I cling to my dad’s enormous hand. With long strides, we are rushing through London. I am six. I am sometimes catching my step, sometimes just being lifted by his forward thrust. I am wearing a bright yellow cape, with a sailor’s hat to keep the rain off, and at every puddle I splash the rushing Christmas shoppers. Dad scolds me, but I know he doesn’t mean it: we are a tight pair. We are coming from an exhibition about some ancient civilisation at the Royal Academy, where he had lifted me high above the crowds so that I could see the twinkling gold swords. Now we have to get somewhere, probably the coffee-bean shop in Soho, for he has very particular tastes. Although we are in a hurry, as we round a corner he stops sharply and I charge straight into his camel-hair coat. It is warm and wet. We have paused because he wants to tell me a story of a man called John Snow whose name and picture is on a pub sign across the road.
Many years ago, Dad says, Dr Snow had hundreds of patients dying of a particularly vicious disease. As Snow had no idea what caused it, he could neither treat nor prevent it. So to discover what connected the patients, he drew a map of London and placed dots where each one lived. Dad sweeps his hand down Broadwick Street, explaining the map: here was dark with dots, but further away the dots became sparser. Dad asks me what linked them. I scratch my head. The doctor didn’t know either. So he questioned the families about their lives. With a flourish, Dad points to the spot where a water pump once stood, and says that Snow realised that all the ill people had used this pump. Some liked the taste of its water so much that they had even travelled from afar. To stop the disease, Snow simply removed the handle of the pump. Nobody became ill again.
Dad tells me it was the first piece of work on demonology. I ask him what kind of demons, but he only laughs. It amused him that I had misheard the word ‘epidemiology’, the science of epidemics, especially since this was a subject he taught to his statistics students.
Being taught about the cholera epidemic of 1854 is my first memory of Dad’s quest to educate me – even though in hindsight Dad’s story was a rather mythologised and childfriendly version of history. From then on, he was always telling me stories about scientists, mathematicians and revolutionaries, from Marie Curie to Benjamin Franklin. From my adolescence it was our habit to stay up late and, with Mum in bed, to sit talking about these things at the kitchen table. For two men who never spoke about their feelings, our intimacy consisted in sharing our interests in politics, history or the progress of science. If I knew history, he thought, then I might be better able to navigate through my life because he had always used the past as a way to understand his place in the world. For as long as I can remember, I was the one who would eventually leave the table. Dad would lock the doors and begin to turn off the lights. I would make my way to bed. The final part of the ritual was that he would open my door just enough for him to stick his head through and wish me goodnight. Then I would listen as he darkened the house before turning in.
Many years later, when Dad became ill, we began spending more time together again and we continued to tell those stories, although this time they would be about the scientists, doctors and patients who had struggled against cancer across the centuries. I searched for a book that we could both read and then discuss. There were memoirs of celebrities who had ‘battled’ through the disease, but I knew that Dad would have no interest in those. There were selfhelp guides that presented basic information but provided no wider context. There were books that described the science in detail, but they didn’t seem to connect to the experience of being a patient. And there were academic histories, which did not seem to bring the past alive.
Even without a book to fall back on, Dad pondered the big questions. Why was there no cure yet, for instance? And I would search libraries for biographies of those who had tried and the reasons why they had failed. Dad would show me a newspaper cutting about the latest genetic cancer cures, and I would try to paint in the background with my recently acquired knowledge. It was like some game from my childhood, but with dark undertones, because the purpose was to provide a distraction from the blizzard of pain.
This book is, in part, the culmination of that journey. It tells the history of cancer medicine, from the Victorian surgical solution to the latest developments in gene therapy, through a dozen stories of scientific endeavour. These are stories of maverick doctors searching for a cure although their colleagues thought them to be charlatans, and of patients campaigning to stay alive. Running through them is a vein of the wider history of medicine, and of the development of science’s understanding of human biology. At the same time, these stories address some of the basic questions that Dad and I had about cancer: what is the biology of the disease, how does a tumour grow, why is it so difficult to detect sometimes, and how does radiation or chemotherapy work?
Dad’s illness mirrored these historical moments. At times, medicine’s history had direct relevance to his own experience. At others, the spirit of some historical age seemed to resonate with the mood of the family. As a consequence, the story of Dad’s illness forms a counterpoint to the broader history of humanity’s struggle against cancer.
It is almost four years since that moment when I was told that Dad was ill and I became filled with fear. I wish that I had known then what I know now. Because learning something about cancer calmed some of those terrors.
When I began writing this book, I thought not only that the disease was becoming more common, that more and more people were dying from it, but that medicine had failed to cure it. But as I met more doctors I realised that, in fact, the last decade has been historic for cancer research: death rates have been falling, in the UK, the US and across Europe, for the first time; and we now understand the biology of cancers in much greater detail than ever before. As a result, in the last few years the first treatments based on understanding the genetic mechanism of the disease have arrived on the market. Many doctors are therefore predicting that in just a few decades cancer will become a disease more like diabetes, one that we will live with rather than only die from.
Most importantly, this book has prepared me for the next time the disease strikes – whether that be within myself, against one of my friends or within a member of my family. I know that this will come, because one in three of us will develop the disease in our lifetimes. When we count our families, our friends and our work colleagues, it is evident that we will all be touched, in some way. And I have learnt that an amalgam of fear, archaic prejudices and ignorance is no way to deal with it. It is time that this disease is no longer shrouded by a dangerous taboo.
Adam Wishart, February 2006