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The Emperor of All Maladies

A Biography of Cancer

By Siddhartha Mukherjee
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The Emperor of All Maladies by Siddhartha Mukherjee

The Emperor of All Maladies is an informative look at the deadly disease that has affected millions. Cancer is one of the greatest challenges facing medical science today, and this book gives us a rare opportunity to learn about every aspect of it – its causes, its astonishing biological processes and our ever-changing fight against it, from the past to the present day.

Key idea 1 of 10

We’ve known about cancer since ancient times – but our understanding of it is very different today.

Ever heard the expression “balanced personality?” Today it might be a way to describe one of your level-headed friends, but around 400 BCE it was closely linked to the ideas of Hippocrates, the “Father of Medicine.” He was convinced that the human body was composed of four cardinal fluids or humors: Blood, phlegm, yellow bile, and black bile. When one of these fluids was out of balance with the other, then an illness or personality problem would result. For example, a short-tempered person would be diagnosed by Hippocrates as having an excess of yellow bile.

How does cancer fit into this four-part physical system? The first known theory of cancer held that tumors were caused by an entrapment of black bile. This understanding, first developed by Greco-Roman physician Galen in CE 160, informed mainstream theory about cancer for centuries.

But, because autopsies were forbidden for religious reasons, there was no opportunity to prove Galen’s theory until the sixteenth century. At this time, the physician Vesalius autopsied cancer-riddled corpses, and was surprised to find that neither the tumors nor the bodies contained black bile. The late eighteenth-century physician Baillie was equally unsuccessful in his investigation.

With Galen’s black bile theory refuted, many scientists turned to a substance that was both external to the body, and invisible. Until 1850, scientists suspected that parasitic and inscrutable poisonous vapors called miasmas led to tumors. Worms, fungal spores and protozoa were also thought to cause cancer. Scientists falsely believed they had found them after examining “cancerous tissues” under microscopes, and in 1926 physician Johannes Fibiger was even awarded the Nobel Prize for “proving” that roundworms cause stomach cancer (he was wrong!)

So humanity first thought cancer’s cause was located in the body’s own substance. Our second theory was concerned with external agents. But what do we think of cancer today?

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