NARCOLEPSY IN THE AMERICAN NEGRO.

Abstract

BRIEF PROPOSALS NARCOLEPSY IN THE AMERICAN NEGRO H. J. ROBERTS, M.D.* This report is prompted by a recent series ofeditorials and letters in perspectives [i] written by distinguished clinicians and investigators "in order to denounce the teachings . . . that the brain ofthe Negro is physically inferior to that ofthe white" and by my increasing awareness ofthe relatively high frequency in Negro patients ofthe syndrome of narcolepsy (pathologic drowsiness and sleep) and diabetogenic ("functional") hyperinsulinism which I have described [2-6]. In an era when it is imperative that physicians, scientists, thejudiciary, and all citizens ofgood will have accurate information with which to handle the tremendous challenge posed by racial problems, I feel morally compelled to present my data. It is my beliefthat it has been gathered in accord with Halstead's prerequisites [1] that "the ghost ofracist dogma must be laid to rest before any comprehensive investigation of the important scientific problem posed by race can be undertaken," and that "the scientific yield ofsuch efforts will depend directly on the freedom to makefree inquiry." The following excerpt from a recent report by the Committee on Science in the Promotion ofHuman Welfare ofthe American Association for the Advancement ofScience is also pertinent [7]: There are, we believe,no valid barriers—beyond those dictated byhumaneness—to precludescientific study ofthe biology ofman, including the nature ofracial characteristics and their inheritance. Such research will surely add—to a degree dependent on the significance ofthe observations—to what we know about nature. . . . Scientists can do a great deal to help the public understand this problem and thereby contribute to a more harmonious resolution ofour present difficulties. My purpose is to acquaint both sides of this controversy with evidence [2-6] for the following: (1) A significant segment ofNegroes whom I attend—both private and clinic patients—is afflicted with unrecognized long-standing narcolepsy. (2) Their narcolepsy represents die symptomatic aftermath of an interaction between genetic factors and, more importantly, acquired metabolic insults to the brain—chiefly prolonged recurrent hypoglycemia. (3) Glucose-induced sleep and insulinogenic arousal are readily definable and reproducible phenomena in such individuals. (4) The strikingly low voltages encountered in these Negro patients have not been found in ninefold more white patients afHicted with the same syndrome—presumably indicative of its greater severity among * Address: 300 27th Street, West Palm Beach, Florida. Consulting Staff, Good Samaritan Hospital and St. Mary's Hospital, West Palm Beach, Florida; Research Professor, Department ofBiological Sciences, Florida Atlantic University, Boca Raton. 36I Negroes. (5) The majority had diabetes mellitus or impaired glucose tolerance, usually unrecognized. (6) Thissyndrome isreadilyresponsive to simple therapy inmost instances. I am the first to admit that these observations are based on a limited number ofpatients who have been seen by only one physician. On the other hand, uieir classic narcoleptic histories, their frequent low-voltage electroencephalograms, and their gratifying response to specific analeptic uierapy indicate that the stigmata of "laziness," "constitutional inadequacy ," "racial inferiority," and "underdevelopment ofthe Negro brain" which have been uncritically directed against many members of this race reflect their narcoleptic diathesis as well as social and economic disadvantages. Narcoleptic patients, both white and Negro, generally present themselves to physicians with subtle manifestations ofthis disorder (particularly undiagnosed and refractory chronic "fatigue" or "tiredness"); numerous misdiagnoses (notably "refractory hypothyroidism ," "metabolic insufHciency," "euthyroid hypometabolism," Pickwickianism, "metabolic obesity," "obesity as a depressive equivalent," "chronic nervous exhaustion"); obesity (due to the summation of narcoleptic hypokinesia and hypoglycemic-induced orexia); or other common manifestations and sequelae of long-standing hypoglycemic stress. The last include diabetes mellitus and its complications, vascular headaches [8], cerebral dysrhythmia, peripheral neuropathy, and angina pectoris, cardiac arrhythmia, or peptic ulcer which have not responded to conventional therapy. The clinical, laboratory, electroencephalographic, electrocardiographic, and experimental grounds for these broad assertions have been documented elsewhere [2, 5, 6]. It is my conviction that physicians must specifically seek out the syndrome ofnarcolepsy and diabetogenic hyperinsulinism in Negroes before making the above-cited vague or potentially hazardous diagnoses, which have served chiefly as diagnostic wastebaskets. Unfortunately, the patient himself often contributes to the confusion because ofthe "phenomenon ofdenial" variously stemming from the effect ofpathologic drowsiness in response to questioning, the accepting ofthe narcoleptic state as his norm...