The discovery of cortisone: a personal memory

Abstract

Fifty years ago this week, Philip Hench showed that “compound E” (cortisone) was capable of reversing the inflammation of rheumatoid arthritis. This discovery resulted from 19 years of imaginative and deductive observation together, perhaps, with that element of serendipity which seems to characterise many fundamental discoveries. It all started in 1929 when Hench noted a clinical remission in one of his patients who suffered an intercurrent episode of jaundice. Convinced that this was no coincidence he decided to devote himself to the discovery of the nature of “antirheumatic substance X” in remissions associated with jaundice, and later, with pregnancy. His clinical researches involved giving many metabolites related to liver disease and subsequently, female hormones related to pregnancy. They were uniformly unsuccessful. Because remissions associated with jaundice occurred as frequently in women as in men, Hench concluded that factor X, if a hormone, must be present in both sexes. This led him to consider the adrenal cortex. He also noted that the gross fatigue seen in patients with rheumatoid arthritis bore some resemblance to the anergy which characterises Addison's disease. By happy chance, his colleague and friend at the Mayo Clinic, Edward Kendall, had, in 1929, switched his research studies to the separation and characterisation of the many unidentified hormones of the adrenal cortex. This work was laborious and …