Historical information requested

[ralph abercrombie]

Hello, my name is Ralph Abercrombie. I lost my father to ALS a few years ago.

He was the administrator at Tuomey Hospital in Sumter SC for more than 20 years. I'm writing a novel about his experiences.

For the sake of accuracy, I need to know what steps might have been taken to diagnose ALS in the early 1960's.

Can anyone here supply some basic information regarding diagnosis, specifically the steps a doctor of that era might have taken to rule out other diseases? I seek nothing too elaborate; the theme and premise of the novel is about faith, compassion and the challenges facing heath care. However, his disease is part of the story and an important component to the novel, and I want it to be accurate and serve to increase awareness.

Thank you in advance.

Here is his obituary:

RALPH M. ABERCROMBIE Jr. | The Sumter Item

 

[lgelb]

Sorry for your loss. Most people here were diagnosed since that time. I did a quick PubMed search and abstracts of relevant literature in that time period are not readily available. So I would ask a clinician who was around then.

 

[ralph abercrombie]

Thank you, I tried that. No one seems to have the answer. Which is strange, given my father's history and affiliations, and my access to them.

Not the case. It certainly drives home certain facts regarding the mystery surrounding this affliction.

Nevertheless, I can't have my fictional Cambridge and Edinburgh educated neurological specialist perform a blood and urine test, ask a lot of questions then scratch his head and guess.

MRI's did not happen until the 70's. Maybe EMG was possible, but only to rule out other things, which as you know is a long list.

I would not bother the good people in this forum if this was not important. However, the book is turning out better than I expected, and a major publisher is interested. The progression of his disease and the effect it had on... everything... is closely mirrored in the novel.

Anything that puts this disease in the forefront of public awareness and stimulates discourse is very desirable!

I hope I'm not bothering anyone with this. If there is any resistance to this fishing expedition I will discontinue the avenue. Suffering folks' privacy and sensibilities are more important.

 

[Nikki J]

You are looking for standard of practice in the UK at that time? I will ask in my FALS group to see if anyone knows from family lore. My guess though is it was indeed blood and urine tests coupled with a physical exam and perhaps xrays followed by a time of monitoring for progression. I would imagine the average patient was not told what they were monitoring for.

 

[Nikki J]

Actually try to contact Dr Stanley Appel in Houston. He first published in 1959 so he was likely a med student or senior undergrad at least by then

 

[ralph abercrombie]

Hello, thank you for the responses. The fictional doctor is educated in the UK and practicing in Charleston SC in 1964. An accident to an arm and a bone spur have masked the principal character's illness, and blood/urine tests and monitoring have been going on for years (in the book).

In fact, my father complained about weakness for decades before the disease progressed to something worse. it was an unusual progression, but not unheard of.

As in real life, none of the doctors in the novel have a clue, and are reticent about providing a firm diagnosis... until the character runs into the fictional doctor mentioned above, who rules out everything except Charcot's disease, which he has run into before in London, and seemed to be prevalent among ex-military men (which I think is true).

Question remains: how did he arrive at the diagnosis?

 

[lgelb]

As with any diagnosis of exclusion, odds of dx go up with the recency heuristic. So you could make your doc a baseball history fan (which even an expat Brit could be) who knows about Lou Gehrig.

 

[ralph abercrombie]

That's covered by a little optional and obligatory intertextuality, here and there about.

The genre is roman a clef. Hey! What happened to my accent?

 

[KimT]

I found a short PubMed article about the history of EMGs. 1st one in 1950. Did all the analysis by hand until 80s. I wish my former neuro was still practicing. He retired two years ago at 82. His expertise was EMG interpretation. I bet he would have been able to provide you with many details. Last I saw him, he was not well.

 

[diagnosed2016]

Have you tried some research into Stephen Hawkings diagnosis? Since he was diagnosed around the time and in the U.K. It might have some helpful information first hand.

 

[ralph abercrombie]

Thank you all. lgelb's (Laurie?) last comment was what I sought. Ironically, I arrived at the answer in much the same way as a 60's diagnosis might have been; that is by exclusion.

The fictional doctor is familiar with the disease, having seen it in London. Too complicated to go into here, but suffice it to say he lost a friend to it, prompting his interest in neurology (hence his study at Cambridge and in Edinburgh).

Gehrig is mentioned later, when the protagonist receives the news. He's the baseball fan.

Thank you all. I consider the question answered.

In parting, I leave you this: my father was able to survive with the disease for a long time. He had a good support group, a lot of love, tremendous optimism, he exercised and ate well and most importantly he kept his faith throughout, which manifested itself in a transcending kind of joy. The disease robbed him physically but he refused to let it rob him of the greater most important things. When he passed on he left no doubt about the firmness of his character or his principles. God bless you all.