Welcome to stuff he missed in History Class from houtworks dot com. Hello, and welcome to the podcast. I'm Holly from and I'm Tracey Wilson, and today is part two of our History of Narcolepsy uh. And in the first episode we talked about what narcolepsy is and when it was first written about, at least in the Western record, and of the work that was being done by German psychiatrist Carl Friedrich Otto Westfall in the late eighteen seventies. And as we left off, Westpall was really kind of onto the idea that he was uh that what he was seeing in these two particular cases that he talked about might actually be a unique condition and not something that could be lumped under an existing diagnosis. And today we're going to pick up with the next big step in the history of narcolepsy. So Jean Baptiste Edward Jeleno is always mentioned in articles about narcilepsy and history because he coined the term. He did so right out of the gate in his article on narcilepsy, which first appeared in the Gazette of the Civil and Military Hospitals of the Ottoman Empire. Jelano was born in eighteen twenty eight in Boardeaux in the south of France, and he served as a Navy physician and made a name for himself as a military surgeon through his studies of tropical diseases while traveling aboard ships in the Indian Ocean and UH. One of the other notable things that he did in his medical career was that he introduced the use of arsenic bromide tablets to treat epilepsy. He also helped to set up an insurance system for physicians of advanced age, and he wrote extensively on medical topics ranging from postpartum psychosis to deafness for various publications, and he also founded a Mineral Waters and Health SPA society. In an interesting bit of crossover, he cited the work of Westfall in an article about agoraphobia in eighteen eighty, which is the same year that Jellino appeared on the narcilepsy timeline. We don't know if the two men ever had direct communications with one another, although they were working on some similar areas of medicine. This is all happening right after Germany had been unified by Otto von Bismarck and France and Germany were not exactly super chatty at this point. Yeah, so we really don't know if they ever had contact, even though, as we said, he cited some of the other man's work and they they were working in similar areas, but those were areas that were kind of exciting throughout the medical community, so there were many people working on them. Uh. In Jellino's writing on Ourcalepsy, he offers up a case of a barrel seller called Mr G. And he is aged thirty eight, and this man experienced up to two hundred incidents each day of uncontrollable sleep, lasting one to five minutes each and even a thirty minute discussion would be consistently interrupted by sleep attacks. I think Jellino mentions in his writing that the longest he was ever able to witness Mr G going without an a tech was about thirty minutes. The patient had grown dependent on his thirteen year old son to stay with him at all times so that the sun could wake him when he dropped off unexpectedly. Mr G had no history of convulsions, no other medical issues that would explain this condition that he presented himself with before Jeleno on February fifteenth of eighteen seventy nine. Yeah he had, you know, he wasn't completely free of of medical issues, but none of them could have been attributed to this. Uh. Mr G had been in a violent fight three years before his contact with doctor Jelenome and after the fight he had been arrested and imprisoned. Not long after that, a log actually fell on his head. But he had continued his life with no apparent consequences of these two events for quite some time. However, about a year after the log incident, Mr G began to experience a loss of muscular tone in his legs and he was laughing aloud or when he game excited because of a good business deal. He started to notice that he would become paralyzed when playing cards if he was dealt a particularly good hand, and then he would drop off to sleep for about a minute. And that's how it began. But his condition progressed pretty rapidly, and soon the slightest excitation would send Mr G into a sleep attack. He tried toward these sleep attacks off to no avail, and he, as anyone else who deals with noircilepsy, had no control over when his body would just fall into a stupor even something as simple as seeing happy children and families at play in the park, he would have this moment of delight and then it would drop him off to sleep. The more intense his emotions, whether it was one of delight or one of pain or anger, the more rapid and intense his sleep attack. The attacks that came upon him when he was very angry were less frequent, but his sleep became deeper and lasted longer. Yeah, so it seems like happiness was a little bit more of a trigger than anger, but the anger ones were a little bit more intense in terms of episodes. Uh. Mr G had already been diagnosed as having a seizure disorder, but none of the treatments that were issued for it did any good. He really didn't think that was what he had. The patient reported no pain associated with his sleep attacks, merely a feeling of deep heaviness and the sensation of his mind being empty. And you may recall that was one of the primary descriptions the sense of empty mindedness of Westfall's primary patient in his study. And Mr G could hear and he was conscious. Despite this apparent stupor right up until the moment where he truly fell asleep, although that sleep only lasted a very brief time. Working alone proved to be better for Mr G than working with a colleague because he enjoyed the company of other people, and he would become very animated while he was talking to them that would trigger a sleep episode. Yeah, while I was reading these notes, and I was reading a translation of Jellano's or Jelino's work on the subject, I became sort of heartbroken. Like, can you imagine every time you experienced laughter or delight you kind of check out for a second. Um, it's sort of a rough thing to think about. Uh. Jelina referred to Mr G's cataplexy in his writing as astasia, and while his patient experienced it, he did not experience hallucinations allegedly were coming around to this um and was able to sleep through the night he woke, he reported just once a night on average. However, there is some contradictory stuff going on here because Mr G also claimed that his infant child he had a thirteen year old son, but he also had a son that was just a baby still, and he claimed that this child had been conceived quote in a moment when the illness came over him. And this particular statement in Jellino's writing has been puzzling sleep researchers for quite some time. So it might indicate that the man was actually having a hypnogogic hallucination, so a hallucination as he fell into sleep, or he was experiencing vivid dreams and dreamt the events. However, it may also indicate that he had a sleep attack immediately after having sex with his wife, or that he had an episode of cataplexy before or after the sexual encounter, and that this is the thing that he remembers. So we that's one of those things that crops up and it doesn't quite fit with the general picture. Uh. It's been talked about a lot and discussed in the medical community and amongst those that do sleep studies specifically, but it kind of stays a mystery. So before we get into how Jeleno tried to categorize Mr G's condition, let's have a brief word from a sponsor. Uh. So, Leno puzzles in his writing as to whether this is a condition that should be grouped in an already recognized neurosis group or if it deserves its own definition. And while he relays the notes and diagnosis of Mr G's previous physician, this is the one that diagnosed him with epilepsy, he is not at all convinced that the epilepsy diagnosis holds water. He points out that while some of the symptoms do overlap, as we talked about in our last episode, part of a problem when arcolepsy diagnosis is that all sleep disorders have a lot of overlap, and at this point in history, a lot of things got lumped under epilepsy that really were not ideally supposed to be there. Uh. But he points out that Mr G had never actually had a seizure. It seemed like the previous doctor was noting that he was falling down in these moments of cataplexy, and he was attributing that to a seizure rather than this sort of loss of muscle control. Jelena's article also compares Mr G's condition to quinophobia, which is the fear of open spaces, to sleeping dropsy, which has talked about a lot in the time, and vertigo, and he finds all of them equally unsuitable as labels for this pattern. Of paralysis and sleep that his patient was exhibiting. Jelena dismissed the idea that Mr G's condition was the result of that conch on ahead we talked about earlier. Instead, he offers the theory that his nerve centers didn't get enough oxygen or that the oxygen supply was being depleted too rapidly. So, according to this theory, his body was just in a constant cycle of seeking restorative sleep. Yeah, it's an interesting theory. Modern science doesn't hold that out. But he was really trying to explore some previously undiscovered territory in terms of finding out why this would happen to a person. The treat Mr G. Jellino initially prescribed picrotoxin, and this is a stimulant that's derived from woody vines. Stimulants continue to be part of the the treatment for a lot of people with narcolepsy and other sleep disorders, and the idea was that this picrotoxin would prevent spasmodic contraction of the blood vessels. He also added bromides which were used as sedatives, and unfortunately, this course of treatment had no positive effect on the patient whatsoever, and it actually made him feel weaker. The next approach was the inhalation of amal nitrate to dilate the blood vessels whenever Mr D felt an attack coming on. This too, failed to curtail any of his sleep attacks. Similarly, apomorphine injections, stryct nine, arsenate, phosphates, and caffeine were all failures. Yeah, you know, some would initially appear like they might be helping. And it's funny because in the description he talks about whenever Mr G inhales the amill nitrate, his cheeks flush, and so they think like it might be doing some good, but no, uh. Jelena did not differentiate between narcolepsy with catoplexy and narcolepsy without catoplexy, because in his patient there was always cataplexy, although today those two conditions are diagnosed differently, and while Jeleno touched on and ultimately dismissed in Mr G's case, the possibility of an injury being the cause of such a condition, it would be sometime before a narcolepsy would be distinguished into two types. Primary narcolepsy, which is when the cause of the condition is unknown and it seems to exist on its own as a neurological condition, and then secondary narcilepsy characterized by the presence of an underlying neurological condition or a traumatic injury. So both the Westpall and Jelino cases have a lot of factors in common. Neither of them, however, include discussion of automatic behavior. So those are those instances where patients go on with the task that they had been partaking in or doing even during episodes of sleep attacks, like continuing to write even after they've dropped off. One of the important aspects of Jelino's work was his observation that episodes of sleep were often linked to or catalyzed by moments of extreme emotional response. And while Westball seems to have been observing similar triggers for cataplexy, he mentions things like the patients seeing two boys fighting or excitation is bringing on cataplexy, he isn't as detailed, and as we mentioned before, he seems to think that the sleep instances are the result or extension of the muscle weakness. But the truly important development is that these two prominent doctors, and there were others writing, but these are the two that really kind of cemented this Uh, they had now written about patients with what appeared to be really similar conditions. Uh, And so narcolepsy started to really be looked at a little more seriously. But unfortunately, as it gained recognition as a sleep disorder, many sleep issues involving daytime drowsiness were then incorrectly lumped together under the diagnosis of narcolepsy. While there was certainly some work being done in the field of narcolepsy in the early twentieth century, cataplexy was given its name in nineteen o two, for example, it wasn't until the encephalitis lethargic outbreak that started in nineteen seventeen that it really got a lot of attention. We have a whole episode on encephalitis lethargica that is extremely scary, so we won't go into more detail about it here. Yeah, Tracy did the research on the encephalitis lethargica episode and it was very, very frightening stuff. An accidental Halloween episode. It was not supposed to be scary stuff for Halloween, but it's very scary to take about to talk about. But just as we said, uh, many sleep disorders were incorrectly being diagnosed as narcilepsy, and this was sometimes a problem with encephalitis lethargica, particularly in the beginning of it its appearance. Although there were cases of encephalitis lethargica where the narcolepsy diagnosis was legits, and this actually caused some doctors to debate whether or not there were truly any cases of idiopathic narcolepsy or if it really was just always linked to another problem that just wasn't always easily identified. In ninety psychiatrists Constantine von Economo, who I think they talk about in that encephalitis lethargica episode, identified the posterior hypothalamus as the region of the brain that was critical and wakefulness. He proposed that allegian lesion or disease of the posterior hypothalamus was a probable primary cause of narcolepsy, and his interest in sleep science grew. Many treatments for narcolepsy were devised In a tempted inthracol injection of air so that's air pumped into the space under the erechnoid membranes of the brain or spinal cord was tried. Removal of cerebro spinal fluid and radiation of the hypothalamic region. Uh. Those were all attempted to try to treat an oar ecilepsy. None really effective, and the pharmaceutical realm ethidrine sometimes offered marginal help. But in and famines were introduced as a treatment. These had and continue to have a significant effect in the way of reducing drowsiness, but there are a lot of side effects and they can be addictive. Tricyclic antidepressants have also been effective, and in many cases doctors use a combination of antidepressants and stimulants to manage patient care. And then before we get to what is maybe the most fascinating part of an oarcilepsy history, at least for me, should we take a moment to thank one of our sponsors. Sure, okay, So now we're getting into the the middle of the twentieth century where some really interesting stuff starts to happen. Starting in nineteen sixty four, Dr William Demmott, who is the father of modern sleep science and is still going he's in his eighties, now open a sleep clinic at Stanford and their intensive study of the causes and patterns of narcolepsy was conducted. The sleep center actually became permanently established a little over five years later in nineteen seventy. This is also where canine narcolepsy enters the picture. The first case of a dog with narcolepsy was identified in nineteen seventy three. The dog, a toy poodle named Monique, had begun having cataplectic attacks as an adolescent puppy. In some cases, Monique would experience only partial cataplexy, and for example, her only her legs would go limp, but at other times she experienced a full collapse, and justice was the case with Westfall and Jellino's patients. Excitement would trigger Monique. A new toy, oi or food or a treat could prompt an episode of cataplexy, and the years after Monique was identified, Dr DeMott traveled to veterinary schools and met with veterinarians who discussed the condition and identify canines who had it, and so eventually a canine narcilepsy colony was actually founded as part of the Stanford Labs so that researchers could start a breeding program to study the role of heredity in narcolepsy. However, initially all of the puppies produced by this program were asymptomatic, researchers were unable to identify a hereditary component. Fifteen different breeds of dog were identified with canine narcolepsy with cataplexy over the years, and two breeds there were men pinchers and Labrador retrievers were found to actually transfer the condition genetically. So with this discovery, it was revealed that there are both sporadic which is non hereditary random occurrences, and familiar or hereditary versions of canine narcilepsy. And while there have been numerous developments in the study of narcolepsy, and some have been quite recent, uh, one of the biggest then happened in and it started with this ongoing study of the condition in dogs as well as in mice because they will also exhibit narcilepsy. And at that point in hypocreting receptor mutations were identified as the cause of narcolepsian dogs. Hypocreting is a brain chemical that regulates sleep and wakefulness. So abnormal levels of hypocreting, so too much or too little, can cause all kinds of havoc on the sleep cycle system. And the following year, so in two thousands, so we're getting quite recent human earcolepsy was also associated with a deficiency in hypocreting, and while there's ongoing research as to why hypocrete and producing cells are lost why they, you know, shut down, one area that's being explored is that it could potentially be caused by an autoimmune reaction. Surprisingly, narcolepsy and narcolepsy with catapory actually weren't acknowledged as discrete clinical disorders until the publication of the two thousand and one International Classification of Sleep Disorders. Yeah, it's still, in some ways such a new thing, uh, and I'm forever fascinated by it. Part of it is that I've had two friends in my life that have anarcilepsy, the real deal, by which I do know. I mean, I think some people will joke in social circles about, oh, I am my friend is a narcolepsy because they tend to fall asleep a lot. But once you have seen someone actually be in the middle of talking to you and just be out, and then forty seconds later they just start talking again and they're awake, and it's like it never happened, it is very fascinating and you realize that this is a very unique condition and it is not just being sleepy and tired. There are also uh and we'll link to them in the show notes. I have them listed in the sources. There are videos of animals experiencing narcolepsy, which if you're an animal person, it can be a little bit hard to watch initially because you see like these, you know, a dog running around and then suddenly like just losing control of its legs, and it looks very upsetting and frightening. The dogs seem to generally not be too distraught by the whole situation. Um, but it's fascinating to watch. And I think if you watch just a a moment or two of those kinds of films, you'll see pretty quickly that again, this is not just a case of someone being sleepy or nodding off. It's not like when you doze off in a in a meeting because your brain is not getting stimulation. It's really like it's like a switch being flipped in many cases. So that's why I'm fascinated by it. Like I said, I'm fascinated by all the sleep things. I also have a little bit of listener mail. I will this is a more listener mail about our gouty podcast. So these are actually two pieces. One is from our listener Kristen, and she says, I started listening to your podcasts on the way from Seattle to Nebraska for the holidays. That is a twenty two hour drive, she says, and she had lots of time for podcasts, um but when I saw the most re podcast we're on Antony Goudy, I had to listen to them. He's been one of my favorite artists, not just architects, for a long time. It was a major reason why I wanted to visit Barcelona. I think you both did an amazing job going over his life and work, especially his death not to be morbid. It's an important detail of his life and it's one that's sometimes overlooked. There were a couple of points that weren't touched on and might be of interest to listeners who are ever in Barcelona. One is that the sidewalk tiles in some places around Barcelona were designed by Goudy. They have a pattern that looks like fossils and it's quite beautiful. Images can be found by googling Gouty sidewalk tiles. I'm sure you've seen some pictures of them. Also on the roof of Kazamila. There is a small archway that Goudy designed to frame the then unfinished Sagrada Familia. He put an immense amount of effort into all of his work, even connecting them like this, which is which I find to be incredibly impressive, and she includes a picture of it. I did not know either of those things. I remember seeing in some of my image searches. Uh. Some of the sidewalk tiles it I presumed, perhaps foolishly, because I didn't see any right up about them being specifically designed by him for parts of Barcelona, Like I thought they were probably just the pieces that were outside of the buildings that he had designed, But apparently they are out and about uh. And the other one is I won't read the whole email, but it is from our listener Scott, and he mentions to us that just after the Gouty podcast aired, and this was complete accident on our part, there was an article about a chapel being built in Chile based upon the designs of Goudy, and it's going to be the first Gouty design building outside of his native Spain. And he includes a link to the article which you will also put in the show notes, he says, I love it when something I've just learned about makes the news. At the same time, I do too, especially when it happens accidentally and I we look like we're really timely, But that was an absolute accident, So hooray for happy accidents. If you would like to write us, talk to us about sleep disorders or uh architects or whatever else De likes you, you you can do so at History Podcast at House of Works dot com. You can also connect with us at Misston History on Twitter, at Facebook dot com, slash mist in History at Misston History dot combler dot com, on pinterest dot com slash mist in history. And if you would like to purchase some misst in History goodies like shirts in topebags and other fun things, you can do that at our spreadshirt store, which is missed in History dot spreadshirt dot com. You would like to research a little bit about what we talked about today, you can go to our parents side House of Works. Type in the word and oarcilepsy in the search bar to get an article called what is an oarcilepsy? And I mentioned this one in the second of our episodes because it's the timeline there is not quite the same as the one that I mentioned. They kind of pick up with jeleno as the start of really the record of it, uh, because that really is when it came into being as the word in ourcilepsy. So have a peek at that article if you like. You can also visit us at miss in history dot com for all of our episodes, show notes, etcetera. And we encourage you to do so. And if you would like to do research on almost anything you can think of, you can do that at our parents site, how stuff works dot com for more on this and thousands of other topics because it how stuff works dot com

Welcome to stuff he missed in History Class from houtworks dot com. Hello, and welcome to the podcast. I'm Holly from and I'm Tracey Wilson, and today is part two of our History of Narcolepsy uh. And in the first episode we talked about what narcolepsy is and when it was first written about, at least in the Western record, and of the work that was being done by German psychiatrist Carl Friedrich Otto Westfall in the late eighteen seventies. And as we left off, Westpall was really kind of onto the idea that he was uh that what he was seeing in these two particular cases that he talked about might actually be a unique condition and not something that could be lumped under an existing diagnosis. And today we're going to pick up with the next big step in the history of narcolepsy. So Jean Baptiste Edward Jeleno is always mentioned in articles about narcilepsy and history because he coined the term. He did so right out of the gate in his article on narcilepsy, which first appeared in the Gazette of the Civil and Military Hospitals of the Ottoman Empire. Jelano was born in eighteen twenty eight in Boardeaux in the south of France, and he served as a Navy physician and made a name for himself as a military surgeon through his studies of tropical diseases while traveling aboard ships in the Indian Ocean and UH. One of the other notable things that he did in his medical career was that he introduced the use of arsenic bromide tablets to treat epilepsy. He also helped to set up an insurance system for physicians of advanced age, and he wrote extensively on medical topics ranging from postpartum psychosis to deafness for various publications, and he also founded a Mineral Waters and Health SPA society. In an interesting bit of crossover, he cited the work of Westfall in an article about agoraphobia in eighteen eighty, which is the same year that Jellino appeared on the narcilepsy timeline. We don't know if the two men ever had direct communications with one another, although they were working on some similar areas of medicine. This is all happening right after Germany had been unified by Otto von Bismarck and France and Germany were not exactly super chatty at this point. Yeah, so we really don't know if they ever had contact, even though, as we said, he cited some of the other man's work and they they were working in similar areas, but those were areas that were kind of exciting throughout the medical community, so there were many people working on them. Uh. In Jellino's writing on Ourcalepsy, he offers up a case of a barrel seller called Mr G. And he is aged thirty eight, and this man experienced up to two hundred incidents each day of uncontrollable sleep, lasting one to five minutes each and even a thirty minute discussion would be consistently interrupted by sleep attacks. I think Jellino mentions in his writing that the longest he was ever able to witness Mr G going without an a tech was about thirty minutes. The patient had grown dependent on his thirteen year old son to stay with him at all times so that the sun could wake him when he dropped off unexpectedly. Mr G had no history of convulsions, no other medical issues that would explain this condition that he presented himself with before Jeleno on February fifteenth of eighteen seventy nine. Yeah he had, you know, he wasn't completely free of of medical issues, but none of them could have been attributed to this. Uh. Mr G had been in a violent fight three years before his contact with doctor Jelenome and after the fight he had been arrested and imprisoned. Not long after that, a log actually fell on his head. But he had continued his life with no apparent consequences of these two events for quite some time. However, about a year after the log incident, Mr G began to experience a loss of muscular tone in his legs and he was laughing aloud or when he game excited because of a good business deal. He started to notice that he would become paralyzed when playing cards if he was dealt a particularly good hand, and then he would drop off to sleep for about a minute. And that's how it began. But his condition progressed pretty rapidly, and soon the slightest excitation would send Mr G into a sleep attack. He tried toward these sleep attacks off to no avail, and he, as anyone else who deals with noircilepsy, had no control over when his body would just fall into a stupor even something as simple as seeing happy children and families at play in the park, he would have this moment of delight and then it would drop him off to sleep. The more intense his emotions, whether it was one of delight or one of pain or anger, the more rapid and intense his sleep attack. The attacks that came upon him when he was very angry were less frequent, but his sleep became deeper and lasted longer. Yeah, so it seems like happiness was a little bit more of a trigger than anger, but the anger ones were a little bit more intense in terms of episodes. Uh. Mr G had already been diagnosed as having a seizure disorder, but none of the treatments that were issued for it did any good. He really didn't think that was what he had. The patient reported no pain associated with his sleep attacks, merely a feeling of deep heaviness and the sensation of his mind being empty. And you may recall that was one of the primary descriptions the sense of empty mindedness of Westfall's primary patient in his study. And Mr G could hear and he was conscious. Despite this apparent stupor right up until the moment where he truly fell asleep, although that sleep only lasted a very brief time. Working alone proved to be better for Mr G than working with a colleague because he enjoyed the company of other people, and he would become very animated while he was talking to them that would trigger a sleep episode. Yeah, while I was reading these notes, and I was reading a translation of Jellano's or Jelino's work on the subject, I became sort of heartbroken. Like, can you imagine every time you experienced laughter or delight you kind of check out for a second. Um, it's sort of a rough thing to think about. Uh. Jelina referred to Mr G's cataplexy in his writing as astasia, and while his patient experienced it, he did not experience hallucinations allegedly were coming around to this um and was able to sleep through the night he woke, he reported just once a night on average. However, there is some contradictory stuff going on here because Mr G also claimed that his infant child he had a thirteen year old son, but he also had a son that was just a baby still, and he claimed that this child had been conceived quote in a moment when the illness came over him. And this particular statement in Jellino's writing has been puzzling sleep researchers for quite some time. So it might indicate that the man was actually having a hypnogogic hallucination, so a hallucination as he fell into sleep, or he was experiencing vivid dreams and dreamt the events. However, it may also indicate that he had a sleep attack immediately after having sex with his wife, or that he had an episode of cataplexy before or after the sexual encounter, and that this is the thing that he remembers. So we that's one of those things that crops up and it doesn't quite fit with the general picture. Uh. It's been talked about a lot and discussed in the medical community and amongst those that do sleep studies specifically, but it kind of stays a mystery. So before we get into how Jeleno tried to categorize Mr G's condition, let's have a brief word from a sponsor. Uh. So, Leno puzzles in his writing as to whether this is a condition that should be grouped in an already recognized neurosis group or if it deserves its own definition. And while he relays the notes and diagnosis of Mr G's previous physician, this is the one that diagnosed him with epilepsy, he is not at all convinced that the epilepsy diagnosis holds water. He points out that while some of the symptoms do overlap, as we talked about in our last episode, part of a problem when arcolepsy diagnosis is that all sleep disorders have a lot of overlap, and at this point in history, a lot of things got lumped under epilepsy that really were not ideally supposed to be there. Uh. But he points out that Mr G had never actually had a seizure. It seemed like the previous doctor was noting that he was falling down in these moments of cataplexy, and he was attributing that to a seizure rather than this sort of loss of muscle control. Jelena's article also compares Mr G's condition to quinophobia, which is the fear of open spaces, to sleeping dropsy, which has talked about a lot in the time, and vertigo, and he finds all of them equally unsuitable as labels for this pattern. Of paralysis and sleep that his patient was exhibiting. Jelena dismissed the idea that Mr G's condition was the result of that conch on ahead we talked about earlier. Instead, he offers the theory that his nerve centers didn't get enough oxygen or that the oxygen supply was being depleted too rapidly. So, according to this theory, his body was just in a constant cycle of seeking restorative sleep. Yeah, it's an interesting theory. Modern science doesn't hold that out. But he was really trying to explore some previously undiscovered territory in terms of finding out why this would happen to a person. The treat Mr G. Jellino initially prescribed picrotoxin, and this is a stimulant that's derived from woody vines. Stimulants continue to be part of the the treatment for a lot of people with narcolepsy and other sleep disorders, and the idea was that this picrotoxin would prevent spasmodic contraction of the blood vessels. He also added bromides which were used as sedatives, and unfortunately, this course of treatment had no positive effect on the patient whatsoever, and it actually made him feel weaker. The next approach was the inhalation of amal nitrate to dilate the blood vessels whenever Mr D felt an attack coming on. This too, failed to curtail any of his sleep attacks. Similarly, apomorphine injections, stryct nine, arsenate, phosphates, and caffeine were all failures. Yeah, you know, some would initially appear like they might be helping. And it's funny because in the description he talks about whenever Mr G inhales the amill nitrate, his cheeks flush, and so they think like it might be doing some good, but no, uh. Jelena did not differentiate between narcolepsy with catoplexy and narcolepsy without catoplexy, because in his patient there was always cataplexy, although today those two conditions are diagnosed differently, and while Jeleno touched on and ultimately dismissed in Mr G's case, the possibility of an injury being the cause of such a condition, it would be sometime before a narcolepsy would be distinguished into two types. Primary narcolepsy, which is when the cause of the condition is unknown and it seems to exist on its own as a neurological condition, and then secondary narcilepsy characterized by the presence of an underlying neurological condition or a traumatic injury. So both the Westpall and Jelino cases have a lot of factors in common. Neither of them, however, include discussion of automatic behavior. So those are those instances where patients go on with the task that they had been partaking in or doing even during episodes of sleep attacks, like continuing to write even after they've dropped off. One of the important aspects of Jelino's work was his observation that episodes of sleep were often linked to or catalyzed by moments of extreme emotional response. And while Westball seems to have been observing similar triggers for cataplexy, he mentions things like the patients seeing two boys fighting or excitation is bringing on cataplexy, he isn't as detailed, and as we mentioned before, he seems to think that the sleep instances are the result or extension of the muscle weakness. But the truly important development is that these two prominent doctors, and there were others writing, but these are the two that really kind of cemented this Uh, they had now written about patients with what appeared to be really similar conditions. Uh, And so narcolepsy started to really be looked at a little more seriously. But unfortunately, as it gained recognition as a sleep disorder, many sleep issues involving daytime drowsiness were then incorrectly lumped together under the diagnosis of narcolepsy. While there was certainly some work being done in the field of narcolepsy in the early twentieth century, cataplexy was given its name in nineteen o two, for example, it wasn't until the encephalitis lethargic outbreak that started in nineteen seventeen that it really got a lot of attention. We have a whole episode on encephalitis lethargica that is extremely scary, so we won't go into more detail about it here. Yeah, Tracy did the research on the encephalitis lethargica episode and it was very, very frightening stuff. An accidental Halloween episode. It was not supposed to be scary stuff for Halloween, but it's very scary to take about to talk about. But just as we said, uh, many sleep disorders were incorrectly being diagnosed as narcilepsy, and this was sometimes a problem with encephalitis lethargica, particularly in the beginning of it its appearance. Although there were cases of encephalitis lethargica where the narcolepsy diagnosis was legits, and this actually caused some doctors to debate whether or not there were truly any cases of idiopathic narcolepsy or if it really was just always linked to another problem that just wasn't always easily identified. In ninety psychiatrists Constantine von Economo, who I think they talk about in that encephalitis lethargica episode, identified the posterior hypothalamus as the region of the brain that was critical and wakefulness. He proposed that allegian lesion or disease of the posterior hypothalamus was a probable primary cause of narcolepsy, and his interest in sleep science grew. Many treatments for narcolepsy were devised In a tempted inthracol injection of air so that's air pumped into the space under the erechnoid membranes of the brain or spinal cord was tried. Removal of cerebro spinal fluid and radiation of the hypothalamic region. Uh. Those were all attempted to try to treat an oar ecilepsy. None really effective, and the pharmaceutical realm ethidrine sometimes offered marginal help. But in and famines were introduced as a treatment. These had and continue to have a significant effect in the way of reducing drowsiness, but there are a lot of side effects and they can be addictive. Tricyclic antidepressants have also been effective, and in many cases doctors use a combination of antidepressants and stimulants to manage patient care. And then before we get to what is maybe the most fascinating part of an oarcilepsy history, at least for me, should we take a moment to thank one of our sponsors. Sure, okay, So now we're getting into the the middle of the twentieth century where some really interesting stuff starts to happen. Starting in nineteen sixty four, Dr William Demmott, who is the father of modern sleep science and is still going he's in his eighties, now open a sleep clinic at Stanford and their intensive study of the causes and patterns of narcolepsy was conducted. The sleep center actually became permanently established a little over five years later in nineteen seventy. This is also where canine narcolepsy enters the picture. The first case of a dog with narcolepsy was identified in nineteen seventy three. The dog, a toy poodle named Monique, had begun having cataplectic attacks as an adolescent puppy. In some cases, Monique would experience only partial cataplexy, and for example, her only her legs would go limp, but at other times she experienced a full collapse, and justice was the case with Westfall and Jellino's patients. Excitement would trigger Monique. A new toy, oi or food or a treat could prompt an episode of cataplexy, and the years after Monique was identified, Dr DeMott traveled to veterinary schools and met with veterinarians who discussed the condition and identify canines who had it, and so eventually a canine narcilepsy colony was actually founded as part of the Stanford Labs so that researchers could start a breeding program to study the role of heredity in narcolepsy. However, initially all of the puppies produced by this program were asymptomatic, researchers were unable to identify a hereditary component. Fifteen different breeds of dog were identified with canine narcolepsy with cataplexy over the years, and two breeds there were men pinchers and Labrador retrievers were found to actually transfer the condition genetically. So with this discovery, it was revealed that there are both sporadic which is non hereditary random occurrences, and familiar or hereditary versions of canine narcilepsy. And while there have been numerous developments in the study of narcolepsy, and some have been quite recent, uh, one of the biggest then happened in and it started with this ongoing study of the condition in dogs as well as in mice because they will also exhibit narcilepsy. And at that point in hypocreting receptor mutations were identified as the cause of narcolepsian dogs. Hypocreting is a brain chemical that regulates sleep and wakefulness. So abnormal levels of hypocreting, so too much or too little, can cause all kinds of havoc on the sleep cycle system. And the following year, so in two thousands, so we're getting quite recent human earcolepsy was also associated with a deficiency in hypocreting, and while there's ongoing research as to why hypocrete and producing cells are lost why they, you know, shut down, one area that's being explored is that it could potentially be caused by an autoimmune reaction. Surprisingly, narcolepsy and narcolepsy with catapory actually weren't acknowledged as discrete clinical disorders until the publication of the two thousand and one International Classification of Sleep Disorders. Yeah, it's still, in some ways such a new thing, uh, and I'm forever fascinated by it. Part of it is that I've had two friends in my life that have anarcilepsy, the real deal, by which I do know. I mean, I think some people will joke in social circles about, oh, I am my friend is a narcolepsy because they tend to fall asleep a lot. But once you have seen someone actually be in the middle of talking to you and just be out, and then forty seconds later they just start talking again and they're awake, and it's like it never happened, it is very fascinating and you realize that this is a very unique condition and it is not just being sleepy and tired. There are also uh and we'll link to them in the show notes. I have them listed in the sources. There are videos of animals experiencing narcolepsy, which if you're an animal person, it can be a little bit hard to watch initially because you see like these, you know, a dog running around and then suddenly like just losing control of its legs, and it looks very upsetting and frightening. The dogs seem to generally not be too distraught by the whole situation. Um, but it's fascinating to watch. And I think if you watch just a a moment or two of those kinds of films, you'll see pretty quickly that again, this is not just a case of someone being sleepy or nodding off. It's not like when you doze off in a in a meeting because your brain is not getting stimulation. It's really like it's like a switch being flipped in many cases. So that's why I'm fascinated by it. Like I said, I'm fascinated by all the sleep things. I also have a little bit of listener mail. I will this is a more listener mail about our gouty podcast. So these are actually two pieces. One is from our listener Kristen, and she says, I started listening to your podcasts on the way from Seattle to Nebraska for the holidays. That is a twenty two hour drive, she says, and she had lots of time for podcasts, um but when I saw the most re podcast we're on Antony Goudy, I had to listen to them. He's been one of my favorite artists, not just architects, for a long time. It was a major reason why I wanted to visit Barcelona. I think you both did an amazing job going over his life and work, especially his death not to be morbid. It's an important detail of his life and it's one that's sometimes overlooked. There were a couple of points that weren't touched on and might be of interest to listeners who are ever in Barcelona. One is that the sidewalk tiles in some places around Barcelona were designed by Goudy. They have a pattern that looks like fossils and it's quite beautiful. Images can be found by googling Gouty sidewalk tiles. I'm sure you've seen some pictures of them. Also on the roof of Kazamila. There is a small archway that Goudy designed to frame the then unfinished Sagrada Familia. He put an immense amount of effort into all of his work, even connecting them like this, which is which I find to be incredibly impressive, and she includes a picture of it. I did not know either of those things. I remember seeing in some of my image searches. Uh. Some of the sidewalk tiles it I presumed, perhaps foolishly, because I didn't see any right up about them being specifically designed by him for parts of Barcelona, Like I thought they were probably just the pieces that were outside of the buildings that he had designed, But apparently they are out and about uh. And the other one is I won't read the whole email, but it is from our listener Scott, and he mentions to us that just after the Gouty podcast aired, and this was complete accident on our part, there was an article about a chapel being built in Chile based upon the designs of Goudy, and it's going to be the first Gouty design building outside of his native Spain. And he includes a link to the article which you will also put in the show notes, he says, I love it when something I've just learned about makes the news. At the same time, I do too, especially when it happens accidentally and I we look like we're really timely, But that was an absolute accident, So hooray for happy accidents. If you would like to write us, talk to us about sleep disorders or uh architects or whatever else De likes you, you you can do so at History Podcast at House of Works dot com. You can also connect with us at Misston History on Twitter, at Facebook dot com, slash mist in History at Misston History dot combler dot com, on pinterest dot com slash mist in history. And if you would like to purchase some misst in History goodies like shirts in topebags and other fun things, you can do that at our spreadshirt store, which is missed in History dot spreadshirt dot com. You would like to research a little bit about what we talked about today, you can go to our parents side House of Works. Type in the word and oarcilepsy in the search bar to get an article called what is an oarcilepsy? And I mentioned this one in the second of our episodes because it's the timeline there is not quite the same as the one that I mentioned. They kind of pick up with jeleno as the start of really the record of it, uh, because that really is when it came into being as the word in ourcilepsy. So have a peek at that article if you like. You can also visit us at miss in history dot com for all of our episodes, show notes, etcetera. And we encourage you to do so. And if you would like to do research on almost anything you can think of, you can do that at our parents site, how stuff works dot com for more on this and thousands of other topics because it how stuff works dot com