Alex Kahn knew he had been “had.” Of course, that was it. Why hadn’t he thought of it? Max Schwartz was absolutely right. He’d spent all his time trying to figure out how the hell Brubaker and Richards had contracted the disease from their patients so quickly, when in fact they might have been carrying it for days—even weeks—and become sick only when the number of organisms in their bodies had become great enough to cause the disease. If a large number of people had been exposed at the same time, they’d all get sick at about the same time.
“I think you’ve hit the nail on the head, Dr. Schwartz. I never thought of that possibility. It completely threw me off the track.”
“Exactly what it was supposed to do, Alex.”
“I have a question,” Warren Tracey interrupted. “Why are the cases increasing so rapidly if it’s not transmitted from man to man?”
“Because more and more persons are being exposed to the source, and the size of the source increases as the bacteria multiply.”
“That makes sense. Go on.”
“Let’s take a look at what we have,” Dr. Schwartz continued. “Very little. The staph we’ve recovered in Boston are the same as those Alex has recovered; from what I gather it’s the same all over. It’s a phage type 80/81. That’s a way of classifying staphylococci—to make it simple, by the viruses, or phages, they keep company with. It’s somewhat resistant to penicillin, but it’s fairly sensitive to other antibiotics, though only in the test tube. None of these drugs seem to work in patients. Why?
“If the staph we’re seeing is the bug but doesn’t respond to therapy, that could be for a number of reasons:
“The sensitivity testing could have been performed improperly in the laboratory. Very unlikely. I checked all the tests myself.
“There’s always the possibility that, due to some freak accident in preparation, a large batch of antibiotics came through with decreased or absent antibacterial activity. Also very unlikely. My lab and two others checked random samples of fifteen different drugs we had used from four different companies. We also had the quality control divisions of these companies check them for biologic activity as well as chemical identity. The drugs are all OK—at least in the test tube. Once again, I can’t emphasize enough that what we see in the test tube, in vitro, may be quite different from what we find in patients, in vivo. This is something we must keep in mind.
“It’s possible that after the drug is given, something in the patient or something produced by the organism itself inactivates it. As far as we can tell, there seems to be nothing to interfere with drug effect except for the penicillinase that the bug produces. For the nonbacteriologists among you, penicillinase is a substance produced by some microorganisms that inactivates penicillin.
“What are the chances that the staph we’re recovering is only one of several organisms that could be causing the disease? This is a real possibility. Staph is fairly easy to grow; it could be overgrowing everything else. I’m leaning toward a mixed infection caused by the staph and an anaerobe. This type of synergistic infection is very virulent and difficult to treat. We could have a problem here because it may take a long time to grow the anaerobe. Another possibility is that we could be dealing with a very unusual organism that requires special culture media. It could be a matter of trial and error to find the right cultural conditions. Sam, I’m hoping you can help us here.”
Alex Kahn never stopped being amazed at how Max Schwartz could simplify the information to put the entire problem into perspective. But he thought Schwartz’s theory about mixed infection failed to fulfill one of the usual requirements—they had not seen two organisms. But why was the staph acting this way? Why was it different from the hundreds of other infections he had seen with the 80/81 strain? Since the advent of the newer antistaphylococcal drugs in the early sixties, 80/81 had been much less of a problem. Maybe it had changed.
The course of the next few days might have been quite different had Alex Kahn’s thoughts not been interrupted by Calvin, who started to speak as he taped some charts to the blackboard. At this point the epidemiology of the infection was as concrete as any other data they had.
Calvin added little that shed light on the problem, but he presented the data well, carefully defining the attack and case fatality rates. The available statistics were listed, charted, and converted into multicolored lines on graphs and diagrams. He showed maps of population, industry and the availability of medical facilities in affected areas of the country. Each important variable appeared as a colored or characteristically shaped symbol on the map.
Alex watched and listened. The audience was attentive and impressed. He looked at Max Schwartz. His pose was the same as before—chair tilted back, knees up, hands folded on his belly, face outlined in the smoke that curled upward from the dangling cigarette. The “boss” was impressed, too.
Alex looked for his opening. He needed that weak spot in Calvin’s presentation to mar his flawless job, to put the two contemporaries on equal footing again. Max Schwartz had taught him well. Don’t let the competition gather too much momentum.
It was a weak blow, but it might work. The epidemiologist had shown another map of the country. On it were black dots that illustrated the clusters of deaths around forty major cities, with an occasional dot on the periphery. He flipped to a map of the Northeast to demonstrate the number of cases in Boston, New York, Philadelphia, Washington and Baltimore.
Alex interrupted him in a carefully chosen tone. “Jim, I know you probably haven’t had time, but I wonder if you’ve coned down on each of the cities separately? Do the cases occur in any specific section? Is there a pattern—for example, restaurants, colleges, beaches, swimming pools? Maybe even hospitals? You know, some suggestion of where the infection started?”
Calvin was ready for him. “I haven’t had time to chart all the information, Alex; but the majority of cases seem to be clustered around the centers of forty of our major cities. We made a list of all the buildings and what’s in each one and of the population densities by block and street in each of these cities. We fed this information to the computer to have it pick out trends and recurrent characteristics. The only common denominator is the main post office in the middle of each city.” He laughed. “That’s not really significant, though, Alex, as I’m sure you know.” His tone reflected that he could play the game, too.
“Maybe they mailed the bug to us,” Alex retorted sarcastically, but with a slight smile.
Max Schwartz suddenly sat bolt upright and stared at him.
“What did you say, Alex?”
For a fleeting second Alex wished he hadn’t said anything. He should have let Calvin gain the “points.” Max Schwartz enjoyed a good joke, but only at the appropriate time, and never at formal meetings.
Alex repeated his statement reluctantly. “I said, ‘Maybe they mailed the bug to us.’” He smiled meekly.
Max Schwartz slammed his fist on the table. “That’s it! How goddamned clever! I’d like to meet the smart son of a bitch who worked this one out.”
The others stared at him blankly.
“Don’t you see?” he went on, his voice and gestures reflecting his excitement. “They did just that. They mailed it to us. Like you said, Jim, every city has a post office in the center. What better way to disseminate an organism? If they worked it right—and I’m sure they did—that damned bug has been contaminating every letter, every package, every stamp that comes out of the post offices in those forty cities.” He pointed to the map Calvin had just shown. “Simple, effective and deadly! I’ll bet you every person who walked into one of them walked out carrying the bug. Probably in the nose and throat. Then all you’d have to do was wait around for it to multiply and travel down into your lungs. They had the U.S. Mail delivering the bug to your doorstep. Open your mailbox, and you’ve got it. No wonder there are more cases around the center of town. The number of organisms is inversely proportional to the distance from the source. The greater the distance, the gr
eater chance for the number to decrease on an inanimate object which won’t support growth for an indefinite period of time—such as an envelope or a package.
“Marion, can you get enough men familiar with decontamination procedures to look into every one of those post offices? Tell them to be careful. If the organism is there, the number could be fantastic by now. Start with mail that most likely wouldn’t be sent out. You know, damaged mail, anything that would cause a postal clerk to toss it into a dead bin. If I’m right, the packages, or whatever this thing came in, would still have to be in the post offices for it to work this way.”
Marion Slade grabbed the phone and dialed a four-digit number while the others listened. For the fist time, it looked as if hope might be just around the corner.
“Paul, Marion Slade here. Listen carefully. I want you to do something for me.
“What do you mean you can’t do it? I’m telling you that you have to do it. This is a national emergency. Your own miserable life may depend on it.” He paused to listen.
“By what authority?” Slade repeated the question, his voice rising. “By mine. And if that’s not enough, here.” He pushed the phone toward Roger Bergen.
Alex was amazed. Roger Bergen merely said two sentences in a soft, leisurely tone before he put down the receiver. “He’ll start within the hour. Every inch of the main post office in each of those forty cities will be carefully examined. Absolutely anything that appears suspicious will be flown here in air-tight plastic bags. It may take some time, but it will be done.”
Obviously, the Postmaster General knew Mr. Bergen.
They waited. Like expectant fathers, they paced the floor, made small talk, drank coffee and smoked.
The hours passed, and they waited—for the word that would prove or disprove the ray of hope Max Schwartz’s astute mind had given them.
“If we get the organism, we probably will know where it came from and why, too.” Dr. Schwartz was thinking out loud. Like the others, he kept looking at the phone.
“I’m sorry, I don’t understand you.” General McKitridge was glad to have something to talk about.
“A man is identified by his work. Most bacteriologists are known by the microorganisms they study—physicians by the diseases they know best. For example, take me. If you mention streptococci or meningitis, you think of me—and a few others, of course.” He laughed good-naturedly; he wasn’t sure, in fact, that there were others. “When we identify the organism, we’ll have a pretty good idea of the people who are good enough to pull a trick like this.”
Alex Kahn took comfort in the fact that Max Schwartz had changed his “ifs” to “whens.”
The call finally came at midnight.
No one moved. All eyes turned to Marion Slade, everyone expecting him to take it. He lifted the receiver.
“General Slade here.”
These were his only words.
When he put down the receiver, he walked over to Alex Kahn and Max Schwartz and shook the hand of each. His face broke into a broad smile.
“They’ve got it!”
seven
The forty cities had been chosen for death because together they were inhabited by 35 percent of the population of the country. Many were centers of government, industry and culture. What better targets?
A city is many things. A star, a red dot, a small grid of squares on a map to symbolize its size. An area of land limited by arbitrary borders. A place where people come to live, to work, to dream, to marry, to bear children—and to die. A cold, impersonal mass of steel and stone and concrete and glass. But most of all, a city is people. People to walk on the streets and boulevards, to live and work in the houses and buildings that make up the blocks, to think and agree and disagree. People—all the rest is merely a shell for them to inhabit, a skeleton to give them support. Without them, a city has no soul, no life. And this weapon was aimed at the people.
They lived, they became ill, they fought for life with their fight for breath, and they died—all without knowing. For Max Schwartz was right. There were no clouds of deadly vapor, no broadcasts to announce a war, no signs which warned of plague.
At first size was the cities’ protector. For in the great and endless mazes, the fear diffused. A hundred died, then two hundred, then three hundred and more. Yet who knew? The impersonal hand that wrote their names in hospital records and statistical tables knew. The doctors and the nurses—the ones who helped them fight and watched them lose—knew. And the figures dressed in black who laid them in the ground—they knew, too.
Fear is, in part, translated into a series of predictable, stereotyped, physiologic phenomena common to man and animals alike. The pupils dilate, the mouth becomes dry, the pulse quickens. This happens to all; yet each person reacts differently, his reaction predetermined by memory, experience and environment. This is what makes the individual response to fear unpredictable.
At one time or another, disease had been a part of all of their lives and death an abstraction of the future that belonged to others. Max Schwartz alone had seen what they could not. This new evil spreading now unchecked up and down the streets, into the homes and houses of the forty cities—and soon beyond—was not the evolution of a disease natural to them all, but a man-made curse. This was no “flu” epidemic from Hong Kong or England, no measles outbreak in Boston; this was no disease they had felt before.
And with each new death, the vicious cycle of fear and death began. No one was spared.
Lori Kahn was frightened. She stood on the sundeck of her parents’ home in New Hampshire and listened to the wind moving through the pine trees that lined the shores of Lake Winnipesauke. The cool evening breeze rippled the orange reflection of the setting sun on the lake in a peaceful, never-ending rhythm. Crickets chirped, and now and then heat lightning lit up the distant horizon. Another time it might have been an ultimate evening, but what she had just heard would have spoiled even the most beautiful sunset.
Their next-door neighbor was visiting with them. He had just returned from New York, from the funeral of an uncle who had died suddenly from “overwhelming pneumonia.” He had planned to stay on for a few more days, but what he had seen and heard had convinced him to return home immediately.
Some sort of fatal epidemic was occurring in New York. People were becoming frightened, and their fear was contagious.
There were also rumors that it wasn’t just New York; it was also Boston, Philadelphia, Washington, and several other large cities.
Lori had excused herself and come out onto the sundeck to be alone with her thoughts and fears. Alex was in New York, and she hadn’t heard from him.
She hated it when they were separated, but she knew his career demanded that he attend scientific meetings, accept speaking invitations, and serve on various committees that often required travel. She had even grown accustomed to not hearing from him for a day or two. Until now she had not been worried. He had told her on Sunday when he had put her and the children on the plane to New Hampshire that he would call as soon as he was settled in New York.
Suddenly the sun’s last rays were gone, dark clouds hid the moon, and the wind turned cold. She pulled her cardigan tightly about her. It was beginning to rain as she went into the house to find the name of the hotel in New York where Alex would be staying until she and the children joined him.
Gamal Machdi sat in his room and mourned alone in the silent darkness. His father was dead. The separation had been too long, the rift too great, the differences too many for him to weep. There were only memories mixed with guilt and anger and a terrible gnawing ignorance of why and how death had come to the man who had been his father.
Gamal Machdi was very unlike his father. He had attended the university only at his father’s insistence. Gamal’s interests lay not in books and laboratories, but in people. As his ability to observe became keener, he began to see his life and those of others dominated by petty bureaucrats lusting for power under the guise of democracy and nationalism
. To Gamal Machdi, that his father merely continued working in his narrow, private world no matter which government paid his wages or supported his research was inexplicable and unacceptable.
At first, father and son talked about it; they listened to each other and discussed. As time went on, they still talked; but now each knew he could never understand the other. Finally they realized there was no further need to speak; their views, their attitudes, their loyalties would never be the same.
They grew apart, seeing each other less and less and finally not at all. Gamal had glimpsed his father for the last time while he stood waiting outside the Government Center for a friend who was obtaining an illegal passport for him. Ahmed Machdi had been on his way to a meeting; he had not seen his son. Gamal had stood there silently and watched his father pass by. That he did not speak to him or embrace him would haunt him with guilt for the rest of his days.
Gamal Machdi had not been too old to fight. With courage and zeal he had joined a group whose goals were to restore dignity and freedom to their people and a place of respect among the nations of the world to their country. They were few in number and poorly organized; they had little money; their discovery was inevitable.
Gamal’s choice was difficult: to stay in his country meant execution for treason; to leave meant to bid farewell to his home to start over in a strange land.
Gamal Machdi had come to the United States in 1956. He had at once realized that here was a place where he could still work for his homeland. He went back to school and excelled. With time came success. As Professor of Political Science at the City College of New York and as an expert on Middle Eastern affairs, he found adequate outlets for his nationalistic pride. He made peace with himself and with his new world. He wanted to make peace with his father, too—if only to rid himself of his plaguing guilt.
The 11th Plague Page 8
