Epidemiologist
My wife loves to regale new patients with my resumé, including announcing that I am an epidemiologist (or was, actually). Folks sound impressed but I suspect they’d be hard-pressed to define what that means. I’m glad you asked.
CDC in Atlanta, originally created to combat malaria, had by the early 50′s become the world’s top communicable disease command post. In order to put trained investigators at the scene of outbreaks and research facilities they came up with an elite group called the Epidemic Intelligence Service (EIS) which took about two dozen physicians, veterinarians and statisticians yearly, trained them and assigned them either to Atlanta or around the nation. EIS officers spearheaded the conquest of smallpox and polio, and its alums make up a major share of heads of health departments and professorships in the spheres of infectious and chronic diseases around and beyond our nation.
Doctors were subject to the draft when I graduated and finished the required internship in 1961. Were my number to come up then with no specialty training, I’d likely be assigned to a dispensary in Greenland. With a wife and two kids, that sounded grim. When one of my favorite teachers recruited me for the EIS, enabling me to satisfy my military obligation, I jumped at the chance.
The science of epidemiology (the study of epidemics) began about 1840 with Dr. John Snow of London and the Broad Street pump. A cholera epidemic was ravaging the city. Dr. Snow spotted cases on a street map and showed that the closer one lived to the infamous water pump, the more likely one was to get cholera. It must have been like a police station tracking a serial murderer.
Learning this exciting discipline from Dr. Alexander Langmuir and his staff was like learning astronomy from Galileo. “Alex” had come from Johns Hopkins to set up the program and treated us like princes. After training for a summer in pre-airconditioned Atlanta, we were encouraged to choose our assignments in a surprisingly open way. The requests for EIS officers far outnumbered us, so Alex took the five of us who were left unmatched because we lacked the years of residency and field experience that others had, and made sure we were all happy with our destinations. I had always wanted to live in California and could barely contain my glee when he suggested I take Berkeley and the California State Health Department (since moved to Sacramento).
My primary responsibilities were tracking influenza, hepatitis and other major diseases and reporting back to CDC. I had a lot of latitude to pursue whatever medical problems popped up around the state, and managed to get into all but three of its 58 counties. When I needed some R&R with the family I’d often find some potential calamity threatening the good people of San Diego or Santa Barbara. I also saw trachoma in the Coachella Valley and took part in the annual health fair for Alpine County, America’s least populated (800), in its county seat of Markleeville (pop. 300). Getting snowed in just added to the adventure of it all.
My biggest project in my two years was a hepatitis epidemic in the little town of Los Banos which occupied the better part of six weeks in my first summer. They speak of “shoe-leather epidemiology” and indeed my associate and I met most of the 7800 people living there. I eventually published a description of the peculiar outbreak in our state medical journal.
A 12-year-old nephew of a local rancher deplaned at SFO from Italy with a sickly yellow complexion. The town had no hospital but one of the four local doctors had a “clinic” with a few beds. The youngster was treated there but for some reason his sickness was not considered contagious. Infectious hepatitis (The A/B/C system was yet to be defined) has a long incubation period but eventually 19 of 21 clinic employees caught it. By strange coincidence some snake-oil salesman passed through town hawking a miracle cure for liver ailments. Since the four doctors were overwhelmed (and undertrained) the word went forth: leave a urine specimen by the back door and if it shows hepatitis we’ll call you in and give you shots for it. Blood tests weren’t done and of course there is no treatment, but we were able to determine through interviews that about 500 cases occurred.
A side issue is worth mentioning. During the six weeks of tooling about in the motor pool Studebaker Lark without air conditioning (choice 1: close windows and suffocate in the 105-degree heat or 2: open windows and inhale the pungent dust of the San Joaquin Valley) I expressed concern about catching Valley Fever (coccidioidomycosis), a fungal disease of the lungs, but I was reassured by my colleagues. That summer the state hired Dr. Bill Reynolds to come down from Seattle and organize medical surveillance of the migrant worker program. Bill contracted Valley Fever and spent almost a year in the hospital!
While assigned as I was to the state, I was a federal officer and CDC made sure its young pups got a taste of real-world epidemiology. My Mission Improbable was to fly to Ketchikan, Alaska (by Constellation and Grumman Goose) to investigate a diphtheria outbreak. The locals greeted me with a banner headline (“Top Epidemiologist Arrives From Alabama”) – not quite geographically accurate – and I got to give a speech at the Lincoln’s Birthday Toastmasters meeting. I spent five days touring the village’s 35 bars doing nasal swabs. The patrons knew of the outbreak and were more than helpful; no one objected to a poke in the nose but first I had to hear their life story!
I found one diphtheria carrier, and left in triumph. On my EIS diploma is a cartoon of a well-dressed fellow who looks a lot like Dr. Langmuir sliding downhill on the right side of a graph, the message being to arrive after the peak of the outbreak so as to add to one’s air of wisdom. I revisited Ketchikan to refuel in later years, and by then there was a real airport and a more prosperous town. That first arrival in the Goose in 1962 was memorable. No one announced that it was an amphibian because it seemed obvious, except to the poor older lady opposite me who screamed and about fainted when the plane splashed down in the bay.
February 16th, 2008 at 8:28 am
Dear Dr. Maller — My Google “alert” for valley fever or coccidioidomycosis brought me your post this morning. We are working very hard to obtain federal funding for valley fever vaccine research and development. Your mention of the specialist brought to the area who spent the next year in the hospital due to Valley Fever would tell me that you are one who understands the personal and community costs of this disease. The state of California has contributed over $7 million to this project already. IT is time for the feds and the state of Arizona to kick in! I haven’t tracked back to see where you are writing from, but anything you can do to help educate, persuade, and motivate our national and your state representatives would be appreciated. The need is described in our January 2008 newsletter posted at our website, http://www.valleyfever.com.