The Medical Detectives Volume I

by Berton Roueche

  The inquiry by the Fresno County Public Health Department into the case of Billy Cordoba was conducted by an investigator in the Division of Environmental Health named R. E. Bergstrom. Mr. Bergstrom, who was then senior sanitarian in the Division (he is now its director), received the assignment within an hour of Dr. Conrad's report to Dr. Hayes on the morning of October 18. He and a colleague named Tiyo Yamaguchi were at the Cordoba house within an hour.

  "We spent the rest of the day out there," Mr. Bergstrom says. "There and around the neighborhood. Mrs. Cordoba told us about the spraying operation near the bus stop. We followed that up and confirmed what she had learned herself. It was a standard cotton- defoliation spray—magnesium chloride and dinitrose. We went through the Cordoba house and the garage out back looking for anything in the way of a garden spray or insect bomb that might include an organic phosphate. Nothing. We examined the family car. Nothing. That left Billy's clothes, and Mrs. Cordoba showed us his blue jeans. She told us about them. They had been bought new about a month before at the salvage depot of the Valley Motor Lines. They were cheap, and she bought five pairs. But Billy had worn only one pair. And he had worn them only twice—to school that day and then to Dr. Conrad's office. I looked at Yamaguchi and he looked at me. We knew we had found what we were looking for. It had only to be proved. We wrapped up the jeans —all five pairs—for laboratory analysis. The Bureau of Vector Control of the California State Department of Public Health has a research station here, and we took the jeans over there the next morning. The first thing we wanted to know was whether they were contaminated. The Bureau had a quick and easy test for that. They breed mosquitoes at the station for experimental purposes, and they simply tossed the worn pair of jeans in with one of the colonies. I tell you, it was a sight to see. Those mosquitoes just curled up and died. It took only fifteen minutes. At the end of that time, every mosquito in the colony was dead. Not only that. There was another breeding colony about twenty feet away, and in about five more minutes all those mosquitoes were dead, too. The poison was that volatile.

  "The next thing we wanted to know was the identity of the poison. We thought it was an organic phosphate, but was it? There is a color-reaction test that reveals the presence of phosphate. It takes a little longer than the mosquito test, but the Bureau had the chemistry to do it. We left the jeans with them to work on, and drove back in to town and down to the office of the Valley Motor Lines. It wasn't a very satisfactory visit. About all we learned was that there had been a sale of blue jeans at their salvage depot in September, and that all the jeans had been sold. They supposed the jeans had been damaged, but they didn't know in what way. They didn't know where the jeans had come from. They didn't know the number of jeans in the batch. All company records were stored at their main office, in Montebello, down in Los Angeles County. And, of course, they had no idea who had bought the jeans at the sale. We left them with the understanding that they would recover the relevant records. When we got back to the office, I called our friends at the Bureau of Vector Control. They were a lot more helpful. They had run the color-reaction test, and they had the result. It was positive for phosphate.

  "That wasn't any great surprise, of course, but it was crucial. It established that Billy's blue jeans were in fact the source of his phosphate poisoning. All we needed to establish now was the source of the poison. And not just where it came from but also what it was. There are at least twenty-five commercial phosphate pesticides in common use. Like Parathion, for example. And Malathion. And Fenthion and Phosdrin and Diazinon and Dicapthon and Trithion and tepp. And so on. So it might be easier to find out where it came from if we knew what particular phosphate pesticide we were looking for. Well, that kind of information can be got. It takes a little time, but it's possible by certain tests to identify an unknown phosphate pesticide. The Bureau couldn't do the analysis, but they knew who could—the Division of Chemistry of the California State Department of Agriculture, up in Sacramento. They said they would make the necessary arrangements. We should have a report in a week or ten days. The following day, we looked in at the Valley Motor Lines again. They still hadn't recovered the blue-jeans records. And the day after that it was the same. Apparently, it wasn't easy to get records out of Montebello. And then we heard about Johnny Morales. Dr. Conrad must have telephoned the news to Dr. Hayes. At any rate, we had the simple facts by the morning of October 25. We went over to the hospital—it's just across the street—and talked to Dr. Warren and to Mrs. Morales, and finally to Johnny himself. Johnny was still pitifully sick, but he had been treated in time with atropine and pam, and he was off the critical list. His story was Billy Cordoba's story all over again. There was a new pair of blue jeans. They came, like Billy's, from the Valley Motor Lines' salvage depot. They carried the J. C. Penney label. So did Billy's. And, as we very soon found out, they were also heavily contaminated with an organic phosphate. Johnny had worn the jeans for (the first time on October 20. He wore them to school that day and got sick around midmorning and was sent home. His mother put him to bed, and in a few days he was well. Then he put on his jeans again and went back to school, and ended up at Fresno General Hospital.

  "Johnny's new jeans brought the total accounted for up to six. Mrs. Morales had bought only one pair. We still didn't know how many jeans had been sold in the sale, but it was certain that there were more than that. Dr. Hayes got in touch with all the local media. She called in the Bee and radio station KMJ and KMJ-TV, and it was all in the paper and on the air that evening, with a warning about the still unaccounted-for jeans and an appeal to the buyers to bring them in to the County Health Department for examination. The response was immediate, and good. As a matter of fact—although we didn't know it for a couple of weeks or more—it was one hundred per cent. We received a total of ten pairs of J. C. Penney jeans, from six different buyers. They represented five families and an institution for children. We checked them out for recent illness and found four cases with much the same clinical picture. Four boys, in four of the five families. They were all recovered now, and they had all been differently diagnosed. Brain tumor was one diagnosis. Another was bulbar polio. One of the others was encephalitis. In retrospect, however, the signs and symptoms were unmistakably those of organic-phosphate poisoning, and when their jeans were tested, that confirmed it. But it was also a little peculiar. Not because they all recovered without specific treatment. That could be explained by light contamination or brief exposure, or both. The peculiar thing was that only those four got sick. What about the fifth family and the institution? They had each bought two pairs of jeans, and the jeans had been worn, but none of the boys who wore them had been even mildly ill. As I say, it seemed a little peculiar—until it turned out that those jeans were not contaminated. And the reason they were not contaminated was that they had been washed. And the reason nobody got sick was that they had been washed before they were worn. Billy and Johnny and the four other boys had worn their jeans the way most kids do. Just as they came from the store."

  The transformation of Billy Cordoba's solitary seizure of organic- phosphate poisoning into a looming epidemic also changed the stature of the investigation. It was now imperative that the records of the Fresno blue-jeans sale be recovered from the Montebello office of the Valley Motor Lines, but doing so appeared to be beyond the strength of the Fresno County Public Health Department. Its exhortations did not carry across the state and into Los Angeles County. What was needed was the stronger voice of the California Department of Public Health. Accordingly, on October 26 Dr. Hayes invited that agency to take over the direction of the larger investigation, and her invitation was accepted. It was, however, immediately obvious to the Department of Public Health that in this instance the interrogational powers of a more specialized state agency would be even more compelling. That agency, whose assistance it sought and at once received, was the Public Utilities Commission, which at that time was charged with enforcing motor-carrier safety regulations.

 
The Public Utilities Commission's investigation was carried out by members of its Operations and Safety Section. They began their inquiry on October 27. Six days later—on Thursday, November 2—they were pleased to receive from the Division of Chemistry of the Department of Agriculture (by way of the Bureau of Vector Control of the Department of Public Health) the ultimate test report on Billy Cordoba's blue jeans. It read, "The stained portion of the jeans contained Phosdrin, 4.8% by weight. The contaminant was specifically identified as Phosdrin by its characteristic infra-red absorption curve...." This was useful information. They now were looking for a particular pesticide. That would make a difference in their progress through the labyrinth of bills of lading, manifests, and invoices. It remained only to link the contaminated J. C. Penney jeans in time and place with a quantity of Phosdrin.

  They did so in just two weeks. The chain of circumstances that led to the poisoning of Billy Cordoba and the others had had its innocent beginning some eight months before at the Bayly Manufacturing Company, in the nearby town of Sanger. On February 3, 1961, a shipment of Bayly blue jeans—two large bales and a carton—consigned to a J. C. Penney store in Los Angeles was picked up at the Bayly plant by the Triangle Transfer Company, a Sanger trucking firm, and taken to the Fresno terminal of the Valley Motor Lines for transshipment south. Within an hour or two of its arrival in Fresno, the shipment was loaded aboard a Valley Lines trailer with a conglomeration of other freight. This freight consisted of machinery, machine parts, metal pumps, and a hundred twenty gallons of emulsifiable concentrate of Phosdrin, in one-gallon and five-gallon cans. The Phosdrin was the product of De Pester Western, Inc., a Fresno manufacturer, and was consigned to the Valley Chemical Company, at El Centro, down on the Mexican border.

  The Valley Lines trailer left Fresno the following morning with this miscellaneous load, and that evening it reached the company terminal at Montebello, where the Phosdrin was unloaded for transshipment. Two days later, on February 6, it was put on board a truck operated by the Imperial Truck Lines, a Los Angeles firm, for the final leg of its journey. The Imperial driver made the usual precautionary inspection of his load before signing the delivery receipt, and found that one of the Phosdrin cans had sprung a leak. He traced the leak to a little puncture about three inches below the top of a five-gallon can. After some discussion, he signed the delivery receipt, but noted a formal exception to the shipment on the grounds that around a gallon of Phosdrin concentrate hail been lost from the punctured can. (How the puncture occurred was never determined, but the loss was estimated in a subsequent claim by the Valley Chemical Company at one and one-eighth gallons, valued at twenty-four dollars and fifty cents.) Meanwhile, the shipment of blue jeans was delivered that same day by the original Valley Lines trailer to a J. C. Penney store in the Los Angeles suburb of Westchester. A shipping clerk there noticed a dark stain on the paper wrapping of one of the bales of jeans. He asked the driver about it, but the driver didn't know. He had never seen it before. The clerk went in and brought out the manager, and the manager told the Valley Lines driver that a damage claim would be filed if any of the jeans turned out to be soiled. Sixteen pairs of jeans were found to be stained with some unknown oily substance, and a claim for damages was filed on February 8. The claim was acknowledged by the Valley Motor Lines, and the sixteen pairs of jeans were stored in the J. C. Penney warehouse for pickup by the Valley Lines. They remained there all spring and all summer—until September 6. Then they were finally picked up and returned to Fresno. On September 19, they were put on cut-rate sale at the company's salvage-depot store. The jeans by then apparently looked all right. They might also by then have been as safe as they looked. It is possible. Seven months of storage in a warehouse subject to swings of heat and cold and damp and dry might well have caused much of the Phosdrin to volatilize and vanish. But the J. C. Penney warehouse was a new and modern warehouse. It was air-conditioned.

  The Public Utilities Commission's report of these findings to the State Department of Public Health ended on a reassuring note. It concluded, "The staff's investigation of the personnel records and waybills of the two carriers involved failed to disclose any evidence of employee illnesses on the days in question or subsequent thereto, and failed to disclose any evidence that foodstuffs or other personal effects, including clothing, had been contaminated."

  The Commission's report was not, however, the end of its interest in the matter. It at once instituted an investigation into the general operations, safety practices, equipment, and facilities of the Valley Motor Lines and the Imperial Truck Lines, and on February 14, 1962, a public hearing on the results of that investigation was held at Fresno. Both companies were found guilty of carelessness, and admonished and fined. The Valley Lines was fined five thousand dollars—the maximum penalty—and the Imperial Lines was fined twenty-five hundred dollars.

  [1969]

  CHAPTER 11

  Something a Little Unusual

  Around noon on October 28, 1963, five people—two men, two women, and a child—sat down to midday dinner in the kitchen of a house they shared on a tobacco farm in the Caney Valley hills of Hawkins County, Tennessee, about fifteen miles southwest of Kingsport. They were (I'll say) Homer Mason and his wife, Louise; the latter's sister and her husband, Grace and Leroy Smart; and the Smarts' son, a boy of three called Buddy. Mason and the two women had spent the morning in the barn stripping and bundling cured tobacco leaves for the market. Smart had had other work to do, and it was he who prepared the meal. It consisted of split-pea soup, spaghetti with meat sauce, sliced tomatoes, sweet milk, and corn bread. Mason was the first to finish eating. He told his wife and Mrs. Smart that he would meet them down at the barn. He was going to stop by the cowshed for a look at an ailing calf. He left the house and crossed the yard, and suddenly began to stagger. He lurched against a tree. The barnyard tilted and the sky reeled. For a moment, Mason clung to the tree, and then it, too, began to sway. He turned and staggered back across the pitching barnyard toward the house. He stopped and blinked and shook his head. Something was happening to his eyes. The house was hardly fifty yards away, but he could only just make it out. He seemed to be going blind.

  So did Mrs. Smart. When Mason stumbled into the kitchen, she was sitting there at the table with her head in her hands and moaning. Her husband stood beside her. Mrs. Mason stood on the other side of the table with Buddy in her arms. He was staring at his mother and whimpering. Mason dropped into a chair, and Mrs. Smart raised her head. "Homer, I can't hardly see," she said. "I think I'm going blind."

  "Me, too," Mason said.

  "And I'm dizzy," she said. "I tried to stand up a few minutes ago and everything was just spinning. I felt like a drunk man."

  "She like to fell," Smart said. "I had to catch her."

  "Same here," Mason said. "I feel the same way."

  "Then it isn't just me," Mrs. Smart said. "I thought it was just me. Because Leroy feels all right, and so do Louise and Buddy."

  "You'll be all right, honey," Smart said. "Everything's going to be all right."

  "I don't feel as good as I did," Mrs. Mason said, and abruptly sat down. "There's something funny in my head. I feel kind of goofy."

  Mrs. Smart gave a little wail. "Oh, my gosh!" she said. "I even feel sick to my stomach! What is it, Homer? What's the matter?"

  "I don't know," Mason said. "Maybe we've been poisoned. There's three of us don't feel right—you and me and Louise. And there was only just the three of us working down in the barn this morning." He stopped and licked his lips. They felt stiff and cracked, and his mouth was dry. "Maybe we've got tobacco poisoning," he said. "We've all of us got the nicotine stain on our hands. Some of it maybe come off in our food."

  "I never heard of tobacco poisoning," Smart said.

  "I have," Mrs. Smart said. "Oh, my gosh, Homer. What are we going to do?"

  Mason looked at Smart. He could see him, but his features were out of focus, and there was something moving just ab
ove his head It was like a play of light and shadow—or a cloud of smoke. It became a swarm of bees. They swarmed silently around and around and around. "Leroy," Mason said, "I think you better drive us in to the doctor."

  The medical needs of Caney Valley residents are served by a middle-aged general practitioner whom I'll call Francis Craig and a young associate whom I'll call Henry Rathbone. These two physicians operate a clinic at Church Hill, a roadside village about midway between Kingsport and the Mason farm, and it was there that Smart drove his wife and son and the Masons. They arrived at the clinic at two o'clock.

  "I was alone that afternoon," Dr. Rathbone says. "Dr. Craig was in Kingsport at the hospital—the Holston Valley Community Hospital—making rounds. Lucy, our nurse, called me on the interoffice phone and said that five people had just come in from Caney Valley. Three of them, she said, were acting very strange She sounded rather agitated. I was with a patient, but I finished up as quickly as I could. Lucy isn't a flighty girl. I went out to the waiting room—and she was entirely correct. They were acting very strange indeed. The women were twitching and jerking and moaning, and one of the men—Mason, it turned out to be—was waving his arms and talking a wild blue streak of gibberish. I thought for a minute that he was simply scared. But then I looked again. He was peering into space and making grabs at the air, and I realized that scared wasn't it at all. He was hallucinating. The other man, the man named Smart, came up and introduced himself and told me what he could about the matter. I gathered that his wife and Mason had been taken right after eating. Then, a little later, Mrs. Mason took sick. Smart and his little boy, however, were perfectly all right. The symptoms, as I made them out, were vertigo, blurred vision, dry mouth, generalized weakness, nausea, and—in Mason's case, at any rate—hallucinations. Smart added that his wife and the Masons had spent the morning stripping tobacco. He wondered if the tobacco could in some way have poisoned them. I told him no on that. Tobacco poisoning could be only nicotine poisoning, and that couldn't happen from that kind of superficial contact. But they had almost certainly been poisoned. My guess was food poisoning—food intoxication. And, to judge from those clearly central-nervous-system symptoms, it was something pretty serious.