Medicine: Sleep Scourge

Down on St. Louis last month swept the fingers of a dreaded plague. At widely-separated spots in & around the city people began to grow drowsy, vomit, feel their heads ache. After 24 hr. their necks crooked stiffly back, their reflexes weakened. Most lapsed into partial, some into complete coma. Others drowsed in daytime, fidgeted at night. As the malady spread, early sufferers grew maniacal.

St. Louis physicians knew it was epidemic encephalitis, the brain inflammation popularly called sleeping sickness.* Known in Europe since 1712, it first appeared in the U.S. at the end of 1918. following the world-wide influenza epidemic of that year. But the name and effects of the disease are almost all that is known about it. Scientists think it must be caused by a virus, but they can only guess at what the virus is, how it is spread, how best combated.

Last fortnight Dr. James Payton Leake of the U.S. Public Health Service and Dr. Eldred Kenneth Musson, State epidemiologist, arrived in St. Louis, began whipping physicians and Washington University scientists into committees for field work, laboratory study, preparation of case-history questionnaires. The U.S. Public Health Service planned to spend $10,000 in research. After careful study, spreading by food, water or milk seemed ruled out. So did case-to-case infection. Only two families had more than one case, and there was no other known contact between sufferers. Dr. Leake thought the evidence indicated transmission by a carrier, human or otherwise. Superintendent William George Patton of the St. Louis County Hospital considered it significant that the epidemic’s start coincided with the greatest influx of mosquitoes in St. Louis County history. Queerest theory advanced was that Catholic missionaries, some from Africa, convening in St. Louis last month had brought genuine African sleeping sickness. Autopsies on three victims showed the brain red and pressing down on the spinal column. Serum from the brain of one victim killed a monkey, left a rabbit unscathed.

Sufferers were widely scattered, both geographically and socially. They were of all ages, though children seemed less susceptible and most victims were middleaged. Noteworthy was the fact that all of them were sick with something else when they contracted the disease.

Almost all that physicians could do for St. Louis sufferers was to isolate them, see that they got careful nursing, warn their relatives not to confuse the disease with infantile paralysis or waste time and money on “cures.” Lumbar punctures (to drain spinal fluid), obligatory for the first few days, gave the only relief. Various symptoms must be treated individually as they arise. Some drugs—sodium salicylate, atropine, pheno-barbital—have been helpful in scattered cases in the past.

Early this week, when sleeping sickness had stricken 137, killed 18 St. Louisans, Kansas City, Mo. reported three sick, one dead of the disease. Individual cases, though they may last five years, usually last only three weeks. Some of St. Louis’ sufferers had already recovered, tragically. Sleeping sickness ordinarily kills about one fifth of its victims. Those spared it nearly always leaves with paralyzed bodies, twisted characters or weakened minds.

Because of newspaper interest rather than the unusualness of her case, the most famed sleeping sickness victim in the U.S. is Patricia Maguire of Oak Park, Ill. In January 1932 her family noticed that it was getting more and more difficult to awaken her in time to catch an early morning elevated train to get to her secretarial job with Liberty. Her friends observed that her eyelids drooped early in the evening, that she drowsed easily. She was taken to Dr. Eugene Traut of Oak Park, to oculists and other doctors for examination. Returning from work one cold night in February, she fell asleep on the “L,” rode past her stop, had to be roused by the conductor at the end of the line.

She was barely able to make the ten blocks to her home without falling asleep again. Her eye-droopings and twitchings increased. Her sister, Mrs. Gladys Hansen, chided her about attempting to imitate a cinemactress. Then she became very quiet, did not talk at all during the ten days preceding the start of her coma.

Last week ended a year and one-half during which Patricia Maguire has recognized no one, said nothing, though doctors say her coma is neither complete nor unusual. She has been removed from the house twice: for a week’s observation at a Chicago hospital and a half day at West Suburban Hospital. Other than that her only movement has been this summer from the second-floor front room of her mother’s yellow stucco, seven-room house at No. 523 Clarence Street down to a first-floor room. She has slept through two birthdays, is now 28. Since Patricia fell asleep the night nurse, who cared for her five months, has married, borne a baby now three months old.

A twitching of the mouth at intervals is the only outward indication that Patricia is not just sleeping. She is still an attractive girl except that her face shows her increase in weight from 125 to 165 lb. Tall (5 ft. 9 in.), she was known as a stately, dignified, reserved girl who did not drink or smoke. She played a good game of golf, skated, swam.

She sleeps quietly in an immaculately-kept full-sized walnut bed, last week was wearing white cotton pajamas. She lies so quietly that hardly a wrinkle can be seen in the white covers. She has been on a liquid diet ever since she fell asleep. At first she was fed through the nose (over 1,000 nasal feedings). Now she is being fed orange juice, eggnogs and milk through the mouth. The better to withstand any disease that might set in, Patricia was fed every two hours day & night when she was first ill. Lately she has not been fed from 10 p.m. to 6 a.m. Her increased weight aided her in throwing off pneumonia which almost did away with her last winter.

Tall, dark Dr. Eugene Traut has been physician on the case from the beginning. Twice a week for a time he injected in Patricia’s back, blood obtained from men who had had her disease. He has also given her a blood transfusion, and nonspecific germ-killing typhoid inoculations.

The Maguire family is keeping a detailed, secret record of Patricia’s diet, medicines, treatment, with the thought that they may some day write a book about her. Their house has been deluged with the usual flood of letters (at one time 50 per mail), advice and offers of help from all sorts of people including a Hindu mystic who offered to cure her for £150 as a first installment. Two people wanted to exhibit Patricia at the Century of Progress. One wanted to build a miniature hospital in the Hall of Science, offered $50 a week plus a day & night nurse. The other was to be a Midway (entertainment) concession.

*Not to be confused with African sleeping sickness (trypanosomiasis), an entirely different disease caused by the bite of the tsetse fly.