Kaufmann

All About Parkinson's Disease

All About Parkinson's Disease

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Mount Sinai School of Medicine, New York, NY, USA

Melvin D. Yahr, one of the giants of 20th century neurology died on January 1st 2004, aged 87, of lung cancer, at his home in Scarsdale, New York. His was an intense and long life of uninterrupted scientific productivity. His first paper, on myasthenia gravis, was published in 1944 and his last one, of course on Parkinson's disease, appeared in press in 2005, sixty one years later. Born in 1917 in New York City, Yahr was the youngest of six children of immigrant parents. His family lived in Brooklyn where his father owned a bakery. He went to New York University School of Medicine and completed an internship and residency at Lenox Hill

Hospital and Montefiore Hospital in New York City. As a student he played the clarinet in a jazz combo to earn extra money, but insisted that he was not a talented musician. Later, when questioned about the origin of the phenomenal musical talent of his daughters, he attributed all to his wife Felice, whom he married when she was a 23-year-old writer working at Fortune Magazine. Yahr served in the US army from 1944 to 1947 and was discharged with the rank of Major. Back in NY, he joined the faculty at Columbia University College of Physicians and Surgeons where he began his work as an academic neurologist. He had wide clinical interests but after a few years he began focusing on Parkinson's disease. Building on the work of Carlsson, Hornykiewicz and Cotzias, in the 1960's Yahr conducted the first double blind randomized large clinical trials of Ldopa in the treatment of Parkinson's disease. The success and impact of this treatment was tremendous; patients were ''unfrozen'' from statue-like rigidity and brought back to life. In 1967, together with Peggy Hoehn, he devised a 5-stage scale, simplicity itself, to determine the severity of Parkinson disease. The Hoehn and Yahr rating scale is still the gold standard and levodopa remains the most widely used medication for the treatment of Parkinson's disease.

Melvin Yahr became H Houston Merritt professor of neurology at Columbia University before moving downtown, as he used to say, to Mount Sinai School of Medicine, where he become professor of neurology and chairman of the department. Yahr brought to Mount Sinai the country's first multidisciplinary center for research in Parkinson's disease and related disorders, a pioneering example of translational research. Under his leadership, basic scientists and clinical investigators working in close proximity, made significant contributions to the understanding and treatment of these disorders.

He chaired study sections for the National Institute of Neurological Communicative Disorders and Stroke, he was an adviser for the National Research Council, the National Academy of Sciences, and the New York City Board of Education. He was president of the American Board of Neurology and Psychiatry, the American Neurological Association, and the Association for Research in Nervous and Mental Diseases. He received many prizes and awards and was an honorary member of the British, French, Belgium and Argentine Neurological societies.

Melvin Yahr was an imposing presence. I first met him in 1982 during my neurology residency at Mount Sinai. He was 64, famous and at the top of his game. He had a low baritone voice and a very characteristic way of speaking that we all used to imitate. He was impeccably dressed and always wore a crisp shirt and tie under his white lab coat. And he smoked a pipe, an indispensable tool for the neurologist-detective of his generation.

Yahr was first and foremost a clinician; but believed strongly in basic research. He loved neurology and he got great satisfaction from his work. He was a superb teacher. I remember vividly Morning Reports as a senior neurology resident; every day of the week at 9 in the morning, after rounding the neurology ward, the senior residents went into his office in the 14th floor of the Annenberg Building, junior residents were not allowed. The 5 or 6 seniors sat in couches and chairs facing him who was sitting behind his desk, reclined backwards, almost always smoking a pipe. The curtains were usually lowered, so the room was dark. Many times we couldn't see his face because it was covered by the desk lamp and by a journal he was reading and holding in front of him. One could only see the smoke from his pipe coming up from behind the journal. We felt we were in front of the oracle. We presented each new patient trying to be brief and to the point. At the end of each patient's presentation we heard his voice saying: next! or some short comment. But sometimes it was different. He would put the journal down and ask a few more questions and then go through the differential diagnosis or focus on one particular aspect of the history and what it meant. For us it was magic, it all made sense when he explained it. He left us mesmerized and we walked out of his office full of ideas and imagining that we actually knew what we were all doing. Clinical neurology was an exciting job with Melvin Yahr.

Twice a week he also did ''Chief of Service Rounds.'' With all the residents and medical students sitting around him, he interrogated and examined a patient from the Neurology ward. With Melvin Yahr this was high theatre. He was a master performer.

Melvin Yahr was outspoken and blunt and was used to be in charge. He was not easily convinced ( - of anything), and his most typical questions were - ''What do you want?'' to his students and ''What is it that you cannot do?'' to his patients. He was frequently gruff and stern but had a fine sense of humor and compassion.

Almost everything that is necessary for a neurological diagnosis is in the history, he used to say and he mostly stuck to that. Of course he used radiology and electro-physiology extensively, but he had a deep distrust for all forms of testing. He asked patients very clear questions and had the ability to make them talk and reveal information that nobody else seemed to have been able to obtain. He listened intently, rarely interrupting with his gaze locked on the patient. His neurological examinations were very focused brief and revealing: as residents, we entertained the possibility that Yahr could actually alter plantar responses in patients at will, and we believed that he always knew what he was going to find, as he never appeared surprised. He kept the tradition of clinical neurology training one on one, almost like an apprentice. Neurology was his passion. He was a methodical thinker, disciplined, focused and persistent.

Melvin Yahr did not believe in retirement. When he stepped down as chairman at Mount Sinai in 1992, his office was demolished, literally. I guess the powers to be thought he would have stayed there otherwise. Undeterred, he got a new office, and a new endowed chair remaining as active as ever.

He appreciated beauty, loved red wine and cognac. A favorite line of his was ''It's a racket!'' applied to a variety of senseless medical or everyday life schemes. He was a Democrat, which in the US, means liberal.

He is survived by Nancy his companion after the death of his wife Felice in 1992, and by 4 brilliant daughters, Carol an opera singer, Barbara, an orchestra conductor, Laura a pathologist and Nina a social worker, and 5 grandchildren.

Melvin Yahr died 200 years after James Parkinson. He would have pointed that out. Until the end Yahr remained intellectually vibrant. He was writing and seeing patients just a few weeks before his death. He will be missed.

Author's address: H. Kaufmann, MD, Mount Sinai School of Medicine, Box 1052, New York, NY 10029, USA, e-mail: [email protected]

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