Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (19 page)

In spite of the brief economic respite in 1930, Americans were nervous at that point; things looked too uncertain. They stopped buying things. By the end of 1930, the drought that had started that summer—the one that would help create the Dust Bowl—was in full force. It crippled American agriculture and sent commodities plunging. At that point, there was finally a run on the banks, but it was too late. The banks themselves were closing. People lost their savings and their jobs, and they had no unemployment insurance. New York was hit harder than any other American city.

T
he economic downturn did not dull Tilney’s vision of New York as a model for neurological advancement. Not even a crashing economy could slow the momentum of neurology at that point, and the importance of encephalitis lethargica in the pacing of that progress was evident in the medical literature of the time. As famed neurologist Bernard Sachs later wrote: “Encephalitis appearing in epidemic form had revolutionized the practice of neurology, so that in the future it would never quite be the same as hitherto.”

Tilney’s dream was looking more realistic by the time the state-of-the-art building for the Neurological Institute and its twin Psychiatric Institute, the country’s first of its kind, were finished—they gave solid form to the vision Tilney had. With J. P. Morgan’s contribution in honor of his wife, the Neurological Institute also had an immediate purpose to serve. When he toured the building, von Economo marveled at the fact that an entire floor of the institute, the Morgan Ward, was used for the study of encephalitis lethargica in New York.

In keeping with the changes in American medicine, hospitals like Bellevue and New York Hospital underwent a transformation as well. Columbia Hospital converged, combining the old Presbyterian Hospital, at Seventy-first and Park, with the Babies Hospital on Lexington and the College of Physicians and Surgeons in midtown. The complex had been built on Hilltop Park, the playing field of the New York Highlanders, which had changed its name to the Yankees years before.

The mammoth hospital complexes built during this time period physically reflected the changing focus of medicine, creating buildings for specific specialties. The new Neurological Institute was built as part of the Columbia complex at 168th Street and Fort Washington Avenue, and beside it was the newly opened Psychiatric Institute. When the Neurological Institute opened in 1929, it also took on another incredible challenge. With Tilney at the helm, Columbia’s College of Physicians and Surgeons, the Neurological Institute, and the New York State Psychiatric Institute would combine to offer a new type of education that would include classes and hands-on demonstrations. In the past, psychiatric institutes were merely custodial, with very little research or study available. Tilney hoped the side-by-side institutes in Columbia’s hospital complex would become the greatest place in the world for the study of the brain.

Tilney, in explaining the need for such a program, said: “The more highly socialized we are, the more complex our existence becomes.” The life of prehistoric man, he said, had been simple and “far removed from the turmoil that follows in the wake of civilization” and “the machine age.” Tilney considered it deplorable that one out of every twenty-five people suffered a nervous disorder. “The human race has not yet begun to recognize the brain as both an asset and a liability....” Tilney’s words, in fact the whole program itself, continued to knit neurology and psychiatry together. “We are today witnessing the dawning of a new era, when man is at last awakening to the importance of his brain and is seeking to understand it and its functions,” said Tilney.

The institute was made to look as little like a hospital as possible. It was fourteen stories high, with the entire second floor devoted to doctors’ offices, so they could be as close as possible to the surgical wards and patients. There were no glaring white walls; all hallways, wards, and rooms were painted in soft colors, with the operating rooms in a serene green shade. The new building held a large amphitheater with tiered seating for teaching courses, and world-renowned lecturers were invited to teach at the institute. Among the distinguished physicians and professors to lecture in the program would be Jelliffe, who was by then president of the American Neurological Association, a position bestowed upon him late in his career because of his unpopular loyalty to psychoanalysis. Jelliffe’s lectures would cover the mental and nervous reactions to general disease—a subject he knew well in the midst of the encephalitis lethargica epidemic.

On December 5, von Economo gave his lecture, in English, at the Psychiatric Institute in the Columbia medical complex. When von Economo first began studying neuropsychiatry, only some 20 areas of the brain had been identified. By the time von Economo gave his lecture series in New York, he alone had isolated another 107. That evening, he lectured on the evolution of the brain and the obvious, superior intellect in humans, which he also considered to be highly hereditary. He also read an important paper about the part of the brain that controls sleep, a subject he had come to know well over the previous decade, and one that the New York neurologists present that night had grown more and more confounded by.

W
ith impressive, world-class hospital buildings in place, two additional factors would help Tilney realize his vision for New York as the center of the world’s brain study.

The team of New York neurologists did not yet know how world history would help accomplish their goal. Throughout the 1930s, especially after 1933, the Nazis gained popularity in Europe. With the Nazi rise to power, some of Germany’s most valuable scientists, who were Jewish, migrated to the United States—New York in particular. For nearly a century, America had admired Germany’s medical system—American schools like Johns Hopkins had emulated it; American physicians graduated from medical schools only to travel to Germany to learn from the masters; and American doctors often learned German in order to read the latest medical studies in their original language. Now, in a swift turn of events, America would replace Germany as the world’s center of science.

The second stroke of luck for Tilney and the Neurological Institute was a man named William J. Matheson.

CASE HISTORY SIX

New York City, 1934—45
NAME:
Sylvia
PHYSICIAN:
Dr. Josephine Neal

CHAPTER 18

The Matheson Commission

I
t is strange that William Matheson loved the ocean. As children, he and his brother were sent overseas to Scotland to boarding school in the 1860s. En route, the schooner encountered a hurricane off the coast of Newfoundland and sprang a debilitating leak. The ship was demasted, and huge waves washed over the decks, taking the captain and a cabin boy overboard. The ship, gutted and wounded, floated through the sea with the remaining passengers. All food and fresh water supplies were lost in the storm, so someone aboard caught a porpoise, and they survived on the meat and salt-water coffee until being rescued by a passing ship called the
Marmion.
Matheson and his brother survived, but Matheson suffered from exposure and health problems well into his twenties. Decades later, Matheson’s son would name his own yacht the
Marmion.

Ironically, it would be aboard his yacht the
Seaforth
that William Matheson would eventually lose his life from a heart attack. Between his boyhood voyage on the
Marmion
that would save his life and that final sail on the
Seaforth,
Matheson survived a great deal and accomplished even more.

W
illiam John Matheson was not born into wealth, but a modest family of Scottish descent living in Wisconsin. During his schooling in Europe, he earned a degree in chemistry and subsequently began working with synthetic dyes. At that time, France and Germany produced the finest dyes, in all colors. Matheson formed his own chemical dye company in America, but kept several production plants in Germany as well for the higher quality. As Europe edged its way toward war, Matheson was all too aware that his supplies in Germany would soon be cut off. He became an expert in patent law, and as soon as war broke out, he closed his plants in Germany and seized the interwar opportunity to overturn German patents. Matheson began production of the same dyes in the United States and produced chemicals for the war effort.

Matheson’s company occupied a large, multistory building in New York, and he amassed enormous wealth, with a city house on Park Avenue, a country home on Long Island, and a winter estate in Key Biscayne, Florida, which he named Swastika after the Indian word for sun. The name was changed during World War II. When Matheson died, the
New York Times
reported that his estate was worth $23 million, not including real estate or life insurance.

M
atheson’s health had always been questionable—from the childhood shipwreck that led to exposure and starvation to a prognosis, when he was thirty-five years old, that he had an enlarged heart and would not live another six months. Lack of sleep and poor nutrition during his service in the war further weakened his health. During the war, Matheson also contracted a case of the flu. It was shortly thereafter that he noticed his right leg began to tremble when he would stand; his left one would tremble when he sat.

Later, Matheson experienced periods of lethargy and weakness, sometimes running a low-grade fever with no discernible cause. It bothered him enough to cancel appointments and, even more telling, golf matches. Matheson began a frustrating round of tests and visits with a number of different physicians. Most doctors would not tell Matheson what his diagnosis was, and one told him it was “toxic palsy.” Another doctor refused to give any diagnosis at all, claiming he had no idea what was wrong. Yet another doctor told Matheson that he had an illness that “came only to people of hardworking correct habits,” and that it would be gone in a year’s time. Still another doctor gave Matheson electric currents to his head, which Matheson found less than impressive: “I feel that this treatment produced no different effect than lying flat on my back would produce without the current.”

Matheson spent the next nine months traveling around the world, and when he returned in 1922, his tremor was worse, he had trouble working, and he had an unusual gait. He tried a long list of treatments including hypnotics, glucose, radium water, cod-liver oil, diluted hydrochloric acid, ox gall, and Christian Science, among others.

In July 1922, he finally saw Dr. Charles Dana, a highly respected New York neurologist. Dana’s
Textbook of Nervous Diseases
was already in its tenth edition, and his involvement in the New York Academy of Medicine and its Public Health Committee had solidified the relationship between neurology and the city health department even more. The health committee offered its official opinion on issues as varied as heroin addiction and daylight savings time and broadcasting health information by radio. Dana himself had been skeptical about an epidemic of encephalitis lethargica when it first broke out, saying in 1919, “encephalitis lethargica was exceedingly rare, probably not contagious, and certainly not epidemic.” That same year, however, Dana diagnosed a case of encephalitis lethargica himself and his opinion changed. In fact, Dana’s first sleeping sickness case had originally been seen by Tilney, who misdiagnosed the disease. That mistake alone sheds light on the difficulty even within the neurological community in recognizing this disease. By then, Tilney had published his own book on the subject, and yet he missed this diagnosis.

It is also interesting to note that Dana did not inform his first few patients that they
had
epidemic encephalitis. Very much in keeping with medical thinking at the time, physicians sometimes considered it in the best interest of the patient to withhold information about their health.

Matheson was sixty-five years old when he first saw Dana. Matheson was an ordinary-looking man, with a balding head, wire spectacles, and a round, inconspicuous face. His erect posture and slightly distinguished appearance, however, gave him the commanding air of power. On his case history, taken July 13, 1922, the diagnosis reads
“Parkinsonism,”
the classic chronic symptom of epidemic encephalitis. Dana included some personal information: Matheson was married with three children and had a brother who died of consumption—it is not known if that was the same brother who survived the shipwreck with him on their way to school in Scotland. Dana included correspondence in the file and Matheson’s own history with this disease—including his frustration with the many doctors he visited, so little information, and the long list of medications. Dana, or his assistant, typed up the report on Matheson’s physical examination—a masklike face and a monotone voice that had improved, as well as normal blood pressure, normal visceral reflexes, normal weight, healthy appetite, and clean tongue.

M
atheson spent nearly a decade trying several different courses of treatment, including some very experimental ones, and he began consulting Tilney at the Neurological Institute. He had essentially offered himself up as a guinea pig for several new theories. Given Matheson’s dogged determinism, his own personal interest in the mysterious disease, and his wealth, it is not surprising that epidemic encephalitis became Matheson’s own biomedical research project. Matheson’s case of epidemic encephalitis would be a turning point in the history of this disease and breathe new life into medicine’s struggle to control it. He created the Matheson Commission, a personally funded team of physicians to work out of the Neurological Institute, researching encephalitis lethargica and developing a vaccine. Then Matheson began the search for a qualified staff and talented leader.