Cancer: A Historical Perspective By Lawrence Broxmeyer MD
Hodgkins cancer under attack When Virginia Livingston was a student at Bellevue Medical College her pathology teacher mentioned, rather disparagingly, that there was a woman pathologist at Cornell who thought Hodgkins disease (a form of glandular cancer) was caused by avian tuberculosis [1]. This lady had published, but no one had confirmed her findings. Afterwards, Livingston compared slides of both. In Hodgkins, the large multinucleated giant cells were called Reed–Sternberg cells. They were similar to the giant cells of tuberculosis, which formed to engulf the tubercle bacilli. Livingston stored away in her memory that this lady pathologist was probably right but she would have a difficult time in gaining acceptance. By 1931, Pathologist Elsie LEsperance was seeing ‘acid fast tuberculosis-like bacteria riddling her Hodgkins cancer tissue samples. And that germ, once injected into guinea pigs, caused them to come down with Hodgkins too, fulfilling Kochs postulates. LEsperance brought her stained slides to former teacher and prominent Cornell cancer pathologist James Ewing. Ewing initially confirmed that her tissue slides were indeed Hodgkins. But when he found out that her slides came through guinea pig inoculation of the avian (fowl) tuberculosis she had found in humans with Hodgkins, Ewing, visibly upset, said that the slides then could not be cancer. It betrayed his checkered history of high-placed medical politician. In 1907, you could have approached Dr. James Ewing about a cancer germ, and he would have embraced you over it. At that time, both for he and the rest of the nations medical authorities, it was not a question of whether cancer was caused by a germ, but which one. Was not it Ewing, at one time, who had proclaimed that tuberculosis followed Hodgkins cancer like a shadow? But shortly after, James Ewing, the Father of Oncology, sent a sword thru the heart of an infectious cause of cancer with Neoplastic Diseases [2], becoming an ambitious zealot for radiation therapy with the directorship of what would one day be called Sloan–Kettering squarely on his mind. His entry lay in prominent philanthropist James Douglas. A vote for Ewing, Douglas knew, was a vote for continued radiation and James Douglas began sizeable uranium extraction operations from Colorado mines thru his company, Phelps Dodge, Inc.[34]. Soon Sloan became known as a radium hospital and went from an institution with a census of less than 15% cancer patients, separated by partition, lest their disease spread to others, to a veritable cancer center. But the very history of radiation revealed its flaws, and by the early 1900s nearly 100 cases of leukemia were documented in radium recipients and not long thereafter it was determined that approximately 100 radiologists had contracted that cancer in the same way [3]. Still, Ewing, by now an Honorary Member of the American Radium Society, persisted. Elise LEsperance was anything but alone in linking Hodgkins to a germ called Avium or fowl tuberculosis. Historically Sternberg himself, discoverer of Hodgkins trade-mark Reed–Sternberg cell, believed Hodgkins was caused by tuberculosis. Both Fraenkel and Much [35] held, as LEsperance, that it was caused by a peculiar form of tuberculosis, such as Avium or Fowl tuberculosis, and of all the cancers, debate over the infectious cause of Hodgkins waxed the hottest. Into this arena LEsperance stepped in 1931, with few listening. She would publish Studies in Hodgkins Diseases [4] in an issue of Annals of Surgery. It proved to be the one legacy that no one, not even Ewing, who would soon die from a self-diagnosed cancer, could take away. Dr. Virginia Livingston Our (cancer) cultures were scrutinized over and over again. Strains were sent to many laboratoriesfor identification. None could really classify them. They were something unknown. They had many forms but they always grew up again to be the same thing no matter how they were cultured. They resembled the mycobacteria more than anything else. The tubercle bacillus is a mycobacterium or fungoid bacillus.–Virginia Livingston, 1972 Virginia Wuerthele-Caspe Livingston was born in Meadville, Pennsylvania and went on to obtain impeccable credentials. Graduating from Vassar, she received her M.D. from N.Y.U. The first female medical resident ever in New York City, with time Livingston became a Newark school physician where one day a staff nurse asked medical assistance. Already diagnosed with Reynauds syndrome, the tips of this nurses fingers were ulcerated and bled intermittently. Livingston diagnosed Scleroderma. But upon further examination there was a hole in the nasal septa, something that Livingston had previous seen in the mycobacterial diseases TB and Leprosy. So Livingston approached dermatologist Eva Brodkin and a pathologist for confirmation, all the while convinced that mycobacterial infection was causing the Scleroderma. She then preformed cultures from a sterile nasal swab – mycobacter