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Reading: What Makes America Sick?

Morbidity and Mortality Weekly Report is the government's official rundown of scourges abroad in the land. From food poisoning to AIDS, it tells the strange, grim tales of who got what and what it did to them.

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Lead poisoning 'mong Hmong, voodoo bean dermatitis;

Eat those minnows in Maryland for bizarre enteritis.

A mussel quarantine in California sounds a little bit sexist,

Zinga virus, rabid cows, Gypsy measles, how they vexed us. . . .

Sure, it's not great poetry--but would a poet laureate know what to do with 21 campers in New Jersey who came down with headaches, stomach cramps, nausea, and dizziness on a summer afternoon? Could he trace their sickness to a pokeweed salad, "prepared from young leaves picked, boiled, drained, and reboiled that morning, a method that reputedly ensured the plant's edibility"?

Dr. Michael Gregg of the U.S. Centers for Disease Control, who wrote the verses for a lark, could, if he wished, sing of hundreds of other epidemics. Gregg is editor of Morbidity and Mortality Weekly Report, a government publication that is to pestilence what Business Week is to commerce. The magazine--called MMWR by insiders--is the U.S. government's official report on scourges abroad in this land. It tells who got what, how they got it, and what it did to them.

For years, MMWR circulated among public health doctors and infectious-disease specialists, who savored the charts on death rates in U.S. cities, nationwide box scores on "specified notifiable diseases," and chilling real-life accounts of maladies ranging from anthrax to lead poisoning. It is an unassuming publication, 16 pages long and printed on plain white paper, with a circulation of about 50,000.

This magazine is not for sale on newsstands. In fact, there's not a store in town that carries it. Still, MMWR is attracting a wider audience today, gaining a degree of name recognition it never enjoyed before. The reason is AIDS. As the premier vehicle for news of the syndrome, MMWR is the publication of choice for many family doctors and concerned nurses. Foundations and educators want the latest statistics on the epidemic, and even a few journalists have added their names to the mailing list.

Though they come to the magazine for AIDS news, readers also find health-care coverage like they've never seen before. Gregg calls them "fun little epidemics," accounts of accidents and outbreaks written up by local health authorities and submitted to MMWR in an effort to warn or educate others in the health field. These are the stories that don't appear in the slick health magazines, tales too strange or too grim for mass consumption.

MMWR chronicles the havoc wrought on innocent people by bad food, infested imports, and poor hygiene. The journal's unobtrusive appearance highlights its stark prose, which often unfolds quickly to reveal the catastrophe. "On January 2-3, 1982, Tate [Georgia] received approximately 4.5 inches of rainfall. On January 4, residents in homes served by the municipal water system noted their tap water appeared turbid." "Turbid" means cloudy, opaque because of suspended particles--a good sign that you shouldn't drink the water. But they did. "That evening, residents reported the first cases of gastrointestinal illness," which afflicted as many as 500 people before the outbreak ended.

Sometimes, MMWR forgoes the suspense, adopting instead a straight journalistic tone. "On September 18, 1981, at a farm in Mohawk, New York, a 39-year-old farmhand was overcome while climbing up the chute of a recently filled concrete stave silo and later died of presumed silo-filler's disease." An account of the tragedy follows, to which Dr. Gregg adds an editorial note explaining that silo-filler's disease is caused by nitrogen oxides that build up where grains are stored. Exposure to these oxides can cause a cough and tightening of the chest, and in cases of extreme exposure, vascular collapse, shock, and death. "Silo-filler's disease represents an occupational hazard associated with ensiled crops," Gregg concludes.

These editor's notes often read like the moral at the end of an Aesop's fable. A 1981 article tells of a salmonellosis outbreak among children, age four to six, at a school party in Lamar County, Georgia.

The kids ate a bad batch of homemade ice cream and wound up with cramps, fever, and nausea. "This outbreak provides a reminder of an important summertime vehicle of salmonellosis," Gregg writes, and he cites CDC figures showing 22 outbreaks of salmonellosis associated with homemade ice cream between 1966 and 1976. That same year, MMWR recounts another meal, in a locale with little need for ice cream, that ended in hospitalization. The story chronicles the decline and recovery of eight people in Barrow, Alaska, whose host fed them "maktak" (whale blubber), "ugruk" (bearded seal meat), raw fish, and "quag," raw frozen meat they thought was caribou but which turned out to be grizzly. It was the quag that got them, felling five men and three women aged 32 to 76. The bear meat, it turned out, was just swarming with Trichinella larvae.

The writer in this case offers a little anthropological background: "Subsistence living is a normal pattern in Barrow, and traditional foods are of major economic and cultural importance. Many dishes include fresh, fermented, dried, or frozen meats that are eaten raw." Still, this doesn't excuse the outbreak, since "many residents state . . . that they were taught by their elders to cook bear meat thoroughly to avoid illness," and since the North Slope Borough Health and Social Services Agency has broadcast radio and television ads warning of the threat of trichinosis posed by eating raw bear and walrus.

Unsanitary if traditional practices crop up frequently in MMWR, as do folk remedies, like stomachache potions made with lead. But modern technology has its unhealthy side, too, as "Occupational Fatality Associated With a Robot" makes clear. As described in this 1985 piece, a man operating a die-casting robot--presumably in an auto plant--stepped inside the machine's "work envelope" and was crushed. The man had 15 years' experience in die casting, had taken a one-week robotics course that included safety information, and "his co-workers considered him a most adept operator." Still, his fellows had seen him violating safety boundaries in the past, and after the accident, a chain-link fence was placed around the machine.

"This is the first documented case of a robot-related fatality in the United States," MMWR notes. But it may be a harbinger of deaths to come, as Japan has already lost two workers to factory automatons. "Robotics have evolved in the workplace in response to economic and ergonomic factors," says the magazine in its role as industrial analyst. "Future use of this technology is anticipated and will give rise to potential hazards."

MMWR is a demographer, an economist, a spinner of yarns. It has resisted the specialization that pervades medicine, wearing a remarkable variety of journalistic hats. It is a chronicler of social trends, covering the malignant fringe of the latest fad. In 1971, as America turned on and protested in the streets, MMWR warned of "Cadmium Contamination of Edible 'Love Beads.'" In 1981, it told the grim story of a sushi party that spawned four-foot tapeworms, and traced an increase in intestinal parasites on the West Coast to the rise of that Japanese delicacy. MMWR is a traveler's companion, listing required vaccinations and inciting xenophobia with accounts of horrible diseases traced to foreign lands (for instance, "Anthrax Contamination of Haitian Goatskin Products"). MMWR is also the ultimate gross-out mag, the perfect fare for people who want to cloak their fondness for cheap horror in a pretense of scientific curiosity.

Sadly, though, MMWR is losing some of its unique character, the victim of both the AIDS epidemic and of a shifting federal bureaucracy. Lately, the deadly syndrome has so dominated MMWR that you might as well call it the AIDS Report. And in keeping with an expansion of the CDC's authority, the pages that were once a fertile medium for tales of leprosy and plague now carry wide-ranging but mundane studies, such as statistical analyses of suicides and accidental deaths. "In the late 60s and 70s, a lot of our articles were about small outbreaks, with some really weird stuff. Quite frankly, I put some of it in because of its human interest value," Gregg says. "More recently, the stuff we put in has been a little more ponderous, heavier: objectives for 1990, and so on. And of course all the AIDS news has overwhelmed us."

The federal budget won't finance a larger CDC newsmagazine. "We are somewhat limited," says Dr. Gregg. "We just can't expand to 24-to-28-page issues willy-nilly. My staff just can't handle it." And although there's been talk around the CDC of beefing up MMWR, Dr. Gregg, who has edited the publication since 1967, is wary of tinkering with the formula. "It has this lightness, this easiness of reading so that you can read it in about half an hour. If you made it much longer, some people might not read it." Still, with some of the drearier pieces that have run lately, Gregg concedes he's a little concerned they might lose some of their traditional readership.

This presents an ideal opportunity for some impresario to step up and cash in on the old Morbidity and Mortality Weekly Report formula. Sign on the correspondents as stringers and change the look, bring it in line with modern packaging ideas. How about a new, glitzy weekly, with color photos and snazzy graphics? The stories could showcase the best New Journalism style while retaining their scientific aura. The hypochondriacs would love it, as would Boomers, who are getting to the age where they need to know about health care and have money to spend on information about how to prevent Lyme's disease and gastroenteritis. And since the readers will have money, the advertisers will flock to this new magazine. It is a niche unfilled, and nature abhors a vacuum.

Morbidity and Mortality Weekly Report published by the Centers for Disease Control (MMS Publications, C.S.T.O. Box 9120, Waltham, Massachusetts 02254), first class $46, third class $ 26 annually.

Art accompanying story in printed newspaper (not available in this archive): illustration/Kurt Mitchell.

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