In spring 1858, the German scientist Rudolf Virchow published an unorthodox vision of the nature of living organisms. In his book, Cellular Pathology, he argued that the human body was simply “a cell state in which every cell is a citizen”. From a single originator, all other cells are derived, he argued, and when their function is disturbed, disease will often ensue.
The origins of Virchow’s arguments are intriguing. A reclusive, progressive, soft-spoken physician who had eschewed a career in the church because he thought his voice too weak for preaching, he championed the cause of public health and promoted free thinking. His views led to frequent clashes with German authorities. He became particularly incensed over their failures to tackle outbreaks of typhus and denounced them in print. For his pains, Virchow was forced to resign from his hospital post in Berlin.
Exiled to suburban Würzburg, Virchow began work on his book. It was time well spent for the young physician who produced a work that would “detonate through the world of medicine”, as Siddhartha Mukherjee puts it. By comparing the human body to the perfect citizen state – a cause he firmly endorsed – and by showing the cell is the locus for all disease, Virchow provided a new vision of human physiology. In doing so, he unleashed a phalanx of scientists who followed up his insights to reveal the crucial roles of cells in determining the human condition. These included John Snow’s work on cholera in London and the bacterial breakthroughs of Louis Pasteur in Paris.
Later, in the 20th century, researchers probed more closely and began to peer inside cells – with greater and greater precision. Virchow had been the first to propose that cancers are caused by cells dividing uncontrollably. A century later, scientists were pinpointing the precise pathways involved in this wayward urge, work that has continued to this day. Tumour treatments have been transformed, surgical procedures improved, and a host of diseases, from sickle cell anaemia to heart defects, are being tackled with increased success. And for this we can thank Virchow’s idea of the citizen cell. Or as Mukherjee describes his vision: “We are built of unitary blocks – extraordinarily diverse in shape, size and function, but unitary nonetheless.”
The liver is among the most frequent sites of cancer while the spleen rarely has any
Yet mysteries remain, as Mukherjee acknowledges. As an example, he points to the liver and spleen. These are broadly similar collections of cells; they are the same size; they are anatomical neighbours; and they possess virtually the same flux of blood – yet one, the liver, is among the most frequent sites of cancer while the other, the spleen, rarely has any. What subtle distinction separates these two collections of cells and explains the extreme difference in their behaviours?
The problem is that we “can name cells… but we are yet to learn the songs of cell biology”, says Mukherjee, a US-based oncologist already hailed for his prizewinning books on genetics and cancer. In other words, we understand the structure of these basic building blocks of life but still do not fully know how they relate to one another, how they interact – how they sing to each other. And the quicker we learn that music, then the more speedy will be our unravelling of the diseases that still afflict us and our ability to treat them, he adds.
It is a fascinating vision of illness and Mukherjee supports it well, presenting a wide variety of characters who have each played their roles in unravelling the song of the cell while peppering his narrative with case studies and cryptic pen portraits of his protagonists. Robert Edwards and Patrick Steptoe, pioneers of in vitro fertilisation – perhaps the ultimate medical act in cellular intervention – are described as “mavericks but careful mavericks”, while Nobel prize-winner Paul Nurse, one of the UK’s most senior scientists, is likened to an “elderly, wizened version of Bilbo Baggins”. A Nobel winner as a hobbit – it is an interesting notion, if nothing else.
An assured book, The Song of the Cell is free of overly complex detail that would submerge the reader. The result is a confident, timely – and most importantly, biologically precise – exploration of what it means to be human.
• The Song of the Cell: An Exploration of Medicine and the New Human by Siddhartha Mukherjee is published by Bodley Head (£25). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply