 Cover ofThe Emperor of All Maladies | |
| Author | Siddhartha Mukherjee |
|---|---|
| Language | English |
| Subject | Cancer |
| Genre | Nonfiction |
| Publisher | Scribner |
Publication date | 16 November 2010 |
| Publication place | United States |
| Pages | 592 |
| ISBN | 978-1-4391-0795-9 |
The Emperor of All Maladies: A Biography of Cancer is a book written bySiddhartha Mukherjee, an Indian-born American physician andoncologist. It won thePulitzer Prize for General Nonfiction.[1]
The book explains its title in itsauthor's note:[2]
In a sense, this is a military history—one in which the adversary is formless, timeless, and pervasive. Here, too, there are victories and losses, campaigns upon campaigns, heroes and hubris, survival and resilience—and inevitably, the wounded, the condemned, the forgotten, the dead. In the end, cancer truly emerges, as a nineteenth-century surgeon once wrote in a book's frontispiece, as "the emperor of all maladies, theking of terrors."
The book weaves together Mukherjee's experiences as ahematology/oncologyfellow atMassachusetts General Hospital as well as thehistory of cancer treatment and research.[3][4] Mukherjee gives the history of cancer from its first identification 4,600 years ago by the Egyptian physicianImhotep. The Greeks had no understanding of cells, but they were familiar with hydraulics.Hippocrates thus considered illness to be an imbalance of four cardinal fluids: blood, black bile, yellow bile, phlegm.Galen applied this idea tocancer, believing it to be an imbalance of black bile. In 440 BC, the Greek historianHerodotus recorded the first breast tumor excision ofAtossa, the queen ofPersia and the daughter ofCyrus, by a Greek slave namedDemocedes. The procedure was believed to have been successful temporarily. Galen's theory was later challenged by the work ofAndreas Vaselius andMatthew Baille, whose dissections of human bodies failed to reveal black bile.
In the 19th century,surgeons devised various approaches to remove tumors, likeWilliam Halsted and theradical mastectomy. Additionally,Emil Grubbe usedX-rays to treat cancer, thus identifying another treatment modality.Rudolph Virchow first observedleukemia, andFranz Ernst Christian Neumann localized the pathology to the bone marrow.
In the 20th century, cancer became the second most common cause of death afterheart disease in theUnited States.Sidney Farber induced temporary remission in pediatric leukemia usingantifolates developed byYellapragada Subbarow.Louis Goodman andAlfred Gilman also usednitrogen mustard to treatlymphoma. TheNational Cancer Institute (NCI) introducedclinical trials to test the efficacy ofchemotherapy. Recognizing the possibility for a cure, Farber sought funding for his efforts throughThe Jimmy Fund andMary Lasker. Inspired by theSpace Race, Farber and Lasker appealed to the nation andPresident Nixon to enact legislation for thewar on cancer, resulting in the passage of the National Cancer Act of 1971 and increased funding for the NCI.
The book also reviews the origins ofhospice andpalliative medicine andcancer screening.
According to Mukherjee, the book was a response to the demand of a patient: "I'm willing to go on fighting, but I need to know what it is that I'm battling."[5] Mukherjee states that two of his influences for the book wereRandy Shilts'And the Band Played On andRichard Rhodes'The Making of the Atomic Bomb, but the defining moment for him was "when he conceived of his book as a biography".[5]
The Emperor of All Maladies won the 2011Pulitzer Prize for General Nonfiction: the jury called it "an elegant inquiry, at once clinical and personal".[1][6][3]The Guardian notes the literary allusiveness: "It takes some nerve to echo the first line ofAnna Karenina and infer that the story of a disease is capable of bearing a Tolstoyan treatment. But that is, breathtakingly, what Mukherjee pulls off. Mukherjee manages to convey not only a forensically precise picture of what he sees, but a shiver too, of what he feels."[7]Literary Review commended Mukherjee's narrative: "It is so well written, and the science is so clearly explained, that it reads almost like a detective story—which, of course, it is."[8]
It was included onTime's list of the 100 most influential books of the last 100 years,[9] andThe New York Times Magazine's list of the 100 best works of nonfiction.[10]
