November 11, 2025 • 37 mins
"No fiction author would have had the temerity to invent a disorder of such incredible clinical diversity and puzzling behavior."
In the winter of 1916-1917, as World War I raged, physicians in Europe began noticing bizarre cases of brain illness. Thousands arrived at hospitals with high fevers, headaches, confusion, and a host of other factors - suspected at first to be meningitis or even poisoning - yet none of the explanations fit. What all of these patients shared was either an overwhelming drowsiness or psychotic agitation.
By late 1918, as the great influenza pandemic struck, this new "sleeping sickness" had spread across Europe and Beyond. Earlier that year, outbreaks were noted in England and the first American case was reported in September. By 1919, enough cases had surfaced worldwide that health officials realized they faced an epidemic of a baffling new illness...
Research & writing by Micheal Whelan and Amelia White
Hosting & production by Micheal Whelan
Learn more about this podcast at http://unresolved.me
If you would like to support this podcast, consider heading to https://www.patreon.com/unresolvedpod to become a Patron or Producer
Become a supporter of this podcast: https://www.spreaker.com/podcast/unresolved--3266604/support.
In the winter of 1916-1917, as World War I raged, physicians in Europe began noticing bizarre cases of brain illness. Thousands arrived at hospitals with high fevers, headaches, confusion, and a host of other factors - suspected at first to be meningitis or even poisoning - yet none of the explanations fit. What all of these patients shared was either an overwhelming drowsiness or psychotic agitation.
By late 1918, as the great influenza pandemic struck, this new "sleeping sickness" had spread across Europe and Beyond. Earlier that year, outbreaks were noted in England and the first American case was reported in September. By 1919, enough cases had surfaced worldwide that health officials realized they faced an epidemic of a baffling new illness...
Research & writing by Micheal Whelan and Amelia White
Hosting & production by Micheal Whelan
Learn more about this podcast at http://unresolved.me
If you would like to support this podcast, consider heading to https://www.patreon.com/unresolvedpod to become a Patron or Producer
Become a supporter of this podcast: https://www.spreaker.com/podcast/unresolved--3266604/support.
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Episode Transcript
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Speaker 1 (00:03):
This episode contains graphic content that may not be suitable
for all ages. Listener discretion is advised. If you or
someone you know is struggling or in crisis, help is available,
call or text nine eight eight, or chat with someone
at nine eight eight lifeline dot Org. Those outside of
the US, reach out to someone at your local crisis
(00:24):
center or hotline. Please do not Suffer in Silence. Nineteen
twenty four, London. During the nightly rounds at a hospital ward,
things felt unusually quiet. In bed after bed lay, patients
(00:46):
locked in uncanny slumber. One young woman, normally vivacious and
twenty years of age, now barely stirred her eyes when
they opened at all were blank and unseeing. Middle aged
man sat propped together pillows, frozen in a statue like pose,
with one arm mid gesture as if turned a stone
(01:06):
across the room. Another patient suddenly let out a delirious murmur,
then just as quickly lapsed back into silence. The only
real sound was the ticking clock and the faint breaths
of the afflicted. Doctors whispered of sleepy sickness, an illness
that gripped its victims in unrelenting lethargy or strange waking trances.
(01:27):
Families kept vigil by bedsides, watching their loved ones hover
between life and becoming living ghost. It was a scene,
at once medical and otherworldly, an early glimpse into a
medical mystery unfolding across the world. This is the story
of encephalitis lethargica. In the winter of nineteen sixteen going
(02:03):
into nineteen seventeen, as World War I raged, physicians in
Europe began noticing bizarre cases of brain illness. In Vienna,
a young neurologist named Constantine van Economo saw patients who
defied known diagnoses. Some arrived with high fevers, headaches and confusion,
suspected meningitis or even poisoning, yet none of those explanations fit.
(02:28):
What they all shared was an overwhelming drowsiness or psychotic
agitation that seemed to arise from nowhere. Profound and prolonged
sleep had been seen in past influence outbreaks, but this
was something new. Van Economo meticulously documented thirteen such cases
in early nineteen seventeen, noting a telltale triad of lethargy,
(02:50):
strange eye problems, and fever. In April nineteen seventeen, he
published a paper announcing a novel disease. He named it
encephalitis lethargica Latin for inflammation of the brain that makes
you tired, give or take. Almost simultaneously, in France, military
doctor Jean rene Crouchet reported soldiers with similar symptoms. At first,
(03:14):
these scattered cases carried many labels epidemic, stupor, bulbar paralysis,
even botulism, because doctors struggled to classify them. But once
von Economo's reports spread, others recognized the pattern. Patients would
start with what looked like a flu or a sore throat, body, aches, fever, fatigue.
(03:35):
Then the illness would veer into the extraordinary. Some victims
became wildly restless or hallucinating, while others slipped into near
comatose lethargy, from which they could barely be roused. Strange
neuropsychiatric behaviors were common. People might speak nonsense, jerk in
ticks or tremors, or lapse into catatonic stillness. One early
(03:57):
French report described children and adults a life like who
one moment seemed simply fatigued, and the next were caught
in a half awake, half dreaming state. Neither fully asleep
nor awake, eyes gazing but unresponsive. By late nineteen eighteen,
as the Great Influenza pandemic struck, this new sleeping sickness
had spread across Europe and beyond. Earlier that year, outbreaks
(04:20):
were noted in England, Initially mistaken for polio or even
a form of botulism, The disease then jumped the Atlantic.
The first US case was documented in New York City
in September of nineteen eighteen. Soon encephalitis lethargica was appearing
in dozens of cities from North America to South America,
India and beyond. Wartime censorship and chaos meant that early
(04:44):
warnings were modeled. Yet by nineteen nineteen, enough cases had
surfaced worldwide that health officials realized they were facing an
epidemic of a baffling new illness. Between nineteen nineteen and
nineteen twenty four, the epidemic of encephalitis lethargica grew to
(05:06):
terrifying proportions. Over one million people were afflicted across the globe.
The disease did not discriminate adults and children. Soldiers and
civilians all were affected, though some reports suggested young people
especially young women were often among the most vulnerable. Public
health reports estimated that hundreds of thousands died during this period,
(05:30):
roughly one in three patients. Many who survived the acute
illness were left with devastating disabilities. Contemporary news articles dubbed
it the sleepy sickness, and it caused both fascination and
panic in communities already worn down by war and influenza.
The symptoms of encephalitis lethargica were astonishingly varied. In most patients,
(05:52):
it began innocently, even mundanely, a slight fever, maybe a
sore throat or sniffles that would normally hint at a
common coal or flew, but within days, far stranger problems appeared.
Double vision was frequently an early clue. Patient's eyes had
trouble focusing, or one eyelid might begin to droop. They
developed tremors and muscle pains that made limbs quiver or jerk.
(06:15):
Unpredictably delayed reflexes were also noted. A doctor could shine
a light in the patient's eye or call their name,
and the response would come seconds too late. As the
illness progressed, dramatic behavioral changes emerged. Some patients flew into psychosis,
hallucinating vividly or behaving erratically, convinced of unreal things. Others
(06:36):
became manically sleepless, unable to close their eyes for days
on end despite extreme exhaustion. Are more common. However, was
the opposite, an overwhelming sense of lethargy. Patients could sleep
twenty hours a day and still be difficult to wake up.
Families described loved ones who could be woken for only
a few minutes to eat before slipping back into a
(06:58):
stupor noted that this was not normal sleep, but a
pathological state. A patient might respond to a loud voice
or pain, but only briefly, drifting away again as if
pulled by an unseen force. Those who fell into the
deepest coma like states often never woke up again entire wards.
In city hospitals were filled with patients in trance. As
(07:20):
one account described, strange neuropsychiatric behaviours and overwhelming lethargic sleepiness,
which induced a coma like state, as well as muscle rigidity,
were cornerstones of the illness. Yet paradoxically, not every patient
had all symptoms, and severity ranged widely. This made the epidemic.
Even more confounding, a young man might lie rigid and mute,
(07:44):
eyes rolled up, while in the next room a middle
aged woman babbled incessantly, gripped by insomnia and paranoid delusions.
Both had the same disease. Doctors struggled to find a
unifying explanation for such a protean illness. What they did
know was that encephalitis lethargica could be deadly. About one
(08:05):
third of patients died in the acute phase, often from
respiratory failure, when the brain's control of breathing faltered. Imagine
a patient who grows drowsier each day, until finally even
the act of breathing and swallowing becomes too sluggish. Many
patients simply slipped away. Newspapers of the early nineteen twenties
(08:25):
carried reports of the sleeping sickness in somber terms. One
American report reassured the public that at present, there was
nothing whatever to justify a scare. It is best avoided
by not worrying about it. Hardly comforting words amidst such strangeness.
In truth, doctors had no effective treatment. Care was supportive,
(08:47):
keeping patients fed and clean, trying stimulant drugs or sedatives
with little effect. Encephalitis lethargica was a medical enigma, and
physicians knew it. By nineteen twenty four, the United States
was experiencing its worst years of the epidemic. In the US,
cases spiked, especially between nineteen twenty and twenty four. Worldwide,
(09:08):
the peak virulins seems to have hit during late nineteen
eighteen going into nineteen nineteen, the same time as the
infamous nineteen eighteen influenza pandemic's second wave. Some historians later
estimated that encephalitis lethargica ultimately claimed over five hundred thousand
lives globally. It was overshadowed in sheer mortality by the
Spanish flu, which killed tens of millions, Yet in many ways,
(09:32):
the sleepy sickness was more mysterious and terrifying to neurologists.
One researcher wrote of encephalitis lethargica's bewildering symptoms, no fiction
author would have had the temerity to invent a disorder
of such incredible clinical diversity and puzzling behavior, Unlike polio,
another scourge of that era, which primarily struck the spine
(09:53):
and muscles. This illness attacked the mind and personality, blurring
the line between psychiatric illness and neurological disease. Patients could
linger in a half alive state that doctors increasingly found eerie.
One New York physician in nineteen twenty one described walking
into a ward and seeing rows of patients as insubstantial
(10:13):
as ghost and as passive as zombies. Such imagery was
no exaggeration, It was the only way to capture what
he saw. The press at the time recounted heartrending stories
school children who one week were energetic and by the
next week sat at their desk staring blankly for hours.
A newlywed bride who collapsed at the altar into a
(10:34):
sleep from which she never truly awakened. A laborer who
flew into a wild rage of hallucinations and then froze
mid stride, trapped in his own body. While some of
these reports were undoubtedly embellished, they all spoke to the
public horror and fascination with this sleeping sickness. Doctors and
(10:58):
caretakers on the front lineans left vivid accounts of this
strange plague. Over in Vienna, Austria, doctor Constantine Vanconomo noted
how patients would sometimes respond normally one moment and then
fade into stupor the next. In the light cases, it
is striking how similar the somnolence is to physiological sleep,
since the patients are easily awakened. He wrote, only to
(11:21):
find that severe cases crossed into an unreachable realm. In France,
physicians observed that some victims had periods of relative lucidity,
even returning to work, before the illness struck again, like
a delayed curse. Diaries of family members tell of desperate
attempts to wake loved ones with loud shouts or sharp pinches,
(11:41):
usually in vain. A mother in Boston wrote in nineteen
twenty three about her teenage son, he simply sits in
the chair all day. If I ask him why, he
says he feels his limbs turning to stone. I cannot
tell when he is awake or asleep. It is as
if he is both and neither. The patients themselves, when
they could communicate, described terrifying experiences. Some said it felt
(12:05):
like being buried, alive in their own bodies, aware of
things around them, but unable to respond. A young woman
who recovered in Paris, recalled the onset I was so tired,
then my mind wandered in nightmares. Even as I sat awake.
I knew something was happening to me when I could
no longer lift my arm or speak a full sentence.
Another man, in an asylum report described a surge of
(12:28):
uncontrollable rage and ticks. My body was not mine. It
jerked and twisted on its own, and I heard voices
that weren't there. These personal voices highlight how encephalitis lethargica
blurred the boundary between sleep and wakefulness, between sanity and delirium.
One striking feature often recounted was the statue phenomenon. Patients
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who did not die in the acute phase sometimes entered
a bizarre chronic state. They could sit motionless, catatonic for hours,
even days, yet occasionally, inexplicably, they would erupt back into
life for a brief time. This led doctor von Aconomo
to famously compare these patients to extinct volcanoes that could
unexpectedly flare up. In one case, nurses reported a woman
(13:15):
who had been mute and rigid for weeks suddenly stood
up and sang an old music hall song, only to
fall silent and frozen again by the next day. Such
episodes were rare glimmers of the person trapped within. The
medical voices of this era also include those of skepticism
and confusion. Some doctors wondered aloud if this was even
a single disease or a mix of different conditions. The
(13:39):
symptom variability was so great that a few suggested encephalitis
lethargica might be a catch all label for disparate brain illnesses. However,
the consistency of the epidemics, timing, and aftermath argued otherwise.
As neurologist Paul Bernard Foley noted a century later, the
evidence was overwhelming that encephalitis lethargica was a disorder Swede generis,
(14:02):
a unique plague of its own. Folly remarked on the
fascinating horror of its course, an acute flu like illness,
an intermediate phase of neurological nightmares, and a chronic phase
that could be more devastating than the acute one. The
fact that this disease then vanished unexpectedly only deepened the intrigue.
(14:30):
Almost as enigmatically as it arose, the epidemic faded out.
By nineteen twenty seven, new cases of true encephalitis lethargica
had dwindled to near zero. There were still isolated patients
in the early nineteen thirties, but no widespread outbreaks. The
sleepy sickness pandemic had burned through in about a decade
(14:51):
and then disappeared. Doctors in nineteen twenty eight were baffled.
Epidemics of infectious disease rarely just stop without a cl reason,
yet that is exactly what happened. One medical report from
nineteen twenty nine stated, almost in disbelief, the pandemic disappeared
as abruptly and mysteriously as it first appeared. So why
(15:14):
did it stop. At the time, some researchers speculated that
the causative agent, whatever it was, had simply died out
or mutated to a harmless form. Others thought that perhaps
the epidemic was tied to the nineteen eighteen influenza, and
that once that flu was gone, this secondary epidemic also waned.
In fact, the worst years of encephalitis lethargica did coincide
(15:37):
with the tail end of the Spanish flu pandemic. One
hypothesis was that influenza infection somehow potentiated the sleeping sickness,
weakening patient's resistance or paving the way for a second infection. However,
when scientists later tried to find influenza virus in the
preserved brain tissue of encephalitis lethargic of victims, they found
(15:58):
no trace between the two. Pandemics remained circumstantial. As the
epidemic receded, it left a long shadow. Many survivors initially
seemed to recover fully and returned to normal life, but
as years passed, an alarming number developed strange post encephalitic complications.
This could happen after a delay, sometimes a year, sometimes
(16:21):
a decade or more of apparent health. Gradually, doctors realized
that encephalitis lethargica was not over for these people at all.
In the late nineteen twenties and thirties, reports emerged of
former patients developing Parkinson's disease like symptoms, tremors, muscle rigidity,
masked facial expressions, and slowed movements. Others showed severe psychiatric changes,
(16:45):
from depression and apathy to impulsive violence. Children who had
survived encephalitis lethargica were especially noted to undergo troubling personality
changes as they grew. Some became hyperactive, aggressive, even psychopathic,
and behavior. One review described how a subset of those
infected at ages five through ten later exhibited pathologic changes
(17:07):
of character that approached the psychopathic cruelty, destructiveness, and self mutilation,
including a horrific case where a child gouged out their
own eyes during a bout of encephalitis induced madness. These
were extreme outcomes, of course, but they highlighted that the
disease's effects could be life long and life altering. In
(17:28):
medical literature, this delayed fallout was termed post encephalitic parkinsonism
or PEP and other post encephalitic syndromes. Some patients deteriorated
rapidly and died young. Others plateaued with moderate disability, yet
others lived for decades in a profoundly disabled state. By
(17:48):
the nineteen forties and fifties, thousands of these survivors were
living in chronic care hospitals or at home, often mislabeled
as simple Parkinson's disease or as psychiatric patients. Over time, however,
their unique history was largely forgotten by the public. The
world moved on with encephalitis lethargica becoming a medical curiosity
(18:09):
in textbooks. As von Aconomo had predicted back in nineteen
twenty nine, the epidemic's impact on neuroscience was significant. It
s burred new understanding of brain regions like the basal ganglia,
the deep structures tied to movement and behavior, in the
role of the substantia negra in parkinson like disorders. But
(18:29):
despite these scientific advances, the patients themselves faded into the
background of mid twentieth century medicine. Encephalitis lethargica, though, became
an almost mythic memory, a ghost of a pandemic that
no one could ever explain. The story of encephalitis lethargica
might have ended as a dusty chapter in neurology if
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not for an extraordinary episode decades later. Nineteen sixty six,
a young neurologist named Oliver Sachs took a job at
a chronic hospital in the Bronx. To his astonishment, he
found eighty survivors of the long ago epidemic languishing in
the wards. These patients had all fallen ill in the
nineteen twenties as children or young adults, and had been
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institutionalized for decades. When doctor Sachs first encountered them, he
was struck by an eerie scene that echoed the epidemic's
peak years. He later recalled, I suppose the first impression
was that had entered a museum or a waxwork gallery.
There were motionless figures, transfixed in strange postures. Everything looked frozen.
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These patients hardly moved or spoke. Some could not even
blink on command, appearing as living statues. Yet occasionally, doctor
sach said, very suddenly one of these patients would be
released from this state and would speak and move. Then
you could see what a vivid a life person was there.
Imprisoned by some strange physiological change, These long neglected individuals
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were effectively catatonic, victims of the chronic phase of encephalitis lethargica.
Doctor sax realized that many of these patients exhibited classic
Parkinsonian symptoms tremors, rigidity, and slowness of movement, albeit in
a very extreme form. He hypothesized that their brain's motor circuits,
(20:18):
especially the dopamine induced substantia negra, had been damaged by
the illness. In the late nineteen sixties, a new drug
called el dopa l dopa or leveedopa, was showing remarkable
success in treating Parkinson's disease by boosting dopamine levels. Zax
pleaded with this hospital to let him try el dopa
(20:39):
on his sleepy sickness patients. In the summer of nineteen
sixty nine, he finally got approval to administer the drug.
What followed would seem almost miraculous. Within days of receiving
el dopa, many of the post encephalitic patients awakened. Some
after decades of near total immobility. They opened their eyes,
(21:00):
sat up, and began to talk, startling the hospital staff.
One of Sax's first patients, a man who had been
virtually mute and wheelchair bound since the nineteen twenties, suddenly
stood and walked, exclaiming over all the changes that had
occurred in the world around him. Another patient, a woman
who had not spoken since childhood, regained fluent speech and
(21:21):
asked for ice cream. Zax wrote that these patients irrupted
into life, like those extinct volcanoes coming back alive. It
was an emotional and profound rebirth. The hospital atmosphere turned
jubilant and astonished for a brief time. Tragically, this miracle
was short lived. As weeks went by, complications set in.
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The patients on Eldoba began experiencing side effects. Some developed
severe takes or manic behavior. Others plateaued and then began
to slip back into inertia. The awakening could not be sustained.
Most of the patients relapsed into their frozen states despite
continued medication. Zax documented these remarkable and heartbreaking events in
(22:05):
his nineteen seventy three book Awakenings. The book, which later
became a Hollywood film, brought the plight of encephalitis lethargica
survivors into public view. In one poignant scene dramatized in
the film, a patient awakened after thirty years, played by
Robert de Niro, and they observed, people have forgotten what
life is all about. They've forgotten what it is to
(22:27):
be alive. This line captured the bittersweet truth for those
few shining weeks, the long lost victims had tasted normal
life again, only to have it slip away. Zach's work
confirmed that the post encephalitic patients were neurologically akin to
extreme cases of Parkinson's. The fact that el doba could
(22:48):
rouse them if only temporarily, was a critical clue. It
suggested that the disease had damaged dopamine pathways and that
their brains still had the capacity, however limited to function
if chemically jump started. Facts and others noted that these
patients were living proof of how encephalitis lethargica had bridged
psychiatry and neurology. These victims were not suffering from a
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psychiatric illness per se, though they appeared catatonic or comatose. Instead,
a neurological injury had imprisoned their minds. By the late
nineteen seventies, most of the post encephaltic survivors had passed
away and the chapter of awakenings closed, but their story
reignited scientific curiosity about what had caused encephalitis lethargica in
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the first place, a question that had lingered without answer
since the nineteen twenties. What caused the Great encephalitis lethargica epidemic.
This question remains one of medicine's biggest unsolved mysteries. From
(23:56):
the start, viral theories were prominent given the timing during
the nineteen eighteen flu pandemic. Many early researchers suspected a link,
perhaps a mutated influenza virus had a rare ability to
attack the brain, or possibly the flu weakened the population,
allowing another unidentified virus to spread. Some autopsies of encephalitis
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lethargic victims did show inflammation in the brainstem and mid brain,
suggesting an infectious agent, but extensive searches for a microbe
were inconclusive. No bacteria grew in culture, no fungi or
parasites were evident, and viruses were very hard to detect
with the technology of the nineteen twenties, so the virus
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theory remained just that a theory. In nineteen eighty two,
British neurologist doctor John Oxford tried applying modern molecular tools
to samples of brain tissue preserved from nineteen twenties patients.
He specifically looked for remnants of influenza virus genetic material.
None was found. This seemed to rule out the simple
(25:00):
idea that the flu virus itself caused the brain illness. However,
it did not exclude the possibility of another virus or
a post viral effect. Another theory that gained traction was
an autoimmune reaction, the body's immune system mistakenly attacking the brain.
Back in the nineteen twenties, this concept was not well understood,
(25:21):
but some doctors had noted that encephalitis lethargica often followed
a sore throat or a respiratory infection. Decades later, this
clue became vital. In the early two thousands, neurologist doctor
Russell Dale and doctor Andrew Church in Britain investigated several
modern patients who presented with encephalitis lethargical like syndromes. They
(25:42):
found an intriguing common thread. Most had recently had strepococcal
throat infections caused by Strepococcus bacteria historically called Diplococci I.
Now I know diplococci. It sounds funny. Doctor Dale and
his colleagues gathered twenty such cases and ran immunological time. Astonishingly,
ninety five percent of these patients at high levels of
(26:04):
antibodies that attacked basal ganglia neurons, a part of the
brain controlling movement. In comparison, fewer than four percent of
healthy controls had such antibodies. They even found these antibodies
in the spinal fluid of some patients, meaning that the
immune system was actively reacting within the brain. His findings,
published in two thousand and four strongly supported that encephalitis
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lethargica might be a form of autoimmune encephalitis triggered by
a common infection. Essentially, the theory is that a strep
throat could, in rare instances, provoke the body to mount
an excessive immune response. Antibodies meant to fight bacteria could
mistakenly attack the brain's own cells, especially in regions controlling
sleep and movement. This would explain both the initial flu
(26:51):
like illness and the delayed Parkinsonian damage. The autoimmune theory
has parallels to other conditions like sydonyms chorea or Saint
Fhytus's day ants, a movement disorder that can follow strep
infection and Panda syndrome, and children pndas, where strap triggers
psychiatric symptoms. It's plausible that encephalitis lethargica was a particularly
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aggressive post infectious autoimmune storm. Supporting this, reports from the
original nineteen twenties autopsies noted not just localized damage, but
widespread inflammation in the brain, even in the core text,
with immune cells active. At least one contemporary pathologist commented
that the pattern looked like the body had attacked its
own brain. Still, not everyone is convinced. Some experts argue
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that a novel virus still could have been the culprit,
perhaps one that has sins disappeared. There are historical hints
for that. For example, around nineteen twenty six, there was
an unusual outbreak of encephalitis in children in Alaska and Canada,
initially thought unrelated but possibly the tail end of the
same phenomenon. If a virus was responsible, it might have
(28:01):
been one that required particular conditions like war and global
movement to spread, and once those conditions passed, the virus retreated.
Because virology was very primitive at that time, the virus
could have vanished unrecognized. In modern times, a few cases
of true encephalitis lethargica have been verified, but occasionally a
(28:23):
report does serve us. In nineteen ninety three, a twenty
three year old British woman named Becky Howells fell ill
with classic symptoms fever, tremors, hallucinations, and limb rigidity. Doctors
diagnosed her with encephalitis lethargica, one of the first such
diagnoses in decades. Her case prompted alarmist headlines about the
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return of sleepy sickness. A few years later, in two
thousand and four, a seventeen year old in the UK
named Sophie Cameron developed encephalitis and cardiac arrest that left
her severely brain damaged. Though her illness was not definitively
the same. It led to the creation of a research fund,
the Sophie Cameron Trust, to study encephalitis lethargica and related
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brain inflammation disorders. These instances show that the mystique of
encephalitis lethargica still haunts the medical community. If the cause
of encephalitis lethargica was autoimmune, we might see sporadic cases
when the same rare immune mishap occurs. If it was viral,
that virus could theoretically re emerge or already be circulating
(29:28):
in milder form. To date, no single pathogen has been
confirmed as the cause. The best guess in recent reviews
is that encephalitis lethargica represented a perfect storm of factors.
A microbial trigger, perhaps strepococcal infection, or less likely, a
virus combined with an aberate immune response in certain individuals
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with modern intensive care and immunotherapies like steroids or IVG
that calm the immune system. One hopes that a future
outbreak could be managed better if such a thing were
to ever occur. Encephalitis lethargica's tail is a haunting reminder
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of the limits of medical knowledge and the unpredictable nature
of diseases. This bizarre epidemic struck without warning, confounded the
greatest medical minds of the time, and then vanished, leaving
more questions than answers. It shows us how, even in
an age of scientific advancement the nineteen twenties, after all,
saw great strides in microbiology and neurology, nature can often
(30:39):
present a riddle that remains unsolved. The legacy of encephalitis
lethargica a century later is multifaceted. Scientifically, it spurred crucial discoveries.
Researchers forced to grapple with an illness that was both
neurological and psychiatric began to break down the silos between
those disciplines. The disease showed that inflammation of the brain
(31:00):
could manifest as hallucinations, personality changes, or catatonia, blending mind
and body symptoms This helped pave the way for modern
concepts of neuroimmunology and the recognition of disorders like autoimmune encephalitis.
The epidemic also led to the identification of the extra
puimidal motor system in the brain, the network outside the
(31:21):
motor cortex that controls movement, habits, and muscle tone. Because
Encephalitis lethargica so often damaged this system, scientists like Constantine,
Vonaconomo and others began to map out structures and their
role in movement disorders. In essence, the disease unwittingly taught
us about parkinsonism and how rigid paralysis can result from
(31:42):
brain injuries, knowledge that later informed treatments for Parkinson's disease itself. Culturally,
the story of the Sleepy Sickness remains both chilling and inspiring.
It is chilling in the sense of how vulnerable we
still are to mystery diseases. A century on, we have
witnessed new pandemics, not only novel influenzas, but others like
(32:04):
HIV and COVID nineteen, and each time faced significant unknowns.
Encephalitis lethargica reminds us that an epidemic can elude explanation
even long after it's gone. It warns against over confidence
that we have conquered all plagues. As late as the
twenty twenties when this episode comes out, scholars were still
debating if the sleepy sickness was due to a virus,
(32:27):
an autoimmune quirk, or something else entirely. But while this
is incredibly terrifying to think about, the human stories from
this epidemic are inspiring for the resilience and curiosity that
they highlight. The patients who endured decades imprisoned in themselves.
Their brief awakenings show the perseverance of the human spirit
and the ceaseless drive of scientists and doctors to help.
(32:48):
Even years later. Doctor Oliver Sach's compassionate work with those
survivors shines as an example of empathy and ingenuity in medicine.
Is description of the patients as extinct volcano that roared
back to life encapsulates both the awe and the tragedy
of encephalitis lethargica. So now as we get to the
end of this episode, I'm sure you're wondering could this
(33:10):
ever come back? Given what we know a repeat epidemic
of the same scale seems unlikely, but not impossible. If
the culprit was an infectious agent that vanished, it might
stay hidden or extinct. If it was an autoimmune phenomenon,
it might be that the specific combination of factors, perhaps
(33:31):
a particular strain of strep circulating widely plus a susceptible
population post war, was unique to that era. However, we
should all remain vigilant. A cluster of unexplained encephalitis cases
today would undoubtedly prompt rapid investigation with tools far beyond
what nineteen twenty science had. The world has also built
(33:51):
networks like the Encephalitis Society to share information quickly if
any sleepy sickness cases emerge. In a sense, encephalitis lethargica
pushed medicine to be more interdisciplinary and alert. The saga
of encephalitis lethargica is a true medical mystery, a real
life plague that unfolded with suspense, baffled experts, left a
(34:12):
trail of devastation, and then disappeared without revealing any of
its secrets. In that uncertainty lies its haunting legacy, a
reminder that not all of nature's mysteries have been solved,
and that the line between wakefulness and oblivion, between a
person and the living statue they might become, can be
thinner than we ever imagined. The story of encephalitis lethargica
(34:35):
remains unresolved. Thank you for listening to this episode of Unresolved.
(35:01):
I have been your host, Michael Wheelan. This episode was
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(35:43):
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(36:25):
us get to a good spot as we begin prepping
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Speaker 2 (36:46):
By everyone, Come come, don't come. Got coll
This episode contains graphic content that may not be suitable
for all ages. Listener discretion is advised. If you or
someone you know is struggling or in crisis, help is available,
call or text nine eight eight, or chat with someone
at nine eight eight lifeline dot Org. Those outside of
the US, reach out to someone at your local crisis
(00:24):
center or hotline. Please do not Suffer in Silence. Nineteen
twenty four, London. During the nightly rounds at a hospital ward,
things felt unusually quiet. In bed after bed lay, patients
(00:46):
locked in uncanny slumber. One young woman, normally vivacious and
twenty years of age, now barely stirred her eyes when
they opened at all were blank and unseeing. Middle aged
man sat propped together pillows, frozen in a statue like pose,
with one arm mid gesture as if turned a stone
(01:06):
across the room. Another patient suddenly let out a delirious murmur,
then just as quickly lapsed back into silence. The only
real sound was the ticking clock and the faint breaths
of the afflicted. Doctors whispered of sleepy sickness, an illness
that gripped its victims in unrelenting lethargy or strange waking trances.
(01:27):
Families kept vigil by bedsides, watching their loved ones hover
between life and becoming living ghost. It was a scene,
at once medical and otherworldly, an early glimpse into a
medical mystery unfolding across the world. This is the story
of encephalitis lethargica. In the winter of nineteen sixteen going
(02:03):
into nineteen seventeen, as World War I raged, physicians in
Europe began noticing bizarre cases of brain illness. In Vienna,
a young neurologist named Constantine van Economo saw patients who
defied known diagnoses. Some arrived with high fevers, headaches and confusion,
suspected meningitis or even poisoning, yet none of those explanations fit.
(02:28):
What they all shared was an overwhelming drowsiness or psychotic
agitation that seemed to arise from nowhere. Profound and prolonged
sleep had been seen in past influence outbreaks, but this
was something new. Van Economo meticulously documented thirteen such cases
in early nineteen seventeen, noting a telltale triad of lethargy,
(02:50):
strange eye problems, and fever. In April nineteen seventeen, he
published a paper announcing a novel disease. He named it
encephalitis lethargica Latin for inflammation of the brain that makes
you tired, give or take. Almost simultaneously, in France, military
doctor Jean rene Crouchet reported soldiers with similar symptoms. At first,
(03:14):
these scattered cases carried many labels epidemic, stupor, bulbar paralysis,
even botulism, because doctors struggled to classify them. But once
von Economo's reports spread, others recognized the pattern. Patients would
start with what looked like a flu or a sore throat, body, aches, fever, fatigue.
(03:35):
Then the illness would veer into the extraordinary. Some victims
became wildly restless or hallucinating, while others slipped into near
comatose lethargy, from which they could barely be roused. Strange
neuropsychiatric behaviors were common. People might speak nonsense, jerk in
ticks or tremors, or lapse into catatonic stillness. One early
(03:57):
French report described children and adults a life like who
one moment seemed simply fatigued, and the next were caught
in a half awake, half dreaming state. Neither fully asleep
nor awake, eyes gazing but unresponsive. By late nineteen eighteen,
as the Great Influenza pandemic struck, this new sleeping sickness
had spread across Europe and beyond. Earlier that year, outbreaks
(04:20):
were noted in England, Initially mistaken for polio or even
a form of botulism, The disease then jumped the Atlantic.
The first US case was documented in New York City
in September of nineteen eighteen. Soon encephalitis lethargica was appearing
in dozens of cities from North America to South America,
India and beyond. Wartime censorship and chaos meant that early
(04:44):
warnings were modeled. Yet by nineteen nineteen, enough cases had
surfaced worldwide that health officials realized they were facing an
epidemic of a baffling new illness. Between nineteen nineteen and
nineteen twenty four, the epidemic of encephalitis lethargica grew to
(05:06):
terrifying proportions. Over one million people were afflicted across the globe.
The disease did not discriminate adults and children. Soldiers and
civilians all were affected, though some reports suggested young people
especially young women were often among the most vulnerable. Public
health reports estimated that hundreds of thousands died during this period,
(05:30):
roughly one in three patients. Many who survived the acute
illness were left with devastating disabilities. Contemporary news articles dubbed
it the sleepy sickness, and it caused both fascination and
panic in communities already worn down by war and influenza.
The symptoms of encephalitis lethargica were astonishingly varied. In most patients,
(05:52):
it began innocently, even mundanely, a slight fever, maybe a
sore throat or sniffles that would normally hint at a
common coal or flew, but within days, far stranger problems appeared.
Double vision was frequently an early clue. Patient's eyes had
trouble focusing, or one eyelid might begin to droop. They
developed tremors and muscle pains that made limbs quiver or jerk.
(06:15):
Unpredictably delayed reflexes were also noted. A doctor could shine
a light in the patient's eye or call their name,
and the response would come seconds too late. As the
illness progressed, dramatic behavioral changes emerged. Some patients flew into psychosis,
hallucinating vividly or behaving erratically, convinced of unreal things. Others
(06:36):
became manically sleepless, unable to close their eyes for days
on end despite extreme exhaustion. Are more common. However, was
the opposite, an overwhelming sense of lethargy. Patients could sleep
twenty hours a day and still be difficult to wake up.
Families described loved ones who could be woken for only
a few minutes to eat before slipping back into a
(06:58):
stupor noted that this was not normal sleep, but a
pathological state. A patient might respond to a loud voice
or pain, but only briefly, drifting away again as if
pulled by an unseen force. Those who fell into the
deepest coma like states often never woke up again entire wards.
In city hospitals were filled with patients in trance. As
(07:20):
one account described, strange neuropsychiatric behaviours and overwhelming lethargic sleepiness,
which induced a coma like state, as well as muscle rigidity,
were cornerstones of the illness. Yet paradoxically, not every patient
had all symptoms, and severity ranged widely. This made the epidemic.
Even more confounding, a young man might lie rigid and mute,
(07:44):
eyes rolled up, while in the next room a middle
aged woman babbled incessantly, gripped by insomnia and paranoid delusions.
Both had the same disease. Doctors struggled to find a
unifying explanation for such a protean illness. What they did
know was that encephalitis lethargica could be deadly. About one
(08:05):
third of patients died in the acute phase, often from
respiratory failure, when the brain's control of breathing faltered. Imagine
a patient who grows drowsier each day, until finally even
the act of breathing and swallowing becomes too sluggish. Many
patients simply slipped away. Newspapers of the early nineteen twenties
(08:25):
carried reports of the sleeping sickness in somber terms. One
American report reassured the public that at present, there was
nothing whatever to justify a scare. It is best avoided
by not worrying about it. Hardly comforting words amidst such strangeness.
In truth, doctors had no effective treatment. Care was supportive,
(08:47):
keeping patients fed and clean, trying stimulant drugs or sedatives
with little effect. Encephalitis lethargica was a medical enigma, and
physicians knew it. By nineteen twenty four, the United States
was experiencing its worst years of the epidemic. In the US,
cases spiked, especially between nineteen twenty and twenty four. Worldwide,
(09:08):
the peak virulins seems to have hit during late nineteen
eighteen going into nineteen nineteen, the same time as the
infamous nineteen eighteen influenza pandemic's second wave. Some historians later
estimated that encephalitis lethargica ultimately claimed over five hundred thousand
lives globally. It was overshadowed in sheer mortality by the
Spanish flu, which killed tens of millions, Yet in many ways,
(09:32):
the sleepy sickness was more mysterious and terrifying to neurologists.
One researcher wrote of encephalitis lethargica's bewildering symptoms, no fiction
author would have had the temerity to invent a disorder
of such incredible clinical diversity and puzzling behavior, Unlike polio,
another scourge of that era, which primarily struck the spine
(09:53):
and muscles. This illness attacked the mind and personality, blurring
the line between psychiatric illness and neurological disease. Patients could
linger in a half alive state that doctors increasingly found eerie.
One New York physician in nineteen twenty one described walking
into a ward and seeing rows of patients as insubstantial
(10:13):
as ghost and as passive as zombies. Such imagery was
no exaggeration, It was the only way to capture what
he saw. The press at the time recounted heartrending stories
school children who one week were energetic and by the
next week sat at their desk staring blankly for hours.
A newlywed bride who collapsed at the altar into a
(10:34):
sleep from which she never truly awakened. A laborer who
flew into a wild rage of hallucinations and then froze
mid stride, trapped in his own body. While some of
these reports were undoubtedly embellished, they all spoke to the
public horror and fascination with this sleeping sickness. Doctors and
(10:58):
caretakers on the front lineans left vivid accounts of this
strange plague. Over in Vienna, Austria, doctor Constantine Vanconomo noted
how patients would sometimes respond normally one moment and then
fade into stupor the next. In the light cases, it
is striking how similar the somnolence is to physiological sleep,
since the patients are easily awakened. He wrote, only to
(11:21):
find that severe cases crossed into an unreachable realm. In France,
physicians observed that some victims had periods of relative lucidity,
even returning to work, before the illness struck again, like
a delayed curse. Diaries of family members tell of desperate
attempts to wake loved ones with loud shouts or sharp pinches,
(11:41):
usually in vain. A mother in Boston wrote in nineteen
twenty three about her teenage son, he simply sits in
the chair all day. If I ask him why, he
says he feels his limbs turning to stone. I cannot
tell when he is awake or asleep. It is as
if he is both and neither. The patients themselves, when
they could communicate, described terrifying experiences. Some said it felt
(12:05):
like being buried, alive in their own bodies, aware of
things around them, but unable to respond. A young woman
who recovered in Paris, recalled the onset I was so tired,
then my mind wandered in nightmares. Even as I sat awake.
I knew something was happening to me when I could
no longer lift my arm or speak a full sentence.
Another man, in an asylum report described a surge of
(12:28):
uncontrollable rage and ticks. My body was not mine. It
jerked and twisted on its own, and I heard voices
that weren't there. These personal voices highlight how encephalitis lethargica
blurred the boundary between sleep and wakefulness, between sanity and delirium.
One striking feature often recounted was the statue phenomenon. Patients
(12:51):
who did not die in the acute phase sometimes entered
a bizarre chronic state. They could sit motionless, catatonic for hours,
even days, yet occasionally, inexplicably, they would erupt back into
life for a brief time. This led doctor von Aconomo
to famously compare these patients to extinct volcanoes that could
unexpectedly flare up. In one case, nurses reported a woman
(13:15):
who had been mute and rigid for weeks suddenly stood
up and sang an old music hall song, only to
fall silent and frozen again by the next day. Such
episodes were rare glimmers of the person trapped within. The
medical voices of this era also include those of skepticism
and confusion. Some doctors wondered aloud if this was even
a single disease or a mix of different conditions. The
(13:39):
symptom variability was so great that a few suggested encephalitis
lethargica might be a catch all label for disparate brain illnesses. However,
the consistency of the epidemics, timing, and aftermath argued otherwise.
As neurologist Paul Bernard Foley noted a century later, the
evidence was overwhelming that encephalitis lethargica was a disorder Swede generis,
(14:02):
a unique plague of its own. Folly remarked on the
fascinating horror of its course, an acute flu like illness,
an intermediate phase of neurological nightmares, and a chronic phase
that could be more devastating than the acute one. The
fact that this disease then vanished unexpectedly only deepened the intrigue.
(14:30):
Almost as enigmatically as it arose, the epidemic faded out.
By nineteen twenty seven, new cases of true encephalitis lethargica
had dwindled to near zero. There were still isolated patients
in the early nineteen thirties, but no widespread outbreaks. The
sleepy sickness pandemic had burned through in about a decade
(14:51):
and then disappeared. Doctors in nineteen twenty eight were baffled.
Epidemics of infectious disease rarely just stop without a cl reason,
yet that is exactly what happened. One medical report from
nineteen twenty nine stated, almost in disbelief, the pandemic disappeared
as abruptly and mysteriously as it first appeared. So why
(15:14):
did it stop. At the time, some researchers speculated that
the causative agent, whatever it was, had simply died out
or mutated to a harmless form. Others thought that perhaps
the epidemic was tied to the nineteen eighteen influenza, and
that once that flu was gone, this secondary epidemic also waned.
In fact, the worst years of encephalitis lethargica did coincide
(15:37):
with the tail end of the Spanish flu pandemic. One
hypothesis was that influenza infection somehow potentiated the sleeping sickness,
weakening patient's resistance or paving the way for a second infection. However,
when scientists later tried to find influenza virus in the
preserved brain tissue of encephalitis lethargic of victims, they found
(15:58):
no trace between the two. Pandemics remained circumstantial. As the
epidemic receded, it left a long shadow. Many survivors initially
seemed to recover fully and returned to normal life, but
as years passed, an alarming number developed strange post encephalitic complications.
This could happen after a delay, sometimes a year, sometimes
(16:21):
a decade or more of apparent health. Gradually, doctors realized
that encephalitis lethargica was not over for these people at all.
In the late nineteen twenties and thirties, reports emerged of
former patients developing Parkinson's disease like symptoms, tremors, muscle rigidity,
masked facial expressions, and slowed movements. Others showed severe psychiatric changes,
(16:45):
from depression and apathy to impulsive violence. Children who had
survived encephalitis lethargica were especially noted to undergo troubling personality
changes as they grew. Some became hyperactive, aggressive, even psychopathic,
and behavior. One review described how a subset of those
infected at ages five through ten later exhibited pathologic changes
(17:07):
of character that approached the psychopathic cruelty, destructiveness, and self mutilation,
including a horrific case where a child gouged out their
own eyes during a bout of encephalitis induced madness. These
were extreme outcomes, of course, but they highlighted that the
disease's effects could be life long and life altering. In
(17:28):
medical literature, this delayed fallout was termed post encephalitic parkinsonism
or PEP and other post encephalitic syndromes. Some patients deteriorated
rapidly and died young. Others plateaued with moderate disability, yet
others lived for decades in a profoundly disabled state. By
(17:48):
the nineteen forties and fifties, thousands of these survivors were
living in chronic care hospitals or at home, often mislabeled
as simple Parkinson's disease or as psychiatric patients. Over time, however,
their unique history was largely forgotten by the public. The
world moved on with encephalitis lethargica becoming a medical curiosity
(18:09):
in textbooks. As von Aconomo had predicted back in nineteen
twenty nine, the epidemic's impact on neuroscience was significant. It
s burred new understanding of brain regions like the basal ganglia,
the deep structures tied to movement and behavior, in the
role of the substantia negra in parkinson like disorders. But
(18:29):
despite these scientific advances, the patients themselves faded into the
background of mid twentieth century medicine. Encephalitis lethargica, though, became
an almost mythic memory, a ghost of a pandemic that
no one could ever explain. The story of encephalitis lethargica
might have ended as a dusty chapter in neurology if
(18:53):
not for an extraordinary episode decades later. Nineteen sixty six,
a young neurologist named Oliver Sachs took a job at
a chronic hospital in the Bronx. To his astonishment, he
found eighty survivors of the long ago epidemic languishing in
the wards. These patients had all fallen ill in the
nineteen twenties as children or young adults, and had been
(19:14):
institutionalized for decades. When doctor Sachs first encountered them, he
was struck by an eerie scene that echoed the epidemic's
peak years. He later recalled, I suppose the first impression
was that had entered a museum or a waxwork gallery.
There were motionless figures, transfixed in strange postures. Everything looked frozen.
(19:35):
These patients hardly moved or spoke. Some could not even
blink on command, appearing as living statues. Yet occasionally, doctor
sach said, very suddenly one of these patients would be
released from this state and would speak and move. Then
you could see what a vivid a life person was there.
Imprisoned by some strange physiological change, These long neglected individuals
(19:57):
were effectively catatonic, victims of the chronic phase of encephalitis lethargica.
Doctor sax realized that many of these patients exhibited classic
Parkinsonian symptoms tremors, rigidity, and slowness of movement, albeit in
a very extreme form. He hypothesized that their brain's motor circuits,
(20:18):
especially the dopamine induced substantia negra, had been damaged by
the illness. In the late nineteen sixties, a new drug
called el dopa l dopa or leveedopa, was showing remarkable
success in treating Parkinson's disease by boosting dopamine levels. Zax
pleaded with this hospital to let him try el dopa
(20:39):
on his sleepy sickness patients. In the summer of nineteen
sixty nine, he finally got approval to administer the drug.
What followed would seem almost miraculous. Within days of receiving
el dopa, many of the post encephalitic patients awakened. Some
after decades of near total immobility. They opened their eyes,
(21:00):
sat up, and began to talk, startling the hospital staff.
One of Sax's first patients, a man who had been
virtually mute and wheelchair bound since the nineteen twenties, suddenly
stood and walked, exclaiming over all the changes that had
occurred in the world around him. Another patient, a woman
who had not spoken since childhood, regained fluent speech and
(21:21):
asked for ice cream. Zax wrote that these patients irrupted
into life, like those extinct volcanoes coming back alive. It
was an emotional and profound rebirth. The hospital atmosphere turned
jubilant and astonished for a brief time. Tragically, this miracle
was short lived. As weeks went by, complications set in.
(21:44):
The patients on Eldoba began experiencing side effects. Some developed
severe takes or manic behavior. Others plateaued and then began
to slip back into inertia. The awakening could not be sustained.
Most of the patients relapsed into their frozen states despite
continued medication. Zax documented these remarkable and heartbreaking events in
(22:05):
his nineteen seventy three book Awakenings. The book, which later
became a Hollywood film, brought the plight of encephalitis lethargica
survivors into public view. In one poignant scene dramatized in
the film, a patient awakened after thirty years, played by
Robert de Niro, and they observed, people have forgotten what
life is all about. They've forgotten what it is to
(22:27):
be alive. This line captured the bittersweet truth for those
few shining weeks, the long lost victims had tasted normal
life again, only to have it slip away. Zach's work
confirmed that the post encephalitic patients were neurologically akin to
extreme cases of Parkinson's. The fact that el doba could
(22:48):
rouse them if only temporarily, was a critical clue. It
suggested that the disease had damaged dopamine pathways and that
their brains still had the capacity, however limited to function
if chemically jump started. Facts and others noted that these
patients were living proof of how encephalitis lethargica had bridged
psychiatry and neurology. These victims were not suffering from a
(23:11):
psychiatric illness per se, though they appeared catatonic or comatose. Instead,
a neurological injury had imprisoned their minds. By the late
nineteen seventies, most of the post encephaltic survivors had passed
away and the chapter of awakenings closed, but their story
reignited scientific curiosity about what had caused encephalitis lethargica in
(23:34):
the first place, a question that had lingered without answer
since the nineteen twenties. What caused the Great encephalitis lethargica epidemic.
This question remains one of medicine's biggest unsolved mysteries. From
(23:56):
the start, viral theories were prominent given the timing during
the nineteen eighteen flu pandemic. Many early researchers suspected a link,
perhaps a mutated influenza virus had a rare ability to
attack the brain, or possibly the flu weakened the population,
allowing another unidentified virus to spread. Some autopsies of encephalitis
(24:19):
lethargic victims did show inflammation in the brainstem and mid brain,
suggesting an infectious agent, but extensive searches for a microbe
were inconclusive. No bacteria grew in culture, no fungi or
parasites were evident, and viruses were very hard to detect
with the technology of the nineteen twenties, so the virus
(24:39):
theory remained just that a theory. In nineteen eighty two,
British neurologist doctor John Oxford tried applying modern molecular tools
to samples of brain tissue preserved from nineteen twenties patients.
He specifically looked for remnants of influenza virus genetic material.
None was found. This seemed to rule out the simple
(25:00):
idea that the flu virus itself caused the brain illness. However,
it did not exclude the possibility of another virus or
a post viral effect. Another theory that gained traction was
an autoimmune reaction, the body's immune system mistakenly attacking the brain.
Back in the nineteen twenties, this concept was not well understood,
(25:21):
but some doctors had noted that encephalitis lethargica often followed
a sore throat or a respiratory infection. Decades later, this
clue became vital. In the early two thousands, neurologist doctor
Russell Dale and doctor Andrew Church in Britain investigated several
modern patients who presented with encephalitis lethargical like syndromes. They
(25:42):
found an intriguing common thread. Most had recently had strepococcal
throat infections caused by Strepococcus bacteria historically called Diplococci I.
Now I know diplococci. It sounds funny. Doctor Dale and
his colleagues gathered twenty such cases and ran immunological time. Astonishingly,
ninety five percent of these patients at high levels of
(26:04):
antibodies that attacked basal ganglia neurons, a part of the
brain controlling movement. In comparison, fewer than four percent of
healthy controls had such antibodies. They even found these antibodies
in the spinal fluid of some patients, meaning that the
immune system was actively reacting within the brain. His findings,
published in two thousand and four strongly supported that encephalitis
(26:28):
lethargica might be a form of autoimmune encephalitis triggered by
a common infection. Essentially, the theory is that a strep
throat could, in rare instances, provoke the body to mount
an excessive immune response. Antibodies meant to fight bacteria could
mistakenly attack the brain's own cells, especially in regions controlling
sleep and movement. This would explain both the initial flu
(26:51):
like illness and the delayed Parkinsonian damage. The autoimmune theory
has parallels to other conditions like sydonyms chorea or Saint
Fhytus's day ants, a movement disorder that can follow strep
infection and Panda syndrome, and children pndas, where strap triggers
psychiatric symptoms. It's plausible that encephalitis lethargica was a particularly
(27:14):
aggressive post infectious autoimmune storm. Supporting this, reports from the
original nineteen twenties autopsies noted not just localized damage, but
widespread inflammation in the brain, even in the core text,
with immune cells active. At least one contemporary pathologist commented
that the pattern looked like the body had attacked its
own brain. Still, not everyone is convinced. Some experts argue
(27:39):
that a novel virus still could have been the culprit,
perhaps one that has sins disappeared. There are historical hints
for that. For example, around nineteen twenty six, there was
an unusual outbreak of encephalitis in children in Alaska and Canada,
initially thought unrelated but possibly the tail end of the
same phenomenon. If a virus was responsible, it might have
(28:01):
been one that required particular conditions like war and global
movement to spread, and once those conditions passed, the virus retreated.
Because virology was very primitive at that time, the virus
could have vanished unrecognized. In modern times, a few cases
of true encephalitis lethargica have been verified, but occasionally a
(28:23):
report does serve us. In nineteen ninety three, a twenty
three year old British woman named Becky Howells fell ill
with classic symptoms fever, tremors, hallucinations, and limb rigidity. Doctors
diagnosed her with encephalitis lethargica, one of the first such
diagnoses in decades. Her case prompted alarmist headlines about the
(28:45):
return of sleepy sickness. A few years later, in two
thousand and four, a seventeen year old in the UK
named Sophie Cameron developed encephalitis and cardiac arrest that left
her severely brain damaged. Though her illness was not definitively
the same. It led to the creation of a research fund,
the Sophie Cameron Trust, to study encephalitis lethargica and related
(29:06):
brain inflammation disorders. These instances show that the mystique of
encephalitis lethargica still haunts the medical community. If the cause
of encephalitis lethargica was autoimmune, we might see sporadic cases
when the same rare immune mishap occurs. If it was viral,
that virus could theoretically re emerge or already be circulating
(29:28):
in milder form. To date, no single pathogen has been
confirmed as the cause. The best guess in recent reviews
is that encephalitis lethargica represented a perfect storm of factors.
A microbial trigger, perhaps strepococcal infection, or less likely, a
virus combined with an aberate immune response in certain individuals
(29:49):
with modern intensive care and immunotherapies like steroids or IVG
that calm the immune system. One hopes that a future
outbreak could be managed better if such a thing were
to ever occur. Encephalitis lethargica's tail is a haunting reminder
(30:16):
of the limits of medical knowledge and the unpredictable nature
of diseases. This bizarre epidemic struck without warning, confounded the
greatest medical minds of the time, and then vanished, leaving
more questions than answers. It shows us how, even in
an age of scientific advancement the nineteen twenties, after all,
saw great strides in microbiology and neurology, nature can often
(30:39):
present a riddle that remains unsolved. The legacy of encephalitis
lethargica a century later is multifaceted. Scientifically, it spurred crucial discoveries.
Researchers forced to grapple with an illness that was both
neurological and psychiatric began to break down the silos between
those disciplines. The disease showed that inflammation of the brain
(31:00):
could manifest as hallucinations, personality changes, or catatonia, blending mind
and body symptoms This helped pave the way for modern
concepts of neuroimmunology and the recognition of disorders like autoimmune encephalitis.
The epidemic also led to the identification of the extra
puimidal motor system in the brain, the network outside the
(31:21):
motor cortex that controls movement, habits, and muscle tone. Because
Encephalitis lethargica so often damaged this system, scientists like Constantine,
Vonaconomo and others began to map out structures and their
role in movement disorders. In essence, the disease unwittingly taught
us about parkinsonism and how rigid paralysis can result from
(31:42):
brain injuries, knowledge that later informed treatments for Parkinson's disease itself. Culturally,
the story of the Sleepy Sickness remains both chilling and inspiring.
It is chilling in the sense of how vulnerable we
still are to mystery diseases. A century on, we have
witnessed new pandemics, not only novel influenzas, but others like
(32:04):
HIV and COVID nineteen, and each time faced significant unknowns.
Encephalitis lethargica reminds us that an epidemic can elude explanation
even long after it's gone. It warns against over confidence
that we have conquered all plagues. As late as the
twenty twenties when this episode comes out, scholars were still
debating if the sleepy sickness was due to a virus,
(32:27):
an autoimmune quirk, or something else entirely. But while this
is incredibly terrifying to think about, the human stories from
this epidemic are inspiring for the resilience and curiosity that
they highlight. The patients who endured decades imprisoned in themselves.
Their brief awakenings show the perseverance of the human spirit
and the ceaseless drive of scientists and doctors to help.
(32:48):
Even years later. Doctor Oliver Sach's compassionate work with those
survivors shines as an example of empathy and ingenuity in medicine.
Is description of the patients as extinct volcano that roared
back to life encapsulates both the awe and the tragedy
of encephalitis lethargica. So now as we get to the
end of this episode, I'm sure you're wondering could this
(33:10):
ever come back? Given what we know a repeat epidemic
of the same scale seems unlikely, but not impossible. If
the culprit was an infectious agent that vanished, it might
stay hidden or extinct. If it was an autoimmune phenomenon,
it might be that the specific combination of factors, perhaps
(33:31):
a particular strain of strep circulating widely plus a susceptible
population post war, was unique to that era. However, we
should all remain vigilant. A cluster of unexplained encephalitis cases
today would undoubtedly prompt rapid investigation with tools far beyond
what nineteen twenty science had. The world has also built
(33:51):
networks like the Encephalitis Society to share information quickly if
any sleepy sickness cases emerge. In a sense, encephalitis lethargica
pushed medicine to be more interdisciplinary and alert. The saga
of encephalitis lethargica is a true medical mystery, a real
life plague that unfolded with suspense, baffled experts, left a
(34:12):
trail of devastation, and then disappeared without revealing any of
its secrets. In that uncertainty lies its haunting legacy, a
reminder that not all of nature's mysteries have been solved,
and that the line between wakefulness and oblivion, between a
person and the living statue they might become, can be
thinner than we ever imagined. The story of encephalitis lethargica
(34:35):
remains unresolved. Thank you for listening to this episode of Unresolved.
(35:01):
I have been your host, Michael Wheelan. This episode was
researched and written by myself and Amelia White. If you
would like to support this show, please head over to
patreon dot com slash Unresolved Pod to become a patron.
Doing so allows you to receive exclusive benefits such as
ad free episodes, bonus episodes, and access to exclusive shows
(35:22):
that you can only find on Patreon, such as Resolved.
To that end, more Patreon exclusive shows are coming which
will allow me to tell new types of stories. In
addition to new bonus episodes of this show, your support
also allows Unresolved to remain fully independent, so I can
tell those stories free of any censorship or guidelines, or,
(35:43):
as my friend from Swindle likes to say, shadowy moneymen.
Your support keeps Unresolved going, so please head over to
patreon dot com slash Unresolved Pod or click on the
link below. In the show notes to become a patron.
If you are unable to do that, then please spread
the word of the show to those in your life
who may be interested. If you have an aunt, or
(36:03):
a neighbor, or a coworker that's interested in true crime,
maybe recommend this podcast or a favorite episode of yours.
Every little bit helps, as do your reviews on Apple Podcasts, Spotify,
or wherever you're currently hearing this. We are quickly approaching
the end of this extended season, which will wrap up
at the end of the calendar year, so please help
(36:25):
us get to a good spot as we begin prepping
for season eleven. Now I'm going to head straight from
here to go begin recording the next episode of Unresolved,
which is going to be one of the strangest and
quite frankly longest recording sessions in this podcast history. So
wish me luck anyhow, I hope you all stay safe,
stay healthy, and I'll talk to you next time.
Speaker 2 (36:46):
By everyone, Come come, don't come. Got coll
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