A hormone isolated, its meaning missed
Cortisone was not, strictly speaking, a new discovery when it became famous in 1948. Edward Kendall, working at the Mayo Clinic, had isolated and characterised the substance from adrenal gland extracts years earlier, labelling it compound E among a series of related hormones he catalogued from the same source. Tadeusz Reichstein and other researchers had independently obtained the same compound through their own work on adrenal chemistry, but, as with Kendall’s early work, its extraction was treated as a chemical curiosity rather than a step toward treating disease, since nobody yet had a strong reason to expect it would matter clinically.
Kendall’s compound E
The gap between isolating a hormone and understanding what it could do closed abruptly when Philip Hench, also at the Mayo Clinic, tested cortisone on patients with severe rheumatoid arthritis in 1948. Hench had noticed for years that arthritis symptoms sometimes eased during pregnancy or jaundice, circumstances he suspected involved some circulating substance, and cortisone became his candidate. Patients given large doses experienced dramatic relief from pain and stiffness within days, a response far more sudden and pronounced than existing treatments for the disease produced, and word of the result spread quickly through medicine.
Watching arthritis symptoms melt away
The clinical effect held up well enough to be recognised almost immediately: Kendall, Hench and Reichstein shared the 1950 Nobel Prize in Physiology or Medicine for their combined work identifying the structure and function of adrenal cortex hormones, including cortisone, within roughly two years of Hench’s arthritis results. Commercial production followed at a similarly fast pace, with Merck manufacturing cortisone by around 1948 or 1949 and researchers soon finding cheaper synthetic routes, including one announced by Percy Julian using bile acids and another developed with Glaxo using extracts from sisal plants, which made the drug practical to produce at scale rather than only in small research quantities.
A shared Nobel, a rushed rollout
What early enthusiasm did not fully anticipate was how broadly cortisone, and the wider glucocorticoid drug class that followed it, would act on the body. Because these hormones bind receptors present in nearly all cells and influence gene activity connected to metabolism, bone maintenance and immune function all at once, using them to dampen inflammation in one place inevitably also affects tissues that were never the intended target. Long-term or high-dose use is now well documented to raise the risk of osteoporosis, elevated blood sugar, increased susceptibility to infection, muscle weakness and other effects, a pattern that only became clear with years of clinical experience beyond the original dramatic arthritis cases.
The cost of a non-selective drug
That non-selective action turned out to matter well beyond rheumatoid arthritis. Glucocorticoid drugs derived from the same basic chemistry are now used to suppress the immune system after organ transplantation, calm severe allergic reactions and asthma, treat certain blood cancers, and manage a wide range of inflammatory and autoimmune conditions, often in carefully tapered doses precisely because abrupt withdrawal after prolonged use can suppress the body’s own hormone production. The same molecule that transformed arthritis treatment in a matter of months became, over subsequent decades, one of medicine’s most widely used and most carefully rationed classes of drug.
Why an old miracle drug still repays study
This is worth understanding because it captures a pattern that recurs across medicine: an initial result dramatic enough to look almost miraculous, followed by a slower, more complicated reckoning with what the same mechanism costs when used for months or years rather than days. Cortisone’s story does not undercut the genuine value of the original 1948 finding, since the relief it offered arthritis patients was real and well documented, but it does show why a powerful, non-selective drug earns caution alongside enthusiasm. An hour spent tracing both halves of the story is a useful template for evaluating any treatment whose early results look too good to have no cost.