Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (12 page)

I
n June 1927, an energy coursed through America, electric and hopeful, an upwelling of pride and awe. On June 13 in New York City, that energy literally filled the air like a blizzard. With the world watching, Charles Lindbergh had just completed his solo trek across the Atlantic from New York to Paris. When he returned, thousands of people lined the sidewalks while stock exchange ticker tapes snaked through the air and the gray confetti of shredded newspapers rained on their upturned faces. People stared skyward at the shredded cotton clouds and tried to imagine how a man was able to fly such a distance. Through the crowds, the gaunt figure of Lindbergh was barely visible through the snowstorm of confetti as he sat on the back of the auto trudging through the crowds. The celebratory spirit continued all week, and Adam, like most other young people, probably took to the rowdy streets. There were parties throughout the city and people had come to New York just to see the return of Lindbergh. Brass bands played on sidewalks, and traffic police wearing white cotton gloves directed crowds. In a city that already echoed with traffic whistles, ship horns, shrieking el trains and streetcars, car horns, and church bells, the sounds seemed even brighter. As the parade ended, a whole fleet of street cleaners wearing their white wing uniforms and carrying sweepers hit the streets.

That same week, run-down and tired, Adam caught a simple fever, a “febrile attack” as it was noted in his case history. He had been out the night before, celebrating with friends and, as his psychoanalyst Jelliffe was quick to point out, had an “amatory adventure” with a young lady. He woke up the next day “shaking like a leaf.”

It had been five years since Adam first saw Jelliffe. The psychoanalysis and psychotherapy had been successful, and Jelliffe included this case among others in an abstract he read at the Fifty-fourth Annual Meeting of the American Neurological Association in Washington, D.C. It was early May when he read his abstract, “Psychologic Components in Postencephalitic Oculogyric Crisis,” and then the paper was presented for publication in June. As the final proofs were going to print, Jelliffe was forced to make a sudden and significant change to Adam’s case history.

Other physicians had warned of the tendency of encephalitis lethargica to have long-term side effects. Someone could suffer an acute case of epidemic encephalitis—often immediately following a case of the flu. Or sometimes the encephalitis followed a sore throat and a fever. The deep sleep usually came next. And that was the end of the acute part of the disease. In Adam’s case, like others, he awoke from that acute phase a different person—something he and his doctors struggled with for years, often including compulsive behavior, tics, stiff movements, or fits of delusion.

As the 1920s progressed, with the epidemic still running its course through the world, the first of those patients began showing what would be the hallmark of this disease: chronic symptoms. It could be weeks, months, or years after an attack of epidemic encephalitis that new, frighteningly similar symptoms surfaced. It became one of the strangest and most terrifying aspects of the disease, leaving thousands, if not millions, of victims institutionalized for the rest of their lives.

A
dam had been fine, fully recovered, from his case of epidemic encephalitis and the symptoms that had immediately followed. He became normal once again—sleeping well at night and waking at around ten or so in the morning. Then he would go to his father’s store, where he worked as a junior salesman, and stay until midafternoon. He would take an afternoon nap before returning to work in the evening or go out at night with friends. His family noticed that he seemed to have “grown up” over the last couple of years, though he was still in his midtwenties.

In June, when Adam’s symptoms returned, his brother called Dr. Jelliffe in a state of panic. Adam had gone into an “oculogyric crisis,” one of the most common chronic symptoms of epidemic encephalitis. His eyes locked upward and sideways in their sockets, his neck and head stiffened, his shoulders hunched upward, and he started going into spasms. To someone watching, it has the terrifying quality of a seizure—a sense that the human body is very much out of our control, and the person inside seems momentarily lost or disconnected. Once again, Adam described it as “Jesusly painful.” It lasted for the next ten hours.

According to Adam’s brother, the attacks came on when he was exhausted or under duress. He had been free of problems for so long, the onset of this disturbing new symptom was very stressful to Adam, worse somehow than the breathing tics and rigid movements and trances he had once been prey to.

“I guess I just deserve this,” Adam would say. “Everybody gets what they deserve.”

The seizures became so distressing to Adam that the worry alone could bring one on. He returned one evening from his father’s store and an oculogyric crisis ensued. His brother asked, “What started your eyes tonight, Adam?”

“I keep thinking about it and worrying and they go south,” he replied.

His brother recorded all of these instances in a letter and sent it to Dr. Jelliffe. Near the end of the letter he wrote, “He certainly is a game little kid and it almost breaks my heart to see him have this new trouble. I hope you will find a way to handle it.”

A
dam and his brother arrived at Dr. Jelliffe’s office to discuss what to do next. The walk was an easy distance from the Sixth Avenue el, or down Fifth Avenue, although the street was growing more crowded now that Bergdorf Goodman was under construction. For the time, it left the plaza with a huge open cavity where Cornelius Vanderbilt II’s chateau mansion once stood. Once onto Fifty-sixth, it was a quieter walk along the row of townhouses to Jelliffe’s home and office. Inside, Adam and his brother passed an older woman, crouched over a typewriter, who had been a former patient of Jelliffe’s and, as a true believer, had gone to work for him when she recovered. Adam again sat in the office with the blanched white tablecloth, bell jars, a microscope, spines of journals. Staring at the long rows of medical journals, it must have seemed sad, even desperate, that there were no answers in them for Adam. Outside, cars honked and pushed slowly through the crowds of pedestrians. Hammering and saws could be heard from the construction outside, and flatbed trucks with rope-tied construction supplies rattled up the street. The house shook each time the el passed.

Jelliffe was disappointed by Adam’s latest attack. He looked at the young man, asked him questions, and talked about options. It was late in the afternoon; twilight was crawling across the office, and the light flushed with dusk. As Jelliffe asked him standard questions, Adam went into another trance and seizure right there in front of the doctor. Had it not been dark, Jelliffe would have photographed the episode for his study, but with the light too dim and Adam’s face eclipsed by shadow, Jelliffe could only watch. Adam’s eyes rolled upward into his head, his body froze, his neck stiffened, his head dropped back, and he began murmuring from the corner of his mouth, “A million ideas are going through my head, rape my sister, rape my mother, kill my brother, kill my father.” “Am I going crazy?” he whispered.

Jelliffe could only helplessly watch the episode that possessed Adam so completely. It was the thought of going crazy that brought on the attack, the uncontrollable, insane, violent thoughts flashing through his mind. They left Dr. Jelliffe’s office, and his brother took him home. People on the streets stopped and stared as they hurried by. Adam’s seizure lasted another thirty-six hours.

Jelliffe wrote in his report that “this is a typical example of what occurs in other patients, with many variations.” At times, it even leads to suicidal thoughts, and it wasn’t long before Adam made an unsuccessful dash for the window in Dr. Jelliffe’s office to try to end all the thoughts once and for all.

Over the next several months, Dr. Jelliffe saw Adam less and less. He was never sure if that was due to lack of money or from the stress brought on by the visits. Jelliffe believed that Adam had a “positive transference” with him, but that too many factors in his life interfered. There is no way of knowing definitively whether Jelliffe’s psychotherapy helped Adam’s case, hurt it, or had any effect at all. Nor is it known what happened to Adam—whether he recovered enough to be able to live a somewhat normal life, or if he, like so many others, ended up in an institution.

Adam’s case was hardly unique. Another neurologist in New York wrote in one journal, “That mysterious disease, the real cause of which is still unknown, which remains dormant for many years, recurs at long but irregular intervals, and leaves after each outbreak a trail of broken minds and crippled bodies.” Neurologists throughout New York, the United States, and abroad were beginning to publish articles about similar cases. By the end of the decade, nine thousand articles on encephalitis lethargica appeared in the medical literature.

E
pidemic encephalitis was approaching its peak in the United States. In Europe, it had been a steady build, a slow burn. For the most part, the cases in Europe had been sleep cases or insomnia cases, but very little was known about the aftereffects of the disease. It was still too new. In Vienna, the birthplace of the epidemic, cases had disappeared. In the United Kingdom, however, cases were becoming more alarming. Not only was the mortality rate soaring toward 56 percent, but the survivors awoke as new, terrible versions of their former selves. Doctors began including in their published studies reports that the disease was said to “alter the dispositions of those who have recovered from it.” It was said almost hesitantly; they were not sure what it meant. Or they did not want the public to know how much worse it could get.

B
y the time the epidemic peaked in New York, the public, the press, and the health department were still chasing the shadows of this disease. The health department could reveal little about how the disease was spread or how to protect oneself from it. There were no notices to tack up in neighborhoods or educational meetings they could hold for the public. They didn’t have enough answers themselves. Even tracking its spread was proving inconclusive. They tried in vain to find a pattern, to trace this epidemic the way they had polio in 1916 or influenza in 1918. But epidemic encephalitis followed no particular time frame, and unlike diseases that target the impoverished, immigrants, or soldiers, this disease showed no discernible class preference. It rarely even spread within one household. For medical investigators, it was like trying to catch the pattern of a snowflake before it melts in an open palm.

The newspapers made only occasional mention of the disease, and even then it was usually to report some oddity or declare the longest-running sleep so far. The newspapers were preoccupied with the idiosyncrasies of the disease and, as a result, were grossly underestimating it. Epidemic encephalitis was about to attack one of New York’s most prominent families, securing its place in the pages of the
New York Times
and bolstering the work of neurologists.

CASE HISTORY FOUR

East Island, New York, 1925
NAME:
Jessie
PHYSICIAN:
Dr. Frederick Tilney

CHAPTER 12

Jessie

T
he yellow summer heat had settled over the city, bringing higher temperatures during the day and nights that were still cool and breeze-filled. While the weather was still mild enough, handcarts sold fresh lemonade and malted milk. Soon, however, those cooler temperatures would give way, leaving the homes and buildings of New York with hot, weary air, and everything about the city would seem to move at a slower pace, people trudging through the heavy heat of summer. The brackish waters of the Hudson gave off a salty air and feeling of imminent escape. And on weekends the empty city became, as F. Scott Fitzgerald described it, like overripened fruit.

In June 1925, Dr. Tilney made his way through the sprawling, two-block, colossal Penn Station. Though the station boasted majestic stone columns and a long lip of shallow steps, the concrete and stone façade betrayed the interior. Inside the light-filled train concourse were vaulted ceilings of glass and a network of arches, a throwback to the Crystal Palaces popular in the previous century. Newsstands carried newspapers and magazines with wholesome images fanned out like the feathers of a peacock.
Ladies’ HomeJournal
showed a color illustration of a bride and groom;
Good Housekeeping’s
cover had a shot of a mother reading to her daughter;
Field and Stream
showed an image of a man and woman having a picnic beside a stream; the
Saturday Evening
Post presented a Norman Rockwell sketch of a woman lounging on a chair; there was even a new weekly called the
New Yorker
on the stand.

As Tilney waited to board the train, sunlight flooded the station, and the iron latticework left a web of shadows across the floors. The sky was cloudless and clear, the color of pale blue porcelain. At any other time, a trip to the Long Island shore on a beautiful summer day would have been a pleasant occasion. But that was not the case on this particular afternoon.

It was a Sunday, and most weekenders were returning to the city after a respite from the heat along the coast or in the country, so the train out to Long Island was almost empty. At times, the commute back into the city was so clogged with automobiles, and the infrastructure of roads so ill-equipped for traffic, that people left their cars on the side of the road and took the train or subway home. The train, too, was hot, but when the windows were lowered, the cooler air carried in the smell of sweet grass and clover. Wild carrot bloomed along the tracks and among the tree trunks.