Doctor Helped Link Extra Oxygen, Blindness in Newborns.
David Brown.
Leroy Hoeck, 97, a Washington pediatrician who helped solve one of the
great
medical mysteries of the postwar era, died May 25 at a retirement home in
Salisbury, Md. He had arteriosclerotic cardiovascular disease. Dr. Hoeck
(pronounced Hake) was a staff member at the District's public hospital
when
he teamed up with a physician still in training to figure out why an
unusual
number of premature infants were becoming blind after prolonged stays in
the
newborn nursery. Their hunch that supplemental oxygen might be the cause
turned out to be correct. But first they had to prove it. They did so in a
randomized controlled trial, the first in ophthalmology, that ran from
1951
to 1953 at Gallinger Municipal Hospital, the huge institution in Southeast
Washington that was later renamed D.C. General. That a pair of unknown
researchers could show that a substance as beneficial as oxygen could
cause
a condition as devastating as blindness was so surprising that the
pediatric
medical establishment repeated the experiment on a huge scale to confirm
the
findings. Nevertheless, the initial clinical trial at Gallinger was
crucial
to showing the importance of testing medical therapies -- even those as
seemingly beneficial as extra oxygen -- with randomized trials. Doctors
have
to approach their patients, and what they think they know, with a certain
amount of humility," said Steven Goodman, a physician at Johns Hopkins
University's Bloomberg School of Public Health and an expert on the
history
of medical research. This is one of the trials that taught us humility.
Dr.
Hoeck's partner in the study, Arnall Patz, went on to become chairman of
ophthalmology at Johns Hopkins Hospital and winner of the prestigious
Lasker
Award for his research on retrolental fibroplasia, as the oxygen-caused
eye
damage was then called. Dr. Hoeck, in contrast, became a private
practitioner after he left Gallinger in 1954. He had an office in his home
in the Prince George's County community of Hillcrest Heights until the
1980s. He then joined two other pediatricians at an office in Clinton. He
retired in 1990. His role in the pivotal oxygen trial is largely
forgotten,
although Patz has credited him with having the initial suspicion that
oxygen
was the culprit in the mysterious blindings. He played a huge role in
finding the cause of the premature-baby blindness," his one-time
collaborator, 88, said yesterday. Patz received the Presidential Medal of
Freedom in 2004, largely for his work on the condition, which is now known
as retinopathy of prematurity. I do think he felt overshadowed," Dr.
Hoeck's
daughter, Barbara Hoeck Miller, a retired radiologist, said yesterday. But
he was not the sort of person who was going to go after the recognition.
There was something that needed to be learned, and he wanted to learn it.
Leroy Edward Hoeck was born Nov. 2, 1911, in Sibley, Iowa. His mother had
gone there as a child from Illinois in a covered wagon. His father ran a
grocery. As a high school junior, Dr. Hoeck later recalled, he took a trip
with a friend to Mount Rushmore, which at the time consisted of George
Washington and half of Thomas Jefferson. He graduated from the University
of
Iowa and its medical school, did an internship at a hospital in
Indianapolis, and worked as a general practitioner in Indiana until he was
drafted into the Army Medical Corps, for which he worked in hospitals in
California, Alaska and England. In 1947, he married the former Dorothy
Cosner. She died in 2006. Besides his daughter, of Rockville, survivors
include a son, Edward Hoeck of Salisbury; a sister; and four
grandchildren.
He and his wife had a third child, Carolyn Sue, who died shortly after
birth. After the war, Dr. Hoeck trained as a pediatrician at Gallinger,
which at the time was the largest public hospital between New York's
Bellevue and New Orleans's Charity. Around that time, he was the doctor
for
the first baby born weighing less than 1,000 grams at Gallinger to survive
and be discharged. When Dr. Hoeck saw the boy several months later, it was
clear the infant was blind. Recalling the moment 50 years later still
caused
him to choke with emotion. That was devastating. I just felt we had to
find
the cause," he said in an interview for a story published in The
Washington
Post in 2005. Dr. Hoeck's research led him to an obscure 1940 article on
the
effects of supplementary oxygen given to pilots at simulated high
altitude.
It showed that when someone breathed nearly pure oxygen, the blood vessels
in the back of the eye constricted severely. Patz and other researchers
later showed that this response was especially dramatic in preemies and
could lead to the destruction of the retina. Dr. Hoeck mentioned the
discovery to Patz, an ophthalmology resident at Gallinger also interested
in
the problem. Patz proposed that they do a trial in which some premature
babies got constant oxygen -- which was the customary practice -- and
others
got it only if they were in respiratory distress or turning blue. In the
first group, 12 of 60 babies became blind. In the second, 1 of 60 did. The
publication of the study caused such consternation that pediatricians at
18
universities cooperated to run the experiment again. They confirmed Dr.
Hoeck and Patz's findings, and the practice of routinely giving
concentrated
oxygen to preemies quickly stopped. By that time, however, nearly 10,000
infants (including the singer Stevie Wonder) had been blinded by the
practice, although in many cases the oxygen might also have saved their
lives.
