Female cancer: a transnational perspective
By Yolanda Eraso
One of the most illuminating examples of transatlantic crossings in the history of medicine is in the area of cancer diagnosis, where the case of colposcopy, a technique for the early detection of cervical cancer, is instructive.
Created in 1925 by the German gynaecologist Hans Hinselmann, the technique relied on the colposcope, an instrument for the visual inspection of the cervix, which initially consisted of a pair of magnifying lenses fixed on a tripod with a light source. After staining the surface of the cervix with acetic acid, the colposcope allowed a trained professional to visualise the morphology of the epithelium, detecting its abnormalities or cancerous areas, and facilitated the performance of a directed biopsy. Although the technique became relatively well known in Austria, Switzerland and Germany, it was its adoption in Argentina and Brazil that saved colposcopy from oblivion during and after World War II.
Here, medical contacts played a distinctive role. They were the result of a well-established practice of academic exchanges that since the 1920s led South American doctors to complete their medical training in European hospitals, with German clinics becoming an obligatory visit for surgeons and gynaecologists. It was within the dynamics of international exchanges that Hinselmann trained in his clinic in Altona (Hamburg) two prominent figures of Argentinian and Brazilian gynaecology: Alfredo Jakob and João Paulo Rieper. On their return, both doctors started the colposcopic examination of women in outpatient consulting rooms, the Sardá Maternity in Buenos Aires (1934), and the gynaecology clinic of the University of Brazil in Rio de Janeiro (1940).
By 1945 a new technique for cervical cancer detection started to be promoted with the support of the lavishly funded American Cancer Society: the cytological examination of vaginal smears devised by Papanicolaou and Traut in 1941 (Pap smear test). While international congresses, training programmes and large-scale American screening studies helped the Pap test to spread rapidly throughout the world, the end of War further delayed the diffusion of colposcopy owing to Hinselmann’s political connections with the Third Reich. By this time, however, colposcopy services had already been organised in Argentina and Brazil, and there were Hinselmann’s disciples in South America who helped him and his diagnostic tool to gain a place in the clinic. In 1949, 1951 and 1957 Hinselmann was invited to Brazil, Argentina and Uruguay respectively, where he was able to share important improvements to the technique, while developing an intensive training programme for doctors. Subsequent academic exchanges of South American gynaecologists and participation in international congresses helped to spread the technique in Europe and the USA.
Towards the end of the 1960s colposcopy finally found a place in European and American screening programmes. Colposcopy clinics were opened within women’s hospitals to assist with the referral of abnormal cervical smears. However, a fundamental difference was established with respect to South American services, naturalising, in turn, perdurable practices: in the South American countries most gynaecologists were trained in both techniques, and both tests were carried out during the same visit to the clinic; but in Europe and the USA, colposcopy was only reserved for the examination of patients with abnormal Pap tests. Although, technically, none of these tests is considered infallible, their transatlantic migration has significantly contributed to the naturalisation of ‘early detection’ policies in cancer care.
Cancer diagnosis is one of the topics investigated in my next monograph, which explores major developments in the history of female cancer. With an initial focus on 1920–60 Argentina, my research (funded by a Wellcome Trust fellowship) adopts a transnational framework – involving South America, Europe and the USA – in order to investigate the creation of specialised institutes, the role of philanthropic leagues, the development of different treatments and clinical research. One aspect that my research highlights is that the importance of the place is given by its value as a point of transit, for its contribution to the circulation and displacement of specific ideas. Place also interests me for the singular ways in which societies adapt and implement migrating medical practices, facilitating our understanding of what has finally moulded different experiences of cancer management in similarly configured healthcare systems. Moreover, the transnational and comparative approach of my research has allowed me to integrate history of medicine into an interdisciplinary taught programme – involving disciplines including sociology, healthcare sciences, psychology, biology and law – that has developed an innovative MSc in Cancer Studies at Oxford Brookes University.
Dr Yolanda Eraso is Wellcome Trust Research Fellow at the Centre for Health, Medicine, and Society, Oxford Brookes University.