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Podcast Episode Summary
Stuff You Should Know - The Mystery of the Sleepy Sickness
Episode Overview In this episode titled "The Mystery of the Sleepy Sickness," hosts Josh and Chuck delve into the unexplained phenomenon of encephalitis lethargica, also known as the "sleepy sickness," which surged in the early 20th century and remains a medical mystery.
Key Themes and Ideas
Understanding Encephalitis Lethargica (EL)
- Definition: Encephalitis lethargica is a neurological illness characterized by prolonged lethargy and sleep-like states.
- Historical Context: The outbreak began around 1916, with symptoms appearing flu-like initially but escalating to severe neurological impairments. It peaked in the late 1910s, troubling communities across four continents, and led to hundreds of thousands of deaths.
- Symptoms:
- Loss of mobility and conscious awareness.
- Hypersomnolence (excessive sleepiness).
- Patients could appear frozen, often described as being in a "statue-like" state, yet may still be aware of their surroundings.
Medical Investigation
- Initial Discovery: Dr. Constantin von Economo was crucial in identifying EL. He ruled out various neurological disorders and hypothesized that it was an infectious disease.
- Research Challenges: Despite extensive studies (over 9,000 papers), the exact cause of EL remains undiscovered, leading to various theories:
- Possible links to the Spanish flu.
- Theories of autoimmune disorders triggered by infections (e.g., streptococcus or herpes).
Forms of Encephalitis Lethargica
- Acute EL: Initial phase with flu-like symptoms transitioning to severe neurological issues.
- Subtypes:
- Ophthalmoplegic form: Most severe with high mortality rates.
- Hyperkinetic form: Involves manic symptoms and involuntary movements.
- Amyostatic akinetic form: Characterized by complete immobility and waxy flexibility.
- Chronic EL: Symptoms may evolve years after initial recovery. Patients might develop Parkinsonism, including mood swings and bizarre behavioral changes.
Case Study
Awakenings
- Oliver Sacks: In the 1960s, neurologist Oliver Sacks treated chronic EL patients with L-DOPA (a treatment for Parkinson's).
- Some patients experienced temporary recoveries, which were profound yet often followed by a return to their previous state, highlighting the tragic nature of the disease.
- Paradoxical Kinesia: The phenomenon where patients could suddenly move during emotional stimuli, suggesting a deeper consciousness than previously believed.
Conclusion
- Current Understanding: Medical understanding of EL is still evolving. There's ongoing research into possible autoimmune connections, but no definitive treatments exist today.
- Cultural Impact: The episode reflects on how historical mysteries like EL not only present medical challenges but also touch on the human experience of illness and consciousness.
Key Takeaways
- Encephalitis lethargica remains one of the great medical mysteries, with historical significance and contemporary relevance.
- The phenomenon showcases the complexity of neurological diseases and the challenges in understanding human consciousness.
- Cultural references, such as the film "Awakenings," help to illustrate the human side of these medical mysteries.
References
- Josh and Chuck's discussions highlight the importance of historical investigations into medical phenomena and their lasting impacts.
- The narrative is supported by both scientific inquiry and personal stories of those affected by encephalitis lethargica.
``` This markdown file summarizes the podcast episode while organizing the content into logical sections, highlighting key themes, ideas, and takeaways in an accessible format.
Written by AI. May contain mistakes. Listen to the episode to check what was said.
Transcript
Automatic transcript. May contain errors.0:00This is an iHeart Podcast. Guaranteed Human.
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1:01John Polk story on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Dr. Priyanka Wally. And I'm Hari Kondabolu. It's a new year. And on the podcast Health Stuff, we're resetting the way we talk about our health. Which means being honest about what we know, what we don't know, and how messy it can all be. I like to sleep in late and sleep early. Is there a chronotype for that or am I just depressed? Health stuff is about learning, laughing, and feeling a little less alone. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Welcome to Stuff You Should Know, a production of iHeartRadio.
1:49Hey, and welcome to the podcast. I'm Josh, and there's Chuck, and Jerry's here too. and this is a good old-fashioned Stuff You Should Know medical mystery episode. That's right. Look at Jerry over there. She's just sitting there. She's frozen. And what you can do is, I don't know if you know this, Josh, if you walk over to Jerry and take her hand off the keyboard and raise it above her head, she'll just keep it there until you move it back down. Well, Chuck, it sounds a lot to me like Jerry might have chronic encephalitic lethargica. I think you might be right. I might be right. I might be partially right.
2:27I think I would have been more right if I had called it encephalitis lethargica. But that's probably what she has if those are her symptoms. That's right. File this under medical mysteries and also file it under a Julia jam. But we're basically going to call it EL or encephalitis lethargica here and there. It was also known as the sleepy sickness. sometimes the sleeping sickness, although there's a new sleeping sickness that is not to be confused with the previous one. No, it's spread by the tsetse fly, and it's epidemic, I don't think it's endemic yet, in Africa. And it has got a couple of similar symptoms, but they're in no way related from what I understand.
3:09That's right. We're talking about an outbreak that happened in the early 20th century in Europe, starting in about 1916, wherein all of a sudden people would, kind of out of nowhere, they would lose mobility. Some people would fall into a coma-like state or a sleep-like state. Many, many people would die within days. And it reached epidemic proportions in at least four continents by 1919, killed hundreds of thousands of people. And it's a medical mystery because we still don't know exactly why it happened or why it just kind of suddenly went away. Yeah, where it came from, what caused it, nothing.
3:49We don't know almost anything about it. They just kind of know the symptoms enough that when you see the very, very, very rare case come along these days, you can say, I think this actually is encephalitis lethargica. lethargica. And there was something you said about people being struck into like a coma or sleep-like state. The people who are struck with encephalitis lethargica, they weren't like laying there like Sleeping Beauty on their backs with like their hands crossed over their chest. Like, it was like you were saying, like they might have their hand in the air and their mouth open in like a silent scream and their eyes were open and they just weren't moving at all.
4:26And they were just sitting like that. That's the kind of like horrible symptom that you could suffer from for decades. Like, once that started, it might just keep going on for the rest of your life, even though this happened to you in childhood. Yeah, exactly. So, and there's a bit of a reveal that we're going to hang on to here. But we're going to start off with not a reveal, because that's not how you do things in the three-act structure. Not in the podcast biz. No, no, no. We're going to start out in 1916 with a Dr. Constantin von, is it Economo, or Economo? I like the first one. That's like saying, is it economy or economy?
5:08This sounds to me like a Cosmo Kramer alias. Why don't you just tell me the name of the movie you want to see? I'll never not laugh at that. No, it's a good one. Oh, boy. So he was a doctor at the University of Vienna's Psychiatric Neurological Clinic. and he started seeing some strange cases come through his office in 1916 where the symptoms were, you know, they had diagnoses on the charts, things like meningitis or MS or delirium, but the symptoms weren't matching these things or anything else that he could think of. Yeah. And the first thing he did was ruled out neurological toxins, infections, and neurological disorders, and then was like, all right, I'm open here.
5:55Let's, like, no one knows what this is, and we need to figure it out. So let's sort of put our minds to this thing. Yeah, he dove in. He started describing it. He wasn't actually the first one to describe it. I think he was actually beaten by a couple of days, even though some people say it was the opposite way around, by a French physician named Dr. René Cruchet. The difference was Dr. Cruchet's take was that this was maybe a behavioral disorder. And Dr. Economo, Van Economo said, no, this is like clearly some sort of infection or something like that. It's an epidemic. It's transmissible. So that's why this is sometimes called von Economo encephalitis.
6:35It was essentially named after because he was the guy who said, this is what's going on. This is what I think is going on. Check out these nutso symptoms. Right. Not so nutso at first because when people would come in at first, they had basically looked like the flu. You know, fever, coughing, you know, kind of what you would think of. Everyone's had the flu, right? Yeah. I don't have to. I don't have to. Yeah, there you go. That's much better. I watched Zoolander recently. You know, a picture is worth a thousand words. A Josh impression of the flu is worth at least 20 of my words. All right. Thanks.
7:08Was that part of Zoolander? Yeah, he had the black lung when he went back home to mine coal with his dad. Oh, I love that dumb movie. It is a really great dumb movie. I thought it was fun. I was like, this is pretty great still. All right, so flu-like symptoms at first, then just a huge array of neurological symptoms that were really inconsistent among the patients, the severity of which was pretty inconsistent. Sometimes it varied wildly from one to another. But one of the most common threads of these neurological symptoms was something called hypersomnolence, which is just really, really sleepy, like feeling really sleepy, and then eventually it could lead to that coma-like state where you're just sort of locked in.
7:53So here's the thing. So the sleep, the type of sleep, though, that is common among people struck with encephalitis lethargica is not what you would consider sleep. They're not getting rest. You can wake them very easily. They are probably semi-aware of what was going on around them the whole time they were sleeping, but they couldn't not fall asleep. Another thing that sometimes gets chalked up under this hypersomnolence is freezing mid-action. Like maybe they're taking a bite of broccoli. That's a bad example because they probably are like, I can't make myself eat this broccoli. It's so disgusting.
8:34But let's say they're eating like a delicious animal cracker and they stopped mid-bite. They might not move again. Or they might like hear a song or something like that. And all of a sudden they start eating the animal cracker again. Yeah. It's not. The point is, it's called the sleeping sickness. It's not sleep as you would understand it. Yeah, yeah. That's good to clear that up. Thanks. Because sleeping sickness sounds pretty good to me right about now. It kind of does. Half of these cases, it's a pretty wide age range. About half of them were in people age 10 to 30. Like I said, a lot of the patients died.
9:12Sometimes they died within like a week or two after onset of symptoms. There was one case of a girl who was walking home from a concert, suddenly experienced a paralysis, fell asleep within about a half hour, and died less than two weeks later. There was also some weird stuff, as we'll see, that had to do with psychiatric symptoms, where sometimes people would be fine after, you know, suffering from this for a couple of weeks, but their personality would have changed. There was one report of, I guess a study found four reports of people who developed kleptomania after having suffered this and then ostensibly were cured from it.
9:54So, like, it could really mess with your head, essentially, in just about any way your head can be messed with. Did Winona Ryder claim that? Remember when she was stealing stuff? Oh, yeah, I remember. It was a big deal. She came back pretty strong, which I'm glad. I like Winona Ryder. She does a great job in Stranger Things. Oh, she's awesome in everything she's ever been in. Heather's, dude, is one of the all-time great movies. She was great in Mermaids. And then, yeah, all the way through to Beetlejuice. I'm not going to say Beetlejuice, Beetlejuice, but definitely Beetlejuice. And then Stranger Things, sure.
10:29Yeah, and a great crush of much of Gen X. For sure. Both dudes and chicks. You got that straight. We're talking Gen X. You still say dudes and chicks? Gen X says that. Yeah, they do. All right, so Von Economo was studying all these people. He was studying corpses of these people. He finally breaks it down into its subgroups, the first of which is acute EL. That is the initial sickness that you're going to get. We talked about the flu-y kind of stuff that you get and all these neurological symptoms that are going to follow. Then he broke those down into three forms, from most common to least common, starting with the most common, somnolent ophthalmoplegic.
11:18How would you say that? Ophthalmologic? Ophthalmoplegic. That's what I'm going with. All right. That's the most deadly form. More than half the patients die when they have this form. This is a really overwhelming sleepiness. But like you said, you're aware, you're easy to wake up. the optimal part is ocular paralysis. So you have, you're not moving your eyes. So if people come and they wave their hand in front of your face, your eyes aren't moving or anything like that. And also those neuropsychiatric symptoms that you were talking about, like delirium sometimes, confusion, catatonia, stupor, stuff like that.
11:54There was also the worst report that I saw. And like, I didn't see anything like this, but I checked. And it does seem to have been a case report of a girl from the 30s who basically had a psychotic break because of it. And she pulled out all of her own teeth and gouged out both of her eyes. A little girl did because of this. And again, it's just some weird outlier symptom. But as you see, when we get further and further into this, it's just the brain getting eaten up somehow, some way in some fairly predictable region. So it's creating this whole cascade or galaxy of different symptoms that are just the worst things that can happen to your brain happening.
12:35Yeah. The next subgroup, the next least common, or I guess the next most common, depending on which way you're looking at it, is hyperkinetic. That is, mania basically is the big part of this one. You have a manic phase, involuntary vocalizations and kind of herky-jerky movements, and then a hypomanic phase where there's a lot of fatigue, a lot of weakness. You can hallucinate. You can have nerve pain in your limbs and in your face. and this is one of the odder symptoms is your sleep pattern will flip from day to night or I guess night to day if you were a factory worker or something. And there's another thing with that sleeping sickness part, you know, like your sleep is messed up.
13:18I also saw Chuck that in at least one of these, people might also be super sleepy, but not be able to fall asleep no matter how hard they try, which sounds worse to me than most of the other stuff. For sure. There's a third one that he said is the least common, but it's also a way that it can present. It's called amyostatic akinetic, which is you can't move, akinesis. And this is kind of what the classic idea of what encephalitis lethargica looks like, where you're just sitting there with like, yeah, your right arms in the air, your left arm's a little further down, your mouth's open. You're basically a statue, essentially, is how it's described.
14:04You're frozen in place, and you're not going to move until somebody maybe puts some slight pressure on your arm, and then maybe you'll move it down. But it's not like they're just going to put pressure on your arm for a second, and then you move your arm down. Like, they have to move your arm down. And this is what's called Waxy Flexibility, you can pose somebody in this state any way that you want them to. So you have to be very kind when you're dealing with patients like this. Yeah. I could not help but think that Waxy Flexibility sounds like an album title. For sure. Like Guided by Voices or somebody.
14:44Lips Inc. Is that a real band? Yeah, they're Funkytown people. Oh, okay. Yeah. Oh, waxy flexibility? Sure. Nailed it. Guided by voices. What was I thinking? This is the biggest part to me that's, I guess, part of all of this because of the sleeping part. The people suffering this, including the people who are wax figures frozen in place for years or decades potentially, are there mentally. They're not like locked in, as in locked in syndrome, where they know every single thing that's going on around them at all times. But they're essentially in the same boat where they're aware of stuff. They're aware of time passing.
15:29There were people coming and going and interacting with them. They cannot respond. They can't speak. They can't change their position of their eyes. They can't focus their attention. They can't do anything that would suggest to anyone that they are there in any way, shape or form. And it wasn't until a genuine medical miracle took place that we understood, oh, my God, these people have been there in their heads the whole time. They're not just like comatose, like just completely out of consciousness. They're conscious. Yeah. Yeah, for sure. And, you know, earlier I said like they're locked in.
16:08I didn't mean the literal locked in syndrome. I just meant sort of, you know, look like they're locked in. Right, right. Yeah. I didn't take it like that. Yeah. But I think people might have. So, yeah. Well, come on, guys. We don't know how many cases there were. It was a legitimate pandemic, though. It's one of the things that was hard to diagnose. They think it was underdiagnosed and reported. Estimates run from 500 ,000 to more than a million. But they think that maybe half of the cases weren't even reported. So who knows how many it could have been. and about a third of them died, a third survived and were kind of okay, and then a third survived and then got it again later on.
16:48And that is acute EL, so maybe we should take a break and talk about chronic EL after this? Let's. All right, we'll be right back.
17:08New year, new goals, and in this economy, a better money plan is more necessary than ever. I am Matt. And I'm Joel. We are from the How to Money podcast, and every week we help you to spend smarter, save more, and make sense of what's going on out there. If you want 2026 to be the year you finally feel in control of your money, we're here to give you the tools and advice to help you make it happen. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Dr. Priyanka Wally. And I'm Hari Kondabolu. It's a new year. And on the podcast Health Stuff, we're resetting the way we talk about our health.
17:44Which means being honest about what we know, what we don't know, and how messy it can all be. I like to sleep in late and sleep early. Is there a chronotype for that or am I just depressed? We talk to experts who share real experiences and insight. You just really need to find where it is that you can have an impact in your own life and just start doing that. We break down the topics you want to know more about. Sleep, stress, mental health, and how the world around us affects our overall health. We talk about all the ways to keep your body and mind, inside and out, healthy. We human beings, all we want is connection.
18:22We just want to connect with each other. Health stuff is about learning, laughing, and feeling a little less alone. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey there, this is Dr. Jesse Mills, director of the Men's Clinic at UCLA Health and host of the Mailroom Podcast. Each January, guys everywhere make the same resolutions. Get stronger, work harder, fix what's broken. But what if the real work isn't physical at all? To kick off the new year, I sat down with Dr. Steve Poulter, a psychologist with over 30 years experience helping men unpack shame, anxiety, and emotional pain they were never taught to name.
19:01In a powerful two-part conversation, we discuss why men aren't emotionally bulletproof, why shame hides in plain sight, and how real strength comes from listening to yourself and to others. Guys who are toxic, they're immature, or they've got something they just haven't resolved. Once that gets resolved, then there comes empathy as in compassion. If you want this to be the year you stop powering through pain and start understanding what's underneath, listen to The Mailroom on the iHeartRadio app, Apple Podcasts, or wherever you get your favorite shows.
19:48Okay, Chuck, so a lot of the stuff I was talking about, about people being frozen in place as if they were statues, they had waxy flexibility, mutism, catatonia, they weren't able to respond or move or anything. When I said for like years or decades, more accurately, I would have been referring to the chronic form of encephalitis lethargica because it was essentially, it seems to me, kind of like amyostatic akinetic, but for years and years. The scariest part about all this was that you had gone through the standard case of encephalitis lethargica, one of those three that we just talked about and got better.
20:31You may have died. You may have gotten better, but maybe you had like behavior changes, like you turned into a kleptomaniac or something like that. Or you got better and thought everything was fine, but then you suddenly suffered from being just a ton of bricks being dropped on you. And all of a sudden you can't move for the rest of your life, even though it's been 10 years since you had that case of encephalitis lethargica. Yeah, for sure. The chronic is much the same as the earlier, but with a few added symptoms, one of which is very, very strange. You can have mood swings, pretty normal. Feelings of euphoria and maybe even an increased libido, which is not the weirdest thing.
21:16Psychosis in about 30 % of patients. Again, not the most abnormal thing in the world. but excessive silliness and the use of puns was an actual symptom that they saw over and over again in acute cases. Yeah. Isn't that bizarre? Or not acute in chronic cases. Right. Yeah. Yeah. But again, the defining trait, the one that people would point to and be like, oh, that person has chronic encephalitis lethargica is that statue thing that I was talking about. And that's more clinically called rather than that statue thing. doctors tend to call it post-encephalitic Parkinsonism. And Parkinsonism is one of those difficult things to grasp until you just stop trying to think too hard about it.
21:59It's essentially a bunch of movement and neurological symptoms and dysfunctions. And Parkinson's includes Parkinsonism, but not all Parkinsonism is Parkinson's disease. That's right. Okay. It took me way longer than I care to admit to finally just nail that down and stop running in circles trying to figure it out. Yeah, I mean, I think they even, one of the reasons they call it post-encephalitic Parkinsonism, Parkinsonism, geez, that's a tough one. Or PEP is to distinguish it from Parkinson's, which isn't exactly the same thing. Yeah, and one of the big things that distinguish it, because it shares a lot of symptoms, But one of the things that distinguishes post-encephalatic Parkinsonism and Parkinson's disease is that Parkinson's disease progresses gradually in a predictable pattern.
22:51Post-encephalatic Parkinsonism, like I said, it can come out of the blue. You could be, again, sitting there eating an animal cracker, and all of a sudden, you never finish eating that animal cracker for the rest of your life. It just can suddenly come out of nowhere. and you're just living your normal life. And then all of a sudden you're in an institution and you're bound never to move again unless you happen to be in the right place at the right time in the late 1960s. That's right. And this is the big reveal. If you were hearing these symptoms and you think, hey, that sounds awfully familiar.
23:22I think I saw a movie about that. Then you're correct. This is the movie from the book Awakenings based on neurologist Oliver Sacks' book of the same name about his work with EL patients in the 1960s. I think there were 80 chronic EL patients he worked with at Beth Abraham Hospital in the Bronx, New York in 1966. When this came around and Oliver Sacks was in there, EL had gone away, basically. It was a medical footnote, and not a lot of people in the 1960s even knew much about it because it was one of those things that they never figured out what it was or how it started or how to cure it or anything.
24:01It kind of just went away. So every all the doctors were like, all right, thank God, I guess we don't have to worry about that anymore. Exactly. And they just moved on to their other work. There was a 1985 NPR interview where he was talking about motion. This is a quote, motionless figures who are transfixed in strange postures, sometimes rather dramatic postures, sometimes not with an absolute absence of motion without any hint of motion. So everything looked frozen. And that was, you know, Robert De Niro's character in the movie Awakening. Yeah. And all the others that he eventually grabbed together.
24:35Yeah. And assembled. When's the last time you saw Awakenings? It's been a while. I think I remember thinking it was a pretty good movie back then, though. It's a great movie. Yeah. I watched it last night. Who directed that? Do you know? Laverne. Oh, was that Penny Marshall? Yeah. She did a great job. It was great. I mean, like, I don't remember if De Niro got an Oscar or not, but if he didn't, that's one of the all-time great snubs. Yeah. He did amazing. I forgot how wonderful Robin Williams is, too. Just, man, what a great guy that dude was. Great dude. Great movie, too. I was watching a thing with him this morning and very, very sad stuff.
25:11What were you watching? It was an Instagram post of him with his mother and his mother making him laugh. And I think the whole point of the post was, like, you rarely got to hear Robin Williams', like, genuine laugh. And I heard it and I was like, yeah, I don't know if I really ever heard that. And his mom made him laugh that hard. It was really sweet. Can you do an impression? It was kind of a ha-ha-ha thing. Oh, you just nailed it. I mean, not like that. It was exuberant, but it was like ha-ha-ha-ha, not like my goofy childish laugh. I got you. Yeah, so good movie, and it was 100 % based on this, so much so that it's funny.
25:48They went to the trouble of changing the names of the changed names that Oliver Sacks had in the book. Wow. So, yeah, so Awakenings actually is pretty faithful in a lot of ways. I mean, there's a lot of, like, movie stuff, literary license in there. But for the most part, it's pretty faithful to Oliver Sacks' book. And again, it's nonfiction. Like, Sacks is a neurologist, or he was a great neurologist and a great writer, too. So he didn't take a lot of literary license as far as I understand. So the movie being close to the book means the movie was fairly close to real life. And one of the tests that Oliver Secks conducted was he would demonstrate that these people had demonstrated what's called paradoxical kinesia, where somebody who seemingly can't move and hasn't moved for days, months, however long it was since the last time somebody moved them, could suddenly move in a way that they just should not be able to.
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26:46and the way that he demonstrates it in the movie, and I believe in the book he did this too, was he would toss them a ball. And all of a sudden somebody who's just sitting there with their hands in the air and their face frozen in this mask, this expressionless mask, just suddenly moves their hand without even moving their eyes and catches the ball. And that was, I think, again, at least in the movie, I haven't read the book, how he identified people in this, what they call the chronic hospital that he worked at in the Bronx by finding somebody who kind of fit these symptoms and then tossing a ball at them.
27:23And there's a very cute, funny part where he does it to one person and she gets hit in the face and is like, ow, why'd you do that? She clearly didn't have encephalitis lethargic. It's pretty cute. It sounded a couple of minutes ago, like you said, Oliver's sex. I know, and I didn't correct myself. You're an all-time great conversation analyst, though, for noticing that. Well, I just, I mean, that's a different movie altogether. Oliver Six. Yeah. Also called Awakening, so. God, was that a couple minutes ago? Have I been talking that much? Oh, I have no sense of time. It might have been 10 seconds.
27:55That was amazing, Chuck. You've been killing it with the jokes lately. Oh, thanks. One of the things you mentioned there is like they could catch a ball or something. Another thing that would happen, like he said that if there was an emergency, like another patient falls on the floor, all of a sudden somebody who like previously has not moved for days or weeks or months might just leap up out of their wheelchair and assist them and then sit back down and go back to their statue pose. And that phenomenon that you're talking about is that's the big key difference between PEP and Parkinson's disease is called kinesia paradoxical, where you're switching, you know, between mobility and immobility.
28:36And that is not something that happens generally in Parkinson's. No, but I saw that it does some. So, yeah, but I think for the most part, it's more associated with chronic encephalitis lethargica, right? Yeah. So this original thing where this disease, this mysterious disease, encephalitis lethargica, suddenly appeared out of nowhere in 1915-16, ravaged the world for 10 years, and then just vanished. And like you said led a whole generation of neurologists off the hook for having to explain what it was. Like, they really tried. Like, people like Von Economo really tried to figure this out. I think 9 ,000 papers were written during this epidemic.
29:19And there were some things that they kind of were able to pin down, but the big, big questions were just left unanswered. We just don't know. like one of the big ones is how do you even catch this terrible disease? Yeah, like is it contagious or not? They still didn't have a definitive answer at the end of their study on that. Evidence on transmission was really, really mixed. There were a couple of anecdotal cases that kind of illustrate that. One of them that was among seven members of the family in a small apartment, only one family member got sick. Another case, there was a girl living at something called the Derby and Derbyshire Rescue and Training Home, showed signs of EL.
30:03And then very soon, within two weeks, 12 of the 21 residents got sick. So, you know, both cases, like one looks clearly contagious. The other one doesn't look like it's at all contagious. So they didn't know. Maybe they thought some people might be immune. Maybe there were different strains that were contagious or had different levels of contagiousness. Or maybe it's just something that they never figured out. Yeah, and I was wondering, too, if the 12 of the 21 residents getting sick at that one home was maybe just a case of mass hysteria or something like that? Oh, interesting, yeah. No, I think half of the people who got sick died within 10 days of falling ill, so that was not mass hysteria.
30:41So that is just a genuine mystery, right? Like, it just doesn't make any kind of sense whatsoever. So they started trying to rule out things they thought it wasn't. Right. One was environmental causes, so that would make it toxic encephalitis. And I don't even know if we said at the outset, did you, I think, that encephalitis is swelling of the brain and spinal cord? Oh, no. Okay. I didn't say that. So I'm sure everybody got like a pretty good idea that encephalitis is something bad that you don't want to have. Right. But what it is is a condition where your brain and or your spinal cord swells and it can start taking on water.
31:18And from doing that, all sorts of terrible things can happen. The thing is, is encephalitis is not just specific to encephalitis lethargica. A lot of different things can make your brain and central nervous system swell. A disturbing amount of things can make that happen, actually, if you stop and think about it. And one of those things is environmental toxins. So that's toxic encephalitis. and that got ruled out very quickly because there just was no pattern whatsoever where everybody was exposed to, you know, like a Tesseract made of kryptonite or something like that for our nerd fans. Yeah, that's good.
31:59I tried to touch you guys. Bone just screwed it up royally, so I'm sorry. I think I may have just conflated DC and Marvel. Oh, yeah, yeah. Tesseract is Marvel. I'm dead, dude. No, I love it. I love it, man. I'm going to get killed. You should meld those. Superman meets Thanos. Sure. I want to see those dudes fight. Oh, that'd be great. I'm sure that would be a really interesting fight to watch. Somebody's going to write in and say, actually, guys, it happened in 1987 when, you know, some dude put out a comic. I suspect that those people aren't going to speak to us any longer. I think you're right.
32:38So like you said, they ruled that out, the toxic exposure. Then they moved on to an infectious kind of possibility, infectious encephalitis, in fact. And that can be, you know, infectious encephalitis is a thing. So it's not like we think it's that. That was already a thing. It can be secondary to bacterial or fungal or viral or parasitic infection. It's usually a virus. is the most common type of encephalitis. It could be like from the herpes virus or maybe measles or West Nile even, influenza. And considering how this went on during the Spanish flu initially, which happened in 1918, and there were flu-like symptoms, they thought that, you know, this probably, early on at least, was an influenza-led infectious encephalitis.
33:32Yeah, and that was, I think, von Economo's leading theory, which makes a lot of sense because they tracked with one another, like you said, at least this start. So was this just some horrible strain of Spanish flu that managed to continue on for years after Spanish flu? And I think that was incontrovertibly proven incorrect because actually when I did The End of the World, I talked about this guy who went up and dug up the corpse of an Inuit woman who had died from Spanish flu to get enough of the genome of it to bring the Spanish flu back to life, to study it. It's one of the most breathtakingly arrogant moments in all of science for somebody to do that.
34:13But the reason we know that encephalitis lethargica wasn't caused by the Spanish flu is because we had the Spanish flu genome and we couldn't find any Spanish flu RNA in like collections of tissue samples of brains of people who definitely died from encephalitis lethargica. Spanish flu wasn't there. Ergo, it wasn't Spanish flu. And because Josh is always too humble to say so after an end of the world reference, everyone, if you don't know, Josh had a great solo album, a eight part or 10 part? It was a 10 part subtitled Waxy Flexibility. The End of the World with Josh Clark, where he, one episode at a time, examined 10, I can't think of the word, existential risks that could face humanity, some of which are currently underway.
35:08Thanks a lot, Chuck. I appreciate that. That was really nice of you. It's very great. You got to be a smarty pants. But even if you're not a smarty pants, you should still give it a shot, I think, because I gave it a shot and I'm not a smarty pants. Hey, you are a smarty pants, but yes, smarty pants or no, I think everybody can be equally scared by this. Yeah, you did live shows too. So if you have a time machine on your hands, go back and see one of those while you're at it. And come talk to us if you have an actual working time machine as well. That'd be pretty neat. Streptococcal infection was another possibility at one point.
35:39There was some data that showed infection with streptococcal bacteria was in front of some of these cases of EL. and in 1931, our old pal, Dr. Ivan Iconomo, did an experiment and streptococcus vaccination actually led to an EL-like condition in dogs. Yeah, it's just sad, but... Yeah. The thing is, the thing that makes it even more sad is it wasn't definitive. They weren't like, oh, it's a strep infection. Right. It was like, I guess it could have been. There was another group called the Matheson Commission that studied encephalitis lethargica because a guy, ostensibly by the last name of Matheson, I couldn't find out who it was, he was a wealthy businessman from America who had been struck down by encephalitis lethargica.
36:28I believe he had gotten better, but not fully. And so he used some money to try to get to the bottom of this and funded this commission for 13 years. They put out four different reports and basically at the end said, maybe herpes? We don't know. And he said, your findings cut off. I've gotten into Sherlock Holmes societies. That's who I'm finding now. At the end of all that dough for that many years, you come back with maybe herpes? Are you kidding me? At the very least, give me herpes too. That reminds me, when I was a kid, I'll never forget, one of the first headlines that ever sunk in with me, because I was a Who's the Boss fan a little bit at the time.
37:09Okay. It had to be the Inquirer or something, but it was Tony Danza gave me herpes. And I looked like just yesterday to see if Tony Danza actually had ever given anyone herpes. And it does not seem to be the case. I don't believe Tony Danza has herpes. So that headline was totally made up. And I hope Tony Danza got some money from that for suing the Inquirer. Yeah. Oh, we should issue that correction too. You got that Tony Danza band name wrong. Oh, I did. In the metal episodes. Do you know what the correct one was? Well, what did you call it? I think I called it the Tony Danza tap dance experience.
37:46Is that not it? I think if that's what you said, I think it was tap dance extravaganza. Oh, okay. Or it's the other way around. Whichever one you said was wrong. That's fine. I can live with that. Yeah, yeah. We had a few metal people write in about that. So can't, you know, can't not correct the Tony Danza tap dance extravaganza. I'll bet they were nice, though. Like to a person, pretty much. All the metal fans that wrote in said, Even the ones correcting us were like, that was great. Yeah, that's the metal way. It is. All right. Shall we take our other break?
38:23Yeah, sure. All right. We'll be right back. Wait.
38:39New year, new goals, and in this economy, a better money plan is more necessary than ever. I am Matt. And I'm Joel. We are from the How to Money podcast, and every week we help you to spend smarter, save more, and make sense of what's going on out there. If you want 2026 to be the year you finally feel in control of your money, we're here to give you the tools and advice to help you make it happen. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Dr. Priyanka Wally. And I'm Hari Kondabolu. It's a new year. And on the podcast Health Stuff, we're resetting the way we talk about our health.
39:14Which means being honest about what we know, what we don't know, and how messy it can all be. I like to sleep in late and sleep early. Is there a chronotype for that or am I just depressed? We talk to experts who share real experiences and insight. You just really need to find where it is that you can have an impact in your own life and just start doing that. We break down the topics you want to know more about. Sleep, stress, mental health, and how the world around us affects our overall health. We talk about all the ways to keep your body and mind, inside and out, healthy. We human beings, all we want is connection.
39:53We just want to connect with each other. Health stuff is about learning, laughing, and feeling a little less alone. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey there, this is Dr. Jesse Mills, director of the men's clinic at UCLA Health and host of the Mailroom podcast. Each January, guys everywhere make the same resolutions. Get stronger, work harder, fix what's broken. But what if the real work isn't physical at all? To kick off the new year, I sat down with Dr. Steve Poulter, a psychologist with over 30 years experience helping men unpack shame, anxiety, and emotional pain they were never taught to name.
40:31In a powerful two-part conversation, we discuss why men aren't emotionally bulletproof, why shame hides in plain sight, and how real strength comes from listening to yourself and to others. Guys who are toxic, they're immature, or they've got something they just haven't resolved. Once that gets resolved, then there comes empathy as in compassion. If you want this to be the year you stop powering through pain and start understanding what's underneath, listen to The Mailroom on the iHeartRadio app, Apple Podcasts, or wherever you get your favorite shows.
41:17All right. So we mentioned some people studying, you know, different causes back in the day. They never could find anything out, like we said, and for about 30 years, they just kind of left it there. and it was in the late 1960s when neurology researchers that were working on Parkinson's really hit on it when they developed L-DOPA or Levodopa, which is a substitute for dopamine, which is the missing neurotransmitter, and Parkinson's disease. And it was released in 1967 and it brought akinetic Parkinson's disease patients back to life. And if you've seen the movie Awakenings, that's basically a big storyline.
41:56That's where it picks up is when Oliver Sacks scores some L-DOPA. He did. Off a guy selling it on the corner below Beth Abraham Hospital. Exactly. Yeah. So he finally starts with Leonard Lowe, who's Robert De Niro, not the patient's real name, obviously. But there's just this amazing transformation where all of a sudden these people, again, who are these frozen statue-like people and have been for decades of their lives suddenly like are like aware and talking and like focusing their attention on you. And when guys playing the piano and they're like going out on field trips now, it's like they were just completely brought out of it.
42:36And that's supposedly was very much the case with people with actual Parkinson's disease. Like they responded beautifully to L-DOPA. But one of the reasons, one of the indicators that post-encephalitic Parkinsonism and Parkinson's disease are different is that the people in Awakenings, the people with encephalitis lethargica, they responded well for a little while, and then they started to show other symptoms that really kind of, for some of them, it basically meant you can't take L-DOPA anymore. And incredibly sadly, Like one of the most sad things I can think of, they were left to just go back to their frozen statue state again.
43:21And don't forget, there is a great level of consciousness within them when they're in this state. So they came out of that state in which they were conscious, came to full consciousness and full interactivity, and maybe even left the hospital on a field trip and then had to go back to their frozen statue state again, conscious of this whole experience. Yeah, very heartbreaking to see in that movie. There was one case of a woman who, is this the Rose of which you spoke of to me privately? Yeah, that was Rose. And then Lucy was her name in the movie for some reason. Okay, well, this woman, just one of the cases of Oliver Sacks, she came out of it.
44:03And she basically described like being aware of everything that was happening for decades. and understanding what was happening, but just not feeling a connection to it. Like there was this weird disconnect. She knew about Pearl Harbor. She described knowing about the assassination of Kennedy, John F., that is. And she said that it just didn't seem real. She said, nothing has seemed real since 1926 when I got the encephalitis and came to a stop. I know I'm 64 now, and this is 1969, and that I'm an elderly woman in a bizarre situation in a chronic hospital, but I feel like I'm 21 and I feel like it's 1926.
44:41Yeah. Man, can you imagine? Yeah, and very sadly, she was one of the ones who did not, like, have her symptoms with L-Dopa were too extreme to continue on taking L-Dopa. Yeah, and some people, you know, came out and were just overjoyed and elated with this kind of thing, obviously. And some people came out and, obviously, you could also see had a very hard time with lost decades. it could not have been an easy thing to accept either way. The movie, there is good news. There is a bit of a silver lining because the movie does not cover the fact that after this, a lot of the patients finally regulated with the L-DOPA and were able to leave, at least lead, compared to sort of their previous life, a somewhat healthy life, like they weren't in that statuesque locked-in state.
45:32They might not have fully recovered, but they led an okay life. Right. Yeah. And they do mention that at the end. Oh, really? In one of those, I guess, epilogues or postscripts where they talk about how they continued on experimenting and some people it kind of worked out with a little bit. But they don't show it in the movie. The movie's all sad at the end. Yeah. It's so sad. It is. And yeah, oh my God, just go watch Awakenings again. I think I might. I accidentally watched Patch Adams first and I wanted to watch Awakening so bad I still watched it after Patch Adams, after Zoolander, and then I finally watched Awakening.
46:10I was up till like four in the morning today, last night. I never saw Patch Adams. Oh, it's not good. That was Saks too though, right? No, it was just Robin Williams too. It was no Awakening, I'll tell you that. Yeah, I need to check that out. It's funny, I met a guy named Leonard Lowe one time years ago and the only thing I could think in my head was, my name is Leonard Lowe. Like, I just remember De Niro saying that. You didn't say that to him? No, because I figured, you know, like our listener, Robert Paulson, he's probably tired of those jokes. I never stopped saying that to Robert Paulson.
46:44I can't help myself. So what about these days? What do we think about EL, medically speaking? Well, so one of the things that we did learn that we still don't fully understand, but was something that they recognized with L-DOPA and the study of the patients before they were administered L-DOPA is that while you're in this frozen state, like I said earlier, somebody throws a ball at you or like you said somebody sees an emergency, they can suddenly move like normal and then they go back to that frozen state afterward. They found that it's not just like an emergency, like a ball coming at you or your friend laying on the floor because they fell down, But things like music, human touch, even like obnoxious sounds like a siren or something can basically prompt the person to start moving again and like come back out of that frozen catatonia or mutism.
47:38and that was one of the things that they found people could do on L-DOPA too. Like even with the extreme like tremors or inability to control the movement of your mouth or eyes, those could be tamed by the same things, by stimulating your brain in some other way. And there is the story of a guy who was a cobbler by trade before he had gotten sick. Oh, yeah. And after L-Dopa came along, he asked for like a cobbler's bench and the hospital staff got him one. And when he was working at his cobbler's bench, he was able to like hold like nails in his teeth and like nail the heel of the shoe with these little tiny nails and just work and control the symptoms because there's something in the brain that was overriding the symptoms.
48:25We have no idea why. We just know that that was part of this whole thing. There's some way that these problematic symptoms can be overridden by some other region of the brain taking importance or precedence over that, which is just bizarre. Like from start to finish, this is one of the most bizarre diseases in history. Yeah, yeah, for sure. Did you also watch Tremors by accident? No, that would have been very pleasant. That's one of my favorite movies. All of a sudden the sun's coming up and you still haven't seen Awakenings. Right. So, getting back to the modern perspectives and what we think medically these days, in the last 75 years, like I said, it completely went away.
49:07They kind of don't know. In the last 75 years, there's only been about 80 case reports where it looks like it might be EL. They call it like an EL-like presentation. You know, the hypersomnolence, maybe ocular paralysis, maybe some of those neuropsychiatric symptoms. but they're really not sure because the cases are pretty varied and the symptoms are pretty varied. And again, all they have is sort of these case studies from before. They never landed on anything, so it's hard to tell if this is still going on at all or not. There's no effective treatment. They still use L-DOPA, I think, right? Yeah.
49:45Isn't that still on the scene? Yeah, so for the tremors and rigidity and stuff like that, sometimes ECT for if you have like pretty extreme psychiatric symptoms. But for Von Economo's work, he got he never won, but he was nominated three times for a Nobel Prize. Pretty good. Yeah, for sure. And remember, he also originally suspected that it was some sort of infection. Yeah. He thought Spanish flu wasn't Spanish flu. but they do think that it's probable now that it is the result of an autoimmune disorder triggered by an infection. Yeah. So what that would amount to is that you are infected by, maybe it is strep, maybe it is herpes, maybe it is influenza, we don't know.
50:29But something that resembles proteins found in different regions of your brain trains your body to attack those proteins in your brain so it triggers an autoimmune disorder. And those proteins are only found on specific regions of the brain that when you step back and look at what those regions do, they control the symptoms that you see in people with encephalitis lethargica. Right. I just sounded like Tim Curry in Rocky Horror Picture Show. Get up on the slab. Oh, that was good. I forgot how good your impression is of Dr. Frankenfurter. Oh, well, you know, I met the man. He held my cat. Oh, that's right.
51:12He said your cat was naughty, right? I said he had dramatic ears. Oh, okay. Yeah. But also naughty. Yeah. Yeah. Naughty. Get on the slab, Laurent. I got nothing else. Oh, okay. Let's see. I guess I got nothing else either. That's it. We don't know the answer to all of this, and I don't know when we ever will, but it's just so fascinating that you have to stop and remind yourself, like, this actually happened to people and that then you realize how terrifying the whole thing really is yeah well chuck said yeah twice within seven seconds which automatically means oh well no he derailed it you have to say yeah one more time hurry yeah okay now we're back on to listener mail uh this is uh you're gonna like this one josh i think hey guys this is about the a-tracks uh i always learn something from you sometimes unexpectedly, you guys.
52:09In the 8-track short stuff, you talked about cart being short for cartridge and sparked a memory. I'm from Buffalo, you see, and I used to listen to a radio announcer called Iron Mike Benson. He famously had what he called, and Jamie says, sorry to you specifically, Josh, about this. Okay. Where Iron Mike Benson would say that he had the heinous anus fart cart. and he would use it to play various fart sounds and strategically place them over the top of whatever songs happen to be getting played on the air at the moment. I always imagine the word cart at the time was referring to like a basket on wheels that contained a bunch of separate tapes.
52:49Yeah. Of fart sounds. Now it all makes sense. It was a tape recording, but because it was a looped tape with multiple tracks on it, he could cue whatever selection he wanted much quicker than you could with a linear cassette tape. So it was the analog way to do that sort of thing before a digital soundboard was used and invented. Thank you for all the useless interest grabbing information. And useless is in quotes, by the way. Okay. That is only useless until you can relate it to something else. Podcasts have come and gone, but your show is the one I haven't gotten tired of. And my sister Ashley agrees.
53:24Keep it up, boys. That is Jamie Lynn Bear. Awesome. Thank you, Jamie Lynn. and thank you to your sister Ashley who ostensibly listens as well. And the whole bear clan. How about that? Yeah. The clan of the cave bear. I thought that as well. Yeah. If you want to be like the clan of the cave bear and write in to let us know how much you like our show and or we triggered some memory in you that helped you put things together and or whatever else you want to say, we love that kind of thing. You can send it to us via email at stuffpodcast at iheartradio.com. Stuff You Should Know is a production of iHeartRadio.
54:04For more podcasts from iHeartRadio, visit the iHeartRadio app. Apple Podcasts are wherever you listen to your favorite shows.
54:17Hey, it's Joel. And Matt. From How To Money. If your New Year's resolution is to finally get your finances in shape, we've got your back. Prices, they're still high, and the economy is all over the place. But 2026 is the year for you to get intentional and make real progress. That's right. Each week we break down what's happening with your money, the most important issues to focus on, and the small moves that make a big difference. Kick off the year with confidence. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I'm John Polk. For years, I was the poster boy of the conversion therapy movement.
54:53the ex-gay who married an ex-lesbian and traveled the world telling my story of how I changed my sexuality from gay to straight. You might have heard my story, but you've never heard the real story. John has never been anything but gay, but he really tried hard not to be. Listen to Atonement, the John Palk story on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Dr. Priyanka Wally. And I'm Hari Kondabolu. It's a new year. And on the podcast Health Stuff, we're resetting the way we talk about our health. Which means being honest about what we know, what we don't know, and how messy it can all be.
55:34I like to sleep in late and sleep early. Is there a chronotype for that or am I just depressed? Health Stuff is about learning, laughing, and feeling a little less alone. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is an iHeart Podcast. Guaranteed Human.
From the publisher
Back in the early 1900s, a new pandemic happened out of nowhere with odd symptoms, that was never solved or cured. It just went away. Which means it's right up our alley.
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