Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (20 page)

CHAPTER 19

Josephine B. Neal

S
ocial change often happens gradually like a large swell moving soundlesslv across the sea, but when the wave reaches land that quiet swell comes crashing against the shore. When modern life began changing at the turn of the century from a farming focus to an urban one, it set in motion the deepwater current.

The shift seemed simple enough at first: people were moving from farms into cities. Trains now brought farm foods into urban centers. Foods and canned goods could be stored in pantries for extended amounts of time. With the advent of the icebox, milk and meats could be kept cool. Washing machines, vacuums, and other appliances simplified household chores.

Those simple changes would have a significant impact on the role of women.

While their days used to be regimented—washing day, ironing day, cleaning day, canning day, mending day, baking day, and Sunday dinner days—their home lives were becoming more modern. It was estimated that women on farms spent nearly forty hours a week on cooking alone. Without the need for farmhands, fewer children were needed to help tend crops and watch after the younger children.

Likewise, with a vast number of childhood diseases and epidemics now under control, there was little need for a larger family to compensate for the inevitable loss of the more fragile lives. The women’s movement, too, was playing a part. With the founding of the American Birth Control League in 1921, women were for the first time in history educated about how to control the number of children they had. They could opt for two instead of ten. Fewer children meant more money for education, and girls, who had been traditionally overlooked because funds went to the education of their brothers, were able to enter schools and colleges. Education gave women a taste of freedom, and consequently, the wave of social change came crashing onto the shoreline.

This was a time, after all, when women had to fight just to be considered something other than the property of their husbands. Most women did not have an income, did not own property, and had no voice in political elections. In some sense, the dramatic change in appearance became like a psychological rebellion. Victorian clothing concealed everything—long hair was worn in buns or hidden beneath hats. Corsets bound breasts, and Victorian lace, pleats, and collars camouflaged them. Long skirts and petticoats drew a heavy curtain over legs. A woman’s physical appearance was considered her husband’s as well. Given that symbolism, it was hard to miss the message that bobbed hair, lower necklines, sleeveless dresses, and short hemlines sent.

Suffragists were also pushing for women to have a vote in politics, or more accurately, be granted the vote
again.
Some women in colonial America did vote before laws were passed denying suffrage to women, immigrants, and “people of color.” The idea that “all men were created equal and endowed by their Creator with certain unalienable Rights” seemed to have been misinterpreted. Lest that misinterpretation be blamed on politics alone, certain sociologists, historians, and religious denominations made sure to solidify those beliefs. A leading French social psychologist wrote that scientists who had studied the subject knew women’s intelligence to be one of the most inferior forms of human evolution, closer to children and savages than to an adult, civilized man. In case anyone missed his subtle point, he added: “Without doubt there exist some distinguished women, very superior to the average man, but they are as exceptional as the birth of any monstrosity.” And it had been famously said in the South: “A woman’s name should appear in print but twice—when she marries and when she dies.” The quote was still relevant enough in 1918 to appear in a book on social progress—or the lack thereof.

Social change and education brought women into professional spheres in greater numbers than ever before—spheres that were not necessarily welcoming. While the number of women in law and doctorate programs doubled and tripled, medicine claimed only 4 to 5 percent of total enrollment. The idea of “separate, but equal” medical schools had started decades earlier, allowing women to attain a degree at a women’s medical school. But it was a double-edged sword that did not translate into egalitarian opportunity. Hospitals and medical practices were quick to condemn those same schools they required to be segregated. And even the accusation that women’s medical schools were ill-qualified was false. One medical historian later pointed out, “Vassar, Bryn Mawr and Smith had been sending large numbers of well-prepared women to Johns Hopkins for over two decades.” Regardless, the percentage of women in medical schools remained low, in large part due to the quota system, which allowed for only a small number of women, Jews, or African Americans per class.

Women, it was believed, simply didn’t have the mind for science or medicine—in spite of the fact that Marie Curie had just become the first person to win the Nobel Prize
twice.

I
t is significant then, that when Matheson sought a leader for his newly formed Matheson Commission, he chose a woman. Dr. Josephine B. Neal was an expert on encephalitis; even more importantly, she was both a neurologist and a bacteriologist.

Neal, born and raised in Maine, had originally been a schoolteacher. When she saved up enough money, she applied for medical school, hoping for a profession in “the healing art.” She earned her degree at Cornell Medical School, one of the first schools to accept women students. Little is known about her years in medical school and immediately following graduation. She lived in New York, in Gramercy Park, most of her adult life; she never married. One of the few existing photos shows her to be serious, with small, round glasses and wearing her gray-black hair pulled into a bun. She looks more like a schoolmarm than a leading medical researcher. Neal was a prodigious record keeper, but a scientific one, which apparently left little time for personal documentation. What is known is that by 1926, Neal had been appointed head of the meningitis division of the New York City Department of Public Health, working under the famed Dr. William Park, head of the bacteriology labs.

In the male-dominated medical world, many women like Neal forced themselves upon the medical community by becoming an especially valuable commodity. One area in medicine where they excelled was public health. By the turn of the century, public health was losing its luster, and women physicians were drawn to the plight of uneducated mothers, working to lower the high infant mortality rates, and child advocacy.

Women then won a legal and political victory in passing laws that provided public health education and care for mothers and infants. Women health officials and physicians also aimed to reduce the shocking number of deaths during childbirth. Male physicians argued for medical doctors and hospitals in the delivery of children; public health advocates argued that two to three times as many women died in a hospital than under a midwife’s care. The primary reason for this was unsanitary practices. In hospitals, a physician would examine diseased patients, then walk down the hall to deliver a baby—without ever washing his hands. Most women who died in childbirth died of infection known as “childbed fever.” The medical community compromised by requiring medical education or licensing for all midwives. Likewise, more women physicians began entering the field of obstetrics, demanding better conditions for both mothers and infants in hospitals.

With a strong focus on educating immigrant populations, protecting maternal and child health, and preventative medicine, public health was becoming known as “the woman’s branch” of the government. Soon, there were too few men left in the field.

N
eal’s work in public health afforded her an excellent view of epidemics firsthand. She followed the outbreaks, identified patterns among neighborhoods or people, studied the tissue samples, and organized all the information. Meningitis is akin to encephalitis in many ways: meningitis is a swelling of the membrane around the brain or spinal cord, while encephalitis is a swelling of the brain itself. Both can occur in bacterial form, viral form, or as the body’s own reaction to something. In both, the swelling can lead to permanent brain damage. Interestingly, meningitis itself can cause encephalitis.

When epidemic encephalitis first appeared, it was often misdiagnosed as meningitis. The symptoms are almost identical—severe headache, a stiffness in the neck, sensitivity to light, fever, and a change in mental function. But autopsies and tissue samples showed early evidence of epidemic encephalitis and not meningitis. So, in a sense, Neal had been tracking encephalitis lethargica from the start.

Neal was also considered an expert on polio, a viral disease that causes swelling of the spinal cord, often resulting in paralysis. It is well-known that Jonas Salk tested the first polio vaccine in the early 1950s and introduced it publicly in 1955. What is not as well-known is that the laboratory for the health department of New York City was working on antipolio vaccines as early as the 1930s. The vaccine moved quickly into human trials and, true to her determined nature, Neal was one of the first people to take an injection in 1934. She fared well, but others did not. Severe allergic reactions occurred in some cases and even polio in others. These results were generally kept out of the media, and the vaccine campaign stopped until the 1950s.

It is easy to see then how Neal’s expertise would cross several lines—public health and private practice, viral agents and bacterial ones, swelling involving any part of the brain or spinal cord, neurology and infectious disease studies, even vaccine development. There could be no better choice to head the Matheson Commission.

I
n a conservative wool dress and sensible shoes, Neal left her home in Gramercy Park for her office. Noise was everywhere. Trolley cars had stopped running in many of the streets in her neighborhood because they slowed car traffic. By then, the number of automobiles—New York City alone had more cars than all of Europe—caused a dense smoke cloud to settle over the city. So Neal took the Lexington el that rose out of the streets, buttressing the bright orange train cars that came thundering along the tracks, sprinkling pedestrians with fine, powdery black soot.

On street corners, cinders, wood ash, and coal dust were swept into large piles, near stacks of crates, wastepaper cans, and empty bottles waiting for the garbage auto to pick up, to deliver and dump in the wetlands outside the city. If Neal had looked out the smudged windows of the el through the downpour of soot below her, she would have seen a sidewalk awash in dusty hats like raindrops hitting pavement.

There was at once an intimacy and a disassociation from the crowds in Manhattan. People moved independently of one another at the same time and in the same direction. Neal walked the rest of the distance among the purposeful throngs of strangers. She undoubtedly blended in with the crowd; none could have guessed who this seemingly unremarkable woman was or where she was going. Neal turned onto 105th at the New York Academy of Medicine. It had been decided that Neal’s office should be located there, where she had access to countless medical articles and information on public health. The academy boasted, and still does, a collection of medical literature dating as far back as 1700 BC. The great, Romanesque building was only two years old but had been endowed with a timeless, traditional interior. Its library had dark wooden floors and tall, beamed ceilings with large, arched windows that looked out onto Fifth Avenue and Central Park.

Neal entered the building, and the elevator operator pulled the cage door to take her up to her office, where Neal sat down and began to absorb the enormous task facing her. The chronic effects of epidemic encephalitis were now considered even more debilitating than polio. A
New York Times
article summed it up well: “Because it particularly attacks young people and either kills them or leaves them incapacitated for the rest of their lives in many cases, medical authorities regard epidemic encephalitis as one of the most imperative problems the science of medicine has to solve.”

CHAPTER 20

Vaccine Trials

I
n the era since the creation of the Centers for Disease Control and Prevention in 1946, medical investigations have become large-scale and fascinating to the general public. The bacterium that causes Legionnaires’ disease, the Marburg virus, the Ebola virus, and HIV conjure a palpable fear because they are relatively new to us, the diseases they cause can be lethal, and there is no vaccine. The word “outbreak” brings to mind secured labs, biosafety levels, and hazmat suits. And yet, it is essentially the same type of research conducted by medical investigators during the 1920s, ‘30s, and ’40s. Polio, yellow fever, smallpox, measles, influenza, and syphilis were the great fears of that age, and the epidemiologists who studied them did so in unprotected clothing in a basic laboratory, often testing the vaccine or treatment on themselves.