Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (18 page)

The neighborhood around the hospital was coming to life, and doctors and nurses made rounds through the ward. Milk bottles had been delivered quickly, packed in thick wooden boxes filled with ice to keep the milk from spoiling. Canvas awnings unfurled over storefronts, and newsboys untied the morning papers. The metallic rattling of the Third Avenue el could be heard. The whole block had an unusual, earthy, dank smell from, of all things, mushrooms. With Prohibition in full force, many of the breweries concentrated in the Morrisania neighborhood were left with empty caves that had once kept beer cool in the summer. To make ends meet, they used the caves to grow mushrooms in compost.

Stronger even than the compost were the smells of chicory coffee, eggs, and bacon that wafted from the hospital kitchen. Somewhere in the courtyard, through the open windows, cigarette smoke floated in the undercurrent of morning scents. The rooms were filling with short-lived light. Soon, the drapes would drop or shutters would close, casting all of the rooms into blue-gray light during the hottest hours. Patients were just waking, and visitors were beginning to make their way into the hospital. Every so often, the scent of fresh flowers, already beginning to wilt, was carried in the breeze from the hall.

The calm of the morning did not last.

At 8:45 A.M., shouting was heard in the ward. A nurse ran toward Rosie’s room, her shoes clapping against the tile floors. When she opened the door, there was very little blood in the grisly scene so vibrant red was not what first attracted the attention of the nurse. Rosie, lying calmly in the bed, told her that her
other
eye had fallen out. The nurse came to her bedside and began frantically pulling at the blankets and bedsheets, while Rosie’s hands groped blindly along the bedding. Finally, they found the missing eye, tangled in the sheets of the hospital linens. Again, Rosie seemed to be in no pain and was completely at ease.

The next day, Dr. Goodhart was brought in to examine Rosie. She sat before him as a waifish sixteen-year-old girl with no eyes and missing all of her teeth. Goodhart found Rosie to be unemotional, cooperative, well oriented, and of normal intellectual capacity. She denied having injured herself and could not remember the details of why her eyes had “popped out.” An X-ray examination of her head showed two dark orbits on an otherwise normal skull. An ophthalmologist saw the girl and noted that her eyes had been removed almost perfectly, with the fibers and muscles still cleanly attached.

Rosie showed a tendency toward more self-harm, scratching at her cheek and biting deeply into her tongue, and by October, she was admitted to Montefiore hospital for children. During her first few weeks, she picked at the dressings over her eye sockets and rubbed her face repeatedly. She was then restrained and watched carefully for a full month. No further self-injuring behavior occurred.

Hospital staff found her to be very cooperative and tidy. Her stream of thought was normal, with no hallucinations or delusions. She was occasionally irritated with the nursing staff, but aside from that, Rosie was very alert and “showed a lively sense of humor.” In general, she showed no depression, weeping, or suicidal tendencies, but would grow very sad when the self-mutilation incident was brought up. She insisted that she did not remember what happened to her eyes, but she did recall pulling her teeth out and the peculiar force that compelled her to do those “horrible things.” Goodhart suspected otherwise; amnesia had proved extremely rare in the encephalitis lethargica cases.

Rosie improved both physically and mentally, even learning Braille reading during her stay at the hospital; but it would take another four months for Rosie to admit to Goodhart that she had actually torn her eyes out with her own fingers. Again, she shrugged it off as an irresistible urge.

“I was like hypnotized at the time, something made me do it,” she said by way of explanation.

I
t was three months later that Dr. Goodhart stood before Tilney, Jelliffe, and hundreds of other neurologists to give his lecture, “Self-Mutilation in Chronic Encephalitis: Avulsion of Both Eyeballs and Extraction of Teeth.” His article was published in the
American Journal of the Medical Sciences.
He also decided to film some of his sessions with Rosie. It was a new form of documentation that doctors found particularly helpful. Tilney had also filmed patients, so that in slow frame, he could watch exactly how his Parkinson’s patients were moving. Goodhart included in his film a shot of Rosie’s eyeballs displayed on a cloth.

Still, no record of what ultimately happened to Rosie exists, and Goodhart’s article on the subject, published that same year, gave no indication. Like so many others, the end of her case history was either forgotten or destroyed. For many patients like Rosie, the insanity caused by epidemic encephalitis was overshadowed by the physical disabilities. Over time, the inevitable Parkinsonism set in. They became living statues confined to wheelchairs or beds. If there was still rage within them, it was buried deep beneath the stony surface.

Given the fact that she was rapidly improving in 1932, Rosie may have been allowed to go home and attempt a life more like the one she could have had before epidemic encephalitis.

If not, she would have lived the rest of her life in an asylum—in the same condition or worse until the day she died. Perhaps it was then, after her death, that Rosie was given a more beautiful pair of eyes.

CHAPTER 17

The Neurological Institute

T
he
Olympic
sailed across a gunmetal gray sea rife with storms, finally arriving in the glassy harbor in autumn of 1929 with a clear view of New York’s skyline. Rather than a rocky island weighed down by buildings, Manhattan looked more like a city carved from a mountain range, molded and sculpted into geometrical shapes. If most cities adapt to their terrain, it was just the reverse in New York. And at night, from a distance, the building shapes dimmed, leaving only rectangular window light and a skyline studded with honey amber.

It was a view that had inspired many. In
The Great Gatsby,
Fitzgerald described a view of the city seen for the first time as one of “wild promise of all the mystery and the beauty in the world.” Ezra Pound described the great buildings as magical, “squares and squares of flame, set up and cut into the aether.” Ayn Rand saw the skyline not in detail, but in shapes: “The sky over New York and the will of man made visible.” And Frank Lloyd Wright saw it through an architect’s eyes: “The buildings are shimmering verticality, a gossamer veil, a festive scene-prop hanging there against the black sky to dazzle, entertain, amaze.”

Constantin von Economo had not been to New York in thirty years, and the city was almost unrecognizable. From the ship, the skyline seemed shrouded in sheer clouds, but even through the haze, the buildings rose high above the gauzy air. Amid the titanic structures, crowded streets, and glowing lights, the von Economos could not help but feel “enchanted,” his wife later wrote.

Before making their journey to America, the couple had taken a trip to Bern, where von Economo worked with European and American neurologists to organize the International Neurologic Congress. Von Economo’s wife later noted in a book she wrote about her husband that, since the war, von Economo had been instrumental in reconciling the broken relations between German and French neurologists. At long last, Europe’s neurological community was coming together, though it was still far behind the advances being made in America. Von Economo and his wife had been invited to attend the grand opening of a huge new Neurological Institute in New York that fall; he would also be giving a talk to the New York Neurological Society. And one person sure to be in the audience was S. E. Jelliffe, who once said of von Economo, “not only was he a scientist in the best sense of the word but peerless as a man.”

In an apt analogy between von Economo and the city of New York, Jelliffe wrote, “Specialist medical towers go up like the sky-scrapers almost unperceived by the busy hard-working physician. Occasionally, however, there occurs a growth roughly comparable to the Rockefeller Center, which no one can fail to see.... Such a development took place in the field of neurology when in 1916-17 Constantin von Economo of Vienna made his observations and published his work on sleeping sickness.”

Von Economo envied the American scientists, who were not burdened with federal control of clinics. In postwar Europe, von Economo had continued his work, publishing an impressive number of papers. But Europe had fallen into a recession after the war, and as a government program, scientific study was falling to the wayside.

He and his wife walked along the streets, beneath the shadows of buildings and scaffoldings crossing the pavement. They passed beneath the giant frameworks of steel bars and reinforcements for the raised tracks, bridges, and highways. In spite of progress in every direction, some problems still existed, including sanitation. The city’s Public Health Committee had recently estimated that the regular tonnage of ashes, garbage, dead animals, street sweepings, and rubbish piled together in the city would be higher than the Woolworth Building. The
New York Times
published an article lamenting that a “New York as clean as Havana is still a dream.” It must have created a strange and malodorous contrast—the clean, elegant, streamlined modern architecture fronted by chaotic piles of crates, loose papers, spoiled food, and burlap sacks. For the von Economos, however, the mounds of refuse were nothing compared to the titanic buildings.

Throngs of people and constant noise filled the streets, but it was the sound of promise—metal against metal, hammering, rumbling subways, automobiles, and train whistles. The wealth of New York was obvious in the architecture, the size and the sheer number of buildings. By 1929, 709 new buildings were planned. Between 1928 and 1931 alone, the Chrysler Building, the Bank of Manhattan Company, and the Empire State Building were erected—all three competing to climb higher into the clouds than any other in the world. The buildings, gigantic in scope and material, somehow appeared weightless, suspended in the sky, literally piercing the clouds on some days.

In addition to those massive skyscrapers, there was the building of major hospital complexes, the West Side Highway was under construction, the Holland Tunnel had just opened, and the George Washington Bridge was midproject. Everything about New York, from its architecture to its skyline to its medical facilities, felt thoroughly “modern.”

Standing on a New York street, staring skyward at the tallest buildings the world had ever seen, must have made it hard to believe the economic foundation beneath them was beginning to quake.

In spite of all the building and an unprecedented economic boom in recent years, Wall Street felt the first tremor of trouble in the summer of 1929 when sales had slowed down and unemployment began to rise. A sharp rise in the Dow Jones that August reassured people—and blinded them to the inevitable fall. New York had seen a brief panic in 1907, which led to the formation of the Federal Reserve, and a recession in 1921, which had been a response to the war ending. The postwar recession was steep, but short. Soon after, returning soldiers entered the labor force. The factories that had been producing war materials now had an abundance of new technology and consumer products to build. Automobiles went from luxury items to mass-produced, affordable ones, a cultural shift that also changed the domestic gas and oil industries, which enjoyed a 250 percent increase in profits; home appliances were available; electricity and plumbing became commonplace; and there were radios to purchase. Consumerism was at an all-time high, and credit was cheap, so it wasn’t long before the average American overbought and went into debt. In addition to that, a number of novice investors flocked to the New York Stock Exchange, the largest in the world, to invest their money. Others put it away in the safest place possible: a bank.

The crash of 1929 happened in fits and starts over a series of weeks when the stock market dropped, then recovered, then dropped again. J. P. Morgan & Co. stepped in, just as it had done in 1907, to pump money into the market and level it. In 1929, the rescue proved ineffective as Black Tuesday, when the Dow Jones fell to unparalleled depths, left Wall Street with a $30 billion loss by week’s end. Contrary to popular belief, an initial run on the banks didn’t happen, and there were not dozens of people jumping from windows, although there were a few notable ones. Winston Churchill witnessed a jumper outside his hotel window in New York, and the Statue of Liberty saw her first suicide in the spring before the crash. In 1930, the market saw an upswing, with a decline in prices and a steady hold on wages. In some sense, the year 1929, rolling into 1930, turned out to be a time of false confidence. It gave no indication of how bad things were about to get, but was instead the moment of inertia before the fall off a steep edge.

Historians have debated the actual cause of the 1929 crash, but most agree it was a complicated combination of factors like consumerism, market speculations, easy credit, and business monopolies. Only two hundred corporations owned almost half of U.S. business wealth. In the boom of the 1920s, the antitrust laws established in the Progressive Era grew lax. In such a top-heavy economy, it was bound to tip.