BABE RUTH BIG HITTER IN MEDICAL ANNALS.

Byline: Lawrence K. Altman, M.D. The New York Times

At Babe Ruth Day at Yankee Stadium in 1947, the baseball hero of the generation stood before an admiring crowd, deep in pain and emaciated from advancing cancer, not yet aware of what ailed him. In the dugout moments before, clad in a topcoat and golf hat, he suffered a coughing spell, then, pulling himself together, walked to home plate, mentally recalling the day Lou Gehrig had made the same trip.

In a broadcast heard around the world, Ruth spoke slowly and extemporaneously in a raspy voice.

``You know how bad my voice sounds,'' Ruth told the roaring crowd. ``Well, it feels just as bad.''

Sixteen months later, at 53, he was dead.

This year, the 50th anniversary of Ruth's death, his sports legacy has been extolled again as baseball heroes of newer generations breezed past the home-run record the Babe held for 34 years, until 1961.

But unknown to many, Ruth also left a legacy in the annals of medical history.

In fact, he was among the first patients anywhere to receive experimental chemotherapy, and some researchers say he was the first ever to receive a combination treatment of chemotherapy and radiation for his type of cancer. For Ruth, the chemotherapy worked dramatically - but only temporarily. Nevertheless, knowledge gained from his case helped shape the combination therapy that is now standard for his disease.

Shortly after his death, the nature of his disease became clear, and well publicized. Ruth suffered from a rare cancer, naso-pharyngeal, that arose in the air passages in the back of his nose and mouth.

But the images of a hoarse Ruth, perpetuated in audio and videotapes on the Internet, in movies and in sports broadcasts, in addition to his well-known smoking and drinking proclivities, have contributed to the myth that Ruth had throat cancer, which is generally taken to mean cancer of the larynx, or voice box.

Crucial distinction

The distinction in cancer type may be academic to fans, but to patients and the doctors who treat them, the difference is crucial.

Recently, even a peer-reviewed medical journal has erred in stating the cause of Ruth's death.

Earlier this year, Cancer Therapeutics, the official journal of the Coalition of National Cancer Cooperative Groups, published an article by Dr. Dennis Cooper, a Yale oncologist, stating that Ruth had cancer of the larynx, and that even 50 years later his chances for being cured were only slightly improved.

The article prompted an intense discussion among doctors at the University of California, San Francisco, who then turned to original source materials, microfilm of The New York Times and Ruth's autopsy report. Next month those doctors are publishing another article, helping to correct the record, in the journal Laryngoscope. Its editors have imposed an embargo on the new paper, even though it is largely based on 50-year-old newspaper accounts.

Ruth's battle against cancer offers a rare glimpse into the many dramatic changes in medicine and attitudes toward research that have occurred in just half a century. The changes include greater accuracy in diagnosis, more effective therapy and stronger rules to inform patients about diagnoses and the consent now required from patients participating in experiments.

Yet the sobering fact is that more than half a million people will die from cancer in 1998 in this country.

Ruth's health began failing in September 1946 when he sought to return to baseball as a manager. His voice became progressively hoarser. He was gripped with severe and relentless pain in his left eye. His head ached. In November, he entered French Hospital in New York City, where doctors diagnosed sinusitis, then looked at possible dental problems and pulled three teeth, without improvement. His face swelled, his left eye became shut and he lost the ability to swallow. Ruth said he ``seldom could speak.'' When he did, he wrote in his autobiography (``The Babe Ruth Story,'' E.P. Dutton & Co., 1948), his ``voice sounded like somebody gargling ashes.''

X-rays showed a large abnormality at the base of Ruth's skull. But several biopsies of tissues in his mouth showed nothing abnormal. Ruth's symptoms worsened. His neck enlarged from swollen lymph nodes. His jaw hurt when he ate and he was unable to swallow. Later, Ruth was fed intravenously. Although doctors were unable to diagnose Ruth's problem, they treated him with radiation. His hair fell out in chunks.

Extensive cancer

In December, the doctors operated on Ruth and documented extensive spread of the cancer in the neck. But in the operation, surgeons had to tie off the external carotid artery because the cancer had wrapped itself around the blood vessel in his neck. The cancer also pressed on nerves that course through the neck from the brain. The pressure partly paralyzed muscles controlling his voice, accounting for his hoarseness, and making swallowing even more difficult.

In February 1947, Ruth spent his 52nd birthday in the hospital. He had played before throngs of cheering fans in his 22-year professional career, which ended in 1935. Now, Ruth was secluded and allowed few visitors. ``I often felt so alone that the tears would run helplessly down my cheeks,'' Ruth wrote.

In April 1947, every ballpark in organized baseball celebrated Babe Ruth Day when Ruth, bolstered by his radiation treatments, uttered his famous hoarse words. By June, those benefits from radiation had waned. Severe pain had returned; he could not sleep.

Ruth then joined the often-unaware group of anonymous patients who ushered in the modern era of anti-cancer treatment, which grew out of American research into chemical warfare agents during World War II. In 1942, researchers at Yale University tested one such agent, nitrogen mustard, in a human for the first time. But government secrecy restrictions prevented publication until 1946, after several hundred patients had been treated.

At the time, a team headed by Dr. Richard Lewisohn, a surgeon at Mount Sinai Hospital in New York City, was experimenting with an anti-cancer drug, teropterin, in mice. There were different teropterins, all extracted from brewer's yeast, and their effects on mice varied widely with the preparation.

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PHOTO BABE RUTH

One of the first to receive chemotherapy.