Let’s talk about that epidemic from a hundred years ago.
No, the other one. The way fucking weirder one.
Leaving half a million dead and countless others in states of suspended animation for decades, this mysterious illness came and went with barely a hint of an explanation.
Today’s Moment of Science… The Sleeping Sickness Pandemic of 1915-1926.
Meaning ‘inflammation of the brain’, whenever you hear the word ‘encephalitis,’ someone is having a miserable goddamn day. Causes can include trauma, autoimmune responses, and a long list of viruses. Sometimes it’s caused by the immune system going fucknuts on an old infection and, amidst the confusion, getting lost and taking a long wet shart on the brain instead.
There are scattered reports of illnesses with descriptions similar to encephalitis lethargica (EL) popping up here and there as early as the 1500s. The mysterious ailment reportedly showed up throughout Europe in the winter of 1915, and was first documented in medical literature by neurologist Constantin Von Economo in 1917. It had been hard to pin down because cases were so different patient to patient. Von Economo noticed a cluster of neurological symptoms tying the cases together.
There were three distinct presentations, the most common one was marked by extreme exhaustion. Presentation typically started out similarly to the flu with a fever, chills, headache, sore throat and vomiting. Some patients would have a sleep cycle switch, becoming more or less nocturnal. Most were deeply lethargic, falling asleep the moment they sat down.
Some recovered and went back to their lives to varying degrees of health. Many developed postencephalitic parkinson’s, which could take mere months or sometimes decades after the acute illness to show up. A million people were estimated to have contracted the illness, with fatalities thought to be around 500,000 people.
Not really comatose, but only tenuously connected to consciousness, many people were left with the motor still running and the transmission stuck in neutral. Patients had their consciousness, aware of everything around them, trapped in a motionless shell of a body.
So, Oliver Sacks.
The late neurologist had seen the phenomenal results of the drug levodopa on parkinson’s patients and he didn’t know what it would do for the EL patients, but after literal years of consideration he decided it was worth a shot. They were warehoused and just watching life pass by, the worst that could happen was nothing… right?
In 1969, after 40 years, they just woke up.
Wheelchair bound patients stood up, some started telling stories about the 1920s like it was yesterday. They remembered things that happened over the previous decades, one patient describing herself as a “spectator” of her life over the previous 43 years. They danced. They sang. They did more than merely exist for the first time in years.
Then the side effects started.
Levodopa is a precursor for dopamine, compensating for some neuron degradation in parkinson’s patients and having similar effects with EL patients. However, dosing people with an assload of dopamine is tricky business. It overstimulated the patients, leading to aggression, impulse control, hallucinations, and hypersexuality. Attempting to moderate the dosage or manage it with another drug didn’t work out for most of the patients.
What was the worst that could happen, eh?
Most of them just chose not to take another dose of levodopa one day, consigning themselves back to the long sleep.
So do we have a clue as to what caused this? Most folks specializing in fucked up diseases of the early twentieth century say it was probably a virus. I know some of you are thinking ‘Mrs. Auntie Scibabe, did you happen to notice there was a itsy little influenza pandemic at the same time?’ Which would have been super convenient, but nay.
A 2012 study on tissues of several of the EL patients suggested that an enterovirus was the likeliest cause. That’s about as close as anyone’s gotten to figuring it out.
This has been your daily Moment of Science reminding you that we barely have a clue what caused or how to treat a (likely) virus that killed half a million people a hundred years ago, and absolutely fucking nothing is stopping it from coming back.
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And well on the radar, EV-D68, which is usually asymptomatic to mild respiratory virus symptoms, save in some children under 5 and immunocompromised adults, both having asthma. Then, it can cause a polio-like paralysis of variable severity and a smattering of fatalities.