The Quest for Cortisone

Chapter 19. The Decision to Test Compound E on Rheumatoid Arthritis

135 Chapter 19 The Decision to Test Compound e on rheumatoid Arthritis I play the game for the game’s own sake. —sherLoCK hoLMes, THE ADVENTURE OF THE BRUCE-PARTINGTON PLANS Charles slocumb had become the Mayo Clinic’s second rheumatologist in 1931; howard Polley joined up as the third in 1942.1 The two junior men had faithfully supported Phil hench’s research into new ways to treat rheumatoid arthritis. The latest effort involved the use of lactophenin, the liver toxin from sweden that caused jaundice in many patients and relieved arthritis symptoms in some.2 These reports had stimulated hench’s interest, and the three investigators were now attempting to confirm and repeat the scandinavian observations at the Mayo Clinic. Many patients came to rochester hoping to get rid of jaundice. But in July 1948 two patients arrived in the strange hope of becoming jaundiced.3 The two had severe, long-standing rheumatoid arthritis. They came as volunteers hoping to receive lactophenin on the chance that it would somehow relieve their symptoms. The therapy was clearly experimental, but given the complete lack of alternative therapies, lactophenin offered at the very least a ray of hope for the two test subjects. 136| Chapter 19 Both patients were accepted for study and admitted to saint Marys hospital, where treatment with lactophenin was initiated. The first patient responded as hoped: jaundice developed, and with it came a dramatic remission of arthritic symptoms. unfortunately, the second patient, “Mrs. G.” from Kokomo, indiana, did not respond. Despite aggressive administration of the hepatotoxic drug, she stubbornly maintained a nonjaundiced milkwhite complexion. her arthritis raged unchecked, making it impossible for her to raise her arms over her head, lift a book, or, at times, even roll over in bed. After administering as much lactophenin as he could safely give to her with no success, Phil hench suggested that Mrs. G. return to Kokomo “while we study the matter further.” Mrs. G. would have none of that suggestion. only twenty-seven years old, she already had a reputation as a professional patient because of her participation in other clinical trials (including one conducted by the eli Lilly Company back home in indiana that had tested streptomycin as a potential antirheumatoid agent). After seeing the dramatic relief that jaundice produced in the other experimental patient, she was buoyed by unfounded optimism. summoning her most defiant attitude, she told hench “no.” Mrs. G. said she had “come for relief and wasn’t leaving until she got it.” To borrow an expression used by doctors in training, she “grew roots” in her hospital bed, stubbornly refusing to go home until she had been a guinea pig for another, hopefully more successful experimental therapy. Although stubborn, Mrs. G. was an extremely cooperative and likable patient. rather than being put off by her demands, hench seriously considered alternative ways to help her. for the next several weeks he discussed the situation with Drs. slocumb, Polley, and others. unfortunately, no one had any brilliant ideas. out of desperation more than anything else, hench considered the possibility of using compound e to treat Mrs. G. hench was aware that Dr. randall sprague, a Mayo Clinic endocrinologist, had in his possession 2 grams of compound e that he’d received from Merck & Company in order to study its usefulness in a patient with combined Addison’s disease and diabetes. hench wanted some of that sample for Mrs. G. he called sprague and made his request. Years later sprague would recall “being in the middle of hospital rounds at the time of the call on a busy August work day and conversing—but mostly listening—for about 45 minutes.” sprague not only declined to contribute some of his compound e, but tossed in the opinion that he thought hench’s plan was “an absurd idea.” sprague had The Decision to Test Compound E on Rheumatoid Arthritis| 137 no desire to waste his precious aliquot of compound e on an application he considered to be preposterous. hench remained undeterred. There was another potential route to compound e. he picked up the phone again and called his colleague Dr. Kendall. hench knew Kendall also had some compound e on hand, although it was a smaller amount than sprague’s supply. hench hoped to charm the chemist into giving him of some of it. unfortunately, Kendall wasn’t in the office. hench left a message with...