Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (14 page)

M
ost historians now consider the 1920s an extension of the Progressive Era. The movement began with the antitrust laws that promised to rein in some of the business megamonopolies, but it soon grew into the progress laws and ideals that aimed for a more modern, safer, and healthier lifestyle. Legislation like mandatory meat and milk inspections, restrictions on tenement housing, improved working conditions, and child labor laws passed. The movement then morphed into legislation concerning civil responsibility, granting Native Americans citizenship, and allowing women to vote, as well as the amendment disallowing alcohol; in an upwelling of civil rights concerns, the right to vote was given, and the right to drink was taken away.

Prohibition also ushered in the age of the bootlegger and the gangster, particularly in cities like Chicago and New York. Incidentally, those were also two of the cities hardest hit by epidemic encephalitis. One newspaper editorial put forth the theory that the rise in lawlessness and gangsterism was, in part, due to the moral degeneracy caused by epidemic encephalitis. A British professor of psychological medicine later asserted the same theory about gangsters, John Dillinger in particular, though there was never proof Dillinger had the disease.

As the progress laws gathered momentum, dramatic change also struck the White House when, in 1923, President Warren G. Harding died suddenly after only two years in office. Doctors never performed an autopsy, and it was never determined whether he had died of a heart attack or stroke. The mystery surrounding his death led to conspiracy theories about poison that implicated everyone from political enemies to his own wife, who knew of his long-term love affair with another woman. The Teapot Dome scandal was the Watergate of that time period, and further scandals arose following Harding’s sudden death. Vice President Calvin Coolidge was visiting his family home in Vermont when a messenger arrived with the telegram—the home had neither a telephone nor electricity, so the thirtieth president was given the oath of office under kerosene lamplight by his father, a notary public. That act alone seems symbolic of the momentous changes taking place in America. Coolidge was sworn in with neither a phone nor electricity at hand; but his successor, Herbert Hoover, would take his oath of office with aircraft flying overhead to mark the occasion.

W
hile the progress laws seemed a giant political step forward, a darker side to the progressive change arose as well, primarily targeting immigration. As rural areas of America moved closer to xenophobia, and the Ku Klux Klan spread throughout the country with millions of members, cities like New York did not escape the anti-immigrant sentiment. The National Origins Quota Act, and then the Johnson-Reed Act, intended to overturn America’s open-door policy and return the country to its original religious and ethnic mix before the great immigration boom. There were more Italians in New York than in Rome, more Germans than in Berlin, and more Irish than in Dublin. A great influx of Puerto Ricans had also arrived following the Spanish-American War, and there was a massive migration of American blacks from the South to New York City, settling primarily in Harlem.

Some historians even consider progressive laws like women’s suffrage and Prohibition to be as much about immigration as they were about civic well-being. Even birth control became a conservative cause, with education at its mildest end of the spectrum and the practice of eugenics at its most extreme. Suffrage was supported by educated, religious-minded women who hoped to have a majority influence on politics; their immigrant counterparts were not as likely to follow politics or vote. Likewise, birth control was in one sense a way to stem the growth of immigrant families, who typically had more children. In other words, white Protestant women could add votes to those of the white Protestant men. Prohibition, or the temperance movement, also took direct aim at immigrant cultures by targeting the German beer gardens and Italian and Irish pubs.

Even religion was playing a part. There was a major push to “Americanize” immigrants, particularly in northern cities like New York. Catholicism and Lutheranism were the religions of immigrant cultures and attempts were made to close parochial schools.

The immigration laws had a definite cultural effect on New York, but it was not the one originally intended. The laws changed the cultural topography of the city, but rather than becoming “Americanized,” the immigrants blended into and ultimately enhanced New York. With second- and third-generation immigrant families easing into American culture, immigrant enclaves began to disappear. The city became less a series of segmented neighborhoods, each dominated by one ethnicity, and more of a whole, integrated city. Rather than living in neighborhoods that revolved around one church, one school, and a handful of vendors, existing almost like small villages within a larger framework, people began to spread out. Mass transportation, primarily the subway system, was facilitating that change. Soon, the diversity beginning to form was of a different nature. Writers flocked to New York, and the city published more books than Chicago, Philadelphia, and Boston combined; there was the Harlem Renaissance, especially in music; theater continued its rise; fashion and department stores flourished. New York was becoming the “City of Cities.”

Part of what was making this change possible was the evolution in public health. With greater public health services and more knowledge about how disease spread, immigrants and their neighborhoods ceased being the scapegoat for the catchall nexus of epidemics, so there was less resistance to integrating neighborhoods and schools.

A
gainst this rapid change in politics, technology, and culture, an almost unnoticed epidemic was proceeding at a sluggish pace. An outbreak of influenza, cholera, smallpox, or polio spread with impressive speed. This one, on the other hand, was too easy to overlook, too easy to forget, and that’s what made it all the more dangerous. As doctors and public health officials focused their attention on acute cases of sleeping sickness, a more grotesque side of the disease was taking shape.

In New York, the rising number of cases of epidemic encephalitis and the notoriety of some of its victims gave the Neurological Institute a steady influx of patients. The American Neurological Association had also celebrated its semicentennial in 1924. It had seen fifty years of rapid change, from phrenology and rudimentary measurements of the skull to the splintering professions of psychiatry, neurology, and neurosurgery—each finally coming into its own by the 1930s. The association wanted to capture that monumental change and the history of neurology in America in a book, and it asked only two neurologists to compile the volume: Dr. Frederick Tilney and Dr. Smith Ely Jelliffe.

Tilney was a natural choice for coediting a book on the history of neurology, but choosing Jelliffe showed the shifting attitude in neurology during that time. Although Jelliffe founded and served as editor of the
Journal of Nervous and Mental Disease,
and continued in that role for over forty years, he also had fallen out of favor with most neurologists, even being asked to step away from his involvement with the Neurological Institute. His reputation as a psychoanalyst had grown and was well established. Jelliffe’s energetic, almost manic devotion to psychoanalysis and psychiatry at first unnerved medical professionals. In time, however, his opinions were becoming a valuable addition to brain study.

In the midst of seeing patients, frequenting the Neurological Institute, publishing articles, and compiling this book, Tilney and Jelliffe, both advancing in years, were working long hours. It was taking its toll. Jelliffe lived with his second wife in his home on Fifty-sixth Street, while Tilney and his wife, Camille, lived around the park, on Fifth Avenue. Their children were grown and had moved on to their own families.

On a personal level, the opening weeks of 1925 would bring a tragedy for one of the physicians, and the closing weeks a tragedy for the other. On January 22, 1925, the second great heartbreak of his life struck Jelliffe. The first had been his wife’s death years before. The second was the death of his son, William Leeming. Leeming, something of a golden boy, was a medical student who had recently graduated from Yale and married just three months before. The younger Jelliffe had been a swimmer for Yale and was known throughout the country, even trying out as an Olympic hopeful. On that night, Leeming Jelliffe returned from the Metropolitan Swimming Championship at the New York Athletic Club. He had the habit of tossing small objects back and forth in his hands when he was happy, and that night at the Athletic Club, he’d been tossing a water polo ball as he closed his locker and left.

When he arrived home, he said hello to his new wife in the kitchen and went upstairs to change into his dressing gown. It was then that his wife heard the shot. She ran up the stairs and found her husband, shot in the head, with a pistol on the floor.

The police and an ambulance were called, but they stalled in the snow. The policemen and physicians ran the last several blocks on foot and arrived at the home just as Jelliffe did. He had his son taken to Roosevelt Hospital and specialists called in. They performed surgery, but his son died just after midnight from a wound to his head—the very part of the body Jelliffe had spent his career studying. As Leeming had been happy, accomplished, and recently married, suicide was ruled out. Friends believed he most likely shot himself by accident—tossing and twirling the pistol, which he kept in his clothes bureau.

At the end of that year, Jelliffe would write to Freud about his son. Freud, after all, could sympathize; he had lost his beloved daughter Sophie to pandemic flu five years before. “He was 25, fatherhood apart, quite a remarkable boy,” jelliffe wrote. “He always did things thoroughly from childhood—had distinct mechanical gifts. He was in his second year in medicine. Lovable, sociable, helpful, and as sound a student as he was an all-round athlete. This thing almost finished me.... I know I am coming round—as my dreams of his being with me are becoming fewer.”

T
ilney, like jelliffe, had been working at a frenzied pace—with his own patients, those in New York as well as those outside the city, and on his research, teaching, and fund-raising for the Neurological Institute. He worked fifteen hours a day without stop, often skipping meals.

Tilney’s frantic work schedule did not seem to diminish his social life. As a testament to his high standing in New York, Tilney was among New York’s elite in the boxes of the Metropolitan Opera House to see the famous Eleanora Duse perform
The Lady from the Sea
. It was her first performance in the United States in twenty years. The New York Times listed the impressive attendees at the opening night performance: Rockefellers, Astors, Morgans, Macys, Marshall Field III, Rose Kennedy, Theodore Roosevelt—and Frederick Tilney.

With his life moving at an unmatchable pace, his body could not keep up. It had been four months since his patient Jessie Morgan died, and a few days before Christmas, Tilney suffered a cerebral thrombosis, a blood clot in the brain. He recovered, partially, but was unable to speak for six weeks. In a few months’ time, Tilney taught himself how to scribble using just his left hand, and, ever the physician, he kept detailed notes on the course of his own recovery.

Time
magazine carried the remarkable story of what happened next. Tilney had a devoted following at the Neurological Institute, and doctors from the institute took turns sleeping at Tilney’s house every night. Five of them at a time would carry Tilney’s heavy, inert body back and forth from his bedroom to his study so he could work.

Scrawling only a few words per page, it took him merely months to write his two-volume masterpiece, totaling 1,100 pages,
The Brain: From Ape to Man.
The book, published in 1928, was called “the finest piece of evolutionary writing since Darwin.” Almost as impressive, given the outcome of the recent Scopes Monkey Trial, was the fact that Tilney managed to publish on the subject of evolution without polarizing science and religion. Several hundred Protestant ministers endorsed his book. Its popularity also shows, once again, how differently the brain was perceived at the time. Tilney was able to study the brain not only as the most important part in the machinery of human evolution, but also maintain the mind’s role in well-being, even calling it the organ responsible for a man’s salvation.

Still, it must have been hard for Tilney to describe and write about the evolution of the brain, about the development over time of walking, talking, and especially the use of hands. “With the brain to direct its action,” wrote Tilney, “ . . . the hand became the master key opening all of the ways leading through the new and vast domain of human behavior.” And, yet, Tilney had lost his natural ability for all of those things, having to learn them again even as he committed their importance to paper.