jdcopp — 17 years ago(September 25, 2008 06:36 AM)

This is reprinted from New England Journal of Medicine (12-08-2005) by Barron H Lerner. Berton Rouech's article "Ten Feet Tall" was the basis of "Bigger than Life".
"He was never going to sleep again. Sleep was a waste of time. Then he got the idea I was trying to poison him. He didn't trust me, he said, and if I didn't leave him alone, he would tear off his clothes and run out in the street naked."1
Fifty years ago, these words taught the public about a horrifying side effect of the new "wonder drug" cortisone: mania. The speaker was the wife of a man who had been treated with cortisone for his previously incurable periarteritis nodosa, and the author quoting her was Berton Rouech, who wrote the "Annals of Medicine" feature in the New Yorker magazine from the 1940s until the 1980s.
Rouech developed his innovative approach to medical writing at a time when two important transformations were occurring in American medicine: the emergence of clinical epidemiology and the growth of media coverage of medical topics. Rouech was an immensely talented writer and storyteller, and his writings introduced not only laypersons but also future generations of physicians to the art of medicine.
Rouech was born in Kansas City, Missouri, in 1911, to a businessman and his wife. His family and friends recall him as an easygoing, soft-spoken man who loved to read and write. In 1936, he married Katherine Eisenhower, niece of the future president. Rouech worked as a journalist in Kansas City and St. Louis until his articles caught the eye of William Shawn, editor of the New Yorker, who hired him as a staff writer in 1944.
Rouech's first medical story, probably his most famous piece, occurred by happenstance. He had heard of a group of gravely ill men who had shown up at a New York hospital, blue with cyanosis. The article he wrote about them, "Eleven Blue Men," published in 1947, described how local health officials deduced the cause of the malady - the inadvertent use of sodium nitrite, in lieu of sodium chloride, to season the oatmeal at the Eclipse Cafeteria in New York's Bowery district.
"Eleven Blue Men" spawned dozens of other stories over the years, many of which were later collected in books.2,3 "The Orange Man" described a plumber who had turned orange by overeating carrots and tomatoes; "A Pig from Jersey" chronicled an outbreak of trichinosis resulting from the consumption of uncooked pork at a German-American festival; "One of the Lucky Ones" was the account of an unfortunate dry cleaner whose use of carbon tetrachloride as a solvent caused liver failure.
What all these stories had in common were mysterious illnesses or deaths, the causes of which were elucidated by clever detective work. Rouech later likened his pieces to the classic detective stories featuring Sherlock Holmes.4 Although the Journal's Clinicopathological Conferences, featuring doctors attempting to solve tricky cases, dated from 1924, the notion of the medical detective who deduced the causes of daunting outbreaks was a new one. In later years, Rouech would parlay his skill in building curiosity and suspense into a career as a mystery novelist.
Rouech also provided his readers with quick lessons in the history of medicine. For example, one of his stories told the improbable tale of a six-year-old Denver girl who had contracted the plague by touching a dead squirrel. "Few diseases," Rouech wrote, "have been more portentously explained than plague." Although the plague was a bacterial infection, he added, over time it had been variously attributed to the misalignment of the planets, the wrath of God, and the purported sins of the Jews.
Rouech's stories held great popular appeal, thanks in part to the growing interest in epidemiology, the study of diseases in populations. The field of epidemiology had existed for decades, mostly tracking large-scale epidemics such as cholera. But as epidemic diseases waned, attention turned to rare or interesting maladies that affected a single patient or groups of patients. This approach, later dubbed clinical epidemiology, sought to identify possible environmental causes of these small eruptions of disease.
Such investigations were carried out either by epidemiologists who worked for local health departments or by the Communicable Disease Center (CDC, now the Centers for Disease Control and Prevention), founded in 1946 in order to track malaria. By 1951, the CDC had inaugurated the Epidemic Intelligence Service, which sent so-called shoe-leather epidemiologists to tackle tough outbreaks of various diseases throughout the country. These investigators were the heroes of many of Rouech's early pieces, identifying a new reservoir of rabies in bats, containing an improbable outbreak of the ancient disease small-pox, or tracing several cases of typhoid fever to a sewage pipe clogged by boys playing a game of "wild Indians."
Rouech became a folk hero in the world of epidemiology. Never before had tracking diseases seemed so