The Disease Detectives

Officials at the National Institutes of Health were quite understandably disturbed and mystified. Eight patients under treatment for cancer had suddenly been struck with blood poisoning; until doctors learned what caused the condition, they were powerless to prevent other patients from being infected. Unable to find the cause on their own, the NIH doctors called in investigators from the U.S. Public Health Service's Center for Disease Control in Atlanta.

The move proved sound. After ruling out food and person-to-person transmission of the infection, the CDC men learned that all of the patients had received platelets--blood components that help promote clotting--from the same donor. Following up that clue, they found that the man unknowingly had chronic, asymptomatic osteomyelitis, an infection of the bone that was the cause of the cancer patients' new illness. The CDC'S discovery helped the cancer victims and may have saved others as well. The man revealed that he had sold 57 pints of blood during a seven-month period, and the CDC was able to locate and destroy all of it before it could be used.

Such scientific sleuthing is routine for the CDC, which is to communicable disease what the FBI is to crime. Since it was established in 1946 as an outgrowth of a World War II agency set up to control malaria, the CDC has tracked down the sources of typhoid epidemics, traced a hepatitis outbreak in Michigan to a single bakery worker, and hunted down untold thousands of venereal-disease victims in need of treatment. Its efforts are essential, since infectious diseases remain one of the country's most troublesome health hazards. This year alone, they are expected to account for 140,000 deaths, cause children to miss 145 million days of school and cost the U.S. economy 130 million lost work days.

The agency that does battle against these diseases is small. The CDC, which can act on its own in interstate outbreaks or assist state and local health departments, has only 90 officers; 50 are located at its headquarters in Atlanta, the rest spread across the country. Most of the officers are physicians; others are statisticians, veterinarians and nurses. Despite the relatively low pay ($1,473 per month for a physician with two years of residency and dependents), most are enthusiastic about their work. "It's a challenge, like detective work," says Dr. John Bryan, a CDC staff officer. "In private practice, there really is a limit to the number of people you can serve. Here, in the long run, you benefit many more people than you could in private practice."

Interstate Epidemic. CDC investigators are able to close the books on some cases with little trouble. They had few problems, for example, figuring out why a batch of plum wine that had fermented in an old bathtub caused lead poisoning in only one of several people who helped concoct the stuff. Under questioning, the man sheepishly revealed that he had consumed 50 gallons of it.

Other cases needed a persistence that would do credit to Lieut. Columbo. In 1971 CDC officers interviewed a total of 387 people afflicted with an intestinal ailment; they finally traced the problem to cheese imported from a single French producer. Equally dogged investigation uncovered the source of an outbreak of intestinal illness in Sioux City, Iowa. After learning that all 250 people affected had eaten at one restaurant, CDC officers continued questioning until they discovered that all had ordered some kind of sliced meat. Further investigation led them to a meat slicer that was contaminated with salmonella, a particularly virulent organism that lives and multiplies in the digestive tract.

A few people resent the CDC'S probing and refuse to cooperate with investigators. A surgeon suspected of being the source of an outbreak of streptococcal infections dosed himself with antibiotics before allowing officers to examine him. But once they understand the dangers of allowing an infection to spread, most people are more than willing to help the disease detectives. CDC officers investigating a California VD epidemic had a great deal of trouble locating a prostitute who had infected a truck driver with syphilis during an encounter when he was on the road. When they finally tracked her down, she was nothing if not helpful in steering the sleuths to her other clients. She produced a diary that listed more than 300 of them in 34 states.

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