Book Review: Asleep

Title
Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries

Author
Molly Caldwell Crosby

Date of Publication
March, 2010

Reason for reading
Micki got an advance copy from the book store she works part-time at because she thought I'd be interested in it, and it did look interesting.

Synopsis
The book is about an epidemic of encephalitis lethargica, also known as sleeping sickness. The epidemic took place in the years immediately following the 1918 influenza epidemic. The author details a number of case studies as examples of how the disease often differed in its symptoms, while simultaneously giving background information on some of the key medical people involved in the treatment and study of encephalitis lethargica.

Review
I would say it's a good book, but not great. Granted, it's an advance copy so changes may be made, but it seems like the only differences will be extended notes/bibliography/etc. I was actually very unfamiliar with the topic. I'd heard of sleeping sickness before, but had no idea what it entailed, and it's not pleasant.

The nominal symptoms include being in an apparent vegetative state, though sometimes it appears the patients would be aware of their environment, but unable to move or communicat. This was often described as being a "living statue." However, the disease varies drastically in onset, duration, and symptoms. Many patients didn't necessarily suffer the prototypical sleeping sickness, but would emerge from their illness with drastically different personalities.

The etiology was thought to be associated with influenza since it took place immediately after the 1918 epidemic, though it appears that it's actually correlated with streptococcal infection.

Quotes
"The health department's future success would depend on separating itself from political strings and adherence to the way things had been done in the past, and instead devoting its funds to a more modern approach to medicine and the study of disease. New knowledge about germs and viruses enabled health officials to take a direct approach in controlling the spread of disease, to become active, not just reactive. Their approach was becoming so aggressive, in fact, that it often stigmatized certain ethnic groups and threatened civil rights. That fact would be obvious on Ellis Island. At the turn of the century, roughly 2 percent of immigrants were turned away due to disease; by 1916, it was up to 69 percent." (58)

"Children with postencephalitic problems were remarkably similar in their behavior, marked by emotional instability, quarrelsomeness, irritability, tantrums, and breathing tics. The aim for the hospital staff was to retrain these children to show emotional control and social adjustment, and in the best cases, they hoped to be able to send the children home. The first days, according to one occupational therapist, were the worst: 'Days of fighting, biting, scratching, lying, and tale telling . . . These were hourly or half-hourly events.' The staff was close to tears from frustration and exhaustion. The therapist added, 'There seemed to be nothing normal about these children. They either grabbed all food in sight or wanted no food at all; they slept half the day and stayed awake half the night; homosexual practices and masturbation were prevalent with both boys and girls." (132)

Further Reading
Epidemic Encephalitis (Encephalitis Lethargica)

Frederick Tilney

1920

Awakenings

Oliver Sacks

1973

"What caused the 1918-30 epidemic of encephalitis lethargica"

RR Dourmashkin

Journal of the Royal Society of Medicine 90 (September 1997), 515-20

Encephalitis Lethargica on Wikipedia

Mystery of the Forgotten Plague

BBC News - Health

July 27, 2004