1 00:00:01,080 --> 00:00:04,600 Speaker 1: Welcome to stuff he missed in History Class from houtworks 2 00:00:04,640 --> 00:00:13,119 Speaker 1: dot com. Hello, and welcome to the podcast. I'm Holly 3 00:00:13,160 --> 00:00:16,640 Speaker 1: from and I'm Tracey Wilson, and today is part two 4 00:00:16,760 --> 00:00:19,400 Speaker 1: of our History of Narcolepsy uh. And in the first 5 00:00:19,400 --> 00:00:21,880 Speaker 1: episode we talked about what narcolepsy is and when it 6 00:00:21,920 --> 00:00:25,840 Speaker 1: was first written about, at least in the Western record, 7 00:00:26,280 --> 00:00:28,160 Speaker 1: and of the work that was being done by German 8 00:00:28,160 --> 00:00:31,960 Speaker 1: psychiatrist Carl Friedrich Otto Westfall in the late eighteen seventies. 9 00:00:32,360 --> 00:00:35,280 Speaker 1: And as we left off, Westpall was really kind of 10 00:00:35,360 --> 00:00:38,120 Speaker 1: onto the idea that he was uh that what he 11 00:00:38,159 --> 00:00:40,400 Speaker 1: was seeing in these two particular cases that he talked 12 00:00:40,400 --> 00:00:43,400 Speaker 1: about might actually be a unique condition and not something 13 00:00:43,440 --> 00:00:47,880 Speaker 1: that could be lumped under an existing diagnosis. And today 14 00:00:47,880 --> 00:00:50,000 Speaker 1: we're going to pick up with the next big step 15 00:00:50,040 --> 00:00:54,920 Speaker 1: in the history of narcolepsy. So Jean Baptiste Edward Jeleno 16 00:00:55,160 --> 00:00:58,840 Speaker 1: is always mentioned in articles about narcilepsy and history because 17 00:00:59,000 --> 00:01:02,040 Speaker 1: he coined the term. He did so right out of 18 00:01:02,080 --> 00:01:05,280 Speaker 1: the gate in his article on narcilepsy, which first appeared 19 00:01:05,280 --> 00:01:08,200 Speaker 1: in the Gazette of the Civil and Military Hospitals of 20 00:01:08,240 --> 00:01:11,880 Speaker 1: the Ottoman Empire. Jelano was born in eighteen twenty eight 21 00:01:11,959 --> 00:01:14,600 Speaker 1: in Boardeaux in the south of France, and he served 22 00:01:14,640 --> 00:01:17,040 Speaker 1: as a Navy physician and made a name for himself 23 00:01:17,080 --> 00:01:21,000 Speaker 1: as a military surgeon through his studies of tropical diseases 24 00:01:21,000 --> 00:01:25,919 Speaker 1: while traveling aboard ships in the Indian Ocean and UH. 25 00:01:26,160 --> 00:01:28,480 Speaker 1: One of the other notable things that he did in 26 00:01:28,480 --> 00:01:30,640 Speaker 1: his medical career was that he introduced the use of 27 00:01:30,720 --> 00:01:35,280 Speaker 1: arsenic bromide tablets to treat epilepsy. He also helped to 28 00:01:35,319 --> 00:01:38,679 Speaker 1: set up an insurance system for physicians of advanced age, 29 00:01:39,240 --> 00:01:42,440 Speaker 1: and he wrote extensively on medical topics ranging from postpartum 30 00:01:42,480 --> 00:01:46,759 Speaker 1: psychosis to deafness for various publications, and he also founded 31 00:01:46,840 --> 00:01:50,960 Speaker 1: a Mineral Waters and Health SPA society. In an interesting 32 00:01:51,000 --> 00:01:53,480 Speaker 1: bit of crossover, he cited the work of Westfall in 33 00:01:53,520 --> 00:01:56,440 Speaker 1: an article about agoraphobia in eighteen eighty, which is the 34 00:01:56,480 --> 00:02:00,400 Speaker 1: same year that Jellino appeared on the narcilepsy timeline. We 35 00:02:00,480 --> 00:02:04,080 Speaker 1: don't know if the two men ever had direct communications 36 00:02:04,120 --> 00:02:07,400 Speaker 1: with one another, although they were working on some similar 37 00:02:07,440 --> 00:02:11,040 Speaker 1: areas of medicine. This is all happening right after Germany 38 00:02:11,080 --> 00:02:14,080 Speaker 1: had been unified by Otto von Bismarck and France and 39 00:02:14,120 --> 00:02:18,400 Speaker 1: Germany were not exactly super chatty at this point. Yeah, 40 00:02:18,440 --> 00:02:20,359 Speaker 1: so we really don't know if they ever had contact, 41 00:02:20,480 --> 00:02:22,840 Speaker 1: even though, as we said, he cited some of the 42 00:02:22,840 --> 00:02:26,480 Speaker 1: other man's work and they they were working in similar areas, 43 00:02:26,520 --> 00:02:28,880 Speaker 1: but those were areas that were kind of exciting throughout 44 00:02:28,919 --> 00:02:32,440 Speaker 1: the medical community, so there were many people working on them. Uh. 45 00:02:32,440 --> 00:02:35,760 Speaker 1: In Jellino's writing on Ourcalepsy, he offers up a case 46 00:02:35,800 --> 00:02:39,440 Speaker 1: of a barrel seller called Mr G. And he is 47 00:02:39,480 --> 00:02:42,440 Speaker 1: aged thirty eight, and this man experienced up to two 48 00:02:42,560 --> 00:02:46,840 Speaker 1: hundred incidents each day of uncontrollable sleep, lasting one to 49 00:02:46,960 --> 00:02:51,520 Speaker 1: five minutes each and even a thirty minute discussion would 50 00:02:51,560 --> 00:02:54,800 Speaker 1: be consistently interrupted by sleep attacks. I think Jellino mentions 51 00:02:54,800 --> 00:02:57,799 Speaker 1: in his writing that the longest he was ever able 52 00:02:57,800 --> 00:03:00,359 Speaker 1: to witness Mr G going without an a tech was 53 00:03:00,400 --> 00:03:04,280 Speaker 1: about thirty minutes. The patient had grown dependent on his 54 00:03:04,320 --> 00:03:06,399 Speaker 1: thirteen year old son to stay with him at all 55 00:03:06,480 --> 00:03:09,080 Speaker 1: times so that the sun could wake him when he 56 00:03:09,160 --> 00:03:13,679 Speaker 1: dropped off unexpectedly. Mr G had no history of convulsions, 57 00:03:13,800 --> 00:03:17,160 Speaker 1: no other medical issues that would explain this condition that 58 00:03:17,200 --> 00:03:20,960 Speaker 1: he presented himself with before Jeleno on February fifteenth of 59 00:03:21,000 --> 00:03:24,799 Speaker 1: eighteen seventy nine. Yeah he had, you know, he wasn't 60 00:03:24,800 --> 00:03:27,440 Speaker 1: completely free of of medical issues, but none of them 61 00:03:27,480 --> 00:03:30,679 Speaker 1: could have been attributed to this. Uh. Mr G had 62 00:03:30,760 --> 00:03:33,840 Speaker 1: been in a violent fight three years before his contact 63 00:03:33,919 --> 00:03:36,680 Speaker 1: with doctor Jelenome and after the fight he had been 64 00:03:36,760 --> 00:03:40,520 Speaker 1: arrested and imprisoned. Not long after that, a log actually 65 00:03:40,520 --> 00:03:43,120 Speaker 1: fell on his head. But he had continued his life 66 00:03:43,120 --> 00:03:46,440 Speaker 1: with no apparent consequences of these two events for quite 67 00:03:46,480 --> 00:03:50,280 Speaker 1: some time. However, about a year after the log incident, 68 00:03:50,640 --> 00:03:53,760 Speaker 1: Mr G began to experience a loss of muscular tone 69 00:03:53,760 --> 00:03:56,360 Speaker 1: in his legs and he was laughing aloud or when 70 00:03:56,360 --> 00:03:59,280 Speaker 1: he game excited because of a good business deal. He 71 00:03:59,360 --> 00:04:02,480 Speaker 1: started to notice that he would become paralyzed when playing 72 00:04:02,600 --> 00:04:05,760 Speaker 1: cards if he was dealt a particularly good hand, and 73 00:04:05,760 --> 00:04:07,880 Speaker 1: then he would drop off to sleep for about a minute. 74 00:04:09,200 --> 00:04:12,360 Speaker 1: And that's how it began. But his condition progressed pretty rapidly, 75 00:04:12,600 --> 00:04:15,880 Speaker 1: and soon the slightest excitation would send Mr G into 76 00:04:15,920 --> 00:04:19,360 Speaker 1: a sleep attack. He tried toward these sleep attacks off 77 00:04:19,400 --> 00:04:22,880 Speaker 1: to no avail, and he, as anyone else who deals 78 00:04:22,920 --> 00:04:25,880 Speaker 1: with noircilepsy, had no control over when his body would 79 00:04:25,920 --> 00:04:28,920 Speaker 1: just fall into a stupor even something as simple as 80 00:04:28,920 --> 00:04:31,680 Speaker 1: seeing happy children and families at play in the park, 81 00:04:32,160 --> 00:04:33,880 Speaker 1: he would have this moment of delight and then it 82 00:04:33,880 --> 00:04:37,840 Speaker 1: would drop him off to sleep. The more intense his emotions, 83 00:04:37,880 --> 00:04:40,240 Speaker 1: whether it was one of delight or one of pain 84 00:04:40,360 --> 00:04:43,640 Speaker 1: or anger, the more rapid and intense his sleep attack. 85 00:04:44,640 --> 00:04:47,159 Speaker 1: The attacks that came upon him when he was very 86 00:04:47,279 --> 00:04:50,919 Speaker 1: angry were less frequent, but his sleep became deeper and 87 00:04:51,000 --> 00:04:54,200 Speaker 1: lasted longer. Yeah, so it seems like happiness was a 88 00:04:54,200 --> 00:04:55,960 Speaker 1: little bit more of a trigger than anger, but the 89 00:04:56,000 --> 00:04:58,120 Speaker 1: anger ones were a little bit more intense in terms 90 00:04:58,160 --> 00:05:01,800 Speaker 1: of episodes. Uh. Mr G had already been diagnosed as 91 00:05:01,839 --> 00:05:04,520 Speaker 1: having a seizure disorder, but none of the treatments that 92 00:05:04,560 --> 00:05:07,000 Speaker 1: were issued for it did any good. He really didn't 93 00:05:07,000 --> 00:05:09,680 Speaker 1: think that was what he had. The patient reported no 94 00:05:09,800 --> 00:05:13,000 Speaker 1: pain associated with his sleep attacks, merely a feeling of 95 00:05:13,040 --> 00:05:16,520 Speaker 1: deep heaviness and the sensation of his mind being empty. 96 00:05:16,640 --> 00:05:19,440 Speaker 1: And you may recall that was one of the primary 97 00:05:19,480 --> 00:05:24,000 Speaker 1: descriptions the sense of empty mindedness of Westfall's primary patient 98 00:05:24,080 --> 00:05:27,320 Speaker 1: in his study. And Mr G could hear and he 99 00:05:27,360 --> 00:05:30,159 Speaker 1: was conscious. Despite this apparent stupor right up until the 100 00:05:30,200 --> 00:05:33,360 Speaker 1: moment where he truly fell asleep, although that sleep only 101 00:05:33,440 --> 00:05:37,720 Speaker 1: lasted a very brief time. Working alone proved to be 102 00:05:37,720 --> 00:05:40,520 Speaker 1: better for Mr G than working with a colleague because 103 00:05:40,560 --> 00:05:43,000 Speaker 1: he enjoyed the company of other people, and he would 104 00:05:43,000 --> 00:05:45,960 Speaker 1: become very animated while he was talking to them that 105 00:05:46,000 --> 00:05:50,640 Speaker 1: would trigger a sleep episode. Yeah, while I was reading 106 00:05:50,680 --> 00:05:53,240 Speaker 1: these notes, and I was reading a translation of Jellano's 107 00:05:53,400 --> 00:05:57,080 Speaker 1: or Jelino's work on the subject, I became sort of heartbroken. Like, 108 00:05:57,120 --> 00:05:59,640 Speaker 1: can you imagine every time you experienced laughter or delight 109 00:05:59,720 --> 00:06:03,520 Speaker 1: you kind of check out for a second. Um, it's 110 00:06:03,520 --> 00:06:06,599 Speaker 1: sort of a rough thing to think about. Uh. Jelina 111 00:06:06,680 --> 00:06:10,200 Speaker 1: referred to Mr G's cataplexy in his writing as astasia, 112 00:06:10,320 --> 00:06:13,400 Speaker 1: and while his patient experienced it, he did not experience 113 00:06:13,760 --> 00:06:17,479 Speaker 1: hallucinations allegedly were coming around to this um and was 114 00:06:17,640 --> 00:06:20,440 Speaker 1: able to sleep through the night he woke, he reported 115 00:06:20,480 --> 00:06:24,560 Speaker 1: just once a night on average. However, there is some 116 00:06:24,640 --> 00:06:28,560 Speaker 1: contradictory stuff going on here because Mr G also claimed 117 00:06:28,600 --> 00:06:31,600 Speaker 1: that his infant child he had a thirteen year old son, 118 00:06:31,600 --> 00:06:33,520 Speaker 1: but he also had a son that was just a 119 00:06:33,520 --> 00:06:35,960 Speaker 1: baby still, and he claimed that this child had been 120 00:06:36,000 --> 00:06:39,880 Speaker 1: conceived quote in a moment when the illness came over him. 121 00:06:39,920 --> 00:06:43,160 Speaker 1: And this particular statement in Jellino's writing has been puzzling 122 00:06:43,160 --> 00:06:47,160 Speaker 1: sleep researchers for quite some time. So it might indicate 123 00:06:47,200 --> 00:06:51,480 Speaker 1: that the man was actually having a hypnogogic hallucination, so 124 00:06:51,560 --> 00:06:55,800 Speaker 1: a hallucination as he fell into sleep, or he was 125 00:06:55,839 --> 00:06:59,880 Speaker 1: experiencing vivid dreams and dreamt the events. However, it may 126 00:07:00,000 --> 00:07:03,080 Speaker 1: also indicate that he had a sleep attack immediately after 127 00:07:03,200 --> 00:07:05,880 Speaker 1: having sex with his wife, or that he had an 128 00:07:06,200 --> 00:07:10,320 Speaker 1: episode of cataplexy before or after the sexual encounter, and 129 00:07:10,360 --> 00:07:12,440 Speaker 1: that this is the thing that he remembers. So we 130 00:07:13,000 --> 00:07:14,840 Speaker 1: that's one of those things that crops up and it 131 00:07:14,880 --> 00:07:18,200 Speaker 1: doesn't quite fit with the general picture. Uh. It's been 132 00:07:18,200 --> 00:07:21,000 Speaker 1: talked about a lot and discussed in the medical community 133 00:07:21,000 --> 00:07:23,560 Speaker 1: and amongst those that do sleep studies specifically, but it 134 00:07:23,720 --> 00:07:27,200 Speaker 1: kind of stays a mystery. So before we get into 135 00:07:27,200 --> 00:07:30,720 Speaker 1: how Jeleno tried to categorize Mr G's condition, let's have 136 00:07:30,800 --> 00:07:35,360 Speaker 1: a brief word from a sponsor. Uh. So, Leno puzzles 137 00:07:35,400 --> 00:07:37,600 Speaker 1: in his writing as to whether this is a condition 138 00:07:37,720 --> 00:07:40,600 Speaker 1: that should be grouped in an already recognized neurosis group 139 00:07:41,040 --> 00:07:44,240 Speaker 1: or if it deserves its own definition. And while he 140 00:07:44,280 --> 00:07:48,640 Speaker 1: relays the notes and diagnosis of Mr G's previous physician, 141 00:07:49,200 --> 00:07:51,720 Speaker 1: this is the one that diagnosed him with epilepsy, he 142 00:07:51,840 --> 00:07:54,680 Speaker 1: is not at all convinced that the epilepsy diagnosis holds water. 143 00:07:54,880 --> 00:07:57,680 Speaker 1: He points out that while some of the symptoms do overlap, 144 00:07:57,760 --> 00:07:59,960 Speaker 1: as we talked about in our last episode, part of 145 00:08:00,000 --> 00:08:03,640 Speaker 1: a problem when arcolepsy diagnosis is that all sleep disorders 146 00:08:03,680 --> 00:08:06,280 Speaker 1: have a lot of overlap, and at this point in history, 147 00:08:06,520 --> 00:08:09,320 Speaker 1: a lot of things got lumped under epilepsy that really 148 00:08:09,360 --> 00:08:14,720 Speaker 1: were not ideally supposed to be there. Uh. But he 149 00:08:14,840 --> 00:08:18,080 Speaker 1: points out that Mr G had never actually had a seizure. 150 00:08:18,640 --> 00:08:20,800 Speaker 1: It seemed like the previous doctor was noting that he 151 00:08:20,840 --> 00:08:23,720 Speaker 1: was falling down in these moments of cataplexy, and he 152 00:08:23,760 --> 00:08:26,680 Speaker 1: was attributing that to a seizure rather than this sort 153 00:08:26,720 --> 00:08:31,120 Speaker 1: of loss of muscle control. Jelena's article also compares Mr 154 00:08:31,200 --> 00:08:34,120 Speaker 1: G's condition to quinophobia, which is the fear of open spaces, 155 00:08:34,559 --> 00:08:36,760 Speaker 1: to sleeping dropsy, which has talked about a lot in 156 00:08:36,800 --> 00:08:39,840 Speaker 1: the time, and vertigo, and he finds all of them 157 00:08:39,840 --> 00:08:43,280 Speaker 1: equally unsuitable as labels for this pattern. Of paralysis and 158 00:08:43,320 --> 00:08:47,560 Speaker 1: sleep that his patient was exhibiting. Jelena dismissed the idea 159 00:08:47,600 --> 00:08:50,040 Speaker 1: that Mr G's condition was the result of that conch 160 00:08:50,080 --> 00:08:53,320 Speaker 1: on ahead we talked about earlier. Instead, he offers the 161 00:08:53,320 --> 00:08:56,720 Speaker 1: theory that his nerve centers didn't get enough oxygen or 162 00:08:56,760 --> 00:09:00,440 Speaker 1: that the oxygen supply was being depleted too rapidly. So, 163 00:09:00,480 --> 00:09:02,720 Speaker 1: according to this theory, his body was just in a 164 00:09:02,840 --> 00:09:07,080 Speaker 1: constant cycle of seeking restorative sleep. Yeah, it's an interesting theory. 165 00:09:07,120 --> 00:09:10,320 Speaker 1: Modern science doesn't hold that out. But he was really 166 00:09:10,320 --> 00:09:15,120 Speaker 1: trying to explore some previously undiscovered territory in terms of 167 00:09:15,160 --> 00:09:18,040 Speaker 1: finding out why this would happen to a person. The 168 00:09:18,120 --> 00:09:22,520 Speaker 1: treat Mr G. Jellino initially prescribed picrotoxin, and this is 169 00:09:22,520 --> 00:09:27,720 Speaker 1: a stimulant that's derived from woody vines. Stimulants continue to 170 00:09:27,720 --> 00:09:31,280 Speaker 1: be part of the the treatment for a lot of 171 00:09:31,280 --> 00:09:34,319 Speaker 1: people with narcolepsy and other sleep disorders, and the idea 172 00:09:34,440 --> 00:09:37,840 Speaker 1: was that this picrotoxin would prevent spasmodic contraction of the 173 00:09:37,840 --> 00:09:42,080 Speaker 1: blood vessels. He also added bromides which were used as sedatives, 174 00:09:42,280 --> 00:09:45,720 Speaker 1: and unfortunately, this course of treatment had no positive effect 175 00:09:45,760 --> 00:09:48,360 Speaker 1: on the patient whatsoever, and it actually made him feel weaker. 176 00:09:49,080 --> 00:09:52,320 Speaker 1: The next approach was the inhalation of amal nitrate to 177 00:09:52,480 --> 00:09:55,280 Speaker 1: dilate the blood vessels whenever Mr D felt an attack 178 00:09:55,440 --> 00:09:58,600 Speaker 1: coming on. This too, failed to curtail any of his 179 00:09:58,679 --> 00:10:04,200 Speaker 1: sleep attacks. Similarly, apomorphine injections, stryct nine, arsenate, phosphates, and 180 00:10:04,280 --> 00:10:09,520 Speaker 1: caffeine were all failures. Yeah, you know, some would initially 181 00:10:09,559 --> 00:10:12,280 Speaker 1: appear like they might be helping. And it's funny because 182 00:10:12,280 --> 00:10:15,600 Speaker 1: in the description he talks about whenever Mr G inhales 183 00:10:15,600 --> 00:10:18,400 Speaker 1: the amill nitrate, his cheeks flush, and so they think 184 00:10:18,440 --> 00:10:22,000 Speaker 1: like it might be doing some good, but no, uh. 185 00:10:22,200 --> 00:10:26,600 Speaker 1: Jelena did not differentiate between narcolepsy with catoplexy and narcolepsy 186 00:10:26,679 --> 00:10:31,000 Speaker 1: without catoplexy, because in his patient there was always cataplexy, 187 00:10:31,360 --> 00:10:35,520 Speaker 1: although today those two conditions are diagnosed differently, and while 188 00:10:35,640 --> 00:10:38,959 Speaker 1: Jeleno touched on and ultimately dismissed in Mr G's case, 189 00:10:39,480 --> 00:10:42,080 Speaker 1: the possibility of an injury being the cause of such 190 00:10:42,080 --> 00:10:45,320 Speaker 1: a condition, it would be sometime before a narcolepsy would 191 00:10:45,320 --> 00:10:48,920 Speaker 1: be distinguished into two types. Primary narcolepsy, which is when 192 00:10:48,920 --> 00:10:51,280 Speaker 1: the cause of the condition is unknown and it seems 193 00:10:51,280 --> 00:10:54,080 Speaker 1: to exist on its own as a neurological condition, and 194 00:10:54,080 --> 00:10:57,720 Speaker 1: then secondary narcilepsy characterized by the presence of an underlying 195 00:10:57,720 --> 00:11:03,280 Speaker 1: neurological condition or a traumatic injury. So both the Westpall 196 00:11:03,400 --> 00:11:06,240 Speaker 1: and Jelino cases have a lot of factors in common. 197 00:11:06,800 --> 00:11:09,960 Speaker 1: Neither of them, however, include discussion of automatic behavior. So 198 00:11:10,000 --> 00:11:12,520 Speaker 1: those are those instances where patients go on with the 199 00:11:12,520 --> 00:11:16,320 Speaker 1: task that they had been partaking in or doing even 200 00:11:16,400 --> 00:11:19,200 Speaker 1: during episodes of sleep attacks, like continuing to write even 201 00:11:19,240 --> 00:11:22,199 Speaker 1: after they've dropped off. One of the important aspects of 202 00:11:22,280 --> 00:11:25,760 Speaker 1: Jelino's work was his observation that episodes of sleep were 203 00:11:25,800 --> 00:11:30,200 Speaker 1: often linked to or catalyzed by moments of extreme emotional response. 204 00:11:30,760 --> 00:11:34,040 Speaker 1: And while Westball seems to have been observing similar triggers 205 00:11:34,080 --> 00:11:37,640 Speaker 1: for cataplexy, he mentions things like the patients seeing two 206 00:11:37,640 --> 00:11:42,120 Speaker 1: boys fighting or excitation is bringing on cataplexy, he isn't 207 00:11:42,120 --> 00:11:45,360 Speaker 1: as detailed, and as we mentioned before, he seems to 208 00:11:45,440 --> 00:11:48,800 Speaker 1: think that the sleep instances are the result or extension 209 00:11:48,960 --> 00:11:53,280 Speaker 1: of the muscle weakness. But the truly important development is 210 00:11:53,320 --> 00:11:56,320 Speaker 1: that these two prominent doctors, and there were others writing, 211 00:11:56,320 --> 00:11:59,000 Speaker 1: but these are the two that really kind of cemented 212 00:11:59,040 --> 00:12:02,960 Speaker 1: this Uh, they had now written about patients with what 213 00:12:03,080 --> 00:12:08,080 Speaker 1: appeared to be really similar conditions. Uh, And so narcolepsy 214 00:12:08,120 --> 00:12:10,680 Speaker 1: started to really be looked at a little more seriously. 215 00:12:10,840 --> 00:12:14,200 Speaker 1: But unfortunately, as it gained recognition as a sleep disorder, 216 00:12:15,320 --> 00:12:19,480 Speaker 1: many sleep issues involving daytime drowsiness were then incorrectly lumped 217 00:12:19,480 --> 00:12:23,720 Speaker 1: together under the diagnosis of narcolepsy. While there was certainly 218 00:12:23,800 --> 00:12:25,920 Speaker 1: some work being done in the field of narcolepsy in 219 00:12:25,960 --> 00:12:29,400 Speaker 1: the early twentieth century, cataplexy was given its name in 220 00:12:29,520 --> 00:12:33,679 Speaker 1: nineteen o two, for example, it wasn't until the encephalitis 221 00:12:33,720 --> 00:12:36,760 Speaker 1: lethargic outbreak that started in nineteen seventeen that it really 222 00:12:36,800 --> 00:12:40,679 Speaker 1: got a lot of attention. We have a whole episode 223 00:12:40,679 --> 00:12:44,920 Speaker 1: on encephalitis lethargica that is extremely scary, so we won't 224 00:12:44,920 --> 00:12:49,080 Speaker 1: go into more detail about it here. Yeah, Tracy did 225 00:12:49,080 --> 00:12:52,160 Speaker 1: the research on the encephalitis lethargica episode and it was very, 226 00:12:52,240 --> 00:12:55,160 Speaker 1: very frightening stuff. An accidental Halloween episode. It was not 227 00:12:55,200 --> 00:12:59,079 Speaker 1: supposed to be scary stuff for Halloween, but it's very 228 00:12:59,160 --> 00:13:02,560 Speaker 1: scary to take about to talk about. But just as 229 00:13:02,600 --> 00:13:06,720 Speaker 1: we said, uh, many sleep disorders were incorrectly being diagnosed 230 00:13:06,760 --> 00:13:11,000 Speaker 1: as narcilepsy, and this was sometimes a problem with encephalitis lethargica, 231 00:13:11,040 --> 00:13:14,040 Speaker 1: particularly in the beginning of it its appearance. Although there 232 00:13:14,080 --> 00:13:19,600 Speaker 1: were cases of encephalitis lethargica where the narcolepsy diagnosis was legits, 233 00:13:20,120 --> 00:13:23,520 Speaker 1: and this actually caused some doctors to debate whether or 234 00:13:23,559 --> 00:13:27,240 Speaker 1: not there were truly any cases of idiopathic narcolepsy or 235 00:13:27,280 --> 00:13:30,240 Speaker 1: if it really was just always linked to another problem 236 00:13:30,600 --> 00:13:35,880 Speaker 1: that just wasn't always easily identified. In ninety psychiatrists Constantine 237 00:13:35,960 --> 00:13:38,120 Speaker 1: von Economo, who I think they talk about in that 238 00:13:38,280 --> 00:13:43,920 Speaker 1: encephalitis lethargica episode, identified the posterior hypothalamus as the region 239 00:13:43,960 --> 00:13:47,240 Speaker 1: of the brain that was critical and wakefulness. He proposed 240 00:13:47,240 --> 00:13:51,199 Speaker 1: that allegian lesion or disease of the posterior hypothalamus was 241 00:13:51,240 --> 00:13:56,120 Speaker 1: a probable primary cause of narcolepsy, and his interest in 242 00:13:56,200 --> 00:13:59,719 Speaker 1: sleep science grew. Many treatments for narcolepsy were devised In 243 00:13:59,800 --> 00:14:04,240 Speaker 1: a tempted inthracol injection of air so that's air pumped 244 00:14:04,240 --> 00:14:07,079 Speaker 1: into the space under the erechnoid membranes of the brain 245 00:14:07,200 --> 00:14:12,160 Speaker 1: or spinal cord was tried. Removal of cerebro spinal fluid 246 00:14:12,320 --> 00:14:15,880 Speaker 1: and radiation of the hypothalamic region. Uh. Those were all 247 00:14:15,960 --> 00:14:20,160 Speaker 1: attempted to try to treat an oar ecilepsy. None really effective, 248 00:14:20,720 --> 00:14:24,360 Speaker 1: and the pharmaceutical realm ethidrine sometimes offered marginal help. But 249 00:14:24,400 --> 00:14:29,080 Speaker 1: in and famines were introduced as a treatment. These had 250 00:14:29,160 --> 00:14:33,120 Speaker 1: and continue to have a significant effect in the way 251 00:14:33,160 --> 00:14:35,560 Speaker 1: of reducing drowsiness, but there are a lot of side 252 00:14:35,560 --> 00:14:39,640 Speaker 1: effects and they can be addictive. Tricyclic antidepressants have also 253 00:14:39,680 --> 00:14:42,520 Speaker 1: been effective, and in many cases doctors use a combination 254 00:14:42,560 --> 00:14:47,080 Speaker 1: of antidepressants and stimulants to manage patient care. And then 255 00:14:47,080 --> 00:14:49,920 Speaker 1: before we get to what is maybe the most fascinating 256 00:14:50,000 --> 00:14:54,160 Speaker 1: part of an oarcilepsy history, at least for me, should 257 00:14:54,200 --> 00:14:58,600 Speaker 1: we take a moment to thank one of our sponsors. Sure, okay, 258 00:14:58,680 --> 00:15:01,600 Speaker 1: So now we're getting into the the middle of the 259 00:15:01,640 --> 00:15:04,640 Speaker 1: twentieth century where some really interesting stuff starts to happen. 260 00:15:05,640 --> 00:15:08,280 Speaker 1: Starting in nineteen sixty four, Dr William Demmott, who is 261 00:15:08,320 --> 00:15:11,200 Speaker 1: the father of modern sleep science and is still going 262 00:15:11,240 --> 00:15:14,280 Speaker 1: he's in his eighties, now open a sleep clinic at 263 00:15:14,320 --> 00:15:17,960 Speaker 1: Stanford and their intensive study of the causes and patterns 264 00:15:17,960 --> 00:15:21,680 Speaker 1: of narcolepsy was conducted. The sleep center actually became permanently 265 00:15:21,800 --> 00:15:26,240 Speaker 1: established a little over five years later in nineteen seventy. 266 00:15:26,800 --> 00:15:30,680 Speaker 1: This is also where canine narcolepsy enters the picture. The 267 00:15:30,680 --> 00:15:33,080 Speaker 1: first case of a dog with narcolepsy was identified in 268 00:15:33,160 --> 00:15:36,720 Speaker 1: nineteen seventy three. The dog, a toy poodle named Monique, 269 00:15:36,760 --> 00:15:41,600 Speaker 1: had begun having cataplectic attacks as an adolescent puppy. In 270 00:15:41,640 --> 00:15:46,080 Speaker 1: some cases, Monique would experience only partial cataplexy, and for example, 271 00:15:46,160 --> 00:15:49,000 Speaker 1: her only her legs would go limp, but at other 272 00:15:49,080 --> 00:15:53,360 Speaker 1: times she experienced a full collapse, and justice was the 273 00:15:53,440 --> 00:15:58,720 Speaker 1: case with Westfall and Jellino's patients. Excitement would trigger Monique. 274 00:15:59,320 --> 00:16:01,800 Speaker 1: A new toy, oi or food or a treat could 275 00:16:01,800 --> 00:16:05,160 Speaker 1: prompt an episode of cataplexy, and the years after Monique 276 00:16:05,200 --> 00:16:08,320 Speaker 1: was identified, Dr DeMott traveled to veterinary schools and met 277 00:16:08,320 --> 00:16:12,080 Speaker 1: with veterinarians who discussed the condition and identify canines who 278 00:16:12,120 --> 00:16:16,400 Speaker 1: had it, and so eventually a canine narcilepsy colony was 279 00:16:16,480 --> 00:16:19,080 Speaker 1: actually founded as part of the Stanford Labs so that 280 00:16:19,160 --> 00:16:22,560 Speaker 1: researchers could start a breeding program to study the role 281 00:16:22,600 --> 00:16:27,160 Speaker 1: of heredity in narcolepsy. However, initially all of the puppies 282 00:16:27,200 --> 00:16:31,080 Speaker 1: produced by this program were asymptomatic, researchers were unable to 283 00:16:31,920 --> 00:16:36,920 Speaker 1: identify a hereditary component. Fifteen different breeds of dog were 284 00:16:36,960 --> 00:16:40,680 Speaker 1: identified with canine narcolepsy with cataplexy over the years, and 285 00:16:40,840 --> 00:16:44,520 Speaker 1: two breeds there were men pinchers and Labrador retrievers were 286 00:16:44,560 --> 00:16:49,479 Speaker 1: found to actually transfer the condition genetically. So with this discovery, 287 00:16:49,520 --> 00:16:52,080 Speaker 1: it was revealed that there are both sporadic which is 288 00:16:52,280 --> 00:16:57,680 Speaker 1: non hereditary random occurrences, and familiar or hereditary versions of 289 00:16:57,760 --> 00:17:02,440 Speaker 1: canine narcilepsy. And while there have been numerous developments in 290 00:17:02,480 --> 00:17:05,239 Speaker 1: the study of narcolepsy, and some have been quite recent, uh, 291 00:17:05,480 --> 00:17:09,280 Speaker 1: one of the biggest then happened in and it started 292 00:17:09,280 --> 00:17:12,040 Speaker 1: with this ongoing study of the condition in dogs as 293 00:17:12,080 --> 00:17:15,280 Speaker 1: well as in mice because they will also exhibit narcilepsy. 294 00:17:15,960 --> 00:17:21,120 Speaker 1: And at that point in hypocreting receptor mutations were identified 295 00:17:21,280 --> 00:17:25,280 Speaker 1: as the cause of narcolepsian dogs. Hypocreting is a brain 296 00:17:25,359 --> 00:17:30,120 Speaker 1: chemical that regulates sleep and wakefulness. So abnormal levels of hypocreting, 297 00:17:30,240 --> 00:17:32,840 Speaker 1: so too much or too little, can cause all kinds 298 00:17:32,840 --> 00:17:37,280 Speaker 1: of havoc on the sleep cycle system. And the following year, 299 00:17:37,440 --> 00:17:40,200 Speaker 1: so in two thousands, so we're getting quite recent human 300 00:17:40,240 --> 00:17:44,800 Speaker 1: earcolepsy was also associated with a deficiency in hypocreting, and 301 00:17:44,840 --> 00:17:47,840 Speaker 1: while there's ongoing research as to why hypocrete and producing 302 00:17:47,840 --> 00:17:51,800 Speaker 1: cells are lost why they, you know, shut down, one 303 00:17:51,880 --> 00:17:54,359 Speaker 1: area that's being explored is that it could potentially be 304 00:17:54,400 --> 00:17:59,600 Speaker 1: caused by an autoimmune reaction. Surprisingly, narcolepsy and narcolepsy with 305 00:17:59,680 --> 00:18:03,399 Speaker 1: catapory actually weren't acknowledged as discrete clinical disorders until the 306 00:18:03,440 --> 00:18:07,159 Speaker 1: publication of the two thousand and one International Classification of 307 00:18:07,200 --> 00:18:11,199 Speaker 1: Sleep Disorders. Yeah, it's still, in some ways such a 308 00:18:11,280 --> 00:18:16,440 Speaker 1: new thing, uh, and I'm forever fascinated by it. Part 309 00:18:16,440 --> 00:18:17,960 Speaker 1: of it is that I've had two friends in my 310 00:18:18,000 --> 00:18:21,199 Speaker 1: life that have anarcilepsy, the real deal, by which I 311 00:18:21,240 --> 00:18:23,200 Speaker 1: do know. I mean, I think some people will joke 312 00:18:23,440 --> 00:18:25,119 Speaker 1: in social circles about, oh, I am my friend is 313 00:18:25,119 --> 00:18:26,920 Speaker 1: a narcolepsy because they tend to fall asleep a lot. 314 00:18:27,200 --> 00:18:29,280 Speaker 1: But once you have seen someone actually be in the 315 00:18:29,320 --> 00:18:32,399 Speaker 1: middle of talking to you and just be out, and 316 00:18:32,400 --> 00:18:34,760 Speaker 1: then forty seconds later they just start talking again and 317 00:18:34,760 --> 00:18:37,760 Speaker 1: they're awake, and it's like it never happened, it is 318 00:18:37,840 --> 00:18:40,160 Speaker 1: very fascinating and you realize that this is a very 319 00:18:40,240 --> 00:18:43,520 Speaker 1: unique condition and it is not just being sleepy and tired. 320 00:18:46,000 --> 00:18:48,600 Speaker 1: There are also uh and we'll link to them in 321 00:18:48,600 --> 00:18:50,440 Speaker 1: the show notes. I have them listed in the sources. 322 00:18:50,840 --> 00:18:54,760 Speaker 1: There are videos of animals experiencing narcolepsy, which if you're 323 00:18:54,760 --> 00:18:56,480 Speaker 1: an animal person, it can be a little bit hard 324 00:18:56,480 --> 00:18:59,000 Speaker 1: to watch initially because you see like these, you know, 325 00:18:59,040 --> 00:19:01,359 Speaker 1: a dog running around and then suddenly like just losing 326 00:19:01,400 --> 00:19:04,320 Speaker 1: control of its legs, and it looks very upsetting and frightening. 327 00:19:04,480 --> 00:19:07,199 Speaker 1: The dogs seem to generally not be too distraught by 328 00:19:07,240 --> 00:19:12,000 Speaker 1: the whole situation. Um, but it's fascinating to watch. And 329 00:19:12,000 --> 00:19:14,280 Speaker 1: I think if you watch just a a moment or 330 00:19:14,320 --> 00:19:16,879 Speaker 1: two of those kinds of films, you'll see pretty quickly 331 00:19:16,920 --> 00:19:19,480 Speaker 1: that again, this is not just a case of someone 332 00:19:19,560 --> 00:19:22,240 Speaker 1: being sleepy or nodding off. It's not like when you 333 00:19:22,320 --> 00:19:24,640 Speaker 1: doze off in a in a meeting because your brain 334 00:19:24,720 --> 00:19:28,720 Speaker 1: is not getting stimulation. It's really like it's like a 335 00:19:28,800 --> 00:19:32,680 Speaker 1: switch being flipped in many cases. So that's why I'm 336 00:19:32,680 --> 00:19:34,919 Speaker 1: fascinated by it. Like I said, I'm fascinated by all 337 00:19:34,960 --> 00:19:38,119 Speaker 1: the sleep things. I also have a little bit of 338 00:19:38,160 --> 00:19:42,960 Speaker 1: listener mail. I will this is a more listener mail 339 00:19:43,040 --> 00:19:47,840 Speaker 1: about our gouty podcast. So these are actually two pieces. 340 00:19:48,440 --> 00:19:50,399 Speaker 1: One is from our listener Kristen, and she says, I 341 00:19:50,440 --> 00:19:52,640 Speaker 1: started listening to your podcasts on the way from Seattle 342 00:19:52,640 --> 00:19:55,440 Speaker 1: to Nebraska for the holidays. That is a twenty two 343 00:19:55,480 --> 00:19:57,480 Speaker 1: hour drive, she says, and she had lots of time 344 00:19:57,480 --> 00:19:59,840 Speaker 1: for podcasts, um but when I saw the most re 345 00:20:00,119 --> 00:20:02,560 Speaker 1: podcast we're on Antony Goudy, I had to listen to them. 346 00:20:02,600 --> 00:20:05,040 Speaker 1: He's been one of my favorite artists, not just architects, 347 00:20:05,080 --> 00:20:07,080 Speaker 1: for a long time. It was a major reason why 348 00:20:07,119 --> 00:20:09,280 Speaker 1: I wanted to visit Barcelona. I think you both did 349 00:20:09,280 --> 00:20:11,520 Speaker 1: an amazing job going over his life and work, especially 350 00:20:11,600 --> 00:20:13,960 Speaker 1: his death not to be morbid. It's an important detail 351 00:20:14,000 --> 00:20:17,040 Speaker 1: of his life and it's one that's sometimes overlooked. There 352 00:20:17,040 --> 00:20:19,040 Speaker 1: were a couple of points that weren't touched on and 353 00:20:19,119 --> 00:20:22,119 Speaker 1: might be of interest to listeners who are ever in Barcelona. 354 00:20:22,240 --> 00:20:25,359 Speaker 1: One is that the sidewalk tiles in some places around 355 00:20:25,359 --> 00:20:28,399 Speaker 1: Barcelona were designed by Goudy. They have a pattern that 356 00:20:28,440 --> 00:20:31,159 Speaker 1: looks like fossils and it's quite beautiful. Images can be 357 00:20:31,160 --> 00:20:34,680 Speaker 1: found by googling Gouty sidewalk tiles. I'm sure you've seen 358 00:20:34,720 --> 00:20:38,560 Speaker 1: some pictures of them. Also on the roof of Kazamila. 359 00:20:38,680 --> 00:20:41,679 Speaker 1: There is a small archway that Goudy designed to frame 360 00:20:41,800 --> 00:20:45,320 Speaker 1: the then unfinished Sagrada Familia. He put an immense amount 361 00:20:45,359 --> 00:20:47,720 Speaker 1: of effort into all of his work, even connecting them 362 00:20:47,760 --> 00:20:50,480 Speaker 1: like this, which is which I find to be incredibly impressive, 363 00:20:50,680 --> 00:20:53,359 Speaker 1: and she includes a picture of it. I did not 364 00:20:53,480 --> 00:20:56,119 Speaker 1: know either of those things. I remember seeing in some 365 00:20:56,240 --> 00:20:59,920 Speaker 1: of my image searches. Uh. Some of the sidewalk tiles 366 00:21:00,040 --> 00:21:03,520 Speaker 1: it I presumed, perhaps foolishly, because I didn't see any 367 00:21:03,640 --> 00:21:06,600 Speaker 1: right up about them being specifically designed by him for 368 00:21:06,680 --> 00:21:09,280 Speaker 1: parts of Barcelona, Like I thought they were probably just 369 00:21:09,320 --> 00:21:11,720 Speaker 1: the pieces that were outside of the buildings that he 370 00:21:11,760 --> 00:21:14,680 Speaker 1: had designed, But apparently they are out and about uh. 371 00:21:14,680 --> 00:21:17,600 Speaker 1: And the other one is I won't read the whole email, 372 00:21:17,600 --> 00:21:20,760 Speaker 1: but it is from our listener Scott, and he mentions 373 00:21:20,800 --> 00:21:26,119 Speaker 1: to us that just after the Gouty podcast aired, and 374 00:21:26,200 --> 00:21:28,920 Speaker 1: this was complete accident on our part, there was an 375 00:21:29,040 --> 00:21:33,080 Speaker 1: article about a chapel being built in Chile based upon 376 00:21:33,119 --> 00:21:35,760 Speaker 1: the designs of Goudy, and it's going to be the 377 00:21:35,760 --> 00:21:38,800 Speaker 1: first Gouty design building outside of his native Spain. And 378 00:21:38,840 --> 00:21:40,560 Speaker 1: he includes a link to the article which you will 379 00:21:40,600 --> 00:21:42,760 Speaker 1: also put in the show notes, he says, I love 380 00:21:42,760 --> 00:21:44,440 Speaker 1: it when something I've just learned about makes the news. 381 00:21:44,520 --> 00:21:46,760 Speaker 1: At the same time, I do too, especially when it 382 00:21:46,800 --> 00:21:49,560 Speaker 1: happens accidentally and I we look like we're really timely, 383 00:21:49,960 --> 00:21:54,240 Speaker 1: But that was an absolute accident, So hooray for happy accidents. 384 00:21:55,040 --> 00:21:57,080 Speaker 1: If you would like to write us, talk to us 385 00:21:57,080 --> 00:22:02,280 Speaker 1: about sleep disorders or uh architects or whatever else De 386 00:22:02,400 --> 00:22:04,399 Speaker 1: likes you, you you can do so at History Podcast at 387 00:22:04,400 --> 00:22:06,919 Speaker 1: House of Works dot com. You can also connect with 388 00:22:06,960 --> 00:22:09,920 Speaker 1: us at Misston History on Twitter, at Facebook dot com, 389 00:22:09,960 --> 00:22:13,640 Speaker 1: slash mist in History at Misston History dot combler dot com, 390 00:22:13,640 --> 00:22:16,800 Speaker 1: on pinterest dot com slash mist in history. And if 391 00:22:16,840 --> 00:22:20,040 Speaker 1: you would like to purchase some misst in History goodies 392 00:22:20,080 --> 00:22:24,520 Speaker 1: like shirts in topebags and other fun things, you can 393 00:22:24,520 --> 00:22:26,560 Speaker 1: do that at our spreadshirt store, which is missed in 394 00:22:26,600 --> 00:22:29,520 Speaker 1: History dot spreadshirt dot com. You would like to research 395 00:22:29,520 --> 00:22:31,320 Speaker 1: a little bit about what we talked about today, you 396 00:22:31,320 --> 00:22:33,280 Speaker 1: can go to our parents side House of Works. Type 397 00:22:33,280 --> 00:22:35,760 Speaker 1: in the word and oarcilepsy in the search bar to 398 00:22:36,000 --> 00:22:38,359 Speaker 1: get an article called what is an oarcilepsy? And I 399 00:22:38,840 --> 00:22:41,160 Speaker 1: mentioned this one in the second of our episodes because 400 00:22:41,160 --> 00:22:44,439 Speaker 1: it's the timeline there is not quite the same as 401 00:22:44,480 --> 00:22:46,640 Speaker 1: the one that I mentioned. They kind of pick up 402 00:22:46,680 --> 00:22:52,360 Speaker 1: with jeleno as the start of really the record of it, uh, 403 00:22:52,640 --> 00:22:54,440 Speaker 1: because that really is when it came into being as 404 00:22:54,440 --> 00:22:57,040 Speaker 1: the word in ourcilepsy. So have a peek at that 405 00:22:57,160 --> 00:23:00,119 Speaker 1: article if you like. You can also visit us at 406 00:23:00,119 --> 00:23:02,600 Speaker 1: miss in history dot com for all of our episodes, 407 00:23:02,640 --> 00:23:05,240 Speaker 1: show notes, etcetera. And we encourage you to do so. 408 00:23:05,800 --> 00:23:08,280 Speaker 1: And if you would like to do research on almost 409 00:23:08,320 --> 00:23:10,080 Speaker 1: anything you can think of, you can do that at 410 00:23:10,119 --> 00:23:17,360 Speaker 1: our parents site, how stuff works dot com for more 411 00:23:17,400 --> 00:23:19,679 Speaker 1: on this and thousands of other topics because it how 412 00:23:19,720 --> 00:23:32,920 Speaker 1: stuff works dot com