The Emperor of All Maladies

by Siddhartha Mukherjee

  60 The professor who blesses the occasion: Mary Lou McCarthy McDonough, Poet Physicians: An Anthology of Medical Poetry Written by Physicians (Springfield, IL: Charles C. Thomas, 1945).

  60 It is over: John Brown, Rab and His Friends (Edinburgh: David Douglas, 1885), 20.

  60 William Stewart Halsted: W. G. MacCallum, William Stewart Halsted, Surgeon (Kessinger Publishing, 2008), 106. Also see Michael Osborne, “William Stewart Halsted: His Life and Contributions to Surgery”; and S. J. Crowe, Halsted of Johns Hopkins: The Man and His Men (Springfield, IL: Charles C. Thomas).

  61 “I opened a large orifice”: W. H. Witt, “The Progress of Internal Medicine since 1830,” in The Centennial History of the Tennessee State Medical Association, 1830–1930, ed. Philip M. Hammer (Nashville: Tennessee State Medical Association, 1930), 265.

  61 “Small bleedings give temporary relief”: Walter Hayle Walshe, A Practical Treatise on the Diseases of the Lungs including the Principles of Physical Diagnosis, 3rd ed. (Philadelphia: Blanchard and Lea, 1860), 416.

  61 “pus-pails”: Lois N. Magner, A History of Medicine (New York: Marcel Dekker, 1992), 296.

  62 In October 1877, leaving behind: MacCallum, William Stewart Halsted. Also see D. W. Cathell, The Physician Himself (1905), 2.

  62 merely an “audacious step” away: Karel B. Absolon, The Surgeon’s Surgeon: Theodor Billroth: 1829–1894, (Kansas: Coronado Press, 1979).

  62 In 1882, he removed an infected gallbladder: John L. Cameron, “William Stewart Halsted: Our Surgical Heritage,” Annals of Surgery 225, no. 5 (1996): 445–58.

  63 “clearer and clearer, with no sense of fatigue”: Donald Fleming, William H. Welch and the Rise of Modern Medicine (Baltimore: Johns Hopkins University Press, 1987).

  63 “cold as stone and most unlivable”: Harvey Cushing, letter to his mother, 1898, Harvey Cushing papers at Yale University.

  64 “Mammary cancer requires”: Charles H. Moore, “On the Influence of Inadequate Operations on the Theory of Cancer,” Medico-Chirurgical Transactions 50, no. 245 (1867): 277.

  64 “mistaken kindness”: Edward Lewison. Breast Cancer and Its Diagnosis and Treatment (Baltimore: Williams and Walkins, 1955), 16.

  65 “We clean out or strip”: William S. Halsted, “A Clinical and Histological Study of Certain Adenocarcinomata of the Breast: And a Brief Consideration of the Supraclavicular Operation and of the Results of Operations for Cancer of the Breast from 1889 to 1898 at the Johns Hopkins Hospital,” Annals of Surgery 28: 557–76.

  65 At Hopkins, Halsted’s diligent students: W. M. Barclay, “Progress of the Medical Sciences: Surgery,” Bristol Medical-Chirurgical Journal 17, no. 1 (1899): 334–36.

  65 “It is likely”: Halsted, “Clinical and Histological Study.”

  65 In Europe, one surgeon evacuated three ribs: See Westerman, “Thoraxexcisie bij recidief can carcinoma mammae,” Ned Tijdschr Geneeskd (1910): 1686.

  65 “surgical elephantiasis,” “Good use of arm,” “Married, Four Children”: from William Stewart Halsted, Surgical Papers (Baltimore: Johns Hopkins, 1924), 2:17, 22, 24.

  66 “performance of an artist”: Matas, “William Stewart Halsted, an appreciation,” Bulletin of the Johns Hopkins Hospital 36, no. 2 (1925).

  66 “I find myself inclined”: Halsted, “Clinical and Histological Study of Certain Adenocarcinomata of the Breast,” Annals of Surgery 28: 560.

  67 “cancer storehouse”: Ibid., 557.

  67 On April 19, 1898: Ibid., 557–76.

  68 A surgeon should “operate on the neck”: Ibid., 572.

  68 Halsted’s 1907 report to the American Surgical Association: William Stewart Halsted, “The Results of Radical Operations for the Cure of Carcinoma of the Breast,” Annals of Surgery 46, no. 1 (1907): 1–19.

  68 “If the disease was so advanced”: “A Vote for Partial Mastectomy: Radical Surgery Is Not the Best Treatment for Breast Cancer, He Says,” Chicago Tribune, October 2, 1973.

  68 “But even without the proof”: Halsted, “Results of Radical Operations,” 7. Also see Halsted, “The Results of Radical Operations for the Cure of Cancer of the Breast,” Transactions of the American Surgical Association 25: 66.

  68 “It is especially true of mammary cancer”: Ibid., 61.

  70 “With no protest from any other quarter”: Ellen Leopold, A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century (Boston: Beacon Press, 1999), 88.

  70 “Undoubtedly, if operated upon properly”: Transactions of the American Surgical Association 49.

  70 “the more radical the better”: “Breast Cancer, New Choices,” Washington Post, December 22, 1974.

  70 Alexander Brunschwig devised an operation: Alexander Brunschwig and Virginia K. Pierce, “Partial and Complete Pelvic Exenteration: A Progress Report Based upon the First 100 Operations,” Cancer 3 (1950): 927–74; Alexander Brunschwig, “Complete Excision of Pelvic Viscera for Advanced Carcinoma: A One-Stage Abdominoperineal Operation with End Colostomy and Bilateral Ureteral Implantation into the Colon above the Colostomy,” Cancer 1 (1948): 177–83.

  70 Pack the Knife: From George T. Pack’s papers, quoted in Barron Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (Oxford: Oxford University Press, 2003), 73.

  70 “Even in its widest sense”: Stanford Cade, Radium Treatment of Cancer (New York: William Wood, 1929), 1.

  70 “There is an old Arabian proverb”: Urban Maes, “The Tragedy of Gastric Carcinoma: A Study of 200 Surgical Cases,” Annals of Surgery 98, no. 4 (1933): 629.

  71 “I know you didn’t know anything”: Hugh H. Young, Hugh Young: A Surgeon’s Autobiography (New York: Harcourt, Brace and Company, 1940), 76.

  71 In 1904, with Halsted as his assistant: Bertram M. Bernheim, The Story of the Johns Hopkins (Surrey: World’s Work, 1949); A. McGehee Harvey et al., A Model of Its Kind, vol. 1, A Centennial History of Medicine at Johns Hopkins University (Baltimore: Johns Hopkins University Press, 1989); Leonard Murphy, The History of Urology (Springfield, IL: Charles C. Thomas, 1972), 132.

  71 “the slow separation of brain from tumor”: Harvey Cushing, “Original Memoirs: The Control of Bleeding in Operations for Brain Tumors. With the Description of Silver ‘Clips’ for the Occlusion of Vessels Inaccessible to the Ligature,” Annals of Surgery 49, no. 1 (1911): 14–15.

  72 In 1933, at the Barnes hospital: Evarts G. Graham, “The First Total Pneumonectomy,” Texas Cancer Bulletin 2 (1949): 2–4.

  72 A surgical procedure: Alton Ochsner and M. DeBakey, “Primary Pulmonary Malignancy: Treatment by Total Pneumonectomy—Analysis of 79 Collected Cases and Presentation of 7 Personal Cases,” Surgery, Gynecology, and Obstetrics 68 (1939): 435–51.

  The Hard Tube and the Weak Light

  73 We have found in [X-rays]: “X-ray in Cancer Cure,” Los Angeles Times, April 6, 1902.

  73 By way of illustration: “Last Judgment,” Washington Post, August 26, 1945.

  73 Röntgen’s discovery of X-rays: Wilhelm C. Röntgen, “On a New Kind of Rays,” Nature 53, no. 1369 (1896): 274–76; John Maddox, “The Sensational Discovery of X-rays,” Nature 375 (1995): 183.

  75 One man who gave “magical” demonstrations: Robert William Reid, Marie Curie (New York: Collins, 1974), 122.

  75 In 1896, barely a year after Röntgen: Emil H. Grubbe, “Priority in Therapeutic Use of X-rays,” Radiology 21 (1933): 156–62; Emil H. Grubbe, X-ray Treatment: Its Origin, Birth and Early History (St. Paul: Bruce Publishing, 1949).

  76 “I believe this treatment is an absolute cure”: “X-rays Used as a Remedy for Cancer,” New York Times, November 2, 1901.

  76 advertised for sale to laypeople: “Mining: Surplus of Radium,” Time, May 24, 1943.

  76 “millions of tiny bullets of energy”: Oscar Carl Simonton, Stephanie Simonton, and James Creighton, Getting Well Again: A Step-by-Step, Self-Help Guide to Overcoming Cancer for Patients and Their Families (Los Angeles: J. P. Tarcher, 1978), 7.

  76 “The
patient is put on a stretcher”: “Medicine: Advancing Radiotherapy,” Time, October 6, 1961.

  77 One woman with a brain tumor: “Atomic Medicine: The Great Search for Cures on the New Frontier,” Time, April 7, 1952.

  77 Undark and the “Radium girls”: Claudia Clark, Radium Girls: Women and Industrial Health Reform, 1910–1935 (Chapel Hill: University of North Carolina Press, 1997); Ross Mullner, Deadly Glow: The Radium Dial Worker Tragedy (Washington, DC: American Public Health Association, 1999).

  78 Marie Curie died of leukemia: Curie’s disease was diagnosed as “aplastic anemia” of rapid, feverish development, but is widely considered to have been a variant of myelodysplasia, a preleukemic syndrome that resembles aplastic anemia and progresses to a fatal leukemia.

  78 Grubbe’s fingers had been amputated: Otha Linton, “Radiation Dangers,” Academic Radiology 13, no. 3 (2006): 404.

  78 Willy Meyer’s posthumous address: Willy Meyer, “Inoperable and Malignant Tumors,” Annals of Surgery 96, no. 5 (1932): 891–92.

  Dyeing and Dying

  80 Those who have not been trained in chemistry: Michael B. Shimkin, “As Memory Serves—an Informal History of the National Cancer Institute, 1937–57,” Journal of the National Cancer Institute 59 (suppl. 2) (1977): 559–600.

  80 Life is . . . a chemical incident: Martha Marquardt, Paul Ehrlich (New York: Schuman, 1951), 11. Also see Frederick H. Kasten, “Paul Ehrlich: Pathfinder in Cell Biology,” Biotechnic & Histochemistry 71, no. 1 (1996).

  81 Between 1851 and 1857: Phyllis Deane and William Alan Cole, British Economic Growth, 1688–1959: Trends and Structure (Cambridge: Cambridge University Press, 1969), 210.

  81 By the 1850s, that proportion had peaked: Stanley D. Chapman, The Cotton Industry: Its Growth and Impact, 1600–1935 (Bristol: Thoemmes, 1999), v–xviii.

  81 Cloth dyes had to be extracted: A. S. Travis, The Rainbow Makers: The Origins of the Synthetic Dyestuffs Industry in Western Europe (Bethlehem, PA: Lehigh University Press, 1993), 13.

  81 ever-popular calico prints: Ibid.

  81 “half of a small but long-shaped room”: William Cliffe, “The Dyemaking Works of Perkin and Sons, Some Hitherto Unrecorded Details,” Journal of the Society of Dyers and Colorists 73 (1957): 313–14.

  82 In 1883, the German output of alizarin: Travis, Rainbow Makers, 195.

  83 “most impudent, ignorant, flatulent, fleshy”: H. A. Colwell, “Gideon Harvey: Sidelights on Medical Life from the Restoration to the End of the XVII Century,” Annals of Medical History 3, no. 3 (1921): 205–37.

  83 “None of these compounds have, as yet”: “Researches Conducted in the Laboratories of the Royal College of Chemistry,” Reports of the Royal College of Chemistry and Researches Conducted in the Laboratories in the Years 1845–6–7 (London: Royal College of Chemistry, 1849), liv; Travis, Rainbow Makers, 35.

  83 In 1828, a Berlin scientist named Friedrich Wöhler: Friedrich Wöhler, “Ueber künstliche Bildung des Harnstoffs,” Annalen der Physik und Chemie 87, no. 2 (1828): 253–56.

  84 In 1878, in Leipzig, a twenty-four-year-old: Paul Ehrlich, “Über das Methylenblau und Seine Klinisch-Bakterioskopische Verwerthung,” Zeitschrift für Klinische Medizin 2 (1882): 710–13.

  84 In 1882, working with Robert Koch: Paul Ehrlich, “Über die Färbung der Tuberkelbazillen,” Deutsche Medizinische Wochenschrift 8 (1882): 269.

  85 “It has occurred to me”: Marquardt, Paul Ehrlich, 91.

  85 His laboratory was now physically situated: Travis, Rainbow Makers, 97.

  86 On April 19, 1910, at the densely packed: See Felix Bosch and Laia Rosich, “The Contributions of Paul Ehrlich to Pharmacology,” Pharmacology (2008): 82, 171–79.

  86 “syphilis—the “secret malady”: Linda E. Merians, ed., The Secret Malady: Venereal Disease in Eighteenth-Century Britain and France (Lexington: The University Press of Kentucky, 1996). Also see Ehrlich, “A Lecture on Chemotherapeutics,” Lancet, ii, 445.

  87 Ehrlich and Kaiser Wilhelm: M. Lawrence Podolsky, Cures out of Chaos: How Unexpected Discoveries Led to Breakthroughs in Medicine and Health (Amsterdam: Overseas Publishers Association, 1997), 273.

  88 “thick, yellowish green cloud”: Richard Lodoïs Thoumin, The First World War (New York: Putnam, 1963), 175.

  88 In 1919, a pair of American pathologists: E. B. Krumbhaar and Helen D. Krumbhaar, “The Blood and Bone Marrow in Yellow Cross Gas (Mustard Gas) Poisoning: Changes Produced in the Bone Marrow of Fatal Cases,” Journal of Medical Research 40, no. 3 (1919): 497–508.

  Poisoning the Atmosphere

  89 “What if this mixture do not work at all?: William Shakespeare, Romeo and Juliet, act 4, scene 3 (Philadelphia: J. B. Lippincott, 1913), 229.

  89 We shall so poison the atmosphere: Robert Nisbet, “Knowledge Dethroned: Only a Few Years Ago, Scientists, Scholars and Intellectuals Had Suddenly Become the New Aristocracy. What Happened?” New York Times, September 28, 1975.

  89 Every drug, the sixteenth-century: W. Pagel, Paracelsus: An Introduction to Philosophical Medicine in the Era of the Renaissance, 2nd ed. (New York: Karger, 1982), 129–30.

  89 On December 2, 1943: D. M. Saunders, “The Bari Incident,” United States Naval Institute Proceedings (Annapolis: United States Naval Institute, 1967).

  89 Of the 617 men rescued: Guy B. Faguet, The War on Cancer: An Anatomy of Failure, A Blueprint for the Future (New York: Springer, 2005), 71.

  90 Goodman and Gilman weren’t interested: Alfred Gilman, “Therapeutic Applications of Chemical Warfare Agents,” Federation Proceedings 5 (1946): 285–92; Alfred Gilman and Frederick S. Philips, “The Biological Actions and Therapeutic Applications of the B-Chloroethyl Amines and Sulfides,” Science 103, no. 2675 (1946): 409–15; Louis Goodman et al., “Nitrogen Mustard Therapy: Use of Methyl-Bis(Beta-Chlorethyl)amine Hydrochloride and Tris(Beta-Chloroethyl)amine Hydrochloride for Hodgkin’s Disease, Lymphosarcoma, Leukemia and Certain Allied and Miscellaneous Disorders,” Journal of the American Medical Association 132, no. 3 (1946): 126–32.

  91 George Hitchings had also: Grant Taylor, Pioneers in Pediatric Oncology (Houston: University of Texas M. D. Anderson Cancer Center, 1990), 137. Also see Tonse N. K. Raju, “The Nobel Chronicles,” Lancet 355, no. 9208 (1999): 1022; Len Goodwin, “George Hitchings and Gertrude Elion—Nobel Prizewinners,” Parasitology Today 5, no. 2 (1989): 33.

  91 “Scientists in academia stood disdainfully”: John Laszlo, The Cure of Childhood Leukemia (New Brunswick, NJ: Rutgers University Press, 1995), 65.

  92 Instead of sifting through mounds: Gertrude B. Elion, “Nobel Lecture in Physiology or Medicine—1988. The Purine Path to Chemotherapy,” In Vitro Cellular and Developmental Biology 25, no. 4 (1989): 321–30; Gertrude B. Elion, George H. Hitchings, and Henry Vanderwerff, “Antagonists of Nucleic Acid Derivatives: VI. Purines,” Journal of Biological Chemistry 192 (1951): 505. Also see Tom Brokaw, The Greatest Generation (1998; reprint, 2004), 304.

  92 In the early 1950s, two physician-scientists: Joseph Burchenal, Mary L. Murphy, et al., “Clinical Evaluation of a New Antimetabolite, 6-Mercaptopurine, in the Treatment of Leukemia and Allied Diseases,” Blood 8 no. 11 (1953): 965–99.

  The Goodness of Show Business

  93 The name “Jimmy” is a household word in New England: George E. Foley, The Children’s Cancer Research Foundation: The House That “Jimmy” Built: The First Quarter-Century (Boston: Sidney Farber Cancer Institute, 1982).

  93 I’ve made a long voyage: Maxwell E. Perkins, “The Last Letter of Thomas Wolfe and the Reply to It,” Harvard Library Bulletin, Autumn 1947, 278.

  94 artificial respirator known as the iron lung: Philip Drinker and Charles F. McKhann III, “The Use of a New Apparatus for the Prolonged Administration of Artificial Respiration: I. A Fatal Case of Poliomyelitis,” Journal of the American Medical Association 92: 1658–60.

  94 Polio research was shaken out of its torpor: For a discussion of the early history of polio, see Naomi Rogers, Dirt and Disease: Polio before FDR (Rutgers: Ru
tgers University Press, 1992). Also see Tony Gould, A Summer Plague: Polio and Its Survivors (New Haven: Yale University Press, 1995).

  94 Within a few weeks, 2,680,000 dimes: Kathryn Black, In the Shadow of Polio: A Personal and Social History (New York: Perseus Books, 307), 25; Paul A. Offit, The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis (New Haven: Yale University Press, 2005); History of the National Foundation for Infantile Paralysis Records; Volume II: Raising Funds to Fight Infantile Paralysis, Book 2 (March of Dimes Archives, 1957), 256–60.

  95 Please take care of my baby. Her name is Catherine: Variety, the Children’s Charity, “Our History,” http://www.usvariety.org/about_history.html (accessed November 11, 2009).

  96 “Well, I need a new microscope”: Robert Cooke, Dr. Folkman’s War: Angiogenesis and the Struggle to Defeat Cancer (New York: Random House, 2001), 115.

  96 money and netted $45,456: Foley, Children’s Cancer Research Foundation (Boston: Sidney Farber Cancer Institute, 1982).

  96 Gustafson was quiet: Phyllis Clauson, interview with author, July 2009; Karen Cummins, interview with author, July 2009. Also see Foley, Children’s Cancer Research Foundation.

  97 On May 22, 1948, on a warm Saturday night in the Northeast: The original broadcast recording can be accessed on the Jimmy Fund website at http://www.jimmyfund.org/abo/broad/jimmybroadcast.asp. Also see Saul Wisnia, Images of America: The Jimmy Fund of the Dana-Farber Cancer Institute (Charleston, SC: Arcadia, 2002), 18–19.

  99 Jimmy’s mailbox was inundated: Foley, Children’s Cancer Research Foundation.

  99 the Manhattan Project spent: See “The Manhattan Project, An Interactive History,” U.S. Department of Energy, Office of History, 2008.

  99 In 1948, Americans spent more than $126 million: Mark Pendergrast, For God, Country and Coca-Cola: The Definitive History of the Great American Soft Drink and the Company That Makes It (New York: Basic Books, 2000), 212.

  The House That Jimmy Built

  101 Etymologically, patient means sufferer: Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York: Picador, 1990), 125.