PHILIP HENCH

In Memoriam

By NANNA SVARTZ

Philip Showalter Hench, Nobel Prizewinner, died a short time ago, at the age of 69, while on holiday in .Jamaica.

Together with the chemists Edward Kendall - employed, as was Hench, at the Mayo Clinic, Rochester, Minnesota - and Tadeus Reichstein of the Base1 Universi- ty, Hench was awarded the Nobel Prize for Physiology and Medicine for his “discovery concerning the cortical hormones, their structure and biological effects”.

As early as 1925 Hench had published a paper in which he pointed out that chronic arthritis, now called rheumatoid arthritis, was probably attended by pronounced metabolic changes. He was struck particu- larly by the common occurrence of low blood pressure in this disease and assumed partly on this account, that the adrenal glands might be involved, but despite numerous attempts he could find no definite changes in these organs. He therefore directed his studies elsewhere, to the possible influence of the liver on the course of chronic arthritis. He had observed several cases of jaundice in chronic arthritis patients, and their arthritic symptoms had manifestly improved as long as the jaundice lasted. Hench now assumed that there was an antirheumatic element in the liver and examined a large number of substances occurring in the liver and bile but with negative result.

In the early thirties Hench began to investi- gate the circumstance, observed also by others, that patients with chronic arthritis

who became pregnant, often experienced a considerable inprovement of their arthritic symptoms. There must, thought Hench, be a lack of some substance in the organism, probably a hormone. He believed at first that this substance was merely antirheumatic, but it soon became clear that pregnancy could also have a favourable effect on hay fever, asthma, migraine and other conditions. Substance X, he assumed therefore, was specific to a group of diseases and not to a particular disease. This proved assuredly to be a true prediction.

Hench and Kendall often discussed dif- ferent medical products and in 1941 they decided to try compound E, later called cortisone, in arthritis, when it became avail- able in sufficient quantities. Kendall had iso- lated an insignificant quantity of this cortical hormone in 1934 in collaboration with Mason and Myers. Reichstein was engaged on the same problem.

The first quantities of the hormone had been reserved for patients with adrenal insufficiency. In September 1948 Hench wrote to Merck & Co., where Sarett in collaboration with Kendall and others had started to synthesize cortical hormones. He asked for a quantity of hormone E large enough at least for trial on one patient. At the end of that month he and his coworkers received a quantity which was given to a patient who had had rheumatoid arthritis for four years accompanied by serious loss of motility. After five days of treatment the

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PHILIP HENCH In Memoriam (Cont. from page 22)

patient said: “I never felt better in my life.” The news of what had happened at the Mayo Clinic spread like wildfire across the world despite all attempts by Hench and his colleagues, Slocumb and Polley, to hush it up until they had tried out the compound thoroughly. Within a few days they realized that the arthritic symptoms recurred if the medication was interrupted. This later gave rise to endless discussions concerning the possible advantages of long-time treatment or of larger doses of cortisone. Attempts in the use of large doses led to the soon widely known side-effects and even resulted in prohibition of the use of the drug in some clinics. This pained Hench deeply. As so often when expectations run high, the reaction was altogether too violent. Hench himself had been very reserved in his judgment and often emphasized that more experience was needed and that one had to proceed with caution. After he had thoroughly tried out the compound he issued detailed directives for the treatment. His principles are at present being followed to a large extent everywhere in the world.

If one asks what were the results of the experiments made by Hench and his col- leagues some 17 years ago, it must first be pointed out that cortisone and allied com- pounds had started to be synthesized by chemists and drug manufacturers solely for use in cases of adrenal insufficiency. Here Selye’s studies of the significance of the adrenal glands enter the picture. The persevering and fundamental studies of

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Hench, Kendall, Slocumb and Polley im- mediately showed that cortisone could have a marked effect in other than adrenal diseases proper. Cortisone soon became an indispen- sable aid in rheumatoid arthritis and other diseases of the connective tissue, allergic diseases, blood diseases, tumours, and so on. Hench may be denoted the prime mover in this enormous and rapid development. Since we have learnt the technique of low dosage and local treatment, serious side- effects have become increasingly rare. Corti- sone and allied compounds have proved to have an unusually fruitful influence also on research. The main point, however, is that millions and millions of people with severe diseases of different organs are finding and will continue to find relief through these and similar chemical compounds. This develop- ment started in the Mayo Clinic, September 1948.

Philip Hench devoted himself with a rare enthusiasm and indomitable energy both to his daily medical practice and to his important research. He was scrupulously thorough and completely honest and sound in all his work. He was a highly intelligent person, a profound thinker and a constant seeker after knowledge, always pondering over new problems which he often wished to discuss all the night long. He was a good man, faithful in his friendship. Relaxation from his work he found in his family circle and in music or in his large library of medical and other literature.