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

while these vivid metaphors might resonate with our contemporary understanding of cancer, what Hippocrates called
karkinos
and the disease that we now know as cancer were, in fact, vastly different creatures. Hippocrates’
karkinos
were mostly large, superficial tumors that were easily visible to the eye: cancers of the breast, skin, jaw, neck, and tongue. Even the distinction between malignant and nonmalignant tumors likely escaped Hippocrates: his
karkinos
included every conceivable form of swelling—nodes, carbuncles, polyps, protrusions, tubercles, pustules, and glands—lumps lumped indiscriminately into the same category of pathology.
    The Greeks had no microscopes. They had never imagined an entity called a cell, let alone seen one, and the idea that
karkinos
was the uncontrolled growth of cells could not possibly have occurred to them. They were, however, preoccupied with fluid mechanics—with waterwheels, pistons, valves, chambers, and sluices— a revolution in hydraulic science originating with irrigation and canal-digging and culminating with Archaemedes discovering his eponymous laws in his bathtub. This preoccupation with hydraulics also flowed into Greek medicine and pathology. To explain illness—all illness—Hippocrates fashioned an elaborate doctrine based on fluids and volumes, which he freely applied to pneumonia, boils, dysentery, and hemorrhoids. The human body, Hippocrates proposed, was composed of four cardinal fluids called humors: blood, black bile, yellow bile, and phlegm. Each of these fluids had a unique color (red, black, yellow, and white), viscosity, and essential character. In the normal body, these four fluids were held in perfect, if somewhat precarious, balance. In illness, this balance was upset by the excess of one fluid.
    The physician Claudius Galen, a prolific writer and influential Greek doctor who practiced among the Romans around AD 160, brought Hippocrates’ humoral theory to its apogee. Like Hippocrates, Galen set about classifying all illnesses in terms of excesses of various fluids. Inflammation—a red, hot, painful distension—was attributed to an overabundance of blood. Tubercles, pustules, catarrh, and nodules of lymph—all cool, boggy, and white—were excesses of phlegm. Jaundice was the overflow of yellow bile. For cancer, Galen reserved the most malevolent and disquieting of the four humors: black bile. (Only one other disease, replete with metaphors, would be attributed to an excess of this oily, viscous humor: depression. Indeed,
melancholia
, the medieval name for “depression,” would draw its name from the Greek
melas
, “black,” and
khole
, “bile.” Depression and cancer, the psychic and physical diseases of black bile, were thus intrinsically intertwined.) Galen proposed that cancer was “trapped” black bile—static bile unable to escape from a site and thus congealed into a matted mass. “Of blacke cholor [bile], without boyling cometh cancer,” Thomas Gale, the English surgeon, wrote of Galen’s theory in the sixteenth century, “and if the humor be sharpe, it maketh ulceration, and for this cause, these tumors are more blacker in color.”
    That short, vivid description would have a profound impact on the future of oncology—much broader than Galen (or Gale) may have intended. Cancer, Galenic theory suggested, was the result of a
systemic
malignant state, an internal overdose of black bile. Tumors were just local outcroppings of a deep-seated bodily dysfunction, an imbalance of physiology thathad pervaded the entire corpus. Hippocrates had once abstrusely opined that cancer was “ best left untreated , since patients live longer that way.” Five centuries later, Galen had explained his teacher’s gnomic musings in a fantastical swoop of physiological conjecture. The problem with treating cancer surgically, Galen suggested, was that black bile was everywhere, as inevitable and pervasive as any fluid. You could cut cancer out, but the