Philip Showalter Hench | Biography

Philip Showalter Hench, an American clinical pathologist, performed groundbreaking research in rheumatoid arthritis . His clinical tests of adrenal compound E, which Hench named cortisone, and of ACTH , which produces cortisone naturally by stimulating the adrenal cortex, offered the first hope for patients suffering from rheumatoid arthritis. Hench and his colleague, biochemist Edward C. Kendall, gained immediate worldwide attention when they filmed the miraculous recovery of arthritis patients--some of whom could barely walk--as they climbed stairs and even jogged in place. Although prolonged clinical trials showed that neither cortisone or ACTH was a viable long-term therapy for arthritis due to side effects such as high blood pressure and high glucose levels, Hench's efforts opened new vistas in medical research, particularly in the study of both hormones and rheumatoid arthritis. A meticulous researcher who methodically collected his clinical data before publishing his results, Hench shared the 1950 Nobel Prize in physiology or medicine with Kendall "for their discoveries relating to the hormones of the adrenal cortex, their structure and biological effects." (Chemist Tadeus Reichstein also received a share of the prize for his independent work with the adrenal cortex and its hormones.)

Hench was born in Pittsburgh, Pennsylvania, on February 28, 1896. The son of Jacob Bixler Hench, a classical scholar and school administrator, and Clara John Showalter, Hench attended a private high school, Shadyside Academy, and then enrolled at the University of Pittsburgh in 1916. His education looked as though it would be interrupted when he enlisted in the U.S. Army Medical Corps. But Hench was transferred to the reserves so he could return to his studies, and he enrolled in Lafayette College in Easton, Pennsylvania. He received his B.A. from Lafayette in 1916 and enrolled at the University of Pittsburgh School of Medicine, where he received his M.D. in 1920.

After completing his internship at St. Francis Hospital in Pittsburgh, Hench became a fellow in medicine at the Mayo Foundation of the University of Minnesota. The bright young physician and scientist would spend his entire career at the Mayo Clinic, where, in 1926, he cofounded the Department of Rheumatic Disease, which was the first training program in rheumatology in the United States. Hench spent the 1927-28 academic year on sabbatical studying research medicine with Ludwig Aschoff , a leading rheumatic fever investigator, at Freiburg University. He also studied with clinician Freidrich von Müller in Munich. Hench completed his formal education in 1931 when he received a master of science degree in internal medicine from the University of Minnesota.

A physician first, Hench's research was clinically based. He began studying rheumatoid arthritis in 1923. Unlike osteoarthritis, a degenerative joint disease common in later life, rheumatoid arthritis is a chronic inflammatory disease of the joints often contracted at the relatively young age of 30 to 35. In advanced stages, rheumatoid arthritis could cause deformity due to bone and surrounding muscle atrophy. In 1929, Hench took note of a patient who had suffered from severe arthritis for more than four years. The patient had entered the Mayo Clinic suffering from jaundice , a disease caused by excess bilirubin , a liver product, in the bloodstream. Amazingly, the man's arthritis had abated and remained dormant for several weeks after his recovery from jaundice. Carefully collecting data, Hench waited until he had authenticated nine similar cases, among them patients who experienced remissions from painful fibrositis and sciatica, two other inflammatory conditions, before publishing his data in 1933.

Hench was convinced that these cases held a vital clue to a therapy for arthritis and set out to induce jaundice artificially. Hench's initial experiments used infusion or ingestion of bile to emulate jaundice's production of excess bile in the blood or the liver. Although these experiments failed, Hench's attention was soon drawn to another group of patients, women whose arthritis vanished during pregnancy. He also observed that some arthritic patients went into less complete remission after surgical operations, anesthesia, or severe fasting. Looking for a common physiological denominator, Hench, who enjoyed reading Sir Arthur Conan Doyle's novels of Sherlock Holmes, had a prime suspect--glandular hormones. Furthermore, the fact that both jaundice and pregnancy caused remission in almost the exact same manner led Hench to believe that his missing compound was not bilirubin or a female-only sex hormone.

Fortunately, the Mayo Foundation's own Edward C. Kendall was a world renowned chemist in the field of steroids, a specific group of hormones. Kendall had isolated six steroids from the adrenal cortex , the outer part of the endocrine glands located atop the kidneys, which he alphabetized compound A through F. Hench's first try with compound A was a failure. Both Hench and Kendall then decided to try compound E. But at that time, in 1941, compound E was extremely difficult to synthesize and, as a result, costly. With both high (300 degrees Fahrenheit) and low (-100 degrees Fahrenheit) temperatures needed to produce compound E, the delicate work took time and attention and the slightest mistake could result in a useless compound. It wasn't until more than two years after World War II that scientists from the pharmaceutical firm Merck & Co. had developed a process that could produce enough compound E for Hench to attempt his experiment. Still, the compound was expensive to produce. Hench recalled in an interview for an article in the Saturday Evening Post that he and his colleagues "almost went into shock" when a $1,000 bottle of compound E was dropped on a marble floor.

Hench's results with compound E were miraculous. The first patient, a 29-year-old woman, experienced total remission of symptoms after three injections over three days. Hench's results were quickly confirmed by five other researchers across the country. Hench and his colleagues received instant public notoriety as a result of their studies both with compound E, which Hench named cortisone , and with adrenocorticotropic hormone (ACTH) , a hormone produced by the pituitary gland which spurs the body's natural production of cortisone through the adrenal cortex.

Unfortunately, Hench's miraculous "cure" for arthritis turned out to be short lived. Without the use of cortisone or ACTH, rheumatic symptoms returned; and long-term use of cortisone or ACTH causes several side effects, including high blood glucose and high blood pressure, as well as obesity associated with adrenal or pituitary gland tumors. Much to Hench's credit, he maintained his scientific cautiousness throughout the heady early days of the discovery, quickly recognizing the harmful side effects and outlining future directions in research of these hormones. Nevertheless, the studies of Hench and Kendall, along with those of Tadeus Reichstein, opened entirely new avenues of medical research; as a result, the three scientists were awarded the Nobel Prize for medicine or physiology in 1950.

Hench retired from the Mayo Foundation in 1957. In addition to the Nobel Prize, he was a recipient of the numerous awards, including the prestigious Lasker Award, which he also shared with Kendall. Hench married Mary Genevieve Kahler in 1927, and the couple had two sons, Philip Kahler and John Bixler, and two daughters, Mary Showalter and Susan Kahler. His hobbies included photography, tennis, opera, and Sherlock Holmes novels. He died from pneumonia on March 30, 1965, while vacationing with his wife in Ocho Rios, Jamaica. To honor him, Hench's alma mater, the University of Pittsburgh, presents the annual Hench Award to a distinguished university alumnus.