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January 18, 2011

The Legion you don’t want to join
Posted by Abi Sutherland at 01:41 AM * 32 comments

On this day in 1977, Dr. Joseph E. McDade discovered the cause of a mysterious flu-like illness that had killed 29 people at an American Legion convention the previous year.

The epidemiological effort was conducted under intense media and political pressure. A swine flu scare earlier in the year had led the Ford administration to start a program of mass inoculation, which it then suspended after reports of severe side effects. Toxic chemicals were blamed, particularly after nickel from autopsy scalpels was mistaken for a causative agent. There was speculation about secret agencies and genetically engineered weapons in the Cold War. Congressional hearings were held.

The causative agent, aerobic bacteria of the genus Legionella, was found in the air conditioning system of the hotel. It also occurs in ice machines, pools and fountains, water cooling systems, humidifiers and windscreen washers in cars.

New York Times retrospective article here, with links to PDFs of contemporaneous articles. More technical account here.

Comments on The Legion you don't want to join:
#1 ::: Ginger ::: (view all by) ::: January 18, 2011, 02:00 AM:

I remember that -- there was some amazing detective work done to isolate the causative agent.

#2 ::: Sylvia ::: (view all by) ::: January 18, 2011, 06:31 AM:

I didn't realise but I only knew bits and pieces of this story. Reading the NYT summary was fascinating and the Edelstein paper is surprisingly accessible.

#3 ::: D. Potter ::: (view all by) ::: January 18, 2011, 07:02 AM:

The hotel in question was the "sister" hotel to the establishment in which Philcons were then held.

(Usual note about passage of time and a cheer for epidemiology's detective work.)

#4 ::: Kvon ::: (view all by) ::: January 18, 2011, 08:37 AM:

I've seen two known cases so far, one in a patient and one in a friend, both quite scary. They quickly developed acute respiratory distress syndrome requiring weeks of intubation and months of recovery, with several days of touch and go prognosis. According to the pulmonologist, the mild cases are probably fairly prevalent, but we usually only test for legionella once the patient is in the ICU, and standard outpatient antibiotics are effective (azithromycin, levofloxacin).

#5 ::: Sarah S. ::: (view all by) ::: January 18, 2011, 10:54 AM:

See also Stephen Johnson's excellent book "The Ghost Map" about similar detective work done to find the origins of the cholera epidemic that hit London in 1854, and John M. Barry's "The Great Influenza" about 1918.

And wash your hands!

#6 ::: a chris ::: (view all by) ::: January 18, 2011, 11:01 AM:

Windshield washers. This is what makes me especially annoyed when I'm out on my bike and someone decides to spray their windshield while passing me. Also: why does most of the fluid miss their windscreen?

#7 ::: ddb ::: (view all by) ::: January 18, 2011, 11:30 AM:

a chris@6: my observations from inside the car are that most of the fluid hits the windshield.

But not all. And I've sometimes noticed fluid from the car ahead of me hitting my windshield.

My guess: the washers are supposed to work across a wide range of vehicle speeds, and this leads to some fluid missing the target especially at lower speeds. They could probably do better if they tried harder, but it would also be more expensive and probably more complex and hence trouble-prone.

Hadn't thought of it in connection with pedestrians and bicyclists previously (sorry!); well bear that in mind.

#8 ::: Debbie ::: (view all by) ::: January 18, 2011, 01:03 PM:

I'm currently reading Wolf Hall*, and "sweating sickness" was mentioned. I wondered if this was just an old name for malaria, and went looking.

Very interesting, and still very mysterious. No one knows what it was or is. It does not sound like the sort of thing that I'd actually -like- to have recur, just to solve a medical mystery, though. From the link above --

"Good descriptions of the malady have come down to us, including several token signs distinguishing it from other infections. The incubation period was frighteningly short; hours, the outcome normally fatal. There were muscle pains or myalgia, headache, abdominal pains, vomiting and delirium, followed by cardiac palpitations, chest pains, prostration and rapid breathing of 'foul, loathsome and putrid vapours' as the contemporary writers had it. Very characteristically there were cascades of malodorous sweating which may have been due to pain, rampant infection or anxiety at the thought of the expected outcome. Its relentless progress could be completed in one day...There were no swollen glands, or buboes, characteristic of plague, nor any haemorrhagic rash common in many fevers....No immunity followed and repeat attacks were common."

*Man Booker Prize winner of 2009, about Thomas Cromwell during Henry VIII's reign -- highly recommended

#9 ::: Sarah S. ::: (view all by) ::: January 18, 2011, 01:30 PM:

Malaria was ague. So were some other kinds of recurring fevers.

#10 ::: Lori Coulson ::: (view all by) ::: January 18, 2011, 01:45 PM:

Debbie @8:

In "Sweating sickness" onset of symptoms is way too rapid to be malaria. The only things I can think of that are close as to speed of onset are hantavirus, Ebola (hemorrhaghic fever) and influenza.

Both hantavirus and influenza are airborne (droplet), but Ebola isn't -- it requires contact with infected blood.

AKICIML: Would the Avian Flu (H5N1) have similar syptoms (or is the Sweating Sickness virus triggering a cytokine storm)?

#11 ::: a chris ::: (view all by) ::: January 18, 2011, 02:25 PM:

ddb: my experience too, from inside the car. I was being crotchety and tarring everyone's washers with the same brush. I have encountered some pretty badly-aimed ones though.

My personal experience suggests that here in the southern UK (where I don't drive) it's not common to put antifreeze in the fluid. Can someone here confirm or refute that hypothesis? I'm curious.

#12 ::: Dave Bell ::: (view all by) ::: January 18, 2011, 02:40 PM:

Typical "screenwash" in the UK is a weak anti-freeze, but the early December, when air temperatures were down to -15C, straight screenwash was freezing. And a lot of people don't bother anyway.

#13 ::: a chris ::: (view all by) ::: January 18, 2011, 04:15 PM:

Thanks, Dave Bell@12. What I've tasted certainly didn't taste very resistant to freezing. And I've been thankful!

I guess "screenwash" is just one of many things that may change subtly in the next few years if we have a string of wintry winters.

#14 ::: Lila ::: (view all by) ::: January 18, 2011, 07:26 PM:

According to the CDC, there was also a Legionella outbreak caused by contaminated grocery store mist machines (the things that spray water on the vegetables to keep them "fresh").

#15 ::: Angiportus ::: (view all by) ::: January 18, 2011, 09:52 PM:

Oh great, now I have to worry when I go to the store. One Safeway I frequent used to herald the onset of these sprinklers with fake thunder and lightning. It was funny the first few times.
Next trip, maybe I will get some sanitizers...

#16 ::: Bill Higgins-- Beam Jockey ::: (view all by) ::: January 18, 2011, 10:11 PM:

In #15 Angiportus writes:

One Safeway I frequent used to herald the onset of these sprinklers with fake thunder and lightning. It was funny the first few times.

A store I frequent plays Gene Kelly's version of "Singin' in the Rain." For me, it continues to raise a smile. Not just because I like the song, or the movie, or Gene Kelly, but also because it's clever engineering. It seems a nicer solution than playing a beep, or a plain voice warning, or no warning at all.

#17 ::: Serge ::: (view all by) ::: January 18, 2011, 10:41 PM:

Bill Higgins @ 16... I like that. I wonder if someone ever thought of rigging the system for Freddy Mercury singing "Thunderbolt and lightning very very frightening me!"

#18 ::: Linkmeister ::: (view all by) ::: January 19, 2011, 01:30 AM:

The Safeway I go to uses the noises of thunder. Other musical suggestions could include "Stormy Weather," Chi Coltrane's "Thunder and Lightning," or the Classics IV's "Stormy."

#19 ::: Terry Karney ::: (view all by) ::: January 19, 2011, 03:32 AM:

re produce sprinklers: They are pretty standardly preceded with a thunder noise, at least in the markets I frequent.

The Ghost Map is a pretty good book (I liked it better than the one he did about the San Andreas Fault). His name, however, always gives me the chills.

Stevens-Johnson Syndrome

#20 ::: alex ::: (view all by) ::: January 20, 2011, 06:16 AM:

Why do Americans like their produce wet? French people tolerate it still with actual dirt on it.

Someone inclined to over-analysis would make much of this.

#21 ::: a chris ::: (view all by) ::: January 20, 2011, 03:38 PM:

I'm pretty sure our local supermarket here in the UK doesn't sprinkle, which is fine with me! If they wanted to import some part of the North American system, I'd just like the thunder part (which I don't remember ever encountering in Canada, including on recent visits).

I'm fine with actual dirt; that shows you when you've done a reasonable job of washing all the surfaces of the food you're about to eat.

#22 ::: Lee ::: (view all by) ::: January 20, 2011, 04:32 PM:

alex, #20: There seems to be a mental equation of "wet = fresh", or at least that the intermittent spraying is keeping the produce from drying up and wilting. In practice, I have no idea whether it actually does any good, or whether it's all psychological.

#23 ::: Sandy B. ::: (view all by) ::: January 21, 2011, 09:41 PM:

I looked at it and decided it was an anti-wilting technique. I have no, whaddayacallit, evidence.

#24 ::: Lila ::: (view all by) ::: January 21, 2011, 10:28 PM:

According to the linked article, the specific sprinkler system that caused the Legionella outbreak was an ultrasonic mister; most grocery store sprinklers now (and possibly then too) just use mechanical spray-heads, which produce much larger droplets that are less likely to be inhaled.

As for the purpose of spraying water on produce in grocery stores, I always figured it was both to make it look fresher and to make it weigh more.

#25 ::: Angiportus ::: (view all by) ::: January 22, 2011, 07:44 PM:

When I buy veggies in the sprinkled section, I shake 'em real good before they go in the bag. I am unsure of all the reasons for those sprinklers, but I would not put it past them to add water-weight on purpose.

#26 ::: david ::: (view all by) ::: January 24, 2011, 12:05 PM:

Abi, what's a legion you _do_ want to join?

#27 ::: thomas ::: (view all by) ::: January 24, 2011, 01:14 PM:

The water spray is probably helpful for keeping the food fresh in places where the indoor humidity is very low, like most of the US in winter or summer.

In Seattle or San Francisco it probably just adds weight.

#28 ::: abi ::: (view all by) ::: January 24, 2011, 02:06 PM:

david @26:
Abi, what's a legion you _do_ want to join?

ObMarx, none that would have me.

#30 ::: Terry Karney ::: (view all by) ::: January 24, 2011, 09:40 PM:

That reminds me, I need to join the Canadian Legion.

#31 ::: Tom Whitmore ::: (view all by) ::: January 25, 2011, 12:00 AM:

Just as long as we're not joining the Inferior Five....

#32 ::: anonymous ::: (view all by) ::: February 14, 2011, 06:59 PM:

I just noticed this in my backlog; it caught my eye because my employer put on a trade show which may have been hit by legionellosis a couple weeks back. Lots of people with flu-like and/or pneumonia symptoms at the same time, CDC and LA Public Health are looking in to it:

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