Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (31 page)

The darker side of the progress laws included a surge in anti-immigrant sentiment. During the 1920s, the Ku Klux Klan had as many as five million members across the United States. The Immigration Act or National Origins Quota Act was passed in 1921, and the Johnson-Reed Act was passed in 1924.

In trying to verify whether or not New York City truly did have more Italians than Rome, Germans than Berlin, or Irish than Dublin, I found references to those statistics in a
New York Times
article (June 4, 1908) and William Joseph Showalter’s article “New York: The Metropolis of Mankind,”
National Geographic
(July 1918).

Though both suffrage and Prohibition had been political issues for decades, Sidney M. Milkis and Jerome M. Mileur’s
The New Deal and the Triumph of Liberalism
(2002) asserted that those two progress laws may have been aimed at the immigrant lifestyle, pages 316-17.

Famed advocate Margaret Sanger in
The Birth Control Review
1, no. 1 (February 1917) outlined her ideas for what would become the American Birth Control League, a precursor to Planned Parenthood.

The American Neurological Association’s
Semi-Centennial Anniversary Volume
of
the American Neurological Association, 1875—1924
was edited by both Tilney and Jelliffe.

The tragic story of Jelliffe’s son and his accidental death came from Burnham’s book, page 95, as well as newspaper accounts. The letter Jelliffe wrote to Freud about the tragedy was published in Burnham’s book, page 217.

I found details about Tilney’s social life and trip to see Eleanora Duse in the New
York Times
(October 30, 1923). The “Tilney Memorial” published in
Time
magazine on May 6, 1940, carried the incredible story of Tilney’s stroke and recovery.

Tilney’s quote came from
The Brain
(1928), page 776.

Chapter 14: A Two-Headed Beast

Jelliffe’s quote about the diversified types of mental illness caused by encephalitis lethargica came from his article “Nervous and Mental Disturbances of Influenza.”

The average age of Parkinson’s during the encephalitis lethargica epidemic—thirty-six—was taken from Melvin Yahr’s article “Parkinsonism before and since the Epidemic of Encephalitis Lethargica,”
Archives of Neurology
9 (September 1963).

The statistic about the number of children who showed psychological changes after a case of encephalitis lethargica came from T. R. Hill’s article “Problem of Juvenile Behaviour Disorders in Chronic Epidemic Encephalitis,”
Journal ofNeurology and Psychopathology
9 (1928).

The “fatal wound healed, the second beast was coming forth” refers to the seven-headed beast from the sea followed by the beast from the Earth in Revelation 13.

CASE HISTORY FIVE

Chapter 15: Madness

The opening quote was taken from E. D. Bond and G. E. Partridge’s article “Postencephalitic Behavior Disorders in Boys and Their Management in Hospital,”
AmericanJournalof Psychiatry
6, no. 25 (1925).

The London Times published an article (June 6, 1924) describing the crimes and violent behavior appearing in the wake of the encephalitis lethargica epidemic.

The examples of insanity described by von Economo came from his book
Encephalitis Lethargica
(1931).

Further examples of violent behavior, like suicide and assault attempts, came from Bond and Partridge’s article as well as H. D. MacPhail’s article “Mental Disorder from Encephalitis Lethargica,”
Journal of Mental Science
68 (1922).

A child’s drawing depicting flames bursting from a head and the violent story of a murdered child appeared in the
AmericanJournalof Psychiatry
10, no. 5 (March 1931).

The tragic description by one patient, “It’s so sad to be like me...,” came from Elizabeth Bixler’s “The Nurse and Neurological Problems,”
AmericanJournalof Nursing
35, no. 5 (May 1935).

The London
Times
reported on the Mental Deficiency Act and its amendment to include postencephalitic patients in articles published on December 4, 1926; January 14, 1926; and June 29, 1927.

Numerous other articles are listed in the bibliography that were written by physicians during the 1920s treating patients—most often children—showing mental problems following a case of encephalitis lethargica.

Tilney’s quote appeared in a chapter of a book discussing the opening of a new children’s unit, though Tilney’s remark refers specifically to the Children’s Unit at Kings Park: “Children’s Unit Opened at Rockland State Hospital,” Notes and Comments,
Mental Hygiene
(National Committee for Mental Hygiene, 1937), page 157.

Much of the physical description of Kings Park came from personal observation during a visit to the asylum in February 2008. At the time, I also interviewed Steve Weber from the Kings Park Museum and was given a tour of the grounds. Weber provided me with historic photos of the asylum during the 1920s, as well as descriptions of how day-to-day life was conducted on a farm asylum.

I also relied upon Leo Polaski’s
The Farm Colonies
(2003).

An article by August E. Witzel, “Epidemic Encephalitis, Sequelae and the Psycho-neuroses,”
State Hospital Quarterly
10, no. 3 (May 1925), outlined the differences between psychopathic children and postencephalitic children. The
State Hospital Quarterly,
now out of print, is held at the New York Academy of Medicine.

Mary Boyle’s
Schizophrenia
(1990), pages 70—75, suggests that many 1920s neurologists may have been confusing schizophrenia with encephalitis lethargica.

I based my research on mental illness on two main sources: Roy Porter’s
Madness
(2002) and Edward Shorter’s A
History of Psychiatry
(1997). I also read David Rothman’s
The Discovery of the Asylum
(2005), which dealt with early nineteenth-century development of institutionalized care; Richard Bentall’s
Madness Explained
(2003); Robert Whitaker’s
Mad in America
(2002), which addressed some of the horrific treatments of the mentally ill throughout the last century; and E. Fuller Torrey and Judy Miller’s
The Invisible Plague
(2001).

The early history of madness came from Roy Porter’s
Madness,
pages 10—11. Bethlehem’s transition into “Bedlam” was mentioned in both Porter’s book, page 71, and Shorter’s book, page 4. The quote about “confinement” in early colonial times in the United States came from Shorter’s book, page 7.

Information about mental illness during the age of Enlightenment, the reclassification of a number of mental illnesses, and the original hospitals and “asylums” came from Shorter’s book, pages 2, 48—49, and 33—34.

Details about Dorothea Dix appeared in Shorter’s book, pages 3—4. Additional biographical information came from Francis Tiffany’s
Life of Dorothea Dix
(1891) and “Dorothea Dix and Franklin Pierce,” a program on NPR with an article online at
www.npr.org
.

Incidentally, Dix’s idea was not a new one. By far, the most revolutionary approach to psychiatric care is a town in Belgium known as Geel, or Gheel. The town hospital started placing mentally ill patients with families in the village or in the countryside as early as the thirteenth century. Other patients, who lived in the hospital full-time, were allowed to have jobs in the town and walk freely through the village before returning to the hospital at night. At its peak, in 1938, nearly four thousand patients were placed with families in Geel; even today, five hundred patients live with Geel families. It is a community effort and an incredibly successful one at that—the hospital pays a small amount to the families who house the patients, and the town in general supports and helps them. The freedom of a “normal” life with responsibility and work proves far more healing than any hospital environment.

The quote referring to the defeated reformers in asylum care came from Shorter’s book, page 46. Likewise, the neurologist who complained of three hundred patients per doctor—famed physician Adolf Meyer—appeared in Shorter’s book, pages 46-47. Adolf Meyer became one of America’s undisputed leaders in brain study and psychiatry.

Most descriptions of the children’s program at Kings Park came from H. A. Robeson’s article “The Children’s Unit at Kings Park State Hospital,”
State Hospital Quarterly
10, no. 4 (August 1925). The article described how the children were treated, the programs they participated in, the schedule they adhered to, and the attempt at normalcy. All quotes about the children’s unit or the children who lived there are attributed to the same article. C. E. Gibbs’s “Behavior Disorders in Chronic Epidemic Encephalitis,”
AmericanJournalof Psychiatry
86, no. 4 ( January 1930), also provided details, as well as statistics about the number of children who lived there during the 1920s.

The quote about losing the original child forever appeared in A. J. Hall’s book
Epidemic Encephalitis
(1924).

Chapter 16: Rosie

Descriptions of the New York Academy of Medicine are based on personal observation. I made several trips there in the course of researching this book. In addition to the main reading room, the NYAM has a beautiful library of old medical texts. Much of the building is unchanged since it was opened in 1926, so the elevator still has a cage door and an elevator operator, and the auditorium where Tilney and Jelliffe sat is still relatively the same.

Information about both Tilney’s and Jelliffe’s involvement in the New York Neurological Society, which held its meetings at the NYAM, came from the
Minutes of the New York Neurological Society
from 1919 (when both Tilney and Jelliffe were on the officer ballot), as well as the program from S. P. Goodhart’s presentation in 1931. Interestingly, Goodhart also gave a lecture that year on the importance of keeping neurology and psychiatry as one entity. The minutes from those meetings are held in the Rare Book Room at the NYAM.

Rosie’s story (her name has been changed for this book) appeared in full in S. P. Goodhart and N. Savitsky’s “Self-Mutilation in Chronic Encephalitis,”
AmericanJournalof the Medical Sciences
185 (January—June 1933), pages 674—83.

The majority of details about Rosie’s case came from Goodhart and Savitsky’s original article. However, her case was also covered by Joel A. Vilensky, Paul Foley, and Sid Gilman in their article “Children and Encephalitis Lethargica,”
Pediatric Neurology
37, no. 2 (2007). Vilensky, Foley, and Gilman are three of only a handful of contemporary physicians still actively studying the 1920s epidemic of encephalitis lethargica. Dr. Vilensky was nice enough to send me documentary footage about the disease and to answer various questions I had while researching this book.

The history of self-mutilation addressed in this chapter came from a variety of sources. NPR had a program entitled “The History and Mentality of Self-Mutilation” (June 10, 2005), which told the story of the “needle girls.” Goodhart himself referred to Saint Lucia, Oedipus, and biblical verses dealing with self-mutilation in his article about Rosie. Different versions of the Saint Lucia or Saint Lucy story exist. In the Christian tradition, her eyes were gouged out as part of torture. In my book, I used another version, in which Saint Lucia gouged them out herself. The biblical quote about plucking out the right eye comes from Matthew 5:29 (American Standard Version).

Historical details about the original Morrisania Hospital came from Christopher Gray’s article “Streetscapes: Morrisania Hospital: A Tidy Relic of the 1920’s Looking for a New Use,”
New York Times
(July 15, 1990).

The weather report of the storm on the night of July 30 came from the
New York Times
(July 31, 1931). And the actual full moon occurred on July 29, 1931, so it would still have looked “full” one or two days later.

I found the unusual fact that the neighborhood around Morrisania once cultivated mushrooms from an online article at
www.forgotten-ny.com
. The same question was also addressed in the
New York Times
“FYI” section (July 20, 2003).

Lisa Cartwright’s book
Screeningthe Body
(1995), pages 72-80, included photos from and information about Goodhart’s film of Rosie: “Acute Epidemic Encephalitis” (1944).

Chapter 17: The Neurological Institute

The account of the von Economos’ voyage on the
Olympic
came from
Baron Constantin von Economo
by Karoline von Economo and Julius Wagner-Jauregg, pages 34-35.

F. Scott Fitzgerald’s quote about the “wild promise of all the mystery and the beauty in the world,” appeared in
The Great Gatsby.
Ezra Pound’s quote about the New York skyline was mentioned in Burns and Sanders’s book, page 293, and first appeared in Pound’s “Patria Mia,” 1912. The Ayn Rand quote came from her classic novel
The Fountainhead
(1943). Rand also wrote, “I would give the greatest sunset in the world for one sight of New York’s skyline.” And Frank Lloyd Wright wrote about the vertical city in
The Disappearing City
(1932).

Jelliffe’s quote about von Economo being “peerless” as a man and a scientist, as well as his analogy comparing great medical advances to the building of a skyscraper, came from his foreword to von Economo’s and Wagner-Jauregg’s book.

The estimate that New York’s tons of rubbish could reach the same heights as the Woolworth Building came from the
New York Times
(May 28, 1928), as did the quote about a New York as clean as Havana.

Statistics about the number of buildings erected between 1928 and 1931 came from Burns and Sanders’s book, pages 368-69, and specific details about the Chrysler Building, Bank of Manhattan Co., and Empire State Building came from
www.nyc-architecture.com
.