The Emperor of All Maladies - Siddhartha Mukherjee - Historical Notes

Question 1

What was the first form of chemotherapy, given in 1947, and who gave it? What disease was he trying to treat?

Answer 1

Aminopterin

Sidney Farber, pathologist

Leukemia among pediatric patients

(Fun fact: The name leukemia came 100 years earlier from another pathologist, Rudolph Virchow, in 1847)

Question 2

Who discovered the epidemiological link between chimney sweeps in London and testicular cancer?

Answer 2

Percival Pott

Question 3

When did AIDS (Formerly known as GRID) become widely known and feared during outbreaks among homosexual men in the U.S.?

Answer 3

The 1980s

Question 4

Who was the 19th-century pathologist that grew frustrated with the incorrect attributions of disease to invisible forces (E.g. miasma, neuroses, bad humors, etc.) and set out to describe human disease in simple, cellular terms?

Answer 4

Rudolph Virchow

–And so, Cell Theory was born–
All living things are composed of cells.
All cells arise from pre-existing cells.

Question 5

What did Virchow’s development of cell theory lead to?

Answer 5

He named the terms hyperplasia, hypertrophy, and neoplasia (Among many others), and he related all these terms back to cancerous growths as the ultimate form of pathological hyperplasia

Question 6

Is there a major difference in signs and symptoms between acute and chronic leukemia?

Answer 6

Yes. Chronic leukemias are generally slower growing and persistent. Acute leukemias are more prone to flashes of fever, paroxysmal bleeding, etc.

Question 7

Why do leukemic patients often get headaches?

Answer 7

Anemia leads to decreased oxygen-carrying capacity

Question 8

When did the age of modern pharmacology begin?

Answer 8

The late 1940s

Question 9

When were x-rays discovered?

Answer 9

The early 1900s

Question 10

How long has cancer been the number two killer in the U.S. behind heart disease?

Answer 10

Since 1926

Question 11

How did Farber come up with the idea of antifolates as a potential drug to treat cancer?

Answer 11

He tried treating leukemia with folic acid (As can be used for some macrocytic anemias) and was surprised at the huge increase in growth rate of the cancer cells.

So, upon viewing folic acid as a cancer accelerator, Farber made the logical assumption that an antifolate might be inhibitory to cancer growth.

Question 12

When was the Nuremberg code for human experimentation developed?

Answer 12

1947

Question 13

What was Hippocrates’ explanation for cancer?

Answer 13

An excess of black bile

This would hugely influence Galen’s later teachings

Question 14

Where does the word oncology originate?

Answer 14

The Greek ‘onkos,’ meaning mass or load

Question 15

Who was the young 16th-century physician who would steal bodies from the gallows/graves in order to give the first detailed maps of human anatomical structure?

Answer 15

Vesalius

Question 16

When was anesthesia first invented?

What was the first substance used?

Answer 16

1846

Ether

Question 17

In the mid-1800s (Soon after Pasteur began working with early germ theory), Dr. Lister used carbolic acid to do what?

Answer 17

As the first successful aseptic technique in cleaning surgical wounds to prevent infection

Question 18

When did surgery emerge from the dark ages? What were some of the main advents of this awakening?

Answer 18

The mid-1800s

• First crude anesthesia (Ether)
• First aseptic salve (Carbolic acid)
• Dr. Billroth identified the safer surgical routes into the abdomen and other parts of the body

Question 19

Who was the surgeon in the early 20th-century that created an extremely radical surgery to combat breast cancer?

Answer 19

Halsted

Question 20

What strange effect of nitrogen mustard was noticed during WWI that made it of interest to oncologists?

Answer 20

Nitrogen mustard severely damages bone marrow and blood cells

Question 21

Who founded the ACS and led much of the fund-raising war on cancer?

Answer 21

Mary Lasker (Starting in the 1940s)

Question 22

Who were the two key players in the 20th-century in pushing cancer research into the national spotlight?

Answer 22

Mary Lasker and Sidney Farber

Question 23

Who were the first two doctors to attempt a regimen of chemotherapy involving multiple drugs all at once? What were the drugs?

Answer 23

Emil Frei and Emil Freiriech (With Sidney Farber involved as well)

VAMP - Vincristine, Amethopterin, Mercaptopurine, and Prednisone

(They got the longest remissions yet - almost a year - before 95% of the children had relapsed. 5% did achieve full and lasting remission though.)

Question 24

In the mid-1960s, what did Dr. Pinkel do in his ‘total therapy’ that was so effective in cancer treatment?

Answer 24

He gave combinations of 6-8 chemotherapeutic drugs intravenously, injected methotrexate directly into the CSF at periodic intervals, utilized heavy x-ray bombardment of the CNS, administered periodic antibiotics, and gave blood transfusions.

Question 25

What was the first cancer-related virus identified?

Answer 25

Rous-sarcoma-virus (RSV) in chickens

Question 26

Who were the epidemiologists that published the strong link between smoking and lung cancer?

Answer 26

Doll and Hill (Using case-control and cohort studies)

Question 27

What are Koch’s postulates of infectious disease (3)?

Answer 27

1. Association - The pathogen must be found in all cases of the disease
2. Isolation - The pathogen must be isolated from the host
3. Retransmission - The pathogen must then be able to cause the disease in a new host

Question 28

What is the Ame’s test?

Answer 28

A method of detecting mutagenic substances.

Bacteria are placed on an agarose where they should not be able to grow (Maybe they cannot digest galactose, and that’s all there is on the gel), and then they are exposed to possible mutagens to see how many colonies of bacteria mutate enough to survive.