Medicine: A Neurologist’s Hunch

Billy Lucas had been a pathetic, apparently hopeless invalid ever since the third day after his birth in Palo Alto, Calif. That was three years ago. Billy’s face was expressionless, his eyes never seemed to move, he could barely raise his eyelids. He could hardly swallow, and for two years he had to be fed through a tube. His arms were so feeble that he could not lift a spoon to his mouth, and he had to have steel braces to be able to stand.

Billy’s parents, Cyrene and Annette Lucas, spent about $30,000 seeking medical help for him. (Cyrene Lucas, a clerk in the family’s San Francisco cigar store, had to have a lot of help from relatives to pay the bills.) It looked as though Billy had cerebral palsy, but recently, at the University of California Hospital in San Francisco, tests showed no damage to Billy’s brain. A visiting British neurologist thereupon had a hunch.

Fingers & Eyes. A fortnight ago, acting on the Briton’s hunch, Mrs. Lucas had a prescription filled for neostigmine. That cost only 35¢. Then the visiting doctor, who has no license to practice in California, got a staff physician to give Billy the injection. While Mrs. Lucas held Billy on her lap, the British doctor waited to see what would happen.

After about five minutes, Mrs. Lucas told the doctor that Billy’s eyes were beginning to change. The doctor, a cool & collected type, scarcely looked up from his brain-wave charts. It was too soon for any change, he said; that would take at least half an hour. After ten minutes, Mrs. Lucas began to feel tension in Billy’s usually limp muscles. The doctor said it was her imagination. After 15 minutes, she insisted that the doctor look at Billy, who was really “coming to life.” Still skeptical, the doctor snapped his fingers beside Billy’s ear, and saw the child instantly turn his eyes to see what had happened. Mrs. Lucas vowed that it was the first time Billy had ever moved his eyes.

Billy was helped to his feet. He stood—unsteadily but unaided. Soon, rejoicing in what she considered a miracle, Mrs. Lucas bundled Billy up and took him home. Now, gradually gaining sureness, he toddles around without leg braces. He proudly eats a dish of cereal all by himself. And instead of expressing his wants in single words, like “hungry” uttered so unclearly that only a loving parent could understand them, he says whole sentences and his enunciation is getting better.

Rare & Grave. Despite Mrs. Lucas’ enthusiasm, what had happened to Billy was really no miracle. He was a victim of myasthenia gravis, a mysterious, uncommon disease which usually strikes adolescents or the elderly. Infant cases are rare, and Billy’s was especially hard for the doctors to diagnose because he was stricken so soon after birth, when cerebral palsy is the likeliest explanation of symptoms such as his.

Neostigmine (a muscle stimulant) is both a standard test and a standard treatment for myasthenia gravis. Perhaps because he was so young, Billy Lucas’ response to the first injection was unusually dramatic. Now he is getting the drug in tablet form every three hours. But he has another chance for relief, now that the doctors know what ails him: his disease seems to be connected with the working of the thymus gland, and about half the victims of myasthenia gravis get better after removal of the thymus.