The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee Read Free Book Online

In 1900, as Roswell Park noted, tuberculosis was by far the most common cause of death in America. Behind tuberculosis came pneumonia (William Osler, the famous physician from Johns Hopkins University, called it “ captain of the men of death ”), diarrhea, and gastroenteritis. Cancer still lagged at a distant seventh. By the early 1940s, cancer had ratcheted its way to second on the list, immediately behind heart disease. In that same span, life expectancy among Americans had increased by about twenty-six years. The proportion of persons above sixty years—the age when most cancers begin to strike—nearly doubled.
    But the rarity of ancient cancers notwithstanding, it is impossible to forget the tumor growing in the bone of Aufderheide’s mummy of a thirty-five-year-old. The woman must have wondered about the insolent gnaw of pain in her bone, and the bulge slowly emerging from her arm. It is hard to look at the tumor and not come away with the feeling that one has encountered a powerful monster in its infancy.

Onkos
    Black bile without boiling causes cancers.
    —Galen, AD 130
    We have learned nothing , therefore, about the real cause of cancer or its actual nature. We are where the Greeks were.
    —Francis Carter Wood in 1914
    It’s bad bile . It’s bad habits. It’s bad bosses. It’s bad genes.
    —Mel Greaves,
Cancer:

The Evolutionary Legacy
, 2000
    In some ways disease does not exist until we have agreed that it does—by perceiving, naming, and responding to it.
    —C. E. Rosenberg
    Even an ancient monster needs a name. To name an illness is to describe a certain condition of suffering—a literary act before it becomes a medical one. A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering—a traveler who has visited the kingdom of the ill. To relieve an illness, one must begin, then, by unburdening its story.
    The names of ancient illnesses are condensed stories in their own right. Typhus, a stormy disease, with erratic, vaporous fevers, arose from the Greek
tuphon
, the father of winds—a word that also gives rise to the modern
typhoon.
Influenza
emerged from the Latin
influentia
because medieval doctors imagined that the cyclical epidemics of flu were influenced by stars and planets revolving toward and away from the earth.
Tuberculosis
coagulated out of the Latin
tuber
, referring to the swollen lumps of glands that looked like small vegetables. Lymphatic tuberculosis, TB of the lymph glands, was called
scrofula
, from the Latin word for “piglet,” evoking the rather morbid image of a chain of swollen glands arranged in a line like a group of suckling pigs.
    It was in the time of Hippocrates, around 400 BC, that a word for cancer first appeared in the medical literature:
karkinos
, from the Greek word for “crab.” The tumor, with its clutch of swollen blood vessels around it, reminded Hippocrates of a crab dug in the sand with its legs spread in a circle. The image was peculiar (few cancers truly resemble crabs), but also vivid. Later writers, both doctors and patients , added embellishments. For some, the hardened, matted surface of the tumor was reminiscent of the tough carapace of a crab’s body. Others felt a crab moving under the flesh as the disease spread stealthily throughout the body. For yet others, the sudden stab of pain produced by the disease was like being caught in the grip of a crab’s pincers.
    Another Greek word would intersect with the history of cancer—
onkos
, a word used occasionally to describe tumors, from which the discipline of oncology would take its modern name.
Onkos
was the Greek term for a mass or a load, or more commonly a burden; cancer was imagined as a burden carried by the body. In Greek theater, the same word,
onkos
, would be used to denote a tragic mask that was often “burdened” with an unwieldy conical weight on its head to denote the psychic load carried by its wearer.
    But