Jan Verhave
Netherlands

The renowned pathologist Ludvig Hektoen maintained a vast correspondence with many people.¹ The science writer Paul de Kruif was one of them. Their contacts started in 1925. Paul de Kruif was in trouble. In 1922, he had written a story on vaccines in Hearst’s International Magazine where he had accused the manufacturer of murder. He and the editors were being sued for 1.6 million dollars. An appeal was made to Professor Ludvig Hektoen, who was also a medico-legal expert.

De Kruif was a third generation Dutch American from Zeeland, Michigan, born in 1890.² He had studied preclinical medicine at the University of Michigan where he earned his PhD in bacteriology. In 1920 he joined the Rockefeller Institute for Medical Research in New York. He was a productive researcher in immunological and bacteriological problems. The Institute housed top-class researchers as well as medical doctors. Some were also physicians at the attached Rockefeller Hospital and the whole crew met each other at lunch and at regular scientific meetings. De Kruif became increasingly irked by the scientific pretentions of doctors. When the hospital director, Dr. Rufus Cole, stated that medicine was now a science on equal footing with physiology and chemistry, De Kruif could not hide his feelings anymore. Meanwhile, he had made acquaintance with the progressive circle of authors and editors in New York and wrote a series for the Century Magazine. “Our Medicine-Men,” by one of them, deals with the—in his eyes—incompatible combination of compassionate doctor’s care for patients and the cool research attitude of the scientist of disease. It cost him his career as a laboratory scientist. In the fourth part of the series, De Kruif wrote about the science of diseases and criticized the mediocre levels of publications, the practice of repeating other people’s work and restricting research to descriptive rather than quantitative methods. Doctors were not fit for the latter.

Interestingly, Ludvig Hektoen had been hammering away at this point for years: pathology, including bacteriology and immunology, had to be studied as a segment of general biology, with no particular reference to practical application. He abhorred the trivial, repetitive, and descriptive studies of certain doctors who attempted to do some research along with their clinical work. Physiologists and chemists had to come to the rescue of the science of disease. It was a perfect template of what De Kruif was to publish in 1922. He must have been aware of these publications, not only because of this, but also because of Hektoen’s interest in immunology and bacteriology.

Hektoen grew up in a Norwegian village in Wisconsin, where he was born in 1863. He graduated as a physician and surgeon in 1887 and acquired the chair of pathology at the University of Chicago in 1901. Immunology, pathology, and bacteriology were his fields of study and he was very prolific. His mastering of the language led to a long-time editorship of the Journal of Infectious Diseases. He never practiced medicine and was essentially an academician. He was well-known for his kind and helpful attitude towards young researchers. In addition, he also specialized in medico-legal matters.³

About the law suit, De Kruif remembered:

Old Doctor Hektoen became my kindly guide: “Look for possible deaths among patients who might have lived if they’d got proper medical care instead of the plaintiff’s bacterins,” he said in his slow-spoken judicious manner with a charming Nordic accent. Dr. Hektoen radiated benignity.

De Kruif followed this advice and the lawsuit was dropped in 1926. He later wrote to Hektoen:

Did you know that the reason you weren’t called to testify in the suit–which thank God we won!–was that the other side discovered you’d sent out the questionnaires in our interest? And that our lawyer, Mr. Steuer, didn’t want to risk putting you on the stand and have it brought out that you had received a considerable retainer for your work?

I was on the stand four days and a little over, and it was horrible, but I stuck to the truth, even when it hurt us, and never once said “I don’t remember!”–and the jury appeared to like it. Anyway–we won, and I’m happy to have any stigma removed from my reputation for accuracy.

Paul and Hektoen got their compensation checks.

A growing appreciation

The story of the fatherly Hektoen and the rebellious De Kruif did not end with this incident. De Kruif kept his older friend informed about his activities. He had collaborated with the author Sinclair Lewis in the writing of a doctor’s novel, Arrowsmith (1925), and then started writing the stories of twelve giants in microbiology in a book called Microbe Hunters (1926). He asked Hektoen to write a recommendation for the latter book, which was meant to be a popularization of science history—the first of its kind. Hektoen wrote: “Accurate as to the facts, absolutely . . . the evaluations are just and fair”—and the book sales rocketed.

De Kruif, now a successful writer, told his friend: “It would be fun to sit once more in your laboratory. I am homesick for the faint reek of reagents and guinea pigs that clings around the McCormick Institute.” Hektoen was the director of this Chicago research laboratory for the study of acute infectious diseases, like scarlet fever

De Kruif began to address Hektoen as ”Dear Geheimrat”⁴ and asked for a signed photograph. He got it and wrote to his Dear Geheimrat: “Your picture is swell and hangs on my wall with my growing collection of uncles whose precept and example rule my life.”

The two passed the ball to each other with regard to various topics such as: public health, the need of pasteurizing cow milk, childbed fever. He also asked Hektoen for an introduction to F.G. Banting in Toronto, the discoverer of insulin, “. . . to drop him a little note telling him that I am a reputable scribbler whose word he can trust.” De Kruif planned to write a chapter on him in his new book, Men Against Death (1932). In it he described, among many other items, the research on the obscure parrot disease in 1930. Hektoen, working in the building of the Public Health Service, got sick one day. Work with parrot fever had been going on in a nearby laboratory room. He was taken to the hospital for fear of infection; fortunately it was nothing serious.

“Hektoen is gray-haired with a brown face that has a quick, kind smile and the whole gang up there looked up to him and loved him, admired him not only because he was such a pathologist but because he was just Dr. Hektoen. He was pretty old to stand the parrot fever that had killed [two men].”

In 1933, Hektoen became professor emeritus;⁵ but after he had turned 70 he started a whole new career serving on the National Advisory Cancer Council from 1937 until 1944.⁶ During this period, there is not a single letter from, or to, De Kruif left among the Hektoen papers.

Then in February 1944, Hektoen wrote:

It is a long time since I saw you but I am following your doings closely and with great interest. I should like very much to see you the next time you come to Chicago. I am quite sure you will be interested in looking over the Institute here.

The Chicago Tumor Institute

The McCormick had to be closed in 1939 due to lack of financial reserves, but the retired Hektoen put his authority behind the founding of the Chicago Tumor Institute where Dr. Max Cutler (also known as Dr. Cancer Surgeon), a Chicago pioneer cancerologist, was appointed director. Hektoen had figured out that cancer patients had more chance if treated and cared for in special institutions with specialized personnel.

The Institute was housed in an old building, but in it America’s most powerful X-ray apparatus was also housed. The radium beam could now be focused very precisely on affected organs under the skin without too much damage of healthy tissue. A special emphasis was given to patients with larynx cancer. It was voice and life-saving. After a few years, 22 victims of larynx cancer were healthy again and talking out loud after irradiation rather than going under the knife. But there were too few specialists and no hospital beds attached to the Institute. Moreover, the knife-wielding surgeons of the Chicago branch of the American Cancer Society began to ignore the Institute; Max Cutler was considered a traitor to surgery. They were afraid that those “dabblers with rays and radium” would take the bread (or champagne and caviar, as De Kruif mocked) out of their mouths. Throat surgeons tried to smear the Institute’s X-ray treatment by innuendo and stopped referring patients, even for those to whom the knife would come too late.

It appeared that Hektoen purposely renewed contact with De Kruif in 1944 because of his active involvement in public health actions (among others an extensive campaign for syphilis awareness in Chicago) and his experience in fund raising (as a former secretary of the National Foundation for Infantile Paralysis). A meeting of De Kruif with Hektoen took place in March, and De Kruif wrote:

. . . I’ve been thinking much about your project; it is certain that I will make the attempt to do a stirring story about the Institute. This attempt should succeed, not only because of the work, but still more because the attempt will be made con amore on behalf of this thing that you are fathering.

The story appeared in the Reader’s Digest issue of November 1944 and was called “Fifty Thousand Could Live.” It appealed to the generosity of the readers to make up for the annual deficit and the lack of endowments. De Kruif’s description of his old friend in this article is telling:

The president of [the Institute’s] board of trustees is Dr. Ludvig Hektoen, the grand old man of American medicine. Aged 81, he’s the active pathologist in charge of cancer diagnosis, and he gets to work at eight o’clock every morning. The optimism of this calm but indomitable scientist puts many a youthful death-fighter to shame. “Every cancer,” says Dr. Hektoen, “passes through a stage when it’s curable, either by surgical removal or radiation.” It’s Hektoen’s fighting spirit that reminds the Institute’s workers that they’ll never know–till they try–just how far that curable stage can be prolonged. Despite [the Institute’s] poverty, Dr. Hektoen insists that no cancer patients shall be refused treatment if they can be helped at all. . . .

“Today,” says Dr. Hektoen, “advances in radiation have reached the stage where we can offer hope for cure without fear of mutilation. When people know that, they will not be afraid to come early.”

Dr. Hektoen believes that science may some day find a simple chemical cure for cancer. But he is practical. “You can’t satisfy the present cancer victim by proving to him that research in the future may bring the cure,” he says with a dry smile. “You’ve got to treat him with the means at hand–and those means are really magic.”

Hektoen, now so old but most youthful of any of them, keeps prodding Max Cutler and his staff to extend the attack against other mass-killing cancers. He hopes that certain cancers like that of the lung, deep in the body and not yet within reach, can be made accessible to the accurate and terrific penetrating power of concentrated X-rays.

In a letter to Hektoen De Kruif wrote:

I am sure that it will make you and Max [Cutler] happy to know that Michigan State Health Commissioner, W[illia]m De Kleine, long-distanced me a few days ago full of enthusiasm about the cancer story. He informed me that a Midland, Michigan millionaire has left one million dollars for cancer research. And that De Kleine has been asked to give counsel in regard to its spending. Stimulated by our story it is De Kleine’s idea that a Tumor Institute similar to yours should be organized in Michigan–preferably Detroit.

And in January 1945 he added:

I wish much to be able to do more for your Institute. Please do not think me forward in the suggestion that I would like to meet with a couple of your Directors with the idea of discussing ways and means of strengthening your basic financial position, and especially with the idea of the small hospital so necessary to the expansion of your work. (There are surely dignified ways of raising the necessary money by touching the correct emotional buttons of those who have the money to give.)

The effect of the RD article was astounding. It brought many more patients to the Institute, many of whom could not afford such an expensive treatment. It helped save more lives.

De Kruif sent a telegram to an industrialist, Mr. Leeds:

Your fine plan makes yours not a voice from the grave but from heaven on earth. Article you read was in Reader’s Digest November 1944 and I wrote it. . . . President board of trustees Dr Ludvig Hektoen one of worlds great cancerologists and the grand old man of American medicine. Medical director Dr Max Cutlet [sic] now worlds pioneer new methods radiation treatment cancer. Institute sponsored by groups finest citizens Chicago yet runs on shoestring needing money badly. In my opinion best single activity entire cancer field . . . [telegram style]

“Of course nothing will come of this, but then you never know.”

However, the article also had a negative effect. It aroused a definitive antagonism to the Institute and its leaders. Moreover, conservative medicos used to consider anything from the sharp pen of De Kruif too hasty and over-simplified. And indeed, he described the situation as: “The local medical political powerhouse called officers of the Institute on the carpet for this undue publication.” The main hospital broke off its relations with the Chicago Tumor Institute and Cutler was kept off scientific programs. Despite the initial lack of expert cancerologists, the Institute persevered and gradually the radiation therapy won recognition. In 1948, the Coin Machine Industries donated $25,000. Cutler extended his research and experimental treatment to other malignancies, like breast cancer. The Institute became and still is a leading center of cancer treatment.

Last years

Meanwhile, De Kruif had published a new book The Male Hormone (1945) and sent it to Hektoen. It dealt in a rather funny way with hormones and liver preparations that could stimulate sportsmen and extend and comfort the lives of old men. De Kruif had used these remedies on himself. Hektoen responded: “Warm congratulations on your The Male Hormone and on the review of it in Time.⁷ Of course I have read the book with keen interest, pleasure and profit.”

In the fall of 1947 Hektoen felt that his days were running short. De Kruif’s last letter written to Hektoen on November 21 of that year reads:

Our meeting Sunday was a great inspiration to Rhea and me, and we are determined on two things: to help keep you going strong till one hundred and to get the hospital for the CTI quick. To this we dedicate ourselves.

In the same letter De Kruif recommended medicaments and instructions for Hektoen to use (multi-vitamins “Pluraxin,” testosterone “Neo-Hombreol,” and estrogen “Premarin”) plus the names of some medical specialists.

De Kruif had been busy writing another book, Life Among the Doctors (1949), in which he wanted to designate one chapter on his revered Hektoen and the CTI. But because of the uneasy situation, the Institute’s éminence grise asked him by telephone with some emphasis to leave out his name, as well as that of the Institute and of Max Cutler. De Kruif respected the wish, and in Chapter XII, “Old man against cancer,” talked only about the anonymous grand old man:

He shows the fragility inevitable in one so very old. His hair remains thick and silky-white. His wrinkles are hardly noticeable except when he smiles. His skin is smooth like that of a man of fifty. His color is faintly rosy except when a medical rebuff makes him sad; then suddenly he may turn pale and look very old. Despite his age, he is on the front step of new science, and is convinced of the benefits of X-ray and radium treatment. For the grand old man there was a salt of life in saving victims given up by the surgeons.

Hektoen was given two and a half years’ grace, but the hundred years he did not reach. He died on July 5, 1951.

Conclusion

With this description of his physiognomy and the stressing of the Scandinavian accent, every contemporary physician and scientist in the field would have recognized Dr. Hektoen, even though Chicago wasn’t even mentioned. But the present and future medical specialists and historians are at a loss. Hardly any biographical note about Ludvig Hektoen mentions the brave activities for cancer treatment he unfolded in the twilight of his life. Popular articles were not considered serious sources, even though De Kruif wrote from personal observation and intimate acquaintance with front-fighting medicos. The veil is now lifted off this chapter on the anonymous “grand old man.” Next to the Reader’s Digest article it is a valuable source for a medical historian who might engage in writing a biography of Ludvig Hektoen (or Max Cutler, or the history of American cancer research for that matter).

Had the professional life of Ludvig Hektoen been distinguished, it culminated in his effort for cancer treatment. Paul de Kruif walked bits of this path with his older friend. From the sober letters of Hektoen and the much more exuberant ones of De Kruif, it becomes clear that the two men appreciated each other. The European-style upbringing of both men may have provided a connecting bond. They exchanged personal ideas and recounted activities.

However, of sad events in Hektoen’s life–which were certainly there–we read nothing. It may have been due to the difference in age between the two, but also because of Hektoen’s stoic character. Though De Kruif normally used a very slang language with other friends, he restrained himself in his letters to his respected friend: “He has quieted my profane boisterousness acquired from a somewhat rough life among rough men. He makes me measure my words; he calms me down.” For that and more of Paul de Kruif, there is a niche to be filled in medical historiography.⁸

Notes

1. Ludvig Hektoen Papers, University of Chicago Library, Special Collections Research Center (correspondence with Paul de Kruif in box 1, folder 10). The University of Illinois at Chicago Library of the Health Sciences also keeps part of the Ludvig Hektoen Papers (group 27/12/21)
2. J.P. Verhave, Paul de Kruif, medical conscience of America. In: Dutch-American Arts and Letters. Proceedings of the 16th Biennial Conference of the Association for the Advancement of Dutch-American Studies, June 2007, Van Raalte Institute, Holland, Michigan (2008)
3. Paul R. Cannon, Ludvig Hektoen 1867-1951. A Biographical Memoir. National Academy of Sciences, Washington D.C., 1954, 163-197
4. German honorary title for very eminent Professors, also with the connotation of trusted counsellor
5. Morris Fishbein, Ludvig Hektoen-A Biography and an Appreciation. Archives of Pathology, 26 (1938), 1-31
6. L. Hektoen, The Federal Cancer Program. American Journal of Public Health 30, 755-759
7. ‘A mixture of laboratory slang, movie-travelogue lyricism and man-to-man locker-room candor’, Time Magazine, May 28, 1945
8. The author has committed himself to writing a biography of Paul de Kruif. He would welcome any information on him and is ready to discuss his place in American medical history.