"But how? One possibility occurred to us almost at once. Northern Arkansas has a good-sized broiler industry, and Larsh picked up the fact that chicken manure is widely used in the area us a lawn fertilizer. While the rest of us were still occupied with our diagnostic studies, he had made some inquiries—and sure enough! Two years before, in the spring of 1953, the school had bought six or seven truckloads of the stuff. It was dumped on the edge of the grounds and left there to rot. Some time later, when the manure was well rotted, a gang of workmen had moved in and spread it on the lawn. Larsh was jubilant, and so were we. Old chicken manure and H. capsulatum are as akin as fire and smoke. Hut then the promise began to fade. The manure hadn't simply been spread. It had been thoroughly diked into the ground. Moreover, the job had been done way back at the end of the previous summer. The last load had been dug in just before the opening of the present school year, in September. That piece of information practically finished it off. It was most unlikely that a source that disappeared in September could have caused a February outbreak. Nevertheless, as a matter of routine, Larsh collected some samples of soil and sent them home for laboratory analysis. In a couple of weeks, the results came back. No soap. No sign of H. capsulatum.
"I can't say that we were greatly disappointed. To tell the truth, the laboratory report was something of a relief. A positive soil analysis would have raised more questions than it answered. We'd come to realize by then that the fertilizer couldn't possibly be in the picture. And not only because it failed to fit the established onset date. It also failed to explain the most peculiar aspect of the outbreak. I mean, of course, the extraordinary concentration of cases in Room 2-A—the Liberace room. The school records listed a total of twenty-eight children enrolled in the class. Of that number, as Chin's study had noted, fourteen—or fifty per cent— were clinically ill. The average for the school as a whole was nine per cent. That was odd enough. But the diagnostic studies told an even stranger story. In the skin-test study, ninety-six per cent of the tests on the children in 2-A gave positive histo reactions. The school average was eighty-eight. In the blood-test study, sixty- eight per cent of the children in 2-A were positive. The school average was thirty-four. In the X-ray study, thirty-eight percent of the children in 2-A showed definitive lung involvement. The school average was twenty-three. That couldn't be accounted for by the fertilizer episode. And it had to be accounted for. It couldn't be ignored. It couldn't be merely coincidence. It had to signify. It had to mean—it could only mean—that the source of infection centered on the Liberace room. More than that. It obviously meant that something out of the ordinary had happened in or near that room. The clinical data told us when. It had probably happened within a day or two of February 1.
"Something had happened around that time. It took a bit of probing—most people have rotten memories—but the school janitor finally dredged it up. On January 29, a truckload of coal— about six tons—was delivered to the school and dumped alongside a chute that led down to a cellar bin. And where was the chute? He walked us around to the rear of the building and pointed it out —a little iron door right under the windows of the Liberace room. A few more questions and a bit of checking produced a few more facts. The chute was only a dozen steps from where the school buses loaded. January 29th had been a Saturday. For some reason to do with labor, the coal remained where it was dumped through Monday. On Tuesday and Wednesday—February 1st and February 2—it was shoveled into the bin. The weather that week was dry and clear and windy. Everybody remembered the wind. It combined with the shoveling and the buses to raise a storm of dust that covered the rear of the building and seeped into most of the classrooms. The dust was particularly heavy, the janitor recalled, in Room 2-A. It was fascinating; everywhere we looked, we found another piece of circumstantial evidence. And they all seemed to fit together like the parts of one of those puzzles. The time was right. The place was right. The conditions were right. They even explained Miss Smith. The habit she had of standing at an open window in Room 2-A to direct the children onto the buses would have exposed her to the dust at its thickest. Everything was right except the only thing that mattered. If the truck had dumped a load of chicken manure—or topsoil or leaf mold or brush—I wouldn't have hesitated. I would have felt we had the answer. But coal! H. capsulatum doesn't grow in the bowels of the earth.
"On the other hand, of course, we couldn't just drop a lead as persuasive as that. It went against the grain. We sat down in Saltzman's office at the courthouse and discussed the possibilities. It was at least conceivable that the coal had accidentally served as a vehicle for H. capsulatum. It might have become contaminated at some point en route from the mine. In some coal- yard, perhaps. Or in the truck that brought it to the school. Maybe the truck had been used for carting chicken manure. We had the name of the trucking company, and Chin and Paxton went off to ask the people there some questions. Larsh and I drove over to the school and went down cellar and had a look at the coal. It wasn't very promising. The bin was practically empty, and what little coal there was looked as clean as coal ever does. We couldn't find any signs of anything but coal. It really looked hopeless. However, Larsh scrambled around and gathered some samples of dust for analysis. The laboratory might tell us something different. Then we went back to the courthouse and waited for Chin and Paxton. They came in looking rather thoughtful. Our truck-contamination theory was out. The company did general trucking, but none of its trucks had ever hauled manure. In the past few months, the records showed, its business had been largely confined to coal, with a few odd loads of sand and gravel. But Chin and Paxton had learned something interesting. Or, at any rate, unexpected. The coal delivered to the school hadn't come from one of the big established mines. It was more or less wildcat coal. It had come from an old strip mine in Washington County, not far from Fayetteville. I remember glancing at Larsh. His expression was as thoughtful as Chin's. A strip mine is an open pit. There's all the difference in the world between an open pit and a modern deep- shaft mine of the sort we'd had in mind.
"Larsh and I spent the next day in Washington County. That was Tuesday, March 29. It was also, as it turned out, our last chance. The laboratory report on Larsh's coalbin scrapings, when it finally came back, was negative. We got to Fayetteville, which is only about a hundred and fifty miles from Mountain Home, well before noon. Then we had to find the mine. Even with the most explicit directions, that took another couple of hours. Old was no word for it. The place was overgrown and tumble-down and practically abandoned. But we found it—not only the mine but also the strip that had last been worked. And then our luck ran out. We were a month or two too late. The pit from which the school's coal had come was gone. Rain and snow and winter weather had weakened the overhang and dropped it into the pit. It was like a cave with the roof fallen in. I've seldom seen a likelier place for H. capsulatum, but likely was all it could be called. We couldn't prove it. We couldn't even reach it. It was buried under tons of earth and rock."
[1960]
chapter 7
Impression: Essentially Normal
Now, after an interval of many months, Rosemary Morton, as I'll call her, is willing to remember the half year she spent immersed in gravitational anarchy. Until only a few weeks ago, she preferred not to think about it. The risk—the chance that memory might have power to draw her back again into that capricious world of tilted buildings and rubbery streets—was too great. Her fears were not, perhaps, quite rational. But then, neither was the episode itself.
Mrs. Morton, a trim little woman with horn-rimmed spectacles and a bun of graying hair, and her husband, Frank, are in their early fifties, and childless. Both have responsible jobs. Mr. Morton is the editor of an industrial trade journal. His wife has been for many years the librarian of a large Wall Street law firm. She is also an accomplished, though amateur, pianist. They live on the top floor of an old brownstone house in the Murray Hill section of Manhattan, and it was there, around six-thirty one February evenin
g in 1957, that her equivocal experience equivocally began.
"I'd been home about an hour," Mrs. Morton recalls. "Dinner was ready and waiting in the oven, and I was sitting at the piano. Not really playing—just amusing myself. That's something I often do at the end of the day. It helps me relax. My husband was in the kitchen making us a cocktail. Which is another Morton custom. We usually have a drink or two before dinner. So everything was quite ordinary and normal. Until Frank came in with the drinks. I got up to join him on the sofa, and as I did—as I started across the room—I felt the floor sort of shake. Maybe sink would be a better word. It only lasted a moment—less than that, I suppose. Just an eyeblink. But the floor very definitely moved. I remember looking at Frank. 'Good heavens!' I said. 'What was that?' Frank just looked at me. His face was a perfect blank. It was obvious that he didn't know what I was talking about. So I told him, as calmly as I could. 'The floor,' I said. 'It shook.' I suppose Frank believed me. I know he did. But he wasn't much impressed. He made some remark about old buildings' stretching and settling, and handed me my drink. In a way, that was reassuring. If Frank hadn't felt anything, it must have been very slight. And what he said was true. Old houses—and ours goes back to the Civil War, almost—do all kinds of strange things. Besides, we have a tremendous amount of weight in our living room. Not only my piano but about a thousand books and any number of phonograph records. So I took my drink and sat down, and Frank began to talk about some repairs that had to be made on a cottage we have up in the Catskills, and by the time we were ready for dinner, I'd forgotten all about it. No, that isn't true. It was too peculiar to forget. But I had put it out of my mind.
"That was early in the week. I remember because it was two or three days before Washington's Birthday, which fell on a Friday last year. And on Washington's Birthday the same thing happened again. The only difference was where it happened. The place was my office. It was a holiday, of course, and the office was closed, but I had some work I wanted to finish up. Some cataloguing. Also, in a way I couldn't explain—it was so unlike me—I wanted to be alone. Frank had turned on WQXR at lunch, and then, while I was doing the dishes, he started playing records—just the sort of lazy afternoon we both love. But somehow I wasn't in the mood. It made me nervous. Anyway, around two o'clock I went downtown. I worked at my desk for about an hour, and it was heaven. So quiet. So peaceful. Then I got up—I've forgotten for what. To get a book from the stacks, or a drink of water, or something. And it happened. The floor gave a shake, and sank. It went down and up, sort of sagging away to the left, and maybe a little more pronounced than the first time. Just one lurch, however, and then everything was back to normal. Except for my state of mind. I didn't know what to think. The best I could do was tell myself that this was an old building, too. It was built around 1900. It never occurred to me that there might be any other explanation. I suppose I didn't want it to. And that probably explains why I didn't mention the incident to Frank. It was on the tip of my tongue a dozen times that night, and over the weekend, but I didn't. Or, rather, that explains part of it. There was another reason why I held back. I don't know how to describe it, but I had the feeling that my sense of touch was getting more and more acute. Especially in the soles of my feet. I could feel little tremors that other people couldn't. But Frank is so matter-of-fact. I was afraid that if I told him—well, he wouldn't understand.
"I didn't tell Frank until the middle of the following week. On Wednesday night, to be exact. By then, I had to. I couldn't keep it to myself any longer. I'd had an errand uptown that morning. On the way back, I dropped in to see a friend in the building at 575 Madison Avenue. She works for a publishing house, and we had a nice visit—not that it matters. What matters came after I left her. I was standing just outside her office, waiting for the elevator, when the corridor suddenly sank. The same sensation as before, only a little worse—almost a jolt. Oh, this one was ghastly. I hardly remember leaving the building, I was so frightened. I was petrified. Because there was really a big difference—575 Madison is practically brand new. It's less than ten years old. I couldn't rationalize this time. I had to face the truth. There was something wrong with me.
"Frank agreed. But I don't think he was much upset. He seldom is, about anything—that isn't his way. I've never known a more thorough stoic than Frank. He agreed, though, that my experiences could hardly be considered normal. More than that, he suggested I see the doctor. That was Dr. Dodge [as he will here be named]—a very good man in the neighborhood, whom both of us knew and liked—and I called him the following morning. He gave me an appointment for Monday, March 4, at six o'clock. All Dr. Dodge knew when I arrived at his office was the general nature of my trouble. I'd told him over the phone that I'd been having dizzy spells. That seemed the simplest way to describe it. But that was on Thursday. By Monday, I hardly knew what to say. There just wasn't any word for the awful sensations I'd been having. The floor-shaking feeling was only one of them. I don't know how many times that happened over the weekend—seven or eight at least. But even that began to have a different feeling. At first, the floor had moved or sagged as a whole, as a plane. It still did, only now I could feel another movement, too. A kind of counterpoint. Sometimes it was as though I were sinking into the floor. The room would tilt and I'd take a step, and the floor was like snow. It would give under my foot and I'd sink what felt like an inch, and other times it was just the reverse—the floor would rise to meet me. That was one new feeling I told Dr. Dodge about. Another was something I'd noticed for the first time on Sunday. By then, it wasn't simply the floor that moved. When the floor tilted, the walls of the room tilted with it. And the ceiling. I mean, the shape of the room never changed—only its position in space. I began to realize that the direction of the movement was always the same. The movement was always from right to left. I don't think Dr. Dodge was very much interested in my case at first. Not until I began to describe those latest symptoms. Then his manner quite noticeably changed. He began to listen very carefully. They seemed to make a serious impression on him. But just how serious, and what he thought they meant, I couldn't tell. He didn't say and I didn't ask. I wanted to, but somehow the visit was over before I ever had an opportunity. The only comment he made was after he'd taken my blood pressure and listened to my chest and checked my reflexes—all the routine tests. He said a series of consultations with specialists seemed advisable. To pinpoint the source of the trouble, I gathered. He would arrange the appointments, he said, and let me know when and where. That was all, except that he wanted to see me again in two weeks. Same time. Same day.
"My first special appointment was with an ear, nose, and throat man. I saw him three days later—on Thursday, March 7. The next day, I saw an oculist. Then, on Thursday of the following week, I saw a gynecologist. They were all top men. I've never had such thorough examinations. And they couldn't have been nicer. But they told me exactly nothing. Especially the gynecologist. He was completely noncommittal. The ear, nose, and throat man gave me a prescription for Dramamine. I tried it—one fifty-milligram tablet twice a day—for a couple of days, but it didn't help. In fact, it made me slightly sick, and my dizzy spells got worse and worse. My vertigo, I should say. I've learned there's a difference. Dizziness is just a giddy feeling in the head. Vertigo is far more violent. It's a feeling outside of yourself. You usually feel that the world is moving—up and down, or around, or sliding off to one side. But you can also feel as if you were whirling with it, somewhere out in space. I did, at least. However, as I say, the ear, nose, and throat man suggested Dramamine, and that was all he said. The only one who made any sort of comment was the oculist. He said he thought my trouble might be partly visual, and recommended new glasses. When he told me that, my heart absolutely leaped. I wanted to believe him. It was such a plausible explanation. And I had been having some trouble with my eyes. I'd noticed lately that I couldn't seem to make them focus properly. Any quick movement, like raising my eyes from a book to look at something acros
s the room, made me almost bleary for a minute. But he was mistaken. I had the new lenses by the time I went back to Dr. Dodge, and they didn't really help a bit. Oh, maybe there was some improvement, but, as I told Dr. Dodge, if there was, it was very, very slight. I remember he nodded, as if he already knew. Then he brought out some papers. They were reports from the specialists I'd been to. He read me their conclusions, and they were all the same. They even used the same phrase—'Impression: Essentially normal.'
"I'll never forget that phrase. I must have heard it a dozen times. It got to be a kind of litany. Even Dr. Dodge used it. He gave me a complete physical examination during my second visit. The next time I saw him—the following Monday—he told me the results. Essentially normal. Meanwhile, he had arranged for two more consultations with specialists, and I had been to see them, too. One was a neuropsychiatrist and the other was an internist, and Dr. Dodge had their reports in my folder. Impression: Essentially normal. It sounds so reassuring. Normal—essentially normal. So comforting. But it isn't. At least, it wasn't to me. It was terrifying. While I hadn't the vaguest notion of its medical meaning, I was sure of one thing. It couldn't mean that I was normal at all, because I wasn't. I was just the reverse. I became convinced it meant I was miserably sick and nobody had the faintest idea why."
The Medical Detectives Volume I Page 12