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New England Journal of Medicine, Volume 353:854-855 August 25, 2005 Number 8 Luckiest Man: The Life and Death of Lou Gehrig Lou Gehrig: A Biography By any reckoning, Lou Gehrig was the best first baseman in the history of baseball. Jonathan Eig, a writer for the Wall Street Journal, deftly tells the story about how the son of impoverished German immigrants became a national hero, how he flourished, and how his career ended in the great misfortune of amyotrophic lateral sclerosis (ALS), the disease that now bears his name. The book by William C. Kashatus, a historian, is smaller but includes helpful tables of batting statistics. Two stories emerge, one about baseball, the other about ALS; the tales collide in the disaster of ALS. Eig's biography of Gehrig includes letters between the patient and Paul O'Leary, his physician at the Mayo Clinic, a renowned dermatologist and expert in syphilis; O'Leary was charming enough to be the designated physician for celebrity patients. Their exchanges would not be likely today — not in number, details, or philosophy. Gehrig repeatedly asked for the truth. The responses were unrealistic but upbeat assurances that he had a 50-50 chance of recovery. According to Eig, Gehrig's symptoms started in 1938 and became apparent to ballplayers and sportswriters. Gehrig knew something was wrong, but his malaise was attributed to gall bladder disease. In 1939, there were only 98 board-certified neurologists in the United States, and Gehrig was still playing baseball for the Yankees regularly (but miserably) when his wife, Eleanor, made an appointment for him at the Mayo Clinic. The diagnosis was apparent to the first internist who saw him and to the founder of the neurology department at the Mayo Clinic, Henry Woltman (who later described the stiff-person syndrome). But they did not tell the patient; instead, they told him he had "chronic poliomyelitis," a euphemism that confused all concerned. Medications were prescribed. Later, Gehrig was one of the patients with ALS who were treated with vitamin E by Israel Wechsler at Mount Sinai Hospital in New York. In Wechsler's published report, Gehrig was one of several patients who were said to have improved. But his muscles wasted in the expected time, and despite loving care from Eleanor, he died in 1941 at the age of 37. The Mayo Clinic has long protected the privacy of its celebrated patients, including Gehrig. His records are sealed, and it is therefore unknown exactly when his symptoms began. Sportswriters and physicians deduced progression of the disease from baseball statistics and from Gehrig's loss of ability to hit homers or extra-base hits, bat runs in, or field. Everything fell apart in the dismal season of 1939, until Gehrig asked Yankees manager Joe McCarthy to take him out of the lineup — not because he was suffering or embarrassed, but because he thought his poor play was harming his teammates. Thus ended his record of starting in 2130 consecutive games. Remarkably, in his last full season with the Yankees, in 1938, he hit 29 home runs, batted in 114 runs, and had a batting average of .295. These figures might have satisfied other players, but not Gehrig. In 1939, he played eight games despite having many symptoms of ALS. The books provide no information about his activities of daily living, the actual duration of his symptoms, or whether the symptoms began in his arms or his legs. Gehrig was a hero because of his unique athletic talents, but he also illustrated another feature of patients with ALS. They are characteristically nice people. What does "nice" mean? Gehrig was a teammate of the great Babe Ruth for a decade. Ruth provided the color. He lived a public night life; he was a drinker and a womanizer. He gained money and fame from endorsements. Gehrig was shy, avoided the public limelight, was home early, was devoted to his mother, never complained, and accepted a salary less than half the amount of Ruth's, even when his statistics were equally impressive. Nothing was nicer about Gehrig than his famous words at New York's Yankee Stadium on July 4, 1939. Even though he had had a "bad break," he said, "I consider myself the luckiest man on the face of the earth," and he then enumerated the reasons why he was grateful to many people. Gehrig was so widely admired that the condition is now called Lou Gehrig's disease. Symptomatic relief for patients with ALS has improved since Gehrig's time, with multidisciplinary centers, therapeutic trials, noninvasive ventilation, gastrostomy, and palliative care. Nevertheless, we still lack therapy that visibly slows progression or reverses the symptoms of ALS. Even so, patients can have more hope because thousands of energetic researchers are now working on the molecular aspects of the disease. A cure has been elusive, but it cannot hide much longer. Lewis P. Rowland, M.D. |
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