Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (24 page)

Dr. Constable went on to mention that Sylvia questioned her closely for any new treatments or surgeries for people in her condition. She had heard of an experimental surgery in which the “pre-motor area of the brain is excised.” In about 50 percent of the operations, some of the physical symptoms of chronic epidemic encephalitis, primarily the Parkinson’s symptoms, could be alleviated. Dr. Constable told Sylvia she would have to gain some weight and get her blood count up before they could consider surgery. It would require that she stay in the hospital three or four weeks after the surgery and, as was the common practice, someone should stand by in case a sudden blood transfusion was needed.

In the spring of 1942, Sylvia was anesthetized and wheeled into an operating room. Her record doesn’t specify which hospital, but it was most likely the Neurological Institute. A left frontal craniotomy was performed on Sylvia. A craniotomy was not a new surgery; in fact, it predates medical literature, but in modern times, it was used in cases of severe brain traumas or tumors. A hole was drilled in her head and an instrument inserted to cut out or sever the part of the basal ganglia that was triggering the tremors and uncontrollable movements. It was a brand-new technique for the treatment of Parkinson’s patients, and a large number of those patients were suffering from postencephalitic Parkinsonism.

Sylvia did improve. Within a few months, she gradually began to walk again and feed herself with some assistance. The neurosurgeon recommended that family members and Sylvia’s regular physicians do everything they could to encourage her independence. The surgeon ended his postoperative summary by writing that Sylvia was also presenting quite a problem for the nursing staff because of her “tendency to be incessantly demanding.”

By then, the Second World War had broken out. Constable’s husband, an army surgeon, was stationed in Memphis, Tennessee, so she went with him and joined a promising neurology clinic headed by Dr. Eustace Semmes, a student of famed neurosurgeon Harvey Cushing. But Constable continued to correspond with Sylvia and her family.

In spite of Constable’s high hopes and the surgery’s temporary success, by 1945 Sylvia’s condition had worsened rapidly. She seemed to suffer a stroke, although Constable said it was most likely just the effects of the disease. Sylvia showed a “very marked tendency to childishness and irrational talking and thinking.” She was completely bedridden, her feet badly deformed, her face distorted. Sylvia could barely talk above a whisper and cried most of the time. Within a few weeks, Constable received a handwritten note from Sylvia’s sister.

March 20,1945

My dear Dr. Constable—

This is to tell you that at last poor Sylvia is at rest. She died this morning, after having been in a coma for over a week.

We shall never forget your thoughtfulness and the many kindnesses you have shown Sylvia—you were surely one of her truest friends.

With deepest appreciation,

Sincerely Yours,

Margaret

CHAPTER 22

I Have Seen the Future

T
here was a sad sort of symbiosis between epidemic encephalitis and the city of New York. When the epidemic first broke out in the 1920s, the city had rallied around public health to fight it, while the success of Tilney’s vision for New York neurology culminated in the greatest neurological center in the world. During those years, from the end of the war to the beginning of the Depression, New York itself had been in the midst of a great economic, technological, and medical boom.

The year 1930 marked the end of two brilliant, parallel tracks: one for neurological research, the other for the city of New York. That year, William J. Matheson died, stunting the work of the Matheson Commission and the Neurological Institute’s hope for worldwide recognition and acclaim. If the Progressive Era had helped pave the way for the rapid and impressive medical research surrounding epidemic encephalitis, medicine’s failure, too, was born of that era. That which did not succeed, progress, or grow quickly fell to the wayside. There was no solution to epidemic encephalitis, no answer. Neither Tilney, Jelliffe, nor Neal wrote about their disappointment personally, but it was undoubtedly present. A decade of work and hope, as well as close connections to patients, ended without resolution on any level.

And that same year, the Depression began, wearing away all the luster of the 1920s to expose a rusting and decayed city over the next ten years. The Depression changed New York dramatically. It imposed limits on a city that thrived on breaking boundaries.

S
ome changes in the city showcased the progress of the times, while others portrayed the decline. Automobiles still covered the streets, and by the 1930s, horses and buggies were almost entirely gone from the city. Gas stations became so necessary that the companies began issuing a card that could be used as credit to purchase fuel, although it would be years before true credit cards became commonplace in all stores.

Dining out meant going to soup kitchens and penny restaurants, though restaurants in general would make a strong comeback when Prohibition ended in 1933. Even a few of the speakeasies, like Jack and Charlie’s ‘21’ Club and the Palm, survived in New York. Now that people ate at home more, there was a return to homemade foods based on the seasons: jellied fruits, roast beef, five-minute cabbage, parsnips, sand tarts, and gingerbread in the colder months and cold meats, pork chops, wilted dandelion greens, beans, and fried tomatoes during the warm ones.

The Depression led to a major turnover in New York City politics as well. Mayor Jimmy Walker had typified the 1920s—he was also a product of Tammany Hall. Walker was colorful, a drinker and a gambler, and he became known as “the Mayor of Night.” He was also negligent. He spent 143 days out of his first two years on vacation. The 1930s was not the decade for a mayor like Walker, and after the Depression hit, it was obvious how much city services had deteriorated. Worse, money funneled into New York for relief efforts quickly went into the pockets of Tammany politicians. Under pressure from New York’s governor, Franklin D. Roosevelt, Walker finally resigned amid political scandal and moved to Europe in fear of being prosecuted.

In the next major election, in 1933, Republican mayor Fiorello Henry La Guardia came into office and vowed to turn the city around. As one historian said, “When La Guardia took office, city finances were chaotic, crime was rampant, housing was a mess, and soon the city’s unemployed equaled the entire population of Buffalo.” The situation was so desperate that state and federal governments had to supply 75 percent of the city’s relief burden—it didn’t hurt that La Guardia had a strong ally in Roosevelt and his New Deal administration. The U.S. government spent a billion dollars on New York City during the years 1933 to 1939.

Ironically, one municipal agency would suffer from progress: public health. As the Depression deepened and ordinary people were no longer able to pay physicians, the government created health insurance for the unemployed. While New York City’s exemplary health department had at one time battled Tammany Hall and city politicians, it now faced federal politics. Municipal public health was no match for the New Deal. Under La Guardia and subsequent mayors, public health would receive less attention and fewer funds.

N
ot everything in New York was failing, however. John D. Rockefeller, Jr., started work on the Rockefeller Center, employing seventy-five thousand men in the ten years between 1930 and 1940. It was the largest private building project in modern times. The Music Hall built as part of the project was considered the most glamorous theater in the world, and in keeping with the popularity of radio, it was renamed Radio City Music Hall.

The Empire State Building, the tallest in the world, was erected during the Depression. As E. B. White wrote about New York, “It even managed to reach the highest point in the sky at the lowest moment of the depression.”

In addition to focusing on the critical civil services needed during the Depression, La Guardia also understood the need to restore New York’s pride, and one of the places he accomplished that was in Central Park. The park had been a political sore point for decades. There was a nonstop struggle between those who wanted to preserve its pastoral quality and those who wanted to make the park a place of urban recreation, with playgrounds, sporting fields, ice skating, zoos, and restaurants. La Guardia appointed Robert Moses as parks commissioner, and using a large chunk of the federal relief funds, they modernized the park, as well as the city.

During the early 1930s, Central Park acted almost as a reflection of New York City itself. Wealthy socialites visited the Casino, a private club frequented by Mayor Walker. With a black-glass ball-room and a terrace, it was considered the most elegant restaurant in the world, and coincidentally, its chef had been personal chef to the Rothschild family in London. In addition to the Casino, new hotels edged the park—the Essex House, the Sherry-Netherland, and the Pierre. Already well established on Central Park South was the Savoy-Plaza. Yet, only yards away, in the middle of the park, the Lower Reservoir had been filled and now served as a home to a number of squatters who built shacks out of scrap materials and called their community Hooverville. Much to the irritation of the residents along Central Park West and Fifth Avenue, Robert Moses also built more playgrounds and athletic fields, which brought in all classes of people and many immigrants who had nowhere else to spend their leisure time. By then, 70 percent of New Yorkers lived in upper Manhattan within an easy walk of the park.

Moses also had the Casino closed down, and as an alternative, a tavern was built on the Green and opened as a more affordable option—the sheep that formerly occupied the Green were sent to Brooklyn for convenience, as well as to protect them from hungry men growing desperate during those times. Moses had the menagerie built into an actual zoo. And, in an attempt to provide jobs to the jobless, hundreds of men were hired to clean the park, so it actually looked better than it had in years.

L
a Guardia set his sights on one more way New York could return to its stature as “the greatest city in the world.” In 1935, in the depths of the Depression, the country was looking for a place to host the 1939-40 World’s Fair. La Guardia and a number of New York businessmen decided New York was just the place. The plan showed a remarkable faith in the city of New York. After all, the city was home to the Stock Exchange, the starting point for the Depression and a glaring reminder of its tenure. A number of Wall Street businesses were under investigation for corruption at that point. The city itself had been so crippled by the economy that the federal government had to help restore it. Everything from the park system to housing to unemployment was in a shambles. Yet, in just four years, the city planned to host the World’s Fair to prove not only to New Yorkers, but to all Americans, that the country would surface from the Depression. For New Yorkers especially, it gave them something they had not had since the autumn of 1930: hope.

The fair, aptly named “Building the World of Tomorrow,” focused on the future, science and technology in particular. An enormous orb and a seven-hundred-foot spire stood as the great monuments to the fair, and the architecture of the buildings was Art Deco with modern, geometrical features. During the day, they stood out as fascinating models of architecture; by night, they glowed with a sense of things to come. Some of the modern inventions on display included a pencil sharpener, IBM’s electric calculator, robotics, FM radio, fluorescent lighting, long-distance phone calls, even Wonder Bread. Moving walkways took people through some exhibits where visitors could watch an actual car being assembled. And as tangible proof of this modern era, the opening of the fair was conducted in high definition on early model televisions by the National Broadcasting Company.

For two seasons in 1939 and 1940, 45 million people visited the fair. Countries from all over the globe participated—the only world power not to be part of the fair was Germany. Fatefully, when the fair closed, the four thousand tons of steel used to build the orb and spire were melted down to make weaponry for World War II. It seems science and technology were indeed the way of the immediate future.

After the fair, people kept a number of collector’s items, including a button that read: “I have seen the future.”

I
n 1942, Sylvia and all other patients involved in the Matheson Commission’s work received a letter from Neal explaining that in July the “Matheson Commission’s service to patients has come to an end due to the lack of funds to carry on this work.” Neal went on to say that she wanted each of them “to be under the care of a neurologist who thoroughly understands the problems of patients afflicted with encephalitis. I am suggesting, should you need the services of a physician in the future, that you should consult Dr. Kate Constable.”

During the 1930s, the Matheson Commission had included work on all types of encephalitis, including the St. Louis outbreak, among other neurological diseases. Preliminary and important work on multiple sclerosis was started by the commission as well. But the nation was entering war again, just as it was emerging from a deep economic depression. In addition to that, the Matheson Commission could no longer find acute cases. With the epidemic well over, its clinics were instead filled with the growing number of chronic patients. Many of the disease’s researchers had moved on to new projects.