Lou Gehrig and Ed Todd: Greatness Interrupted

Growing up in the 1930s, I was an avid baseball fan. My favorite team was the New York Yankees, and my favorite players were Babe Ruth, Lou Gehrig, and Joe DiMaggio. They all subsequently became prominent members of the Baseball Hall of Fame, but only one of them—Lou Gehrig—became forever linked with medicine. Consequently, he shares the batter's box in this editorial.

Lou Gehrig was perhaps the best first baseman of all time. Amid American sports heroes, his extraordinary achievements on the playing field, combined with his humility, kind-heartedness, and generosity, put him in a class by himself. He was nicknamed the “Iron Horse” after he played in 2,130 consecutive games—a record that stood for 56 years. Gehrig also holds the record for grand slams (he hit 23) and the American League record of 184 runs batted in during a single season (1931).¹

On 4 July 1939, 2 weeks after having been diagnosed with amyotrophic lateral sclerosis (ALS), Gehrig delivered his farewell speech. Before 62,000 admiring and teary-eyed fans, he stood on the infield of Yankee Stadium, flanked on one side by his 1929 teammates (arguably the best team in baseball history), and on the other side by his current 1939 teammates. His speech concluded with, “I consider myself the luckiest man on the face of the Earth. And I might have been given a bad break, but I've got an awful lot to live for.”² He died 2 years later, just 17 days short of his 38th birthday, of what has been referred to ever since as Lou Gehrig's disease.

You might be wondering who Ed Todd was, and why he is mentioned with Lou Gehrig in the title of this editorial commentary. Ed Todd was the former chief of Cardiothoracic Surgery at the University of Kentucky School of Medicine. Like Gehrig, he was a master of his trade. Like Gehrig, he was a hero to his fans—in this case, his trainees, colleagues, patients, and family members. Like Gehrig, he was kind-hearted, generous, and humble. And, like Gehrig, his greatness was interrupted by ALS.

In this issue of the Journal, Ed Todd's wife, Marilyn, provides a poignant account of how she and Ed confronted his diagnosis. In a letter that accompanied her invited manuscript, she said, “Initially, I was unwilling to revisit this time of my life. Hence, I procrastinated for a year. Although reliving this experience was painful, completing the article has been therapeutic and has enabled me to achieve closure. For that I am eternally grateful.” We, in turn, are grateful to her.

Now, a few words about ALS. It is a chronic, progressive, degenerative process that affects more men than women, usually begins between 40 and 70 years of age, involves the cortico-bulbo-spinal and lower motor neurons, and leads to spastic and atrophic phenomena in the cranial and spinal musculature.³ Its cause and cure remain enigmatic, and its therapy is symptom-driven and supportive.⁴

In the United States, ALS affects approximately 1 in 50,000 people per year. About 90% of cases are sporadic,⁵ including the occasional appearance in couples⁶ and in clusters.⁷ The remaining cases are familial,⁶ inherited as a Mendelian trait.⁸ Patients lose control of voluntary movement, speech, swallowing, and respiration. Death is typical within 2 to 3 years after onset. Some patients, however, die after 1 or 2 months, and others might live for 10 or more years with the support of artificial feeding and respiration.

Others who have died of ALS include U.S. Vice President Henry A. Wallace, U.S. Senator Jacob K. Javits, U.S. Army General Maxwell D. Taylor, actor David Niven, boxer Ezzard Charles, jazz musician Charles Mingus, Jr., and another Hall of Fame baseball player, pitcher Jim “Catfish” Hunter.⁹

True to his character, Gehrig saw himself “not as a mere victim of a form of paralysis but a symbol of hope for thousands of sufferers of the same disorder.”¹⁰ Today, Gehrig's hope lives on as the search for a cure continues. Memories of Ed Todd and the thousands like him live on, as well.