October 28, 2013 • 29 mins
From 1916 to about 1927, a strange epidemic spread around the world. It caused unusual symptoms, from drastic behavior changes to a deep, prolonged sleep that could last for months. Between 20 and 40 percent of people who caught the disease died.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You missed in History Class from how
Stuff Works dot Com. Hello, and welcomed to the podcast.
I'm Tracy B. Wilson and I'm probably from So. I
did not intend for today to be a Halloween episode.
(00:22):
Is scary. Yeah, due to some quirks in our publishing schedule,
it happens to be coming out right before Halloween. It
is a listener request from listener Ellen or perhaps Ellen,
And in researching it, I realized it was the most
frightening thing I had ever learned about. So, so buckle up.
(00:42):
History has scared Tracy. History has scared Meat. So. From
nineteen sixteen to about nine seven, this really bizarre epidemic
spread around the world. It came to be known as
sleepy sickness, and it is not to be confused with
sleeping sickness, which is a tropical disease found in sub
Saharan Africa. This is another name for a disease called
(01:03):
encephalitis lethargica, and it caused this really weird variety of symptoms,
from drastic behavior changes to unusual eye movements. Especially in
the beginning years of it. Uh, the really common element
was this deep, prolonged sleep that went on and on
from days two months, and people just couldn't wake up.
(01:27):
Between twenty and of the people who got this disease died,
and of the ones who survived, only about a third
really fully recovered. The rest developed what came to be
known as post and syphilitic parkinson ism, and some of
these patients persisted in a semi comatose state for decades.
(01:48):
It's extra terrifying. The next part is even more terrifying. Yeah,
As if all of this were not enough to scare
the pants off of you. While in this extremely deep sleeps,
it was part of many of the aces. People appeared
to be unconscious, but in reality they were actually alert.
They were completely aware of what was going on, but
(02:08):
they were unable to move or speak, so it was
a sort of paralysis. Really. Yeah, So people today may
have heard about this whole disease from the movie Awakenings
starring Robin Williams, or maybe from the first pages of
Neil Gaiman's amazing comic book series Sandman, which starts off
when a ritual that was meant to capture death instead
(02:31):
captures dream and causes people to sleep endlessly. Otherwise, it's
pretty far in the background of medical history most of
the time. It's not something that people remember all that
well today, but from its onset until about ten years
after it faded away, there were more than nine thousand
papers and books published on it, So at the time
(02:52):
it was a big deal, even though people don't necessarily
come up with it immediately when thinking about huge epidemic today. Yeah,
and I wonder why that is ull talk about some
of that. Yeah, Prolonged sleep as an illness has been
reported really really way back into history. There are written
(03:13):
records as early as Hippocrates of this kind of incident happening.
And then there are also, of course in our cultural
consciousness tales like sleeping beauty and these stories like ripped
van Winkle uh, and some people along the line have
theorized that these were actually rooted to some degree in
some kind of sleeping illness. In the real world, there
(03:34):
had also been an outbreak of a similar condition in
Italy in eighteen eighty nine and eighteen ninety, which came
to be known as Landona, and it was thought at
the time to be a complication of the flu. And
around the world other outbreaks of encephalitis had also followed
behind other epidemics, particularly the flu. This particular one started
(03:55):
just a couple of years before the nineteen eighteen Spanish
flu epidemic, which killed between twenty and forty million people,
and when it came to the encephalitis lethargica epidemic, the
first reports came at about the same time in different
two different places, which were France in Austria. In nineteen
six in France, a doctor named Genrene Cruche started to
(04:18):
see six soldiers with this weird assortment of seemingly unrelated
neurological symptoms, and the one common element was that the
patients just slept, apparently peacefully and deeply, and that they
could not be woken up, and he started to wonder
whether there was some kind of new chemical weapon at work.
At about the same time, a British doctor named A. J.
(04:41):
Hall also reported similar symptoms, and other troops who were
stationed in France. In Vienna, it came to the attention
of Romanian Austrian psychiatrists Constantine von Economo after a sleepy,
disoriented civilian wandered into the Wagner Jarre clinic where he worked.
The doctor's there had mostly been treating soldiers who were
(05:02):
wounded in the war, so they really weren't prepared for
this apparently uninjured civilian with nothing physically wrong that they
could really point to. And then more and more patients
with similar symptoms arrived at the clinic, and there you know,
they had the similar part of this uncontrollable sleepiness and sleep,
(05:23):
but the rest of their symptoms were so strange and
diverse that the doctors were really at a loss to
figure out a cause or a treatment. These patients had fevers, malaise,
double vision, they became lethargic. Sometimes they had sore throats.
Their eye muscles would start working and their eyes would
dart around or roll back in their heads. Some of
(05:44):
them developed very strange eye and tongue movement movements, and
this variety of other neurological and psychiatric symptoms. A few
of them even had uncontrollable hiccups and one died of that.
How that work. Well, if you can't stop pickuping, you
can't really eat or sleep, and then it can cause
(06:08):
all kinds of other Yeah. Once again, throughout all of this,
the common element was this strange deep sleep from which
they could not be woken. Vanni Conomos saw this common
element and said, we're dealing with a sleeping sickness. Yeah,
he was really the one that just laid that out there,
and he's a character on his own. He was also
(06:30):
a pilot who had been serving in the war, but
he came back home to Vienna after his brother was
killed and he really wanted to be flying, but reluctantly
transferred to doing medical work instead to try to keep
himself more out of danger and spare his family from
further grief. On top of all that, he was also
a baron, having been born to a family of Greek
(06:51):
aristocrats and then married the daughter of an Austrian prince.
As the patient started to die from sleep, Vonni Konomos
started an intense research effort to find a cause and
a cure. He studied autopsies of patients who had died
of the disease, and he found common areas of damage
to their brains, specifically in the hypothalamus, and he suspected
(07:14):
that the differences and how much people slept was related
to just how their hypothalamus was damaged. He also found
that brain tissue could transmit the disease to monkeys, so
he concluded that they were looking at something that was contagious.
He publicly announced his conclusion that they were dealing with
a new disease, probably a virus, before the Psychiatric Society
(07:35):
in Vienna, on April seventeenth of nineteen seventeen. UH. Consequently,
sometimes the disease has been referred to as von Economo's disease.
His announcement was not at all well received. At a
time the prevailing view with that mental illnesses were all
products of things like trauma and buried memories. Freud was
really at the forefront of psychology at this point, so
(07:57):
a lot of people just scoffed at the idea that
there could be a virus or other disease process causing
the kinds of behavior changes in psychological problems that some
of the patients were exhibiting. The ongoing debate and this
mystery of the whole thing kept much progress from being
made in terms of treatment and prevention. But then UH,
the illness mostly disappeared from continental Europe. It really just
(08:19):
fell off suddenly, and Spanish flu on the rise took
its place and it became a much more pressing priority.
Not long after that, though, the disease appeared in London
and it followed much the same pattern as it had
on the continent. There were, you know, all these patients
who were suddenly having this strange collective collection of symptoms
and sleeping constantly. The government in Britain quickly made it
(08:43):
a reportable disease. The Ministry of Help had to be
notified of all new cases, and its appearance and spread
uh in London was much like it had been in
France and Austria. Strange symptoms and unending sleep uh, you know,
baffling the doctors. But in England the symptoms became even
more alarming, with patients who could never sleep, or who
(09:04):
couldn't stop laughing, or had other strange physical or emotional presentations.
It also seemed like fewer and fewer people were truly recovering.
In Austria and France, there had been people that had
gotten better, but as it's spread around England, a lot
of people were becoming comatose or developing. As we mentioned
(09:26):
at the beginning, what later came to be known as
post en syphilitic parkinson is um or PEP. Sometimes the
onset of parkinson is um happened years after people recovered,
after they had apparently been healthy all that time. During
the epidemic, the average age for the onset of Parkinson's
dropped to thirty six years old. Today, while there are
(09:48):
people who have early onset, the average age for people
to start exhibiting Parkinson's is sixties. So this was really
a significant and strange happening. Uh following the epidemic, two
thirds of Parkinson's patients had previously had encephalitis, so it
clearly was causing it right, This disease was causing a
(10:10):
drastic shift in who developed Parkinson's and when. So, to
return to the story of encephalitis Letharctica from England, the
disease spread all over the globe, and the same story
just played out over and over and over. People would
start showing up with these strange symptoms that prevent that
(10:32):
presented themselves in such different ways that it would take
a while for doctors to realize what was happening. It
really didn't help that the epidemic had started just at
the end of World War One and just before the
start of the nineteen eighteen Spanish flu epidemic, and so
resources were just scarce and there were definitely bigger priorities
(10:52):
going on, and this crazy although terrifying disease, and as
it spread it started to prompt a variety of different
sleep disorders, so while some patients would sleep for months
at a time, others couldn't sleep at all, and they
would actually die of exhaustion. The disease came to be
known in some places as epidemic encephalitis rather than encephalitis lethargica,
(11:13):
since not everyone could really be called lethargic anymore. As
it spread, it also started to affect more and more
children and young people. Children who contracted the disease developed
impulse control issues that led to them having violent behavior
in their adolescence. Some of them injured themselves or other people.
One even removed her own eyes and several of her
(11:37):
own teeth okay after I unclenched after that um, this
behavior often would continue for the rest of these patients
lives after they progressed out of childhood, unless post and
cephalitic parkinson is M made them physically unable to continue.
For children with the disease, outbursts were so severe that
many had to be institutionalized. Hospitals and asylums that were
(12:00):
accustomed to providing care for adults suddenly had to develop
new practices to care for children because there were so
many suddenly having a movement institutions. Researchers theorized that the
reason this encephalitis was causing behavior changes like this and
young people was because their brains hadn't yet developed the
capacity for self control that adults typically had by the
(12:23):
time they were infected, and this tendency towards violent behavior
and other erratic behavior even led to encephalitis lethargica being
blamed for gangster behavior and lawlessness during the nineteen twenties.
Once this disease spread to the United States, neurologist Frederick Tilney,
who was known as Fred and had also been Helen
Keller's neurologist, became the country's foremost authority on sleepy sickness.
(12:47):
One of his most famous encephalitis patients was Jesse Morgan,
who was the wife of Jack p Morgan, who himself
was the son of banker and philanthropist John Pierpoint Morgan.
She got the disease in ninety five. Five. After Jesse's death,
Jack donated two hundred thousand dollars to the Neurological Institute
the fund research into this disease. The Neurological Institute was
(13:10):
behind most of the research into encephalitis authargica that came
from that point. Later on, William Matheson, who was the
wealthy founder of a chemical company and an encephalitis patient,
started the Matheson Commission to fund research at the Neurological Institute,
with Dr Josephine B. Neil, who was an encephalitis expert,
(13:30):
helming the project, and the commission's aim was to study
the disease and eventually find a vaccine. Since nobody knew
exactly what was causing the disease, they worked on three
theories simultaneously. One was that it was being caused by
an unknown virus, the next was that it was being
caused by bacteria, possibly strap uh, and the third was
(13:52):
that it was being caused by herpes. This was a
long shot to begin with because no causative agent had
been found for this disease. They were basically operating in
the dark based on best guesses. On top of that,
there was a ton of infighting among the researchers. A
lot of them were extremely prominent neurologists and scientists. Each
(14:16):
of them really wanted to be the one to crack
this case and figure out what's going on um that
they were not working together very well. They were each
trying to get the glory for themselves. And then there
was another huge setback when Matheson himself died in nineteen thirty.
That was in the middle of the Great Depression, and
he had been providing the funding, so after his death
(14:39):
there wasn't really other funding to be had, so the
Matheson Commission ceased operations in two and so no workable
vaccine had been developed, and one of the things that
doctors tried to treat post and cephalitis patients with was lobotomies,
which also did not work. There was a lot of
(15:01):
ending that did not work. There were a few outlying
successes during this time that we kind of give people
false hope that maybe they were on the right track,
but nothing led to an actual treatment or cure. Most
of the medical care that the patients were receiving was
really about just caring for their bodies and keeping them alive.
(15:21):
The thirty or so percent who developed parkinson is um
generally wound up in long term care for the rest
of their lives, and many of them were completely unable
to move or take care of themselves in the nineteen sixties,
after the drug love Adopa or el dopa as it
was called, was introduced for treating Parkinson's. New York doctor
Oliver Sachs, who are some of our listeners may have
(15:43):
heard of, administered it to some encephalitis lethargica patients who
were in long term care. Some patients actually showed a
limited recovery from their post and sephalitis lethargica Parkinson symptoms. Uh.
This is the story that's actually told in the movie Awakenings,
which is why people may have heard of all over sex.
But they all apparently developed a tolerance until the dosage
(16:05):
was really just too much for the human body to handle,
and then they would return to their semi comatose state
in the end. This epidemic went on from nineteen sixteen
to nineteen twenty seven, reaching its peak in nineteen twenty four,
after which the number of cases started to drop off.
The total numbers of people affected are really unclear. There
(16:26):
are sources who say that a million people were killed,
while others say that only half a million were affected
in one way or another. Regardless, though the mortality rate
was pretty serious in England, almost half of the cases
in nineteen nineteen and nineteen twenty died. Although it was
roughly concurrent with the Spanish flu pandemic, and flu came
(16:48):
up frequently when looking at possible causes, many doctors at
the time didn't really think the disease was actually flu related.
Only a small percentage of the patients had also had
Spanish flu, and teen eighty two, however, doctors from the
Centers for Disease Control published this list of connections between
the two diseases. So for a little while. In more
(17:09):
recent years, flu became a prime suspect for causing encephalitis lethargica.
Uh there is, you know, especially since there have been
other incidents of encephalitis that have followed outbreaks of the flu. Today,
the idea that the flu was the culprit has pretty
much been ruled out thanks to modern testing methods. They
haven't turned up any sign of the flu virus in
(17:31):
tissue samples from patients who died from encephalitis, Although it's
never reached that same epidemic state again, isolated cases of
encephalitis lethargica have continued to crop up even in recent years,
most recently in a twenty three year old named Becky
Powell was diagnosed with the disease and it took her
(17:53):
two years to recover. Several similar cases followed. In two
thousand three, a team of doctors public a paper in
the journal Brain that put forth a pretty good case
that the cause of encephalitis lethargica is actually a massive
autoimmune reaction to an unidentified pathogen. A strain of strap
comes up in the discussion, but it's ultimately dismissed as unlikely.
(18:15):
And their research was done on twenty different patients who
developed the disease between two thousand two, and those patients
had a much lower mortality rate than during the epidemic.
Only one died, but five of them did have to
be placed on a ventilator. Had those five patients lived
in the ninety twenties, they probably would not have made it,
but almost none of them had fully recovered a year
(18:37):
or so later when the paper was published. They continued
to have neurological and psychiatric symptoms. Yeah. If if there
had been if today's ventilation technology had existed in the
nineteen twenties, the mortality rate would have been Yeah, because
people would get into this just deep uninterrupted sleep and
(18:59):
their respiratory functions would fail, and there wasn't really anything
that people could do about it. But now that we
have violators UH, that there are actual there's a treatment
for that part of it that didn't exist back then.
In paper in the journal BMC Infectious Diseases reported that
a team of researchers had found virus like particles in
the brains of both epidemic encephalitis patients and modern patients,
(19:24):
so people who had died UH either recently or during
the epidemic. This supports the idea that the cause of
encephalitis lethargica is an interarovirus, but exactly what interovirus we
still do not know. And on that note, so encephalitis
lethargica has a some you know, a legacy today, even
(19:46):
though a lot of people have not really heard of
it as tragic and frightening as the disease was and
is really. In the end, it helped doctors understand more
about the brain. Von economist conclude Usian about the hypothalamus
and its role in the patients sleep, for example, was
hugely unpopular at the time, but many years later it
(20:09):
was proved to be true after we developed sorts of
imaging technologies that we can use to look directly at
the brain as it's working today. Neurologist Bernard Sacks also
wrote that the epidemic of encephalitis quote revolutionized the practice
of neurology. So it really changed the way that, uh,
these things were examined from the get go. Yeah, it
(20:30):
helped solidifying neurology as an actual field. In the early days,
there was sort of this hodgepodge of neurology ideas and
psychology ideas and all these things that were kind of
together in one big pot. And in part because of
encephalitis being spread the way that it was, a group
of doctors branched off to study just neurology and encephalitis.
(20:55):
Lethargica was also one of the conditions that made it
clear that disease process says, can lead to mental illnesses. Uh,
it's solidified the idea that mental illnesses were not solely
in the realm of emotions or traumatic experiences. It's not
always buried memories. Sometimes there can actually be a physical
happening that causes mental illness. There are a couple of
(21:16):
books that are out about this epidemic. The one that
I read researching. This podcast was called Asleep, The Forgotten
Epidemic that remains one of Medicine's greatest mysteries by Molly
Caldwell Crosby and her grandmother survived Sleepy Sickness. It starts
with sort of a case study of her grandmother. That's
(21:37):
terrifying because it's about her grandmother being asleep for so long,
but also being aware of what was happening around her,
which to me is just terrifying. The one caveat about
this book is that it was written before the very
most recent research about what might have caused this particular epidemic,
which is going to be the case which just about
(21:57):
every book now since the latest research is just very new. Yeah.
Last year, as we were recording, I have read several
papers that, uh, you know, and when the bird flew
epidemic was was everybody was very frightened about bird flu.
There were several articles that that came up where doctors
were like, actually, what you really should be afraid of
(22:19):
is a resurgence of this still unidentified encephalitis that sometimes
sometimes follows outbreaks of other diseases. I yeah, it's basically
my worst nightmare. I mean, I have not a good
relationship with sleep anyway. If I didn't have to do it,
I wouldn't. So the idea of not having any control
(22:40):
over the situation and just being asleep but not really
because you're conscious of things happening around is my worst nightmare. Yeah,
not to play on sleep jokes, but well, it's terrifying
and the there are many things about this whole, the
epidemic and the illness itself that are are frightening to me,
And one of them is that people would seem to
(23:03):
recover and they would be fine for a long time,
and then they developed, yeah, developed parkinson symptoms um and
once it had been established that that was a pattern,
I can imagine like the people who had gotten better
really being like I'm never going to be which I
know that's the case with a lot of diseases that
people have now, Like there are many cancer patients who
(23:25):
never feel like they are in the clear because you
can be intermission. So yeah, it's a scary thing to
live with that kind of over you cheerful it is.
Do you have listener mail? The cheer aside, do have
listener mail? And actually the first listener mail that I
have is very cheerful. I have two of them. One
(23:47):
of them is short. The first one is from Vince,
and he says, Dear Tracy, thank you for helping me
through some boring work days. During your recent podcast on
Louis Alvarez, you mentioned all the Berkeley Nobel laureates from
its past. Being a proud alum, I had recently had
a chance to visit Berkeley, and strolling around the campus,
I noticed this cute photo op between the two physics buildings,
(24:09):
and basically he attached a picture of this row of
prime parking spaces that all are like this space is
for a novel, a Nobel laureate. So Nobel laureates get
awesome reserved parking at Berkeley. They deserve it. They've probably
lost a lot of time in their lives to work
very hard on very difficult problems. Yeah. There there are
(24:29):
a lot of spaces, and they are right by building.
Says for me. It truly illustrates how good Berkeley research
really is. Thanks again, Vince, Thank you, Vince. I love
that picture. Yes, okay, the other one is from Sarah,
and I'm going to just start with a confession that
I worried that when we were talking about Luis Alvarez
that we were talking too much about how hard a
(24:51):
lot of his discoveries are to understand if you are
not also a physicist. So I particularly liked this letter
from Sarah. Sarah says, Hi, Holly, and Tracy. I'm a
graduate student at m I T and i love listening
to your podcast when I set up reactions in our
nitrogen filled glove box or washed my glassware. I just
listened to your podcast on Luis Alvarez, and I wanted
to thank you for all the podcasts you've done which
(25:13):
touch on science, even though for the purposes of this episode,
I'm a chemist and not a theoret radical physicist. I
find your descriptions clear and engaging, which is so rare
fined in science communication. I have a small correction to
make on your last episode where you mentioned that the
temperature of liquid hydrogen is degrees below zero celsius. I
think you meant minus two fifty three degrees celsius, since
(25:35):
absolute zero zero kelvin is minus two seventy three degrees celsius.
At this point, molecules cease to have entropy, and it
is the coldest possible temperature, so liquid hydrogen is twenty kelvin,
which is still really really cold, but not as clear
as liquid helium, which is for kelvin. Also, I was
(25:56):
interested in hearing the cheek lub crater mentioned. I studied
odd in the Yucatan Peninsula in college and visited the
town of chik Lube several times. But it was only
after I got back to the States that I saw
that twenty ten science paper that you mentioned and realized
that I had been in the impact site probably responsible
for the mass extinctions without knowing it. By the way,
(26:17):
you got the pronunciation pretty close, but it's actually pronounced
more like cheek salub. The x mention s h sound
apparently means something like lee devil according to Wikipedia. In
any case, it was amazing to have the chance to
study there. So much of the Mayan culture and the
language is preserved in the Yucatan. And then Sarah recommends
(26:38):
h subject for us to talk about, which we're just
going to save in case we're able to do that
in a later podcast, and she says, anyway, sorry this
email got so long, but I wanted to thank you
guys for your science recording. Keep up the good work, Sarah,
thank you so much. Sarah. Yeah, we got a few
corrections on the temperature thing we did. I would like
to thank Sarah's correction for being very nice about it.
(27:02):
There were a couple of people who needed to tell
us that corrections are bad and that mistakes are bad,
and we know that we try our best. So yes,
that is totally either a typo in my notes or
a typo and something I was making notes from. So
thank you very much for clarifying just how extremely extremely
cold liquid hydrogen is. Thankfully we did not work in
(27:23):
a lab where there would be actual scary implications of
us making the error of that magnitude. Yes, we're safe.
It's just words. It's just words, and we're edited though
it's kind of her job. But yeah, occasionally we do
get stuff wrong in spite of our best effort. So
(27:43):
thank you so much, Sarah. I am so glad to
hear from science people who enjoy us talking about science,
because I do love science, but because it is not yes,
because it is not like my primary field of study. Uh,
sometimes get stuff a little wrong. So if you would
like to write us a letter about this or any
(28:05):
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Welcome to Stuff You missed in History Class from how
Stuff Works dot Com. Hello, and welcomed to the podcast.
I'm Tracy B. Wilson and I'm probably from So. I
did not intend for today to be a Halloween episode.
(00:22):
Is scary. Yeah, due to some quirks in our publishing schedule,
it happens to be coming out right before Halloween. It
is a listener request from listener Ellen or perhaps Ellen,
And in researching it, I realized it was the most
frightening thing I had ever learned about. So, so buckle up.
(00:42):
History has scared Tracy. History has scared Meat. So. From
nineteen sixteen to about nine seven, this really bizarre epidemic
spread around the world. It came to be known as
sleepy sickness, and it is not to be confused with
sleeping sickness, which is a tropical disease found in sub
Saharan Africa. This is another name for a disease called
(01:03):
encephalitis lethargica, and it caused this really weird variety of symptoms,
from drastic behavior changes to unusual eye movements. Especially in
the beginning years of it. Uh, the really common element
was this deep, prolonged sleep that went on and on
from days two months, and people just couldn't wake up.
(01:27):
Between twenty and of the people who got this disease died,
and of the ones who survived, only about a third
really fully recovered. The rest developed what came to be
known as post and syphilitic parkinson ism, and some of
these patients persisted in a semi comatose state for decades.
(01:48):
It's extra terrifying. The next part is even more terrifying. Yeah,
As if all of this were not enough to scare
the pants off of you. While in this extremely deep sleeps,
it was part of many of the aces. People appeared
to be unconscious, but in reality they were actually alert.
They were completely aware of what was going on, but
(02:08):
they were unable to move or speak, so it was
a sort of paralysis. Really. Yeah, So people today may
have heard about this whole disease from the movie Awakenings
starring Robin Williams, or maybe from the first pages of
Neil Gaiman's amazing comic book series Sandman, which starts off
when a ritual that was meant to capture death instead
(02:31):
captures dream and causes people to sleep endlessly. Otherwise, it's
pretty far in the background of medical history most of
the time. It's not something that people remember all that
well today, but from its onset until about ten years
after it faded away, there were more than nine thousand
papers and books published on it, So at the time
(02:52):
it was a big deal, even though people don't necessarily
come up with it immediately when thinking about huge epidemic today. Yeah,
and I wonder why that is ull talk about some
of that. Yeah, Prolonged sleep as an illness has been
reported really really way back into history. There are written
(03:13):
records as early as Hippocrates of this kind of incident happening.
And then there are also, of course in our cultural
consciousness tales like sleeping beauty and these stories like ripped
van Winkle uh, and some people along the line have
theorized that these were actually rooted to some degree in
some kind of sleeping illness. In the real world, there
(03:34):
had also been an outbreak of a similar condition in
Italy in eighteen eighty nine and eighteen ninety, which came
to be known as Landona, and it was thought at
the time to be a complication of the flu. And
around the world other outbreaks of encephalitis had also followed
behind other epidemics, particularly the flu. This particular one started
(03:55):
just a couple of years before the nineteen eighteen Spanish
flu epidemic, which killed between twenty and forty million people,
and when it came to the encephalitis lethargica epidemic, the
first reports came at about the same time in different
two different places, which were France in Austria. In nineteen
six in France, a doctor named Genrene Cruche started to
(04:18):
see six soldiers with this weird assortment of seemingly unrelated
neurological symptoms, and the one common element was that the
patients just slept, apparently peacefully and deeply, and that they
could not be woken up, and he started to wonder
whether there was some kind of new chemical weapon at work.
At about the same time, a British doctor named A. J.
(04:41):
Hall also reported similar symptoms, and other troops who were
stationed in France. In Vienna, it came to the attention
of Romanian Austrian psychiatrists Constantine von Economo after a sleepy,
disoriented civilian wandered into the Wagner Jarre clinic where he worked.
The doctor's there had mostly been treating soldiers who were
(05:02):
wounded in the war, so they really weren't prepared for
this apparently uninjured civilian with nothing physically wrong that they
could really point to. And then more and more patients
with similar symptoms arrived at the clinic, and there you know,
they had the similar part of this uncontrollable sleepiness and sleep,
(05:23):
but the rest of their symptoms were so strange and
diverse that the doctors were really at a loss to
figure out a cause or a treatment. These patients had fevers, malaise,
double vision, they became lethargic. Sometimes they had sore throats.
Their eye muscles would start working and their eyes would
dart around or roll back in their heads. Some of
(05:44):
them developed very strange eye and tongue movement movements, and
this variety of other neurological and psychiatric symptoms. A few
of them even had uncontrollable hiccups and one died of that.
How that work. Well, if you can't stop pickuping, you
can't really eat or sleep, and then it can cause
(06:08):
all kinds of other Yeah. Once again, throughout all of this,
the common element was this strange deep sleep from which
they could not be woken. Vanni Conomos saw this common
element and said, we're dealing with a sleeping sickness. Yeah,
he was really the one that just laid that out there,
and he's a character on his own. He was also
(06:30):
a pilot who had been serving in the war, but
he came back home to Vienna after his brother was
killed and he really wanted to be flying, but reluctantly
transferred to doing medical work instead to try to keep
himself more out of danger and spare his family from
further grief. On top of all that, he was also
a baron, having been born to a family of Greek
(06:51):
aristocrats and then married the daughter of an Austrian prince.
As the patient started to die from sleep, Vonni Konomos
started an intense research effort to find a cause and
a cure. He studied autopsies of patients who had died
of the disease, and he found common areas of damage
to their brains, specifically in the hypothalamus, and he suspected
(07:14):
that the differences and how much people slept was related
to just how their hypothalamus was damaged. He also found
that brain tissue could transmit the disease to monkeys, so
he concluded that they were looking at something that was contagious.
He publicly announced his conclusion that they were dealing with
a new disease, probably a virus, before the Psychiatric Society
(07:35):
in Vienna, on April seventeenth of nineteen seventeen. UH. Consequently,
sometimes the disease has been referred to as von Economo's disease.
His announcement was not at all well received. At a
time the prevailing view with that mental illnesses were all
products of things like trauma and buried memories. Freud was
really at the forefront of psychology at this point, so
(07:57):
a lot of people just scoffed at the idea that
there could be a virus or other disease process causing
the kinds of behavior changes in psychological problems that some
of the patients were exhibiting. The ongoing debate and this
mystery of the whole thing kept much progress from being
made in terms of treatment and prevention. But then UH,
the illness mostly disappeared from continental Europe. It really just
(08:19):
fell off suddenly, and Spanish flu on the rise took
its place and it became a much more pressing priority.
Not long after that, though, the disease appeared in London
and it followed much the same pattern as it had
on the continent. There were, you know, all these patients
who were suddenly having this strange collective collection of symptoms
and sleeping constantly. The government in Britain quickly made it
(08:43):
a reportable disease. The Ministry of Help had to be
notified of all new cases, and its appearance and spread
uh in London was much like it had been in
France and Austria. Strange symptoms and unending sleep uh, you know,
baffling the doctors. But in England the symptoms became even
more alarming, with patients who could never sleep, or who
(09:04):
couldn't stop laughing, or had other strange physical or emotional presentations.
It also seemed like fewer and fewer people were truly recovering.
In Austria and France, there had been people that had
gotten better, but as it's spread around England, a lot
of people were becoming comatose or developing. As we mentioned
(09:26):
at the beginning, what later came to be known as
post en syphilitic parkinson is um or PEP. Sometimes the
onset of parkinson is um happened years after people recovered,
after they had apparently been healthy all that time. During
the epidemic, the average age for the onset of Parkinson's
dropped to thirty six years old. Today, while there are
(09:48):
people who have early onset, the average age for people
to start exhibiting Parkinson's is sixties. So this was really
a significant and strange happening. Uh following the epidemic, two
thirds of Parkinson's patients had previously had encephalitis, so it
clearly was causing it right, This disease was causing a
(10:10):
drastic shift in who developed Parkinson's and when. So, to
return to the story of encephalitis Letharctica from England, the
disease spread all over the globe, and the same story
just played out over and over and over. People would
start showing up with these strange symptoms that prevent that
(10:32):
presented themselves in such different ways that it would take
a while for doctors to realize what was happening. It
really didn't help that the epidemic had started just at
the end of World War One and just before the
start of the nineteen eighteen Spanish flu epidemic, and so
resources were just scarce and there were definitely bigger priorities
(10:52):
going on, and this crazy although terrifying disease, and as
it spread it started to prompt a variety of different
sleep disorders, so while some patients would sleep for months
at a time, others couldn't sleep at all, and they
would actually die of exhaustion. The disease came to be
known in some places as epidemic encephalitis rather than encephalitis lethargica,
(11:13):
since not everyone could really be called lethargic anymore. As
it spread, it also started to affect more and more
children and young people. Children who contracted the disease developed
impulse control issues that led to them having violent behavior
in their adolescence. Some of them injured themselves or other people.
One even removed her own eyes and several of her
(11:37):
own teeth okay after I unclenched after that um, this
behavior often would continue for the rest of these patients
lives after they progressed out of childhood, unless post and
cephalitic parkinson is M made them physically unable to continue.
For children with the disease, outbursts were so severe that
many had to be institutionalized. Hospitals and asylums that were
(12:00):
accustomed to providing care for adults suddenly had to develop
new practices to care for children because there were so
many suddenly having a movement institutions. Researchers theorized that the
reason this encephalitis was causing behavior changes like this and
young people was because their brains hadn't yet developed the
capacity for self control that adults typically had by the
(12:23):
time they were infected, and this tendency towards violent behavior
and other erratic behavior even led to encephalitis lethargica being
blamed for gangster behavior and lawlessness during the nineteen twenties.
Once this disease spread to the United States, neurologist Frederick Tilney,
who was known as Fred and had also been Helen
Keller's neurologist, became the country's foremost authority on sleepy sickness.
(12:47):
One of his most famous encephalitis patients was Jesse Morgan,
who was the wife of Jack p Morgan, who himself
was the son of banker and philanthropist John Pierpoint Morgan.
She got the disease in ninety five. Five. After Jesse's death,
Jack donated two hundred thousand dollars to the Neurological Institute
the fund research into this disease. The Neurological Institute was
(13:10):
behind most of the research into encephalitis authargica that came
from that point. Later on, William Matheson, who was the
wealthy founder of a chemical company and an encephalitis patient,
started the Matheson Commission to fund research at the Neurological Institute,
with Dr Josephine B. Neil, who was an encephalitis expert,
(13:30):
helming the project, and the commission's aim was to study
the disease and eventually find a vaccine. Since nobody knew
exactly what was causing the disease, they worked on three
theories simultaneously. One was that it was being caused by
an unknown virus, the next was that it was being
caused by bacteria, possibly strap uh, and the third was
(13:52):
that it was being caused by herpes. This was a
long shot to begin with because no causative agent had
been found for this disease. They were basically operating in
the dark based on best guesses. On top of that,
there was a ton of infighting among the researchers. A
lot of them were extremely prominent neurologists and scientists. Each
(14:16):
of them really wanted to be the one to crack
this case and figure out what's going on um that
they were not working together very well. They were each
trying to get the glory for themselves. And then there
was another huge setback when Matheson himself died in nineteen thirty.
That was in the middle of the Great Depression, and
he had been providing the funding, so after his death
(14:39):
there wasn't really other funding to be had, so the
Matheson Commission ceased operations in two and so no workable
vaccine had been developed, and one of the things that
doctors tried to treat post and cephalitis patients with was lobotomies,
which also did not work. There was a lot of
(15:01):
ending that did not work. There were a few outlying
successes during this time that we kind of give people
false hope that maybe they were on the right track,
but nothing led to an actual treatment or cure. Most
of the medical care that the patients were receiving was
really about just caring for their bodies and keeping them alive.
(15:21):
The thirty or so percent who developed parkinson is um
generally wound up in long term care for the rest
of their lives, and many of them were completely unable
to move or take care of themselves in the nineteen sixties,
after the drug love Adopa or el dopa as it
was called, was introduced for treating Parkinson's. New York doctor
Oliver Sachs, who are some of our listeners may have
(15:43):
heard of, administered it to some encephalitis lethargica patients who
were in long term care. Some patients actually showed a
limited recovery from their post and sephalitis lethargica Parkinson symptoms. Uh.
This is the story that's actually told in the movie Awakenings,
which is why people may have heard of all over sex.
But they all apparently developed a tolerance until the dosage
(16:05):
was really just too much for the human body to handle,
and then they would return to their semi comatose state
in the end. This epidemic went on from nineteen sixteen
to nineteen twenty seven, reaching its peak in nineteen twenty four,
after which the number of cases started to drop off.
The total numbers of people affected are really unclear. There
(16:26):
are sources who say that a million people were killed,
while others say that only half a million were affected
in one way or another. Regardless, though the mortality rate
was pretty serious in England, almost half of the cases
in nineteen nineteen and nineteen twenty died. Although it was
roughly concurrent with the Spanish flu pandemic, and flu came
(16:48):
up frequently when looking at possible causes, many doctors at
the time didn't really think the disease was actually flu related.
Only a small percentage of the patients had also had
Spanish flu, and teen eighty two, however, doctors from the
Centers for Disease Control published this list of connections between
the two diseases. So for a little while. In more
(17:09):
recent years, flu became a prime suspect for causing encephalitis lethargica.
Uh there is, you know, especially since there have been
other incidents of encephalitis that have followed outbreaks of the flu. Today,
the idea that the flu was the culprit has pretty
much been ruled out thanks to modern testing methods. They
haven't turned up any sign of the flu virus in
(17:31):
tissue samples from patients who died from encephalitis, Although it's
never reached that same epidemic state again, isolated cases of
encephalitis lethargica have continued to crop up even in recent years,
most recently in a twenty three year old named Becky
Powell was diagnosed with the disease and it took her
(17:53):
two years to recover. Several similar cases followed. In two
thousand three, a team of doctors public a paper in
the journal Brain that put forth a pretty good case
that the cause of encephalitis lethargica is actually a massive
autoimmune reaction to an unidentified pathogen. A strain of strap
comes up in the discussion, but it's ultimately dismissed as unlikely.
(18:15):
And their research was done on twenty different patients who
developed the disease between two thousand two, and those patients
had a much lower mortality rate than during the epidemic.
Only one died, but five of them did have to
be placed on a ventilator. Had those five patients lived
in the ninety twenties, they probably would not have made it,
but almost none of them had fully recovered a year
(18:37):
or so later when the paper was published. They continued
to have neurological and psychiatric symptoms. Yeah. If if there
had been if today's ventilation technology had existed in the
nineteen twenties, the mortality rate would have been Yeah, because
people would get into this just deep uninterrupted sleep and
(18:59):
their respiratory functions would fail, and there wasn't really anything
that people could do about it. But now that we
have violators UH, that there are actual there's a treatment
for that part of it that didn't exist back then.
In paper in the journal BMC Infectious Diseases reported that
a team of researchers had found virus like particles in
the brains of both epidemic encephalitis patients and modern patients,
(19:24):
so people who had died UH either recently or during
the epidemic. This supports the idea that the cause of
encephalitis lethargica is an interarovirus, but exactly what interovirus we
still do not know. And on that note, so encephalitis
lethargica has a some you know, a legacy today, even
(19:46):
though a lot of people have not really heard of
it as tragic and frightening as the disease was and
is really. In the end, it helped doctors understand more
about the brain. Von economist conclude Usian about the hypothalamus
and its role in the patients sleep, for example, was
hugely unpopular at the time, but many years later it
(20:09):
was proved to be true after we developed sorts of
imaging technologies that we can use to look directly at
the brain as it's working today. Neurologist Bernard Sacks also
wrote that the epidemic of encephalitis quote revolutionized the practice
of neurology. So it really changed the way that, uh,
these things were examined from the get go. Yeah, it
(20:30):
helped solidifying neurology as an actual field. In the early days,
there was sort of this hodgepodge of neurology ideas and
psychology ideas and all these things that were kind of
together in one big pot. And in part because of
encephalitis being spread the way that it was, a group
of doctors branched off to study just neurology and encephalitis.
(20:55):
Lethargica was also one of the conditions that made it
clear that disease process says, can lead to mental illnesses. Uh,
it's solidified the idea that mental illnesses were not solely
in the realm of emotions or traumatic experiences. It's not
always buried memories. Sometimes there can actually be a physical
happening that causes mental illness. There are a couple of
(21:16):
books that are out about this epidemic. The one that
I read researching. This podcast was called Asleep, The Forgotten
Epidemic that remains one of Medicine's greatest mysteries by Molly
Caldwell Crosby and her grandmother survived Sleepy Sickness. It starts
with sort of a case study of her grandmother. That's
(21:37):
terrifying because it's about her grandmother being asleep for so long,
but also being aware of what was happening around her,
which to me is just terrifying. The one caveat about
this book is that it was written before the very
most recent research about what might have caused this particular epidemic,
which is going to be the case which just about
(21:57):
every book now since the latest research is just very new. Yeah.
Last year, as we were recording, I have read several
papers that, uh, you know, and when the bird flew
epidemic was was everybody was very frightened about bird flu.
There were several articles that that came up where doctors
were like, actually, what you really should be afraid of
(22:19):
is a resurgence of this still unidentified encephalitis that sometimes
sometimes follows outbreaks of other diseases. I yeah, it's basically
my worst nightmare. I mean, I have not a good
relationship with sleep anyway. If I didn't have to do it,
I wouldn't. So the idea of not having any control
(22:40):
over the situation and just being asleep but not really
because you're conscious of things happening around is my worst nightmare. Yeah,
not to play on sleep jokes, but well, it's terrifying
and the there are many things about this whole, the
epidemic and the illness itself that are are frightening to me,
And one of them is that people would seem to
(23:03):
recover and they would be fine for a long time,
and then they developed, yeah, developed parkinson symptoms um and
once it had been established that that was a pattern,
I can imagine like the people who had gotten better
really being like I'm never going to be which I
know that's the case with a lot of diseases that
people have now, Like there are many cancer patients who
(23:25):
never feel like they are in the clear because you
can be intermission. So yeah, it's a scary thing to
live with that kind of over you cheerful it is.
Do you have listener mail? The cheer aside, do have
listener mail? And actually the first listener mail that I
have is very cheerful. I have two of them. One
(23:47):
of them is short. The first one is from Vince,
and he says, Dear Tracy, thank you for helping me
through some boring work days. During your recent podcast on
Louis Alvarez, you mentioned all the Berkeley Nobel laureates from
its past. Being a proud alum, I had recently had
a chance to visit Berkeley, and strolling around the campus,
I noticed this cute photo op between the two physics buildings,
(24:09):
and basically he attached a picture of this row of
prime parking spaces that all are like this space is
for a novel, a Nobel laureate. So Nobel laureates get
awesome reserved parking at Berkeley. They deserve it. They've probably
lost a lot of time in their lives to work
very hard on very difficult problems. Yeah. There there are
(24:29):
a lot of spaces, and they are right by building.
Says for me. It truly illustrates how good Berkeley research
really is. Thanks again, Vince, Thank you, Vince. I love
that picture. Yes, okay, the other one is from Sarah,
and I'm going to just start with a confession that
I worried that when we were talking about Luis Alvarez
that we were talking too much about how hard a
(24:51):
lot of his discoveries are to understand if you are
not also a physicist. So I particularly liked this letter
from Sarah. Sarah says, Hi, Holly, and Tracy. I'm a
graduate student at m I T and i love listening
to your podcast when I set up reactions in our
nitrogen filled glove box or washed my glassware. I just
listened to your podcast on Luis Alvarez, and I wanted
to thank you for all the podcasts you've done which
(25:13):
touch on science, even though for the purposes of this episode,
I'm a chemist and not a theoret radical physicist. I
find your descriptions clear and engaging, which is so rare
fined in science communication. I have a small correction to
make on your last episode where you mentioned that the
temperature of liquid hydrogen is degrees below zero celsius. I
think you meant minus two fifty three degrees celsius, since
(25:35):
absolute zero zero kelvin is minus two seventy three degrees celsius.
At this point, molecules cease to have entropy, and it
is the coldest possible temperature, so liquid hydrogen is twenty kelvin,
which is still really really cold, but not as clear
as liquid helium, which is for kelvin. Also, I was
(25:56):
interested in hearing the cheek lub crater mentioned. I studied
odd in the Yucatan Peninsula in college and visited the
town of chik Lube several times. But it was only
after I got back to the States that I saw
that twenty ten science paper that you mentioned and realized
that I had been in the impact site probably responsible
for the mass extinctions without knowing it. By the way,
(26:17):
you got the pronunciation pretty close, but it's actually pronounced
more like cheek salub. The x mention s h sound
apparently means something like lee devil according to Wikipedia. In
any case, it was amazing to have the chance to
study there. So much of the Mayan culture and the
language is preserved in the Yucatan. And then Sarah recommends
(26:38):
h subject for us to talk about, which we're just
going to save in case we're able to do that
in a later podcast, and she says, anyway, sorry this
email got so long, but I wanted to thank you
guys for your science recording. Keep up the good work, Sarah,
thank you so much. Sarah. Yeah, we got a few
corrections on the temperature thing we did. I would like
to thank Sarah's correction for being very nice about it.
(27:02):
There were a couple of people who needed to tell
us that corrections are bad and that mistakes are bad,
and we know that we try our best. So yes,
that is totally either a typo in my notes or
a typo and something I was making notes from. So
thank you very much for clarifying just how extremely extremely
cold liquid hydrogen is. Thankfully we did not work in
(27:23):
a lab where there would be actual scary implications of
us making the error of that magnitude. Yes, we're safe.
It's just words. It's just words, and we're edited though
it's kind of her job. But yeah, occasionally we do
get stuff wrong in spite of our best effort. So
(27:43):
thank you so much, Sarah. I am so glad to
hear from science people who enjoy us talking about science,
because I do love science, but because it is not yes,
because it is not like my primary field of study. Uh,
sometimes get stuff a little wrong. So if you would
like to write us a letter about this or any
(28:05):
other subject, you can. We're at History Podcast at Discovery
dot com. We're also on Facebook at Facebook dot com,
slash history class stuff and on Twitter at missed in History,
are Tumbler, isn't missed in History dot tumbler dot com,
and we are pinning things up on Pinterest. If you
would like to learn a little more about something we
talked about today, you can go to our website and
put the words sleep in the search bar. You will
(28:27):
find the article how sleep Works. You can do all
that in a whole lot more at our website, which
is how stuff Works dot com for more on this
and thousands of other topics because it how stuff Works
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