Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (5 page)

As the temperatures plummeted, coal rationing started. Coal had already been a scarce commodity during the war, but with few shipments arriving in New York, and with those that did encased in ice, the situation was becoming dire. “Workless Mondays” were issued to keep most businesses, including the New York Stock Exchange, closed one additional day per week to prevent further use of coal.

Dr. Frederick Tilney walked out of his office one icy day in the middle of January. A colorless sky was punctuated by milky clouds and white gulls hanging on the wind over the Hudson River. Tilney always visited patients in the morning so he could keep his afternoons and evenings free for research.

He left his townhouse on Fifth Avenue, stepping through piles of gray snow and splintering frozen mud puddles every few steps. On the sidewalks, snow had been collecting and graying, and icicles hung from shop awnings. The memory of a fresh snow was now replaced with the reality of piles of slush fouled by ash, horse manure, and litter.

In spite of the strong scent of refuse, the harsh cold only sharpened the smell of roasting chestnuts in the handcarts, coffee at the lunch counters, tobacco smoke, and coal-burning fires. In the distance, lonely ship sirens sounded, and church bells marked the hour. The snow had quieted everything, and the city itself seemed to absorb all sound and motion.

Tilney walked past five-and-ten stores, United tobacco, hand laundries, shoe repairs, millineries, drug and soda shops, linen and handkerchief stores, tailors. But the cold air had closed most of the newsstands and the carts selling wares.

As he stood at the edge of the street, Tilney paused cautiously to watch the traffic, the steady flow of automobiles rolling through the snow. On the streets that were paved, they sounded like wooden sleds slicing through an icy hillside. More than the weather had created a sense of chaos on the streets. Streetcars ran along tracks, cars and double-decker buses wove in and out of any free space, and then there were horse-drawn buggies. With no real lanes and no speed limits that could accommodate that many modes of transportation, New York streets were chaotic. The ice only slowed the chaos.

As he crossed the street, Tilney hunched his shoulders and pocketed his hands against the wind gusts. He was clean-shaven, as he always was; Tilney didn’t particularly like the trim “facial forestation” that had become so popular. He had a round face, accentuated by round spectacles, and managed to look boyish through most of his life. Like most men, he wore a sacque suit, the one he would wear all morning, with a tie and tiepin. Sometime in the afternoon, Tilney would return to his office and change into an afternoon suit after soot, ash, and a fine film of soft-coal grease had soiled the morning one. On some days, the pollution was so bad that ocean liners had to anchor in the harbor and wait out the impassable yellow fog.

Tilney was on his way to see a new patient that morning, a girl named Ruth. As he neared her neighborhood, he passed men and women along the sidewalks, braving the weather. Victorian wide-brimmed hats brushed by him, the women draping their skirts in one hand, their long hemlines crackling with ice as they walked by. But the younger women modeled the dramatic changes in fashion since the war. Women accustomed to being nurses and wearing pants in the trenches, or working long hours in the war factories or at volunteer stations, had not come home to embrace the corset. Clothing styles were also changing because of their availability; the Garment District was mass-producing simpler styles. Most of the women Tilney passed that morning wore shorter, straighter hemlines and bell-shaped cloche hats. Some of the daring ones had even cut their long hair into a “Castle bob,” like popular dancer Irene Castle.

Tilney did not know what kind of woman his patient was that morning—what she was like, how she dressed, how she thought—and he never would. All he knew was that Ruth was a sixteen-year-old who presented with a number of unusual symptoms, the most pressing one being that she was asleep and would not wake. So her parents had sought help from one of New York’s best-known and most well-respected neurologists.

F
red Tilney, as he was called by friends, seemed to see medicine differently than other physicians. He was willing to consider the unknown.

In what would become his most famous piece of writing, Tilney would state that most men use only a quarter of the 14 billion cells of the brain cortex and that “the brain of modern man represents some intermediate stage in the ultimate development of the master organ of life.” Tilney predicted that “once man is able to use all of his brain cells—maybe a thousand years from now—he’ll be wise enough to put an end to wars, depressions, recessions, and allied evils.”

In fact, choosing neurology as his specialized field showed an attraction to the unknown. It was relatively new and uncharted. Up to that point, doctors were treating neurotic patients with fever boxes—placing them in heated boxes, hoping to raise the body temperature enough to kill germs. Or patients suffering from hysteria were treated with “crown breezes.” They were strapped into something that looked like an electric chair and given continual, small doses of static electricity that literally made their hair stand on end.

In America, neurology first came to the public’s attention with the sensational case of Phineas Gage in 1848. The railroad worker survived an accidental explosion that sent an iron rod through his head, entering and shattering his jaw, passing behind his eye, and piercing through the top of his skull. The three-and-a-half foot rod landed several hundred feet from Gage, and in spite of his wounds, he stood up, walked, and talked. What should have been a fatal accident instead left Gage relatively normal—except for a marked change in his personality. It gave physicians direct clues as to which parts of the brain control which functions.

If Gage’s was the first case, the first major wave in neurology came with the Civil War. Only the
term
“shell shock” is unique to World War I; survivors of the Civil War also knew it, calling it “Soldier’s Heart.” By the 1880s, neurology was taking off—primarily in Europe—and up to that point, America had been lagging behind. It wasn’t until the turn of the century that America’s interest in “nervous disorders” began to progress. Modern life, it seemed, had put too much strain and stress on the human nervous system—automobile accidents, airplane testing and crashing, the recent anarchy movement, and epidemics of disease, among other things, were taking their toll. And then the Great War filled clinics with glassy-eyed, shell-shocked soldiers or survivors of severe head wounds. For brain researchers, the distinction was a moot point. An injury to the psyche or an injury to the actual brain demanded the attention of the same specialists.

As a testament to that fact, early twentieth-century neurology was actually referred to as
neuropsychiatry.
It was an important term, one that saw the mind and the brain as one entity, but soon that would change. In later decades, the
brain
would be seen as the gray matter surrounding the central nervous system of any animal; the
mind
would be defined as the center of emotions and thought processes distinct to humans. In much the same way, nerves would be disunited from nervous conditions, the former becoming the realm of neurology, the latter the domain of psychiatry. In Tilney’s lifetime, those two fields would sever from one another, and never again in medicine would the brain and the mind be part of the same medical specialty.

In the 1920s, the dual force of neuropsychiatry would prove to be essential. When encephalitis lethargica struck, physicians were confronted with a disease of the brain that wholly affected the mind.

Aside from war wounds, the other reason brain study was becoming popular was through the impressive work being done in radiology and image technology. Up to that point, the brain had been the mysterious, unseen part of the body. As one observer noted, “The X-ray threatened to expose the two holiest sanctums of the human body—the sex organs and the brain—and the process demystified both.” When Thomas Edison invented the lightbulb, he was just steps away from the X-ray, and he soon attempted early versions of the X-ray machine. His closest assistant, Clarence Dally, operated the X-ray tube—holding the images with his left hand. Dally soon suffered burns and hair loss, then he lost fingers and eventually had to have his left hand amputated. Still the burns and infection spread, until Dally lost both arms and, ultimately, “died by inches.” Distraught, Edison abandoned the project altogether. The research on image technology did not stop, however, and a lost finger or amputated hand became the emblem of a radiologist.

By World War I, X-rays were in regular use for identifying brain fractures and finding bullets and foreign objects in the body. X-rays were becoming so commonplace they even became public attractions. Fashionable New York women had X-ray images taken holding hands with their betrothed, and there were coin-operated X-ray machines on the street or in shoe stores, called “Foot-O-Scopes.”

Still, it would be several more years before X-ray technology could identify emotions or even brain death, so in the early decades of the twentieth century, X-rays only illuminated the mystery beneath the skull, and neuropsychiatry was the field that delved into that mystery. As a result, neurology was a frightening field full of unknowns in an era that liked certainty.

One reason Tilney may have been willing to choose such an uncertain field of medicine was because he had never intended to be a physician in the first place. He had been born and raised in Brooklyn and went on to attend Yale. At school, he had been editor of the
Yale Literary Magazine,
and in 1895, he contributed a poem he had written, one that would seem to foreshadow his work to come:

It was thy gold, oh butterfly,
That caught the childish fancy of my eye,
But when within my hands thy powdered gold fell off,
I cast thee by to weep,
And then again in dreams I’d chase thee in my sleep.

After graduation, Tilney went to work as a cub reporter for the
New York Sun.
At that point, and for reasons he never explained, he decided to become a professor of medicine.

In order to pay his way through medical school at Long Island College of Medicine, Tilney wrote baseball stories for a boys’ magazine. His stories became so popular that his editor approached him to stay on full-time, offering him a $5,000 salary. Tilney must have been committed to medicine by that point because becoming a doctor rather than a sports reporter would mean a major pay cut. When Tilney later became president of the American Neurological Association, his annual salary would be only $1,000.

As he had done with his writing, Tilney would attract attention for his talent in medicine. A classmate named Roy Chapman Andrews, who would later become director of the American Museum of Natural History, noticed the young Tilney near him working intently on their comparative anatomy assignment. The class professor leaned over to Andrews and said: “You watch that fellow. He is the most brilliant student I’ve ever had in neurology. He’ll be a great doctor some day.”

Andrews and Tilney were often in the labs, late in the night, at Columbia’s College of Physicians and Surgeons, breaking from their studies to eat hamburgers and drink beer in the early hours of morning.

At that time, the study of medicine took a certain amount offortitude. Prisons had recently adopted electrocution as their solution for inmates on death row. For physicians, it was a chance to study the effects of electrocution on the internal organs, so crisp corpses regularly arrived from Sing Sing.

Tilney was graduated from medical school as the valedictorian of his class and soon left for Berlin to study neurology further. After all, at the turn of the century, Berlin and Vienna were the neurological centers of the world. The labs of Germany had long been superior to most others in the world, and in Vienna, psychiatry as well as neurology was gaining attention. Tilney’s work in Germany would leave a lasting impression, the shadow of an idea that would begin to come into focus in the coming decade.

When Tilney returned to New York, he began teaching at Columbia University, and in 1920 he was asked to join the newly formed Neurological Institute. Tilney became part of a major transformation taking place in American medicine. In the previous century, America’s medical teaching, considered far inferior to Europe’s, focused on the general practitioner and the body as a whole. Its inner workings were based on a mysterious, intricate system of balance. Preserve that balance, and good health could be maintained. Physicians were educated through apprenticeships and vague medical schooling; degrees came too easily. As a result, there were quacks, odd medical practices, and a long list of herbal tonics having very little to do with science. In the twentieth century, at the height of the Progressive Era, medicine evolved into medical specialties. Germs and viruses had been discovered, putting an end to the mystery of what causes disease. Medical schooling became more rigorous and more expensive; degrees were harder to attain. Doctors specialized in particular fields; and, as opposed to days past when they went straight into practice, physicians completed their education by working in the hospitals as interns.

It seemed ridiculous to Tilney that America boasted hospitals all over the country dedicated to the eyes, ears, skin, obstetrics, surgery, the crippled, and the convalescent yet had no hospital devoted to the nervous system. For America, that was still a virgin field. One of the institute’s founders wrote, “Future generations will call us pioneers.” (Incidentally, Tilney’s devotion to specialized schools didn’t end with medicine; he once wrote an article in the
Washington
Post explaining the need for schools to train politicians.) But it was a central institute for neurology that Tilney believed in the most, adding, “a brain institute would be of more good to civilization than a whole fleet of battleships.” Another time he said, “It is amazing how little interest man has shown in his brain, the most important organ of his body, which controls his work, his happiness and perhaps his salvation.”