TICKS, CARROTS, AND A PARAKEET NAMED LIBERACE. COULD ANY OF THEM BE DEADLY?
• When thirty-nine schoolchildren fell ill in northern Arkansas, health officials immediately suspected a variety of "parrot lever" because of a sick little bird that local children called Liberace. But was the bird to blame? The truth would prove as intriguing as it was unexpected.
• A forty-year-old dishwasher had a touch of dyspepsia. Within days he was dead. The only clue his physician had uncovered was a word the man uttered twice: "Schlachtfest." A Schlachtfest is a pork feast, and there was one at a German-American meeting-and-banquet hall. But why did only the dishwasher get sick?
• A woman doctor woke up feeling very sick with cramps, joint pain, and nausea. She drank a steaming cupful of milk and felt better. Later her symptoms worsened, especially when she and her husband visited their summer cottage. But he wasn't affected. Was her illness psychosomatic? Or was the doctor in jeopardy from a totally unexpected cause?
THREE OF THE FASCINATING CASES IN THE MEDICAL DETECTIVES
BERTON ROUECHE joined the staff of The New Yorker in 1944. His "Annals of Medicine" department and his stature as a medical journalist have been recognized by numerous awards, including those from the Lasker Foundation and the American Medical Association. He lived and worked in Amagansett, Long Island, for many years, and died, at age 83, in April 1994.
THE
MEDICAL DETECTIVE
Berton Roueche
TT
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Published by Truman Talley Books/Plume, an imprint of Dutton Signet, a division of Penguin Books USA Inc. Previously published in a different form in a Truman Talley Books/Times Books hardcover edition.
First Plume Printing, March, 1991 30 29 28 27 26 25
Copyright © 1947, 1950, 1952, 1956, 1958, 1960, 1964, 1965, 1967, 1968, 1969. 1970, 1971, 1974, 1975, 1977, 1978, 1979, 1980, 1988 by Berton Rouech6 All rights reserved.
All of the material in this book has previously appeared in The New Yorker in somewhat different form.
REGISTERED TRADEMARK—MARCA REGISTRADA
Library of Congress Cataloging-in-Publication Data Roueche. Berton, 1911-1994
The medical detectives/Berton Roueche.
p. cm. "Truman Talley books." Includes index.
1. Medicine—Case studies. I. Title RC66.R655 1988
616'.09—dc20 90-14267
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For: William Shawn
I hope that Lord Grey and you are well—no easy thing seeing that there are above 1500 diseases to which Man is subjected.
—Letter to Lady Grey from Sidney Smith
Contents
1.
Eleven Blue Men
3
2.
A Pig from Jersey
14
3.
A Game of Wild Indians
26
4.
The Incurable Wound
39
5.
CH,C02C6H4C02H (Aspirin)
61
6.
The Liberace Room
81
7.
Impression: Essentially Normal
105
8.
A Swim in the Nile
124
9.
The Orange Man
38
10.
The Dead Mosquitoes
150
II.
Something a Little Unusual
164
12.
A Man Named Hoffman
179
13.
Three Sick Babies
200
14.
The West Branch Study
217
15.
The Huckleby Hogs
236
X
§
Contents
16.
All I Could Do Was Stand in the Woods
255
17.
As Empty as Eve
271
i8.
Two Blue Hands
288
19.
Antipathies
302
20.
Sandy
317
21.
A Rainy Day on the Vineyard
330
22.
Live and Let Live
345
23.
The Fumigation Chamber
361
24.
A Lean Cuisine
375
25.
The Foulest and Nastiest Creatures That Be
390
The Medical Detectives
CHAPTER 1
Eleven Blue Men
At about eight o'clock on Monday morning, September 25, l944, a ragged, aimless old man of eighty-two collapsed on the sidewalk on Dey Street, near the Hudson Terminal. Innumerable people must have noticed him, but he lay there alone for several minutes, dazed, doubled up with abdominal cramps, and in an agony of retching. Then a policeman came along. Until the policeman bent over the old man, he may have supposed that he had just a sick drunk on his hands; wanderers dropped by drink are common in that part of town in the early morning. It was not an opinion that he could have held for long. The old man's nose, lips, cars, and fingers were sky-blue. The policeman went to a telephone and put in an ambulance call to Beekman-Downtown Hospital, half a dozen blocks away. The old man was carried into the emergency room there at eight-thirty. By that time, he was unconscious and the blueness had spread over a large part of his body. The examining physician attributed the old man's morbid color to cyanosis, a condition that usually results from an insufficient supply of oxygen in the blood, and also noted that he was diarrheic and in a severe state of shock. The course of treatment prescribed by the doctor was conventional. It included an instant gastric lavage, heart stimulants, bed rest, and oxygen therapy. Presently, the old man recovered an encouraging, if painful, consci
ousness and demanded, irascibly and in the name of God, to know what had happened to him. It was a question that, at the moment, nobody could answer with much confidence.
For the immediate record, the doctor made a free-hand diagnosis of carbon-monoxide poisoning—from what source, whether an automobile or a gas pipe, it was, of course, pointless even to guess. Then, because an isolated instance of gas poisoning is something of a rarity in a section of the city as crammed with human beings as downtown Manhattan, he and his colleagues in the emergency room braced themselves for at least a couple more victims. Their foresight was promptly and generously rewarded. A second man was rolled in at ten-twenty-five. Forty minutes later, an ambulance drove up with three more men. At eleven-twenty, two others were brought in. An additional two arrived during the next fifteen minutes. Around noon, still another was admitted. All of these nine men were also elderly and dilapidated, all had been in misery for at least an hour, and all were rigid, cyanotic, and in a state of shock. The entire body of one, a bony, seventy-three-year-old consumptive named John Mitchell, was blue. Five of the nine, including Mitchell, had been stricken in the Globe Hotel, a sunless, upstairs flophouse at 190 Park Row, and two in a similar place, called the Star Hotel, at 3 James Street. Another had been found slumped in the doorway of a condemned building on Park Row, not far from City Hall Park, by a policeman. The ninth had keeled over in front of the Eclipse Cafeteria, at 6 Chatham Square. At a quarter to seven that evening, one more aged blue man was brought in. He had been lying, too sick to ask for help, on his cot in a cubicle in the Lion Hotel, another flophouse, at 26 Bowery, since ten o'clock that morning. A clerk had finally looked in and seen him.
By the time this last blue man arrived at the hospital, an investigation of the case by the Department of Health, to which all outbreaks of an epidemiological nature must be reported, had been under way for five hours. Its findings thus far had not been illuminating. The investigation was conducted by two men. One was the health Department's chief epidemiologist, Dr. Morris Greenberg, a small, fragile, reflective man of fifty-seven, who is now acting director of the Bureau of Preventable Diseases; the other was Dr. Ottavio Pellitteri, a field epidemiologist, who, since 1946, has been administrative medical inspector for the Bureau. He is thirty-six years old, pale, and stocky, and has a bristling black mustache. One day, when I was in Dr. Greenberg's office, he and Dr. Pellitteri told me about the case. Their recollection of it is, understandably, vivid. The derelicts were the victims of a type of poisoning so rare that only ten previous outbreaks of it had been recorded in medical literature. Of these, two were in the United States and two in Germany; the others had been reported in France, England, Switzerland, Algeria, Australia, and India. Up to September 25, 1944, the largest number of people stricken in a single outbreak was four. That was in Algeria, in 1926.
The Beekman-Downtown Hospital telephoned a report of the occurrence to the Health Department just before noon. As is customary, copies of the report were sent to all the Department's administrative officers. "Mine was on my desk when I got back from lunch," Dr. Greenberg said to me. "It didn't sound like much. Nine persons believed to be suffering from carbon-monoxide poisoning had been admitted during the morning, and all of them said that they had eaten breakfast at the Eclipse Cafeteria, at 6 Chatham Square. Still, it was a job for us. I checked with the clerk who handles assignments and found that Pellitteri had gone out on it. That was all I wanted to know. If it amounted to anything, I knew he'd phone me before making a written report. I hat's an arrangement we have here. Well, a couple of hours later I got a call from him. My interest perked right up."
"I was at the hospital," Dr. Pellitteri told me, "and I'd talked to the staff and most of the men. There were ten of them by then, of course. They were sick as dogs, but only one was in really bad shape."
"That was John Mitchell," Dr. Greenberg put in. "He died the next night. I understand his condition was hopeless from the start. The others, including the old boy who came in last, pulled through all right. Excuse me, Ottavio, but I just thought I'd get that out of the way. Go on."
Dr. Pellitteri nodded. "I wasn't at all convinced that it was gas poisoning," he continued. "The staff was beginning to doubt it, too. The symptoms weren't quite right. There didn't seem to be any of the headache and general dopiness that you get with gas. What really made me suspicious was this: Only two or three of the men had eaten breakfast in the cafeteria at the same time. They had straggled in all the way from seven o'clock to ten. That meant that the place would have had to be full of gas for at least three hours, which is preposterous. It also indicated that we ought to have had a lot more sick people than we did. Those Chatham Square eating places have a big turnover. Well, to make sure, I checked with Bellevue, Gouverneur, St. Vincent's, and the other downtown hospitals. None of them had seen a trace of cyanosis. Then I talked to the sick men some more. I learned two interesting things. One was that they had all got sick right after eating. Within thirty minutes. The other was that all but one had eaten oatmeal, rolls, and coffee. He ate just oatmeal. When ten men eat the same thing in the same place on the same day and then all come down with the same illness ... I told Greenberg that my hunch was food poisoning."
"I was willing to rule out gas," Dr. Greenberg said. A folder containing data on the case lay on the desk before him. He lifted the cover thoughtfully, then let it drop. "And I agreed that the oatmeal sounded pretty suspicious. That was as far as I was willing to go. Common, ordinary, everyday food poisoning—I gathered that was what Pellitteri had in mind—wasn't a very satisfying answer. For one thing, cyanosis is hardly symptomatic of that. On the other hand, diarrhea and severe vomiting are, almost invariably. But they weren't in the clinical picture, I found, except in two or three of the cases. Moreover, the incubation periods—the time lapse between eating and illness—were extremely short. As you probably know, most food poisoning is caused by eating something that has been contaminated by bacteria. The usual offenders are the staphylococci—they're mostly responsible for boils and skin infections and so on—and the salmonella. The latter are related to the typhoid organism. In a staphylococcus case, the first symptoms rarely develop in under two hours. Often, it's closer to live. The incubation period in the other ranges from twelve to thirty-six hours. But here we were with something that hit in thirty minutes or less. Why, one of the men had got only as far as the sidewalk in front of the cafeteria before he was knocked out. Another fact that Pellitteri had dug up struck me as very significant. All of the men told him that the illness had come on with extraordinary suddenness. One minute they were feeling fine, and the next minute they were practically helpless. That was another point against the ordinary food-poisoning theory. Its onset is never that fast. Well, that suddenness began to look like a lead. It led me to suspect that some drug might be to blame. A quick and sudden reaction is characteristic of a great many drugs. So is the combination of cyanosis and shock."
"None of the men were on dope," Dr. Pellitteri said. "I told Greenberg I was sure of that. Their pleasure was booze."
"That was O.K.," Dr. Greenberg said. "They could have got a toxic dose of some drug by accident. In the oatmeal, most likely. I couldn't help thinking that the oatmeal was relevant to our problem. At any rate, the drug idea was very persuasive."
"So was Greenberg," Dr. Pellitteri remarked with a smile. "Actually, it was the only explanation in sight that seemed to account for everything we knew about the clinical and environmental picture."
"All we had to do now was prove it," Dr. Greenberg went on mildly. "I asked Pellitteri to get a blood sample from each of the men before leaving the hospital for a look at the cafeteria. We agreed he would send the specimens to the city toxicologist, Dr. Alexander O. Gettler, for an overnight analysis. I wanted to know if the blood contained methemoglobin. Methemogiobin is a compound that's formed only when any one of several drugs enters the blood. Gettler's report would tell us if we were at least on the right track. That is, it would g
ive us a yes-or-no answer on drugs. If the answer was yes, then we could go on from there to identify the particular drug. How we would go about that would depend on what Pellitteri was able to turn up at the cafeteria. In the meantime, there was nothing for me to do but wait for their reports. I'd theorized myself hoarse."
Dr. Pellitteri, having attended to his bloodletting with reasonable dispatch, reached the Eclipse Cafeteria at around five o'clock. "It was about what I'd expected," he told me. "Strictly a horse market, and dirtier than most. The sort of place where you can get a full meal for fifteen cents. There was a grind house on one side, a cigar store on the other, and the 'L' overhead. Incidentally, the Eclipse went out of business a year or so after I was there, but that had nothing to do with us. It was just a coincidence. Well, the place looked deserted and the door was locked. I knocked, and a man came out of the back and let me in. He was one of our people, a health inspector for the Bureau of Food and Drugs, named Weinberg. His bureau had stepped into the case as a matter of routine, because of the reference to a restaurant in the notification report. I was glad to see him and to have his help. For one thing, he had put a temporary embargo on everything in the cafeteria. That's why it was closed up. His main job, though, was to check the place for violations of the sanitation code. He was finding plenty."
"Let me read you a few of Weinberg's findings," Dr. Greenberg said, extracting a paper from the folder on his desk. "None of them had any direct bearing on our problem, but I think they'll give you a good idea of what the Eclipse was like—what too many restaurants are like. This copy of his report lists fifteen specific violations. Here they are: 'Premises heavily infested with roaches. Fly infestation throughout premises. Floor defective in rear part of dining room. Kitchen walls and ceiling encrusted with grease and soot. Kitchen floor encrusted with dirt. Refuse under kitchen fixtures. Sterilizing facilities inadequate. Sink defective. Floor and walls at serving tables and coffee urns encrusted with dirt. Kitchen utensils encrusted with dirt and grease. Storage-cellar walls, ceiling, and floor encrusted with dirt. Floor and shelves in cellar covered with refuse and useless material. Cellar ceiling defective. Sewer pipe leaking. Open sewer line in cellar.' Well . . ." He gave me a squeamish smile and stuck the paper back in the folder.
The Medical Detectives Volume I Page 1
