ABSTRACT
When he suggested that poor incurable cancer sufferers were of no social worth, Alban Bergonié was only crudely expressing a point of view largely shared by the medical elite of his time. The use of categories taken from economics to classify and locate sick persons gave rise to medical opinions devoid of all humanistic references. The effacement of the suffering individual originated with the clinic. The social conditions presiding over the practice of hospital medicine – where, in exchange for free care, the ‘poor person’ lent his body to learned investigation – were such that the idea of taking an objective view of the patient proper to a clinical anatomy approach could play its full part. The patient tended to be considered as a receptacle of the illness, the subjectivity of which would be incidental. As soon as the illness was considered incurable, the terms of the exchange were altered, the patient came under palliative care, no longer needing the intervention of a doctor and becoming a long-stay patient of relatively no further medical interest everything predisposed the clinician to see him as a being of no social value. Hence this trend to relegate him to other organisations where the cost of his care was reduced to a minimum and
which the Paris Assistance Publique described by using the evocative description ‘depot’. It might, however, be shown that the ideology of social utility could find in the incurable a source of interest for the community, as a subject of experiment contributing to medical progress. But that, under certain conditions, was a matter for professional ethics, not scientific relevance. It was thus laid down that an experiment useful for the advance of knowledge but unethical should not be practised. The meeting on 23 June 1891 of the Academy of Medicine was relevant to one of these. The hypothesis of the inoculability of cancer came up again since several works had mentioned the possibility of grafting cancer cells from one affected animal to another of the same species.2 But the paper presented that day by Professor Cornil concerned two observations made on a human being. The surgeon who was the originator, whose name was not to be divulged, contacted the academic (Cornil was the holder of the chair of pathological anatomy) for the first time so that the latter could analyse fragments of tissue from breast cancers, one primary, the other secondary, following an attempted graft. While he was carrying out the removal of a ‘large breast cancer’ the surgeon ‘cut off a small portion of it and inserted it under the skin of the other breast which was perfectly normal. The operation had been performed while the patient was under the influence of chloroform, taking the most rigorous antiseptic measures.’3 Two months later, a nodule ‘of the size of an almond’, which had developed on the ‘grafted breast’, was removed by the same surgeon. The histological examination made by Cornil on the fragments of the two tumours revealed that ‘the tissues of the first and second showed an identical structure’.4 The patient died a little later of an ‘acute intercurrent illness’. A second experiment, repeating the preceding one and under the same conditions, on another patient, should have been, according to Cornil ‘less demonstrative and less complete’ since ‘the patient did not want to have the operation to remove the graft which had become a small tumour. She left the hospital and was not followed up’.5
