Leroy Hoeck; linked oxygen, newborns' blindness
WASHINGTON - Leroy Hoeck, 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 was 97. He had arteriosclerotic cardiovascular disease.
Dr. Hoeck (pronounced Hake) was a staff member at the District of Columbia'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 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 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 a specialist 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's 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," Patz, 88, said this week. Patz received the Presidential Medal of Freedom in 2004, largely for his work on the condition, which is now known as retinopathy of prematurity.
Leroy Edward Hoeck was born 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.
After the war, 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
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 singer Stevie Wonder) had been blinded by the practice, although in many cases the oxygen might also have saved their lives. 