Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (8 page)

Mary Mallon’s story is one of the most famous examples of the complicated relationship between civil liberties and public health. During an outbreak of typhoid, an engineer was asked to examine the aqueduct and other water sources in the city to find contamination. As it turned out, the “contaminant” was a person, a carrier of the disease. “Typhoid Mary,” an Irish cook for some wealthy New York families, did not have a case of typhoid, but she carried the germs nonetheless and spread them in food. The health department demanded that she stop working as a cook. Wary of the health officials, Mary moved from job to job as a cook, each time leaving several people sick or dead of typhoid. Finally, the health department imprisoned her in an isolation hospital for the rest of her life.

When it came to infectious diseases, community health overruled individual rights. Physicians as well as citizens had a legal responsibility to report any cases of infectious disease; individuals could be isolated and quarantined in their homes; even landlords were responsible for not allowing a sick tenant to leave or move without consent of the health department.

Aggressive disease prevention became the full-time commitment of the New York City Department of Public Health. The department focused on educating the public: teaching better hygiene and preventative medicine, keeping neighborhoods clean, coordinating reports among hospitals, sending out informative pamphlets (in several languages), and keeping ever mindful of the fact that if disease was not directly a product of its environment, the environment certainly played a part in the spread of an epidemic.

The health department was called to action during both the 1916 polio outbreak and again in the 1918 pandemic flu. Polio had forced public health workers into a frenzy of preventative measures. They quarantined homes, physically took infants and children to protected wards, and even banned children under the age of sixteen from public places like theaters. At first the health department focused its efforts on the immigrant neighborhoods, but it quickly became obvious that polio was not attacking the Irish or Italian tenements; the disease was striking wealthier children in the cleanest neighborhoods. Polio is one instance when progress worked against civilization: the virus is spread through filthy water, and when water systems were cleaned and made safer, people lost their immunity to this pathogen that had regularly circulated in soiled water for centuries. That’s why polio largely became a twentieth-century plague. In spite of the health department’s best efforts, by summer’s end, polio left thousands of maimed survivors, most of them children, in New York City.

Interestingly, the 1916 outbreak of polio afflicted nine thousand people and went down in history as the most devastating polio epidemic in New York. By the time epidemic encephalitis would suddenly and inexplicably disappear, it would infect at least five thousand New Yorkers, and it would not go down in history as anything at all.

W
ith barely a reprieve after the polio epidemic, and in the midst of a world war, influenza hit the city. The health department again rushed to action. It published notices prohibiting public spitting, and it closed stores, except those selling food or drugs. It even staggered work hours to avoid concentrations of people on mass transportation during rush hours. Even so, the epidemic became so overwhelming, with more losses than the war’s casualty lists, that the department had to intercede in areas it would not normally oversee—food distribution to the sick, converting private homes into makeshift hospitals, even caring for children suddenly left without parents.

New York City and its public health department had been dealt a series of blows. Still, in 1918, the
New York Times
reported that “the Health Department of the City of New York stands as a model of municipal health service in this country, and has been recognized abroad.”

In the mid-nineteenth century, New York had the highest death rate of any American city, higher than London or Paris for that matter. By the end of World War I, New York City’s handling of public health was considered exemplary. In everyday life, it could be a nuisance, but when a major epidemic struck, the public depended entirely on the health department.

Often, it is not how a city functions on a daily basis that is the measure of its civic success, but the way it survives a tragedy. New York would rise to that occasion time and again.

T
ilney was not the only one to see New York as a rising star in worldwide medical research. Five months after Tilney’s address to the New York Neurological Society, Royal Copeland, the city’s health commissioner, continued work on a plan to place New York as a medical center that rivaled Vienna and Berlin. Copeland had been planning to retire, and as one newspaper account tells it, Mayor John Hylan held his fist to Copeland’s face and demanded he stay in the position out of patriotic duty. Copeland spearheaded a nationwide campaign to raise $30 million for public health and medical education. He wanted New York to offer the same valuable education that drew American physicians to Berlin, Vienna, or Paris for study. After all, he argued, there were more hospital beds on Blackwell’s Island than in all of Vienna. Furthermore, Copeland argued, there were places in the world, like India, where the average life span was as low as twenty-one years; in New York, it was as high as fifty years. The bacteriological lab of the New York health department, Copeland added, was the greatest vaccine laboratory in the country. America, which had never been able to compete against a European medical education, was now being recognized worldwide for its exemplary public health.

New York’s research lab was a critical part of that public health success because it allowed the doctors to grow cultures and diagnose a disease based on science and not a set of vague symptoms. It also turned the focus of public health into a full-time commitment, not one that simply rallied together during an epidemic of disease. During the lull between major epidemic outbreaks, the laboratory would focus on endemic diseases like diphtheria.

In addition to the health department lab, New York’s medical community included the New York Academy of Medicine, which itself had been created in part to monitor the health of the city and protect citizens from incompetent physicians. New York’s Public Health Committee, under the helm of the academy, gathered and interpreted information from local hospitals. When neurologists began asking for reports of epidemic encephalitis from hospitals, the response was immediate: more than 213 cases in Mount Sinai, Jewish of Brooklyn, and Bellevue. Physicians on the committee were convinced that encephalitis lethargica was in fact its own disease, distinct from flu or polio or any other ailment, and that it was occurring in epidemic form. The health department then made the disease reportable.

Likewise, the Rockefeller Institute, under the direction of medical giant Simon Flexner, had also vowed to discover the germ spreading encephalitis lethargica. In fact, Flexner, having seen many cases of the disease where sleep or lethargy was not the primary symptom, had been the one to publicly change the name to
“epidemic encephalitis.”

All of these institutions were coming together, drawn to the vortex of New York’s public health activities. Epidemic encephalitis would give neurology its chance to join the current. The organized and well-run public health offices were thus able to supply the Neurological Institute with an epidemiological gold mine—patient records, statistics, outbreaks. There could not be a better system for investigating an outbreak of disease than to have all of those separate pieces working together. The health department went into the neighborhoods and recorded cases; the public health laboratories diagnosed cases and studied tissue samples; the New York Academy of Medicine provided an endless source of articles published throughout the world; and the Neurological Institute had the funding, space, and talent to conduct brain studies. Certainly, with that kind of combined effort, doctors hoped the mystery of this disease could be solved in the coming decade.

Sigmund Freud wrote in his book
Mass Psychology
that “One of the few pleasing and uplifting impressions furnished by the human race is when, faced with an elemental disaster, it forgets its cultural muddle-headedness and all its internal problems and enmities and recalls the great common task of preserving itself against the superior might of nature.”

CASE HISTORY THREE

New York City, 1922-27
NAME:
Adam
PHYSICIAN:
Dr. S. E. Jelliffe

CHAPTER 8

Adam

I
was Easter break in 1922, in mid-April, when Adam left his preparatory school for home. As he traveled on the train through upstate New York, spring was emerging from winter’s icy grip. The green shoots of daffodils speared through the dead underbrush. Buds, tiny and jewel-toned, appeared almost miraculously along the gangly branches of cherry trees and dogwoods. And vivid yellow bloomed along the bowing arcs of forsythia branches. Though it happened without fail every year, it always seemed a surprise to see the first trace of life after the long, dead winter.

For Adam, the images of spring were blurred. He shivered with fever and peered through the train window with red, tired eyes. Gusts of wind blew through the window cracks when the train rattled across a rough patch of track. Each breath of air felt like gravel in his throat—burning, raw, and painful. He was glad to have the chance to go home and rest.

Adam’s mother put him in his bed, his childhood bed, and he curled up still feeling feverish and very depressed. The family doctor diagnosed a light case of the flu and told his mother that he should be fine after a few days in bed. The doctor recommended an alkaline gargle for the boy to use every few hours and left a prescription for a cough compound that contained codeine—it would help with the pain and allow the boy to sleep better. The family had no reason to assume it was anything worse than a case of the flu.

The next morning, a little after nine, Adam’s older brother, a reporter who worked for a New York daily and still lived at home, came into the room to check on Adam. The room was dark as he cracked the door open and looked at the motionless shape beneath the blankets.

“Get out and let me alone! Let me rest. I had an awful night,” Adam shouted.

The brother pulled the door shut, a little surprised by his brother’s angry outburst. It seemed out of character.

Later that afternoon, Adam got out of bed and started to wash and shave. His brother watched him through the open door and later remarked that it was obvious something had happened—Adam twitched and jerked and acted as though he labored under some tremendous excitement that he could not control. He was not the same boy who had climbed off the train platform, feverish, depressed, and tired.

Adam was shouting and laughing in the bathroom, singing to himself. When he noticed his brother standing in the doorway, he grinned and shouted, “Wow! I like my liquor strong and my women weak.”

Adam’s eyes were bright, and his hands moved spastically for his comb and razor. His teeth chattered uncontrollably, and he shook all over. Adam’s brother stood in the bathroom, frightened and concerned. It took nearly half an hour for Adam to calm down and for the burst of delirium to subside. His teeth stopped chattering; his hands quit jerking; his body stopped convulsing. Adam looked up at his brother and said, “I can’t tell you what happened to me last night except that it was something terrible. I suffered all night. I dreamt that I died and then came to life again and saw angels.” They could have been the delusions of a feverish boy, except that Adam’s fever was never that high.

Finally, Adam told his brother, “It was just as if I died and came back to life. Mark what I tell you. This is going to change my whole life. I’ll never be the same again after what happened last night.” He repeated it over and over: “I’ll never be the same again.... I’ll never be the same again.... I’ll never be the same again.”

At first Adam’s parents worried that their son’s reaction could have been caused by an accidental overdose of codeine. But there were only trace amounts in the cough medicine, barely enough to cause any reaction at all. Although Adam’s family was worried, they went ahead and let the boy return to school the next day and hoped that the strange reaction, whatever it was that caused their son to depart so dramatically from his senses and personality, was over.

I
t was not until summer break that the next episode began. This time, it arrived in the form of a respiratory tic, a compulsive sniffing. Adam also began to talk incessantly and excitedly—again, as though it was something compulsive he could not control. His brother slept in the room with him and was kept awake at nights listening to the quick, unceasing, bizarre sniffing. When the sniffing wasn’t keeping Adam’s brother awake, his talkativeness was. He asked questions endlessly, coherent questions, but unceasing. Finally, his brother would tell him to shut up and go to sleep. The talking would stop, but moments later, the sniffing would begin.