Chemotherapy at its creation

YALE (US) — Medical records of the first patient to receive intravenous chemotherapy for cancer offer insight not only into how much the treatment has changed, but also how much it has remained the same.

A paper detailing the 1942 surgery appears online in the Journal of the American College of Surgeons.

The patient, known only as “J.D.” (even today, because of privacy laws, he can only be identified by his initials) was born in Poland in 1894 and immigrated to the United States at age 18.

He had no known family, never married, and lived alone in a rented four-room house in Meriden, Connecticut.  He worked in a ball-bearing factory until his illness began in 1940.

His first admission to New Haven Hospital (later to become Yale-New Haven Hospital) came in February 1941, for what began as enlarged tonsils that grew into a full-blown lymphosarcoma, a malignant tumor of his lymph nodes that doctors tried unsuccessfully to reduce with radiation.

During these early years of World War II, Yale School of Medicine researchers had been participating with the U.S. government to develop antidotes to chemical warfare agents, which the government feared would be used by the Germans against Allied troops.

Attention turned to nitrogen mustard, and studies of its lethal effects on mouse tumors suggested that it might also be effective against certain cancer cells, despite its toxicity. Although the research was censored by the War Department, physicians began exploring nitrogen mustard for this purpose.

By the time J.D. was admitted on August 25, 1942, at age 47, his tumor mass was so large and hard that he could not move his head. Physicians had been looking for a cancer patient willing to undergo experimental treatment with nitrogen mustard. J.D. volunteered and two days later received the first dose of intravenous chemotherapy. Daily injections were given in the days that followed.

By the end of August, he was improving and was able to sleep comfortably in bed. Eating was easier, and he could move his head in a wider arc and cross his arms on his chest for the first time in weeks.

By September 6 his condition had improved markedly, but his white blood count, which indicates levels of the immune system’s disease-fighting white blood cells, was falling precipitously. A month into his treatment, his cancer was undetectable.

Whatever cells did remain had become resistant to the nitrogen mustard. And the cancer returned. Suffering from bone marrow depression, bleeding, and respiratory distress, he died on December 1, 1942, the 96th day of his hospital stay.

In the chaos of those war years, J.D.’s medical records were misplaced and subsequent inaccurate reports were filed.

Two years ago, Yale University physicians John Fenn, clinical professor of vascular surgery, and Robert Udelsman, professor and chair of surgery, began looking for the medical records, a process made difficult because of a lack of a name, date of birth, medical record number, or precise dates of surgery.

Sketch found in the medical records of  J.D, the first patient to receive intravenous chemotherapy.

They went through every record, including pathology reports, of every “J.D.” they could find and finally found one with lymphosarcoma.

Discovery of the first patient’s file, nearly 70 years after his death, brought into sharp focus how new cancer therapy was, but how some aspects of chemotherapy are the same today as they were in the 1940s: its effectiveness as a cancer treatment, and its toxicity and the risk of patient resistance.

“It was all there,” says Fenn. “In one patient, there was the revelation that cancer would respond to chemical injections, and that chemotherapy also had potentially lethal implications in the depression of bone marrow.”

“That first proof of chemotherapy’s efficacy as well as its side-effects paved the way for decades of improvement in these life-saving agents,” Udelsman says.

“J.D. gave us hope for the future, says Fenn. “This one patient was responsible for the birth of medical oncology.”

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