In the wake of the 1918 Flu Pandemic, physician Charles Bradley made an accidental discovery in 1935. It was this: A stimulant medication can mitigate what we now view as ADHD symptoms. But that wasn’t his intention. Instead, he’d sought to alleviate pain in pediatric survivors of the Spanish Flu, as it was then called.
Only a few years earlier, flu survivors’ lasting maladies changed medical and societal perception of physical and mental illness. It eventually led to other major medical discoveries. This four-part post series details a few of them.
Will we see similar lasting effects from COVID-19 influenza? Medical experts say we already are.
Why This Topic?
My intention in presenting key points on this topic is not to create more COVID-related anxiety. Rather, my goals are:
- Putting to rest the often-made criticism that ADHD is a “made up” condition—hatched in a Big Pharma marketing department—when instead it happened by accident, in trying to help pediatric influenza survivors
- Documenting the often highly accidental nature of monumental medical discoveries in the context of pandemic
- Drawing connections between the aftermath of the 1918 Flu pandemic and what we might come to see in the aftermath of the COVID pandemic
Highlights of this Four-Part Series
This is an unusually long—but I hope, interesting—look at these topics.
- The lingering and often devastating physical effects in 1918 Flu survivors. This included “the Disease of Criminals” in children
- How affected children’s extreme changed behavior made it clear: Issues of biology over “character” were in evidence. This was revolutionary. So was the idea that children needed neurological care.
- Attempts to treat those physical effects paved the way to important scientific discoveries. They include penicillin and yes, that a stimulant called Benzedrine helped children who displayed what we now recognize as ADHD symptoms. And both were sheer accidents.
The Spanish Flu – or 1918 Flu Pandemic
A pandemic, as everyone knows by now, describes a worldwide epidemic. The Spanish Flu, or 1918 Flu Pandemic, remains the most well-known. (We no longer call it the Spanish Flu because it did not start in Spain. It had nothing to do with Spain. It’s a long story, involving WWII-era news blackouts everywhere but Spain.) It killed 50 million people worldwide—ten times more than died in WWI.
It’s considered history’s most deadly pandemic. It was only one, however, in a series of pandemics that preceded it over decades. They came in waves and in various forms.
The Little-Discussed Survivors
One in the late 1800s took both my newly immigrated paternal great-grandparents, orphaning my grandmother (pictured), age 9. She grew up in St. Peter’s Orphanage in Memphis. As a young teen, she was sent to work as a domestic servant. Fortunately, she was smart and a fantastic cook, with a nice personality. She married well. Many orphans were not so lucky.
What’s do most discussions about the 1918 Flu miss? The fact that an estimated 500 million contracted the virus. That is, 10 times as many people contracted the virus as died from it.
Many Survivors Suffered New, Crippling Illnesses
Technically, the majority recovered—though to what extent we do not know. It might be more accurate to say that they survived. Medical science was ill-prepared to investigate fully. Lingering effects might have been attributed to other causes.
One thing that we know for sure: Survivors in significant number were left with new and crippling illnesses. Tragically, most had no treatment.
With time and scientific inquiry, these illnesses led to important medical breakthroughs. In fact, one discovery caused medical and political authorities to re-examine what we thought we knew about criminality.
Three Influenza-Related Topics in Three Posts:
In the subsequent three posts, I’ll distill only three highlights that stood out for me in the context of ADHD and other neurobiological conditions.
1920-1927: Coming on the heels of the 1918 Flu—and some say, related to it—the pandemic of Encephalitis Lethargica created devastating brain impairments.
Reportedly, the majority of children who contracted EL manifested neurological disturbances after recovering from the acute stages of the disease. Some even displayed psychopathic tendencies. For most, this lasted for the rest of their lives.
—1928: A a dust mote randomly lands in an influenza researcher’s petri dish. Penicillin is discovered. That discovery was ignored for 20 years.
—1935: An accidental discovery leads to medication treatment for what we now recognize as ADHD symptoms. It happened in the first psychiatric hospital for children. Grieving parents of a child with severe after-effects from EL created that hospital.
That discovery was ignored for 85 years, despite having no other treatments for these children.
—1969: Famed neurologist Oliver Sacks played a role in “awakening” adult EL survivors who had for years lingered in a “ghost-like” state. He did so by targeting the neurochemical we often talk about in the context of ADHD: dopamine.
Note that pediatric and adult EL survivors manifested different symptoms. Some attribute this to children’s brains not yet being fully developed.
But First: What is Encephalitis Lethargica (EL)?
As mentioned, all three of these highlighted topics involve a condition called Encephalitis Lethargica (EL). Before continuing, let’s define it.
The term encephalitis refers to an inflammation of the brain. There are several causes. The most common, however, is a viral infection—that is, infection from a virus.
Can we make a direct connection between having 1918 Flu and developing this disease—called “the sleepy sickness” in adults and, in some children, “the disease of criminals”—with its typically lingering impairments? Several medical theories posit yes. None has been proven conclusively. One theory is that the debilitating effects of the influenza left survivors vulnerable to a type of encephalitis transmitted virally.
Back when influenza pandemics from the late 1800s to the early 1900s devastated the world, however, we knew very little about these complex factors. We did not understand that surviving the flu could change the body in ways that left an individual vulnerable to developing a new condition—and, therefore, that the two illnesses were connected.
These pandemics survivors suffered profound and novel maladies that medical science did not yet understand and could not treat. That included “behavioral” disorders such as that found with EL. The malady was so closely associated in time with the 1918 Flu that some researchers link the two in cause.
Might This Relate To COVID Survivors?
Will we see novel medical phenomenon in the wake of COVID? We already are, as well as some old phenomenon.
In fact, medical historians have been sounding the alarm since at least last summer (2020): We should be on the watch for permanent health changes among COVID survivors. That includes in the brain and nervous system as well as cardiovascular system.
How is this? The brain is an extremely delicate and vulnerable organ. Even as our immune response might keep our bodies alive, it can devastate our brain. Current research points to four likely ways in which this influenza, as with the 1918 Flu, can harm the brain:
- Severe infection
- Immune-system overdrive—producing a “maladaptive” inflammatory response that may cause much of the tissue and organ damage seen in this disease, perhaps more than the Coronavirus itself.
- Chaos in the body: e.g. high fevers, low oxygen levels, multiple organ failures
- Blood-clotting abnormalities: e.g. strokes
For Further Reading:
On that last point, Johns Hopkins researchers uncovered the long-range impact of the 1918 Flu pandemic among the children whose mothers had the flu during those pregnancies. Effects include the increased incidence of heart disease. To read more: How Does Coronavirus Affect the Brain?
University of Southern California at Davis gerontology researcher Caleb Finch found that “even mild sickness from flu could affect fetal development with longer consequences.” To read more: Lasting Legacy of the H1N1 Flu of 1918
Why did Dr. Bradley even consider Benzedrine when seeking to alleviate headaches in children after a painful radiologic diagnostic procedure? Read more about the historical use of Benzedrine: Did Mrs. Murphy Abuse Benzedrine—Or Did She Have ADHD?
Research Update August 2021
This paper examines the evidence for “long COVID” in children, similar to what researchers are seeing in adults.
More recently, an Australian study reported post-acute COVID-19 symptoms in 8% of 151 children followed more than 3 months after having been tested positive for SARS-CoV-2 .
An Italian study also reported that more than 50% of a cohort of 129 children had residual symptoms at follow-up 4 months after the initial diagnosis .
And in a study from the UK , 4.4% of 1,734 children who were positively tested for SARS-CoV2 experienced illness duration ≥ 28 days.
Look for Posts 2, 3, and 4 to follow.
As always, I welcome your comments.