THE EMPEROR OF ALL MALADIES - a book review

The book, 'The Emperor of All Maladies', authored by the eminent American-Indian physician, Dr.Siddhartha Mukherjee, is a must-read book for all medical students. The book covers the natural history of evolution, experimentation, treatments and advances in the field of oncology. It is the author's never-ending tryst with the fields of medical and surgical oncology that resulted in the birth of such a legendary treatise on the Big C, cancer.

"Will you turn me out if I can't get better?"

- a cancer patient to her physician,1960s

The writer observes that the first article on cancer was from the Egyptian Civilization, by the Egyptian physician, Imhotep. It was in his notion that cancer emerged as a distinct disease. In his treatise, Imhotep described breast cancer as 'bulging masses cool to touch and afebrile - much like the unripe hemat fruit'- he added a single sentence under the heading 'Therapy'-"There is none."

The author quotes a piece of poetry by William Blake, which goes thus:

"When my mother died I was very young,

and my father sold me while yet my tongue,

could scarcely cry, weep weep weep weep,

so your chimneys I sweep and in soot I sleep...

And so he was quiet and that very night,

as Tom was a sleeping he had such a sight

that thousands of sweepers Dick, Joe, Ned and Jack

were all of them lock'd up in coffins of black."

Second year undergraduate medical students learn the history of scrotal cancer in Pathology. Sir Percival Pott drew up an association of chimney sweeps with the incidence of scrotal cancer. He proposed that soot is carcinogenic and exposure to soot brought about scrotal cancer in the adolescents who swept chimneys for a living.

The book tells us about chemotherapy and surgical methods in the treatment of breast cancer. Beatson and others found that some cases of breast cancer responded dramatically to removal of ovarian tissue and shrunk on their own - whereas the others were least affected by estrogen deprivation. Thus came into concept, the author describes, the tumours which are positive or negative for estrogen receptors(ER). ER-positive tumours responded to estrogen deprivation whereas ER-negative tumours were unresponsive to the same stimulus.

Tamoxifen, a very popular birth control pill, was patented as part of an experimental study - it is an estrogen antagonist which worked like magic on breast cancer tissue and metastatic masses in lungs. The author tells us about a lot many other pharmaceutical preparations that were found to be effective in combating cancers of different pathologies.

The book also briefly explains the natural history of HIV-AIDS- that AIDS was the result of contaminated germ, of social mutability gone wild. To quote the author, the typical patient of AIDS would be "a young man, fresh out of the bathhouses, defiled and ravaged by profligacy, now lying namelessly in some hospital ward." That AIDS was discovered in the 80s when researching on cancer.

On the whole, the book, "The Emperor of All Maladies" is a prolific work of medical science on the vast subject of oncology. Dr.Mukherjee successfully explains every nuance of cancer through instances and examples, turning the practically boring subject of oncology into a more concrete realm that even non-medical people would find easy to comprehend. This book is a masterpiece by Dr.Mukherjee, which, I reiterate, is a must read for all medical students.