Hunting that most elusive of enemies: the Big C
This is a story of pioneers and mavericks; of serendipity, risk-taking and wild leaps of faith; of meetings of minds that changed medical history, and obsessive experiments conducted in solitude.
It is a story of inspiration found in bathtubs, blizzards and on nighttime walks; one in which the studios of Titian have their place. Artists assisted student Andreas Vesalius in creating his atlas of anatomy that would tumble Claudius Galen's theory of humours, its 'black bile' long considered the origin of cancer.
It is also a story of the early days of fund-raising, of love-ins and rifts with politicians; of the effects of war, of the specific "War on Cancer" declared in 1969 and its continuing war rhetoric; a tale of hopes, dreams and pincer-sharp disappointment. This is the story of cancer, that most "desperate, inventive, fierce, territorial, canny, and defensive" of illnesses.
At a time when there is scarcely a family unaffected by cancer, Siddhartha Mukherjee's stocktaking feels like essential reading. Medicine, the author writes, is also storytelling, beginning with a patient's narrative of suffering. In Dr Mukherjee, cancer has a master storyteller: a frank, compassionate, erudite and straight-talking guide.
For cancer, although often considered a "plague of modern times", is ancient. The Egyptian physician Imhotep first mentioned it in 2625BC.
While cancer was certainly present, it remained little understood in subsequent centuries. Treatments included "fox lungs, tortoise liver and crab's eyes". In the 18th and 19th centuries, advances in surgery emerged, with seeds of further knowledge sown.
One of the book's great strengths is the bringing to life of scientists: from the Scottish surgeon, Joseph Lister, who in 1865, inspired by Pasteur, discovered carbolic acid's vital role in surgery, to the morphine-addicted William Stewart Halsted. At the peak of his surgical career, in the 1890s, he learned from the "refined European techniques" in the medical version of the Grand Tour. Halsted's name will be forever linked to mastectomy. It moves from the Curies' discovery of radium in 1902 to wartime mustard gas informing "Four-Button Sid" Farber's experiments with antifolates in 1947, oncology's first achievement. The full palette of human nature is revealed here.
The development of treatments is explored: from radical surgery to early chemotherapy, increasingly lethal cocktails of chemicals, combination approaches, preventative innovations and the portrayal of palliative measures not as defeatist but as dignified. Mukherjee also considers the difficulties of trials in the search for the elusive "magic bullet" cure.
Mukherjee looks ahead with guarded optimism and avoids blithe promises. He contemplates whether more modest goals - the substantial prolongation of life by increasingly palatable treatments, rather than cancer's complete eradication - might be a more feasible, and still enormous, victory. De-mystifying the disease, rendering the science accessible, and wearing respect for the patients uppermost, The Emperor of All Maladies is an elegantly written overview that allows us to look a once whispered-about illness squarely in the eye.