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

bile would flow right back, like sap seeping through the limbs of a tree.
    Galen died in Rome in 199 AD, but his influence on medicine stretched over the centuries. The black-bile theory of cancer was so metaphorically seductive that it clung on tenaciously in the minds of doctors. The surgical removal of tumors—a local solution to a systemic problem—was thus perceived as a fool’s operation. Generations of surgeons layered their own observations on Galen’s, solidifying the theory even further. “ Do not be led away and offer to operate,” John of Arderne wrote in the mid-1300s. “It will only be a disgrace to you.” Leonard Bertipaglia, perhaps the most influential surgeon of the fifteenth century, added his own admonishment: “ Those who pretend to cure cancer by incising, lifting, and extirpating it only transform a nonulcerous cancer into an ulcerous one. . . . In all my practice, I have never seen a cancer cured by incision, nor known anyone who has.”
    Unwittingly, Galen may actually have done the future victims of cancer a favor—at least a temporary one. In the absence of anesthesia and antibiotics, most surgical operations performed in the dank chamber of a medieval clinic—or more typically in the back room of a barbershop with a rusty knife and leather straps for restraints—were disastrous, life-threatening affairs. The sixteenth-century surgeon Ambroise Paré described charring tumors with a soldering iron heated on coals, or chemically searing them with a paste of sulfuric acid. Even a small nick in the skin, treated thus, could quickly suppurate into a lethal infection. The tumors would often profusely bleed at the slightest provocation.
    Lorenz Heister, an eighteenth-century German physician, once described a mastectomy in his clinic as if it were a sacrificial ritual: “ Many females can stand the operation with the greatest courage and without hardly moaning at all. Others, however, make such a clamor that they may dishearten even the most undaunted surgeon and hinder the operation. To perform the operation, the surgeon should be steadfast and not allow himself to become discomforted by the cries of the patient.”
    Unsurprisingly, rather than take their chances with such “undaunted”surgeons, most patients chose to hang their fates with Galen and try systemic medicines to purge the black bile. The apothecary thus soon filled up with an enormous list of remedies for cancer: tincture of lead, extracts of arsenic, boar’s tooth, fox lungs, rasped ivory, hulled castor, ground white-coral, ipecac, senna, and a smattering of purgatives and laxatives. There was alcohol and the tincture of opium for intractable pain. In the seventeenth century, a paste of crab’s eyes, at five shillings a pound, was popular—using fire to treat fire. The ointments and salves grew increasingly bizarre by the century: goat’s dung, frogs, crow’s feet, dog fennel, tortoise liver, the laying of hands, blessed waters, or the compression of the tumor with lead plates.
    Despite Galen’s advice, an occasional small tumor was still surgically excised. (Even Galen had reportedly performed such surgeries, possibly for cosmetic or palliative reasons.) But the idea of surgical removal of cancer as a curative treatment was entertained only in the most extreme circumstances. When medicines and operations failed, doctors resorted to the only established treatment for cancer, borrowed from Galen’s teachings: an intricate series of bleeding and purging rituals to squeeze the humors out of the body, as if it were an overfilled, heavy sponge.

Vanishing Humors
    Rack’t carcasses make ill Anatomies.
    —John Donne
    In the winter of 1533, a nineteen-year-old student from Brussels, Andreas Vesalius, arrived at the University of Paris hoping to learn Galenic anatomy and pathology and to start a practice in surgery. To Vesalius’s shock and disappointment, the anatomy lessons at the university were in a preposterous state of