The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee
A book review.
Brief: The book is a scientific memoir of the disease that has been the biggest biological puzzle to humans in the 21st century.
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Overall Flow:
A shorter version of the Book with all the Good Stuff (quoted) in italics😄
Prologue:
The first chapter is a short introduction to how it feels to be a 11 month old fellow of Oncology (a two year cancer training program) at a hospital. It deals with a 30 year old schoolteacher finding out she has acute lymphoblastic leukemia with a 30% chance of survival. It has some medical details of the condition but most of the matter is emotional focussing on the stress (undergone by physicians) related to the diagnosis, suffering and collapse of patients in their care. This sets the tone of the book, which gradually unfolds into a terrifying narration of the Emperor of All Maladies. It briefly touches upon how ancient physicians treated (suspected) cancer and how those choices effected the current form of the disease. The author stresses on his treatment of the subject (in this book) being driven by a study of the history of the disease and justifies his doing so.
Part I: Of Blacke Cholor Without Boyling
Meaning of the title of this part:
Chapter 1: The Suppuration of Blood (suppuration: suh·pyoo·ray·shn: inflammation/pus formation)
Etymology: White blood cells are the primary constituent of pus. Leukemia causes white blood cells to increase in number. This chapter deals with leukemia. One of its initial manifestations (1845) was inaccurately descirbed by Dr John Bennett as the combustion of blood into true pus, hence the title. Subsequently, Dr Virchow (1847) recongnized the inaccuracy as blood does not convert into anything but the blood itself is overpopulated by white blood corpuscules, which led him to name it leukamia (leukos is Greek for white). The author pointed out how similar renaming acutally helped improve the understanding of the disease in the case of AIDS (acquired immuno deficinency syndrome) renamed from GRID (gay related immune disease ).
Cell Disease: Dr Virchow really wanted to understand the disease and his learning approach was unconventional. He started off by eliminating each preconception about the disease. He tried to understand diseases in terms of cells (that he can see under the microscope), an idea that would lead to the cellular theory of human biology and revolutionize our understanding of diseases. This, however, was not some accidental genius and was mostly fuelled by his frustration at being unable to manuever the existing complex theory that described diseases based on unseen forces.
Experimental Treatment: The chapter starts with a scene set in the year 1947 at the Children's Hospitals' pathology laboratory centering around the doings of the pathologist, Dr Farber (born a year after Dr Virchow's death): who was called "doctor of the dead", impatient watching illness from its sidelines, analyzing tissues and cells, without ever treating a live patient decides to try treat leukemia in children, at a time when patients of this malady were eventually sent home to die. His choice to study the most hopeless breed of cancer was simple: to understand cancer, you needed to start in its basement. In trying to understand leukamia, he observed that contrary to other cancers, one could see it (blood) and hence one could measure (count) it. This actually gave a way to quantify the efficacy of treatments of leukamia. Thus he started experimenting with the treatment of cancer.
Chapter 2: A Monster more insatiable than the guillotine
Extirpations: This chapter presents a picture of the effect of the socio-economic conditions on the treatment of cancer (late 1940s) and how the discoveries of treatment of other diseases (during the time) influenced it. Post World War II, the boom in medical discoveries fuelled peoples expectations of treatment and mortality leading them to focus on other aspects of living like child care (the mid-20th century baby boom). However cancer was far from being conquered and there were political reasons behind it too. Specially, there were lack of funds for cancer research. As cancer rose into prominence, only under the favourable condition when the tumour would be strictly confined to a single organ/location such that it could be surgically removed (a process called extirpation) or the cancer cells destroyed via X-rays (radiotherapy), there was a hope for successful treatment. Still cancer remained something to be cut-off rather than treat with chemicals (as envisioned by Dr Farber in 1947).
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