November 20, 1958

Your poignant letter just emphasizes how helpless we still are in the face
of certain medical problems. {'m afraid that there is very little t could do
to help or encourage you if only for the reason that this question Is rather
outside the field of my own immediate work at the present time. You can be sure
that there are literally hundreds or thousands of physiclans and medical research
workers who are dedicating thelr energies to alleviating such tragedies as you
have suffered.

What you say {fs of course perfectly true: exercise cannot regenerate a
destroyed nerve cell and a reconnected nerve fiber, if a connection is esta-
blished, is likely to be very much less effective than the one it succeeded.

On the other hand many patierts have had tremendous benefit from the persistent
devotion of their families end themselves to rehabilitation measures. If there
is any nervous function left at all these measures can make the most of it.
Nerve fibers cannot be reconnected, in the present state of our knowledge, but
there is an amazing reserve of control that can be relearned when new muscles
have to be taught to do old tasks. In my own family | have been gratified, and
in a certain sense surprised, to see how far my father has been able to recover
from a cerebrovascular accident that seemed at the time to leave him in a
utterly hopeless condition. L‘'kewlse | have seen one of my graduate students
recover to a remarkable degree from what otherwise might have been an utterly
incapacitating brain injury.

! am confident that your own medical advisors would not be bouylIng you up
with false hopes if there were utterly no basis for it. If there is anything
left to work on at all their measures are the best we now have to make the
best use of residual function.

| suspect that you addressed your letter to me less in the hope that |
would have any personal expertise pertaining to your problem than that | might
be able to point the way to someone who js as you say on the "threshold of some
new discovery", # do not know of any work that could give you more comfort
and help than the procedures you are now using. There have been a number of
exciting discoveries on the plasticity of the central nervous system in early
development and you might find a recent review of these by Eccles in @ recent
issue of the periodical "Perspectives in Biology and Medicine" published by the
University of Chicago Press. These studies are along the lines that you
surmised of attempts to discover the basic biological factors involved in the
‘wiring arrangement", but sad to say, these studies offer no immediate prospect
of even the remotest application to human disease at the present time. We can
only hope that this research or other work Iike it will ultimately give us some
answers. In the circumstances | can only hope that you can take courage and
most important help as best you can to imbue your wife with the confidence and
hope that she will need to get the most out of her exercises. f am sure that
your physician can quote tangible cases where his procedures have given
substantial help to patients afflicted in the way that your wife has been.

Yours sincerely,

Joshua Lederberg
Professor of Medical Genetics

JL/Jp