John P Peters (1887–1955): McCarthyism and the Unfinished Revision of Quantitative Clinical Chemistry

Volume I Interpretations (1931)

John Punnett Peters received his MD from Columbia in 1908 (Figure 1). He served as Chief of Medical Services in a field hospital in France in World War I. After the War, he spent time at the Rockefeller Institute where he met Donald Dexter Van Slyke with whom he developed a professional and personal relationship that lasted for 35 years. In 1922, he joined the Medical School at Yale University. ⁴ When the publisher Williams & Wilkins asked Peters to write a manual on clinical chemistry, he asked Van Slyke to review the chapters he had completed. The back and forth between the two authors made them realize, as Peters said “ …  we have to do this together; it takes a chemist as well as an internist.” ⁵ Volume I Interpretations was released in February 1931. Peters’ wife, Charlotte Morse Peters (1888–1963), proofread and produced the subject index. The book was well received. One reviewer called it “ … the most comprehensive and authoritative book on the subject in this country.” ⁶ Arthur H Sanford whose own book, Clinical Diagnosis by Laboratory Methods, was in its seventh edition in 1931, wrote that it was “a monumental work” that “will doubtless last for many years as the best example of such writing.” ⁷ A second printing was released in April 1932 and a third in July 1935. Work on a new revised edition was begun in 1937, the same year that Peters’ professional life changed dramatically. He became an outspoken public advocate for health care reform. OPEN IN VIEWER

The social activism of John Peters, 1937–1940

In April 1937, Eleanor Roosevelt invited 17 physicians and health care analysts to have lunch with the President at The White House. The purpose was to discuss with President Roosevelt the state of health care in America. Among the guests were John Peters, Thomas Parran, Jr (1892–1968), Surgeon General of the US and Esther Everett Lape (1881–1981), Head of the American Foundation for Studies in Government, a philanthropic think tank. Under Lape’s direction, the American Foundation had recently published a two-volume study on the state of medicine in the US. The report claimed that most people could not afford medical care and that there was a need for universal health insurance. ⁸ Peters was on the Advisory Committee that produced the report. ⁹ Eight months after lunch with the President, he formed the Committee of Physicians for the Improvement of Medical Care, Inc (CPIMC). Among the officers of CPIMC was Russel L Cecil (1881–1965), author of a Textbook in Medicine, now in its 24th edition, George Minot (1885–1950), winner of the Nobel Prize for his work on pernicious anaemia and John Peters, the Secretary. John Peters wrote the Principles and Proposals of CPIMC. They called for providing health care for the indigent, the use of public funds for medical education and research, and the establishment of a separate department in the Federal Government to administer these services. ¹⁰ Twenty-eight years before Medicare, these ideas were considered radical in the extreme.

The American Medical Association (AMA) in an editorial in the Journal of the American Medical Association attacked the members of the CPIMC as “unthinking physicians” and denigrated the Principles and Proposals as the first steps toward socialism. ¹¹ The newspapers covered the conflict between the AMA and CPMIC with headlines including “AMA Fight Begun on Social Medicine.” ¹² Despite the backlash from the AMA, John Peters pushed ahead with speeches and articles in support of the Principles and Proposals. In May 1937, he wrote “My social philosophy, I presume, would be termed radical, though I prefer to believe myself merely curious and intelligently open-minded.” ¹³ On 4 April 1938, he read a paper before the American College of Physicians that opened “The social responsibility of medicine, as I see it, is to provide to all classes of the population medical care of the highest quality.” He ended this talk with words that would prove prophetic: “These are bold statements and are sure to arouse at once cries of socialism or worse. I should hope that this company would not be frightened by mere words. Large ends cannot be gained by little means and the goal I have set is highly ideal.” ¹⁴ Another article published in The New England Journal of Medicine ended “That forty percent of our people are too needy to pay for their own medical care is a deplorable … condition.” ¹⁵

Like many liberals in the 1930s, John Peters lent his name to petitions, manifestos, and open letters that called for social justice for all. In 1938, when the German Nobel Laureate in physics Johannes Stark (1874–1957) published a paper in Nature that claimed Jews were not intellectually capable of conducting theoretical research in physics, Peters joined the protest. He signed the Manifesto On Freedom of Science that condemned the “racial nonsense of the Nazis.” ¹⁶ In 1939, he signed an open letter that praised the Soviet Union for universal health care and equality among the sexes. His fellow signers included Ernest Hemingway, Dashiell Hammet, Langston Hughes, George S Kaufman, William Carlos Williams, and James Thurber. ¹⁷ In April 1940, the play Medicine Show opened on Broadway staring Dorothy McGuire. The play was a polemic on the problems of health care in the country. In one scene, an actor declares “What we need now are men like Dr Sigerist of Hopkins and Peters of Yale. That’s what we need!” ¹⁸ Association with liberal social causes helped to contribute to the problems Peters would face in the McCarthy era that began at the end of World War II. In August 1946, after eight years of work, the second edition of Interpretations Volume I was released. It was, however, not a revision but an entirely new book (Figure 2). OPEN IN VIEWER

Interpretations Volume I (1946)

Work on the new edition began in 1937. It was decided by mutual agreement that Peters would revise Interpretations and Van Slyke Methods. Another decision was that Interpretations would be expanded into two volumes. Chapters 1–10 in the original 1931 first edition were expanded into 13 chapters (Table 1). ¹⁹ The original ketone chapter was merged into the lipids chapter; two new chapters were added, one on steroids and one on the fat-soluble vitamins; and the carbohydrate chapter would be expanded into three chapters. The remaining chapters, 11–21 in the first edition, were held for inclusion in Interpretations Volume II. These chapters, never finished, included those on plasma proteins, blood volume, the elements (sodium, potassium, chloride, calcium, magnesium), and two chapters that would, years later, become an important part of the history of this book, namely chapter 12 Hemoglobin and Oxygen and chapter 18 Carbonic Acid and Acid Base Balance.

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Table 1.

Table of contents, Interpretations first and second editions.

1931	1946
1. Total metabolism	Part I. Energy metabolism
2. Carbohydrates	1. Energy metabolism
3. Lipoids	Part II Carbohydrates
4. Nonprotein nitrogen and nitrogen metabolism	2. Chemistry
5. Urea	3. Physiology
6. Ammonia	4. Clinical
7. Amino acids	Part III Lipids
8. Uric Acid	5. Lipids
9. Creatine and creatinine	6. Steroid hormones
10. Total organic acids; lactic acid, and ketones	7. Fat-soluble vitamins
11. Phenols	Part IV Protein metabolism
12. Hemoglobin	8. The net metabolism of proteins
13. Proteins of the blood plasma, urine	9. Amino acids
14. The volume of the circulating blood	10. Urea
15. Total base, sodium and potassium	11. Ammonia
16. Calcium	12. Creatine and creatinine
17. Magnesium	13. Purines and pyrimidines
18. Carbonic acid and acid–base balance
19. Chlorides
20. Phosphorus
21. Sulfur

In prose that is clear and precise, each chapter in the revised edition of Interpretations begins with a historical introduction to the subject. In the urea chapter, for example, the author begins with Bright’s Disease, first described in 1827; Wohler’s synthesis of urea in 1829; and Christensen’s first description of elevated urea in kidney disease, also in 1829. Laboratory methods that did not meet the highest possible analytical standards were dismissed as inadequate. In the chapter on creatinine, the Jaffe Assay is described as “So non-specific … for creatinine … that there have been continuous uncertainty and controversy concerning the concentrations … in blood.” The enzymatic assay for creatinine, first described in 1937 by Miller and Dubos, is presented and then shown how it was used to obtain accurate serum levels in advanced renal disease. For each topic, the functions in the body and alterations in disease conditions were reviewed in detail. In addition, topics including the effects of age, sex, ethnicity, drugs, diet, and exercise on these laboratory tests were also covered.

Interpretations Volume I contained more than 4596 references. In each chapter, the literature citations are listed alphabetically and numbered sequentially. A single citation may include multiple references and this increased the above total. References added to the sequence, possibly after the chapter was completed, are inserted with the appended letters a, b, and c. The most recent citations in the book range in publication from 1 January to 1 September 1945. This appears to indicate that the manuscript was completed sometime after September 1945. Williams & Wilkins released the book in August 1946. Interpretations Volume I was reprinted in October 1947 and again in February 1948.

The reception to Interpretations Volume I (1946)

Reviewers received the second edition with enthusiasm. One in the Archives of Pathology wrote “The long-awaited second edition of this monumental handbook of clinical chemistry has finally arrived.” ²⁰ The clinical chemist Victor C Myers (1883–1948) offered that it “is an essential reference book for clinical chemists” ²¹ and F William Sunderman (1899–2003) claimed the book “lives up to its high expectations.” ²² Reviewers made reference to the forthcoming Volume II and to the revision of Methods. An advertisement in the 13 September 1946 issue of Science noted that Interpretations Volume II would be “ready about December” and that Methods was “in preparation for early 1947.” At the bottom of the advert was a coupon for preordering Volume II and Methods.

Years later, when Van Slyke was asked about the unfinished volumes, he said “I got so involved in laboratory work, that I just didn’t do it, much to Peters’ disgust.” He added “he carried out his part and revised it, and I never did carry out my part.” ⁵ Although Peters wrote all of Interpretations Volume I, they agreed that Van Slyke would revise chapter 12 (Hemoglobin and Oxygen) and chapter 18 (Carbonic Acid and Acid-Base Balance). These two chapters were intended to become major sections in Volume II. Van Slyke said “I feel very much ashamed that I never did do my job on that, but the war came along and then this job at Brookhaven organizing the medical department.” In 1948, Van Slyke moved from the Rockefeller Institute to Brookhaven National Laboratory. These admissions of failure by Van Slyke are commendable, but they do not explain what happened to Peters in the postwar period after the release of Interpretations Volume I.

The red scare and the start of the Cold War (1947–1949)

In April 1947, John Peters was elected to the National Academy of Sciences. In July, he testified before the Senate Committee on Labor and Public Welfare. He was opposed to a pending legislation that failed to provide universal health care, but which was supported by the AMA. He told the Senators “Medical care is meant for patients, not doctors.” ²³ The year 1947 was also the year when he was appointed to the Study Section on Endocrinology and Metabolism of the National Institutes of Health (NIH). Three times a year he traveled to NIH in order to review research grant applications. He was paid $50 a year for his services. This made him a part-time employee of the Federal Government and subject to review by the LRB. President Harry S Truman established the LRB in 1947 in order to provide a process that would root out communist influence in government. ²⁴ Each department of the Federal Government established its own LRB and relied on Federal Bureau of Investigation (FBI) reports to screen their employees. The FBI did not interview employees, but relied on informants who remained unknown to the accused and to the LRB. The Federal employees who were brought before the LRB were denied their right to cross-examine their accusers. When the FBI reports contained evidence that the employee supported racial equality, socialized medicine or labour unions, this was taken as evidence of reasonable grounds for the claim of disloyalty. When reasonable grounds existed, the employee was fired from government service. The LRB system, according to Haynes Johnson in his book The Age of Anxiety, “more than anything else initiated America’s … Red Scare.” ²⁵

The first interrogation (1949)

In January 1949, John Peters received a letter from the LRB responsible for screening NIH employees. The letter stated “The Board has received information relating to your loyalty to the government of the United States.” He was cited with 11 charges that demonstrated reasonable grounds for believing he was disloyal. The charges were based on the claim that he was associated with organizations that were considered subversive. At his hearing before the LRB, he denied under oath that he was a communist. He told the committee “It is quite alien to my inherent curiosity and my scientific training to subscribe to not only Communism, but also to other isms.” He continued “I heartily subscribe … to the principles of Voltaire and Jefferson. I fear suppression of thought and speech … lest the spirit of suppression grow on us.” ²⁶ In February, he was cleared of all charges.

Despite this close call with the LRB, John Peters continued his open support of liberal causes. On 28 March 1949, some 18,000 people attended the closing session of the Scientific and Cultural Conference for World Peace at Madison Square Garden. John Peters, Thomas Addis, and Albert Einstein were among the sponsors of the Conference. A month later, the House Un-American Activities Committee (HUAC) released a report that claimed that the conference was a communist front and that the sponsors were used as “decoys for the entrapment of innocents.” ²⁷ In the HUAC report, Peters was listed as belonging to 11 different subversive organizations: one of these was the National Council of the Arts, Sciences, and Professions. His name was included along with those of Leonard Bernstein, Aaron Copland, Albert Einstein, Lillian Hellman, Langston Hughes, Linus Pauling, and Paul Robeson. Despite the turmoil of the 1949 LRB hearing and the HUAC report, Peters published five clinical and laboratory research articles. However, the work on Interpretations was three years behind. In 1951, new disloyalty charges were filed against him and the interrogation process began for the second time.

The second interrogation (1951)

In December 1951, for the second time the LRB charged John Peters with being disloyal to the United States Government. The chairman of the LRB program at the Federal level in 1951 was Hiram Bingham (1875–1956), a professor of South American history at Yale from 1907 to 1924, the self-proclaimed discoverer of Machu Picchu and the two-term Republican Senator from Connecticut from 1925 to 1933. As head of the LRB, he lowered the standards for determining disloyalty from “reasonable grounds” to “reasonable doubts.” He was “dissatisfied with the rate of dismissals, and took responsibility for lowering the basic disloyal standard.” ²⁸ At Bingham’s request, the NIH Board was asked to reopen the Peters case. The 16 new charges were mostly repeats of the original 1949 charges. The hearing was held in New Haven on 1–2 April 1952. More than 20 witnesses appeared on behalf of Peters, including former presidents, deans, and professors of Yale, along with Esther Lape from the American Foundation. On 23 May 1952, Peters was found not guilty for the second time and cleared of all charges.

The third interrogation (1953)

Ten months later, on 6 April 1953, John Peters was charged a third time with being disloyal and of being a communist sympathizer. On 27 April 1953, President Eisenhower abolished the LRB program, but his executive order did allow pending cases to be completed. The notification sent to Peters stated that the LRB was conducting a postaudit of the previous decisions made in his favor. The third hearing was held in May 1953. In addition to a number of character witnesses, he submitted a letter of support from Eleanor Roosevelt. On 16 April, he received a letter signed by Bingham that stated “There is reasonable doubt as to Dr Peters’ loyalty to the Government of the United States.” ²⁹ With that, he was fired from his NIH position and had to forfeit his NIH grants, all of which he transferred to other researchers at Yale. Peters was convinced he had not been given his right to due process. He had never been allowed to confront his accusers who claimed that he was a communist sympathizer and disloyal to the government. For John Peters, fighting this injustice was what was required in a democracy. He would take his case all the way to the Supreme Court.

The Peters’ family legacy

The determination to fight perceived or real injustice in society or medicine may have been in John Peters’ genome. He owned a letter written by Abigail Peters in 1692. It was addressed to a judge in Salem, Massachusetts, protesting the ongoing witch trials. ¹⁸ Peters’ father was Rector of St Michael’s Episcopal Church in New York City. His sermons and lectures were often reported on in the city newspapers. In one Sunday sermon, he claimed that the Church’s alliance with money alienated the masses and he warned about the power of wealth in religion. During a talk in 1911, fellow clergy members walked out in protest because he condemned the church for its degradation of women and oppression of the poor. ³⁰ John Peters, the rector’s son, carried the legacy forward. After World War I when he was discharged as an Army Major, Peters refused to accept his wartime bonus. He returned it to the government and said that he was only doing his duty as a citizen. In his 30 years of clinical practice at Yale, he never charged for his medical consultation services. He felt that his salary from Yale was sufficient and that it required him to provide these services to his patients. John Peters’ son, Richard M Peters (1922–2006), also a physician, was responsible for desegregating the intensive care unit at the North Carolina Memorial Hospital in 1954. This led to the eventual desegregation of the entire hospital. On the local school board in Chapel Hill, North Carolina, he and other members worked for six years to desegregate the public schools. Their school system became the first in the south to be desegregated. ³¹

The Supreme Court decision (1955)

In 1954, John Peters took the claim for his right to due process to the US Federal District Court and lost. He filed his case with the US Federal Court of Appeals and lost again. In November 1954, the Supreme Court agreed to hear his case. The civil rights lawyer Abe Fortas (1910–1982), later appointed to the Supreme Court, was on the legal team that presented the case before the Court on 16 April 1955. The argument before the Court claimed that branding John Peters disloyal and removing him from employment with the NIH was a form of punishment. However, the US Constitution forbids punishment without due process. Further, the current Federal loyalty program places the employees at the mercy of gossip, personal enemies, and irresponsible informants. The American Civil Liberties Union, the Congress of Industrial Organizations, and the United Auto Workers all filed briefs in support of Peters. ³²

The case was decided in his favor on 6 June 1955. The New York Times covered the story on its front page with “High Court Voids Dr Peters’ Ouster By Loyalty Board.” ³³ To Peters, however, it was a hollow victory. The court ruled on a technicality, but did not address the claim concerning the lack of due process. The court maintained that the original executive order that created the LRB did not allow favorable decisions made in the past to be overturned. They also ruled that the LRB did not have the authority in April 1953 to reopen his case after President Eisenhower had disbanded the loyalty program.

The final year (1955)

Between January 1955 and the Supreme Court ruling in June, John Peters was an author of three clinical papers submitted to the Journal of Clinical Investigation. The last of these papers was submitted for publication on 1 April two weeks before the Supreme Court hearing. ³⁴ In addition, he was the sole author of three chapters in a book on clinical physiology. His chapters on carbohydrates, lipids, and proteins consisted of 141 pages of text. Many of the journal citations in the chapters included articles published between January and October 1955. This indicated that he was working on these chapters through October of that year. ³⁵ On Thursday 27 October, Peters suffered a myocardial infarction while on hospital rounds. He died 10 weeks later, on 29 December 1955.

One newspaper obituary stated “ … his two volume work, Quantitative Clinical Chemistry [was] known throughout the scientific world.” ³⁶ The journal Diabetes claimed that his “scientific achievements played an integral part in the development and growth of quantitative clinical chemistry.” No other single work “epitomizes this so well as the monumental Quantitative Clinical Chemistry. And concluded ‘Although he had time to revise only part of this by 1946, it still remains the classic in its field.” ³⁷

Richard M Peters delivered a tribute to his father in 1998 at the 40th reunion of the last class of medical students at Yale that John Peters taught. With reference to the ordeal with the LRB, he said “We, his children, believe that the charges not only placed him under grave stress but also actually shortened his life and certainly diminished the quality of his final years.” He added “He was diverted from the thing he most wanted to complete, the revision of Quantitative Clinical Chemistry.” ³⁸ At the same tribute symposium, Donald W Seldin, a former student, said “We miss his courage … The plain fact of the matter is that he was a courageous and morally dignified man.” ³⁹

The partial reprint of the 1931 Volume I Interpretations (1963)

In 1963, Williams & Wilkins made the decision to reprint two unrevised chapters from the 1931 first edition of Volume I Interpretations, 32 years after it was first published. This happens often with popular novels, but is unusual for medical textbooks. The chapters were chapter 12 (Hemoglobin and Oxygen) and chapter 18 (Carbonic Acid and Acid-Base Balance) (Figure 3). Both chapters were to be revised and included in Interpretations Volume II, but were never completed. An advertisement in the December 1963 issue of Clinical Chemistry explained the publisher’s reasoning. It read in part “ … reprint copies of these classics of modern medicine, so often requested by two generations of clinical chemists, has been printed, bound, and is now ready for distribution. Over 500 advance orders have already been received.” The advert continued “During the revision of Vol I, when the book lacked but two chapters of being complete, Dr Peters died.” One can only speculate as to what Peters would have thought of a reprint of a 32–year-old unrevised text. Perhaps the fact that this reprint exists may be the ultimate tribute to his lasting scientific achievements. OPEN IN VIEWER