#HematologyTweetstory 26 - a short thread on arsenic and leukemia. Take a look at this graph, depicting the blood counts of a patient with leukemia. I took this picture from an old book on my shelf. Looks like successful cytoreduction, eh? Now look at the date on the top: 1890-1! 
This graph was prepared by Dr William Osler, describing a patient he saw shortly after he took up his position at the new Johns Hopkins Hospital in Baltimore. The drug Osler used: #arsenic. The case is in the 1892 edition of his textbook "The Principles and Practice of Medicine."
Osler's patient probably had chronic myeloid leukemia (CML), given prolonged survival in 1890 with a WBC ranging between 170,000-600,000/mm^3. Arsenic had been in use for CML since a report of successful palliative treatment of two cases by Abraham Lissauer from Danzig in 1865.
Here's what Osler said about therapy of leukemia & how arsenic "given in large doses" was the best treatment (other than fresh air, good diet & positive thinking.) "The indicatio morbi can not be met": a nice way of saying the root cause is not alterable; leukemia was incurable.
Fowler's solution (1% potassium arsenite) was often used. This bottle, probably from the 1940s (S.T. Oliver bought the pharmacy in 1935; Bill Oliver was a '38 grad from @FryeburgAcademy) is from a Maine pharmacy that still exists; formerly a Rexall, then Rite-Aid, now Walgreen's.
Thomas Fowler (1736–1801) of Staffordshire, England, worked as an apothecary before qualifying in medicine @EdinburghUni in 1778. In 1786, Fowler created an arsenical "tasteless ague drop". I could find no image of Fowler, but Derek Doyle of Edinburgh found this inscription.
In 1931, Claude Ellis Forkner (1900-1992), then at Boston City Hospital & later Cornell (depicted here golfing with a colleague), published a series that emphasized arsenic toxicity in CML. It was still used sometimes for myeloid leukemias until busulfan came along in the 1950s.
The renaissance of arsenic in leukemia came in 1997 when 2 papers @BloodJournal from Shanghai described use of arsenic trioxide (As2O3) in acute promyelocytic leukemia. @US_FDA approved Trisenox for that indication in 2000; Prof. Chen Zhu won 2016 @ASH_hematology Beutler prize.
Yellow orpiment (As2S3) had been part of Chinese traditional medicine & was studied beginning in the 1970s by Zhang Tingdong (张亭栋) at First Clinical Hospital of Harbin Medical University in China. His genius was to test each component of mixture "713 cancer spirit" separately.
For those keen for more details, there have been a number of good reviews of arsenic such as this one./End
