-
Chapter 21. A Promising Start
- Michigan State University Press
- Chapter
- Additional Information
147 Chapter 21 A Promising start American slang is very expressive sometimes. —sherLoCK hoLMes, THE ADVENTURE OF THE NOBLE BACHELOR Dr. and Mrs. hench departed for their ten-week trip to england on september 28, 1948, just seven days after Mrs. G.’s first dose of compound e. Although hench’s trip had been set in stone for months, the events of the previous week mandated a slight change of plans. he made a short side trip to new York City en route to London, and there he met with two important corporate people: Dr. James Carlisle and Dr. Augustus Gibson .1 Dr. Carlisle was the medical director of Merck, and now had primary responsibility for the compound e project and the huge ($14 million) investment his company had made in it so far.2 Dr. Gibson, Merck’s laboratories director, had supplied hench with the original 5 grams of compound e. hench’s visit was more than a chance to thank his benefactors directly. Without revealing too much information, hench wanted to foster continued support for the project. Mrs. G.’s stunning response was encouraging, but hench—in sharp contrast to Kendall—knew the tremendous downside to a premature (or, God forbid, incorrect) announcement of success. A lot more work needed to be done before any claims were made. it was largely up to hench to convince Merck that it should support the work financially until it could be heralded in public. The details of his meeting with Merck are unknown, but hench, always persuasive, must have worn down any opposition to his plans. A deal was struck in which Merck agreed to supply additional compound e for up to four more patients. But there was a catch. Dr. Carlisle himself wanted to 148| Chapter 21 travel to rochester and see the drug’s effects on the next patient or two. hench agreed, passed the news back to his colleagues in rochester, and headed across the Atlantic to give the heberden Lecture in London. The first patient to receive compound e had been a woman. With the blessing of Merck, Polley and slocumb decided that the next two patients should be men.Two additional patients were identified and admitted to saint Marys hospital, where they shared a double room. They were an odd couple. The older gentleman, Mr. W., was, at least to the extent that any patient can be considered typical, a fairly typical patient with rheumatoid arthritis. Polite and cooperative, he was extremely debilitated by his disease; he’d be quietly appreciative if this new therapy turned out to provide any benefit at all. in contrast, his younger roommate, Mr. M., seemed to be a difficult, manipulative patient—far more crotchety and frustrating than the older man. Both men were essentially bedridden when therapy with compound e was initiated. The administration and dosages were the same as those used on Mrs. G., and within a few days there was a similar—and striking— improvement in both men. What differed markedly between the two was their attitude about this stunning change. Mr. W. readily admitted that he was feeling much better with the treatment. But Mr. M., even though he was now frequently jumping out of bed to assist his more severely afflicted elderly roommate, stubbornly refused to concede that he’d had any improvement at all. All the doctors and nurses watching his progress could easily see the changes that were taking place, and they were amazed by the apparent discrepancy between their observations and Mr. M.’s perception. This scene went on for a few more days—Mr. M. prancing about the room while adamantly denying that he was the slightest bit improved. Charles slocumb finally decided to get to the bottom of this odd behavior. exactly one week after starting treatment, slocumb asked Mr. M. during morning rounds whether he was feeling any better yet. When told “no,” he suggested that “maybe we shouldn’t waste injections if they aren’t helping?” Mr. M. collapsed suddenly into his chair and a panicked expression crept over his face. “no, no, no!” the young man protested. There was more fear than anger in his voice. Dr. slocumb sat down next to him and gently began to probe the situation . Mr. M. reluctantly explained that he had “been afraid to accept the improvement as being genuine until it had been sustained.” on too many occasions in the past, he claimed, he had thought that a particular new treatment...