Nitrogen Mustard Therapy in Hodgkin ’ S Disease Analysis of Fifty

INTRODUCTION M USTARD gas was first discovered by Ritchie in 1854 and prepared for manufacture by Meyer in a 886. It was first used as a war gas by the Germans at Ypres in the spring of 1915. Five hundred deaths and 14,2.76 casualties resulted from this initial attack. By the end of the war, there was a total of 400,000 casualties from mustard gas poisoning. The clinical course of these victims was described by Marshall,’ Mandell and Gibson2 and others. Pappenheimer and \Tance,a Warthin and Weller,4 Lynch et al.5 studied the effects of mustard gas upon experimental animals. Krumbhaar and Krumbhaar6 reported upon the hematologic complications. With the advent of World War II, the Chemical Warfare Service of the United States Army undertook a systematic study of the mustard gases as potential offensive agents. In 1940, these chemicals were submitted, among others, to Drs. L. Goodman and A. Gilman, then at the Yale Medical School, for pharmacologic evaluation. During the course of their investigations they found that following the parenteral administration of an aqueous solution of nitrogen mustard in normal rats, there developed a marked lymphocytopenia together with some degree of anemia and thrombocytopenia. Dr. Thomas Dougherty of the Yale Department of Anatomy studied the effects of the chemical in the spontaneous leukemia and lymphosarcoma of rats. In a number of cases, a marked reduction in the size of abnormal tissues took place. The possibility then suggested itself that nitrogen mustard might be of some value in the treatment of the leukemias and lymphomata of man. The first patient,