Magazine article USA TODAY

What Insane Asylums Taught Us

Magazine article USA TODAY

What Insane Asylums Taught Us

Article excerpt

ALTHOUGH the Spanish flu pandemic lasted for only a year, its dark legacy still haunts us. The year 1918 saw the appearance of the novel strain of influenza virus called H1N1, which caused the most widespread and lethal flu infection in recorded history. As many as 100,000,000 people died worldwide. It killed more Americans in one year than died in all the wars of the 20th century. This virus especially was lethal for young adults, and particularly pregnant women. Interestingly, this also was true of the pandemic virus of 2009.

Because of the work of Jeffrey Taubenberger and colleagues at the Armed Forces Institute of Pathology in Washington, D.C., we now know quite a bit about the 1918 virus. Taubenberger and Ann Reid used tissue that had been preserved in formaldehyde and paraffin from soldiers who died of the flu in 1918, and Johan Hultin retrieved tissue from Eskimos who died of the flu that year and were buried in the permafrost, which preserved the virus. Sequencing the genes of this lethal virus has revealed that it probably was derived from an influenza virus that infected birds and, through mutation, became able to infect mammals such as pigs and people.

This remarkable virus still casts its ominous shadow today: its descendants have continued to cause pandemics or global outbreaks such as those in 1947, 1951, 1957, 1968, 1997, and 2003. The global pandemic in 2009 was caused by a fourth-generation descendant of the bird-swine-human influenza virus of 1918.

Far less appreciated, however, is another sinister, decades-long legacy left by this virus. A graduate student at Columbia University and the National Bureau of Economic Research, Douglas Almond, used a remarkably simple method of uncovering the continuing human costs of the 1918 pandemic. In addition to the obvious effects on families from the loss of mothers or fathers, there were hidden effects on the fetuses gestating at the time the pandemic swept through the U.S. Some of those effects did not become clear until the fetuses became adults. Using the socioeconomic data collected each decade by the Census Bureau, Almond discovered that the offspring of women who were pregnant precisely during the time the flu came through their area grew up to have lower income, socioeconomic status, and educational attainment than those who had been gestating just before or after the pandemic.

These effects suggest that the virus affected fetal brain development. Other data indicates that this group also had higher rates of physical disability, heart disease, and diabetes. Thus, more than 60 years later, this group of offspring still was suffering the consequences of the pandemic. These results support the more general "fetal origins of adult disease" hypothesis, which arises from studies showing that a number of disorders, such as cardiovascular disease and diabetes, are associated with problems experienced by the mother during fetal development.

Infection of pregnant women also increases the risk of mental illness in the offspring. Research on this association particularly is strong for schizophrenia, where the initial hospitalization for psychosis typically occurs in late adolescence or early adulthood. Thus, it is another example of the fetal origins of adult disease syndrome. In this case, the outcome is related to the mother's inflammatory response to various types of infection, including influenza. In fact, the connection among infection, immune reactions, and psychosis has been investigated and hotly debated for more than 100 years.

The most striking experimental studies done on humans in this context were carried out at the torn of the last century by Julius Wagner-Jauregg, who received the Nobel Prize in 1927 for his work on "pyrotherapy" (fever therapy). He had noted as early as 1883 during his psychiatry residency in the Vienna Asylum that some patients experiencing psychiatric symptoms such as hallucinations, mania, depression, paranoia, apathy, and severe disorientation displayed a marked improvement while they were sick with infections such as those caused by streptococcus, tuberculosis, or typhoid. …

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