Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (11 page)

Progress was not just evident above the ground, but beneath it. In the last twenty years, city designers had been building train tracks
below
ground. One forward-thinking New Yorker predicted, “surface travel will be an oddity in New York twenty years from now.” Futuristic plans for the city also included second-story sidewalks made of glass, leaving the dusty and dirty streets to automobiles and double-decker buses.

For New Yorkers, for Americans, and for the world, the 1920s would prove to be the decade with the most rapid technological change in history. In one generation, travel by horse and carriage would make way for autos; people would travel underground, and soon, in the sky; wireless radio would change ship travel; kitchen appliances and indoor plumbing would become mainstream; light would come from a switch and heat through pipes; telephones would appear in the majority of homes; and the canned music and crackling voice of radio would provide home entertainment and news.

Of course, those modern conveniences would not reach all corners of society. A simple walk into the tenement housing showed exactly where the borders of modern life stopped. The faded, water-stained brick buildings had no indoor plumbing or electricity, a fact made more obvious by the clothing lines strung between the buildings, with linens, cloth diapers, and the limp legs of stockings waving like white flags. The monotonous façades of naked windows were broken only by the skeletal staircases fronting every floor. In more appreciated New York architecture, the façades of the buildings boasted ornate detailing, columns, eaves, and tresses. In tenement housing, it was the fire escapes.

With or without those modern conveniences, this modern life was creating a new kind of stress. The War to End All Wars ushered in America’s most violent century in history, and Americans had just come out of a war that seemed to have no definitive finish, established no sound peace. The draft had also been enacted in 1917, changing attitudes toward war, especially one fought in another part of the world during a time of isolationism.

Those immediate dangers, however, were still across the Atlantic. It was on American soil that a new fear arose to add to the amalgam of modern stress, and it was known as the Red Scare. New Yorkers now passed armed police outside every church and federal or municipal building in the city. Anti-immigrant sentiment, particularly toward Germans, peaked during the war; but it was the Bolshevik revolution in Russia that was igniting fear in the United States. A flurry of legislative activity like the Espionage Act of 1917 and the Sedition Act of 1918 addressed these fears, but the laws only fueled more anarchist activity. In the spring of 1919, a plot to explode thirty-six bombs in the United States was thwarted just in time. On June 2, however, another anarchist plot was not uncovered fast enough, and eight bombs exploded just before midnight in eight different cities. The targets were judges, attorneys, and congressmen involved in anti-anarchist legislation. In New York, at the home of a judge, a bomb exploded prematurely on the front porch of a brownstone on East Sixty-first Street. The judge himself was not home, but his wife and the housekeeping staff were there when the explosion took out the front half of the home. A child came down the staircase just moments before it collapsed. Windows shattered, and iron was found embedded in the walls of neighboring homes. In spite of that, there were only two deaths, a man and a woman believed to be the bomb makers. The
Times
did not mince words with the morning coverage on June 3: “A man and a woman were blown to pieces this morning.” The article went on to explain how investigators located body parts all over the block. Those explosions were followed a few months later by a large explosion outside of J. P. Morgan’s bank on Wall Street.

In addition to the anarchist violence was the birth of bootlegging. The Five Points Gang, now boasting members like A1 “Scarface” Capone, Charles “Lucky” Luciano, and Frank Costello, was the most powerful in a number of crews that bloodied New York streets.

If violence was not enough to make New York feel unsafe, the latest progress in automobile mass production would. At a time when medicine was rapidly advancing life expectancy, one observer wrote, “The one appalling increase in the number of deaths, from a cause that is among the least excusable, has been in automobile accidents.” Stepping off a curb could literally prove fatal.

Parents also worried about the children of this age. For the first time in history, children had a wealth of free time and free roam of the streets. They were not saddled with the hefty responsibility and chores of farm life. Modern food production, mass transportation, and appliances eased those burdens. Parents worried that their children were losing something valuable in the exchange. They stood by and shook their heads at a generation of children who spent their time on tops, marbles, and kick-the-can rather than learning riding, shooting, tool work, and other building blocks of self-reliance.

All of these changes, rapid and monumental, were affecting the American psyche. At the same time, the field of psychiatry was finally gaining the approval and acceptance of the medical community—in some sense
because
the stress of life had become so pervasive. Jelliffe was convinced that physical manifestations of these psychological worries plagued modern man. For neurologists in the 1920s, the focus was not so much on tackling every problem as it was on maintaining what they referred to as “mental hygiene.” Just as personal hygiene helped control infectious disease, mental hygiene would keep the mind clean and healthy.

S
urely that thought occurred to Jelliffe as his new patient, Adam, sat before him in the fall of 1924. Like the physicians in Europe—von Economo in Vienna and Hall in England—Jelliffe wondered about food poisoning when he encountered his first encephalitis lethargica patients. Jelliffe went so far as to suspect faultily packed olives. But, like the other physicians, he soon dismissed the idea as the disease took on new symptoms. By the time epidemic encephalitis had reached its peak in New York City, Jelliffe began to see patients who were not in the throes of the disease, but had sustained damage from it.

Adam had arrived at Jelliffe’s office on West Fifty-sixth wearing a gray suit buttoned over a vest and a striped tie. A fedora was tilted on his head. Looking around the office, Adam would have seen the spines of dozens of medical journals, a desk cluttered with stacks of paper, and a patchwork of sunlight on the glass vials and jars. In front of the journals was one large bell jar and a microscope that gave the office an air of scientific research, as though peering through that great lens would shed any light on the darker confines of the mind.

The first thing Dr. Jelliffe noticed about the young man sitting before him was a well-marked and progressive type of Parkinson’s disease. For the first three weeks Jelliffe saw him, Adam walked like a dummy, his arms drawn up to his sides, hands limp before him, and he showed a distinct tremor. Jelliffe diagnosed him as having the chronic effects of epidemic encephalitis.

Adam, Jelliffe recorded, was a young Jewish man about twenty years of age. His father was Russian, his mother Hungarian. Adam was one of five children and, according to his files, had been born without difficulty, walked and talked at the usual age, read by the age of five or six. He did not wet his bed, bite his nails, stammer or stutter, walk in his sleep, or show any other compulsive habits before his case of flu during Easter break of 1922.

Since that attack, he had suffered as many as three or four respiratory attacks a day. At times, lighting a cigarette would help divert his attention and stop an attack. At other times, lighting a cigarette could trigger one. During an attack, Jelliffe noted, Adam’s eyes would dilate and his face would turn into a mask. Sometimes, his hands would clench and cramp like they were trying to grasp something. Adam described it as “Jesusly painful.” He grew to dread the attacks so much that he could become anxious and cry just thinking about them.

Jelliffe started asking Adam to record his dreams. Ever the psychoanalyst, Jelliffe found Adam’s dreams rife with sexual content, innuendo, and Oedipal tendencies. The fact that Adam had seen angels the night his delirium first started seemed clear from a psychoanalytical point of view: wooden angels were etched into the back of the sofa where his mother had nursed him as an infant. After particularly vivid dreams, including one in which a dog was biting and shaking his hand—an obvious symbol of masturbation in Jelliffe’s analysis—Adam would feel rotten and spend the next day in bed.

Toward the end of the month, Adam arrived at Jelliffe’s office after a hard trip from Philadelphia. He had gone into a trance in the taxicab over a fear of hitting an elevated train pillar. Adam came into the office bent over and stooped like an old man. Jelliffe patted him hard on the back and said, “Limber up! Brace up!”

Jelliffe noticed a look cross the boy’s face like a shadow. He asked Adam what he felt just then.

“I wanted to say, Cut it out—God damn you! I hate you! You were so like father trying to make me get up in the morning. The goddamn son of a bitch!” Adam left the office agitated and angry.

Jelliffe was convinced there was a link between the stress still present in Adam’s mind and the triggers for the physical reaction. Adam’s particular case, it turned out, was not so unusual. Throughout Europe there had been strange respiratory tics occurring in epidemic proportions—hiccups, unceasing yawning, and breathing tics like Adam’s. All of them had been triggered by a case of encephalitis lethargica. Jelliffe would later write, “No single situation in neurology has offered so much opportunity for the analysis of physio-pathological phenomena ... as has epidemic encephalitis.”

Epidemic encephalitis created an opportunity to study the effect of an organic disease of the brain damaging the mind—the very argument being made by neuropsychiatrists like Jelliffe. The disease injured the brain and caused physical repercussions that could not be controlled by patient or doctor. Yet the symptoms
could
change given certain personal circumstances. Patients responded to different types of stimulation and different types of people.

In New York in 1920, epidemic encephalitis kept a twenty-nine-year-old woman asleep for more than one hundred days. Knowing how she loved music, her husband hired a young violinist to play at her bedside. He started with one of Liszt’s Hungarian Rhapsodies, to no effect; but when he played Schubert’s “Serenade,” the woman suddenly opened her eyes and remained awake. She had a full recovery. The
London Times
reported, “This is the first case in the records of the New York Health Department of a cure in a case of Encephalitis Lethargica.”

Decades later, Dr. Oliver Sacks would encounter similar cases in his studies of encephalitis lethargica survivors at the Beth Abraham Hospital in the Bronx. Sacks was able to revive the patients briefly with the drug levodopa or L-dopa—a story he chronicled beautifully in the book
Awakenings.
Although Sacks encountered these catatonic, “extinct volcanoes” in the ward, he found they were anything but extinct. If thrown a ball, a patient would reach up and catch it. They would respond to certain pieces of music, but not others. If held by the hand, a patient could walk. Sacks found that the dysfunction was not in physical impairment or paralysis, but in the inability to initiate movement. The patient simply did not have the “will” to begin to move. Inside their brains, damage to the basal ganglia corrupted message signals like interference on a telephone line, and the automatic impulse to move was stunted. When Sacks or a member of his staff stood beside a patient and walked, the patient could follow, as though sharing the willpower to move. When let go, the patient would fall to the floor.

Sacks, like jelliffe, also found that in many cases, the patient’s own life and experiences played a large part in determining the course of this disease. As the brain is the body’s most mysterious organ, and because no two people are exactly alike, no two cases of encephalitis lethargica were the same. This encephalitis was an epidemic disease—it was
spread
somehow. It was not inherited, and it was not the result of a traumatic personal event. Its damage to certain parts of the brain was physiological and visible in autopsy. And, yet, the disease could prey upon personal aspects of a patient’s life. It blurred all the lines between an organic disease and the psychology of a patient. As Sacks himself said: “Psychiatry and neurology are inextricably linked. Defining it one way or the other doesn’t do justice to the patient.”

Sacks would also refer to jelliffe as “perhaps the closest observer of the sleeping sickness and its sequelae.”

J
elliffe found that certain authoritative personalities triggered respiratory attacks in Adam—usually having to do with Adam’s strict father. Once Jelliffe knew this, he was able to work to great effect, analyzing Adam’s responses and helping him understand his emotional and physical reactions. For Adam, just understanding what prompted these tics and symptoms must have given him some comfort. After years of feeling out of control of his own body and mind, Adam could at least understand what was happening and why.

In 1925, jelliffe wrote a letter to “My Dear Dr. Freud” and described Adam’s case and progress; he even described Adam as “practically completely restored.” jelliffe went on to say, “He was a severe Parkinsonian with respiratory attacks and all the character changes that threatened a deteriorating psychosis, and I only analyzed his efforts to use regressive mechanisms in your sense ... and have had a brilliant therapeutic result.”

If Jelliffe had any failings in his study of encephalitis lethargica, it was his optimism. The mind healed, the brain might still be broken.

CHAPTER 11

Only the Beginning