumstances, surgeons operating on tumors appeared to subsequently develop cancer from cuts or needle pricks. A Canadian physician warned that "a woman suffering from cancer of the uterus may, during a year or two before she dies, infect her friends and neighbors with cancer of the face, lips, throat, stomach and intestine."(Continues…)
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Table of Contents
List of Acronyms Introduction: “An Infectious Disease—A Virus” 1. Cancer and Contagion 2. Cancer as a Viral Disease 3. Policymakers and Philanthropists Define the Cancer Problem 4. The Biomedical Settlement and the Federalization of the Cancer Problem 5. Managing the Future at the Special Virus Leukemia Program 6. Administrative Objects and the Infrastructure of Cancer Virus Research 7. Viruses as a Central Front in the War on Cancer 8. Molecular Biology’s Resistance to the War on Cancer 9. The West Coast Retrovirus Rush and the Discovery of Oncogenes 10. Momentum for Molecular Medicine Conclusion: Afterlife, Memory, and Failure in Biomedical Research
Time Line Acknowledgments Bibliography