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2 march 2014

Molly Caldwell Crosby's Asleep is a disjointed but compelling look at, as her subtitle puts it, "one of medicine's greatest mysteries," the epidemic of encephalitis lethargica that smouldered in the United States, and worldwide, throughout the 20th century. And while I call it "disjointed" – the narrative line is far from smooth and often not very coherent – that's not entirely a criticism. In some ways, the progress and cultural meaning of the disease were and remain extremely incoherent phenomena. Asleep mirrors that reality.

Most readers know encephalitis lethargica from Oliver Sacks's profound book Awakenings. But Sacks's masterpiece is only incidentally about the epidemic of "sleeping sickness" itself; it's centrally about the survivors who made dramatic (if mostly temporary) recoveries from its aftereffects, decades later.

In the 1920s and early 30s, encephalitis lethargica swept across the United States (where most of the cases that Crosby documents occured). It struck rich and poor alike. The victims seemed to share nothing. No cause or vector could be determined. In fact, no cause or vector has ever been determined; it isn't really known for sure if the sleeping sickness should be considered a single disease, or a syndrome of symptoms that appear in reaction to various causes (such as strep throat or influenza). One theory examined by Crosby holds that the great encephalitis was an autoimmune reaction to cases of the "great influenza." And almost necessarily to mild cases: serious cases killed their victims. A cruel twist of encephalitis is that it struck people who had weathered the great influenza relatively well.

Crosby's Asleep alternates narratives of doctors and institutions that studied and tried to treat encephalitis with case histories of patients. The case histories are upsetting – and not just because they sometimes involve great pain, even insanity. No, most upsetting in the accounts is how so many of these patients were seen, were marveled at, were documented – and then disappeared. One expects medical stories to lead to thrilling victories or tragic defeats. The encephalitis led instead to frustration and oblivion.

Crosby's book, then, is a bit about sufferers of the illness, a bit about the careers of physicians and researchers who intersected their lives, a bit about public health in America, quite a bit about general contextual history (read these pages diagonally if it's familiar). Intriguing photographs tell a somewhat parallel story, not really illustrating the key themes from the book. Most intriguing are images of the Kings Park Asylum in Suffolk County, Long Island – both of its heyday as a haven for children suffering the aftereffects of the encephalitis, and of its later overdevelopment and consequent fall into decay. A part of the old asylum has been redeemed as Nissequogue River State Park.

Crosby, Molly Caldwell. Asleep: The forgotten epidemic that remains one of medicine's greatest mysteries. New York: Berkley [Penguin], 2010. RA 644 .E52C76