Eleven Blue Men
Encyclopedia
Eleven Blue Men, and Other Narratives of Medical Detection is an award winning collection of twelve true short stories written by Berton Roueché
and published in 1953. Each story, including the titular story Eleven Blue Men, was originally published in the "Annals of Medicine" section of The New Yorker
between 1947 and 1953.
.
At this point, it becomes an epidemic and the Department of Health is called in to investigate. The two investigators recognise the case as similar as an extremely rare poisoning. Only ten recorded outbreaks have happened, and up until then the largest number of people affected in each one was four. This had become the worst incidence in history.
By the time they reach the hospital, one man has already died. The others have begun to recover, but the Department of Health is determined to find the underlying cause. They quickly rule out gas poisoning – they don't have one of the main symptoms, and it took too long to present. Instead, after questioning the men, they discover that the men all got sick soon after eating the same food in the same place: oatmeal in a cafeteria.
This suggests food poisoning, but of an incredibly rare type that the doctors have never seen before. The men do not have the main symptoms of food poisoning: diarrhoea and vomiting. Also, the incubation period is too short for the most common bacterial poisonings. They also suspect recreational drugs, but the men deny this, saying that they drink quite heavily but nothing else. This brings them back to the oatmeal. Did it have something in it that could cause this reaction?
The other possibilities are a chemical contaminant. The men are given a blood test and the doctors also visit the cafeteria where they had eaten shortly before becoming ill. They meet someone from the Bureau of Food and Drugs, who finds multiple violations of the health code in the cafeteria – it is infested with vermin and has open sewage lines, amongst other things.
They ask the cook how he made the oatmeal that morning and he explains how he uses dry cereal, water and a handful of salt. The cereal is a generic brand and the water is municipal; these are ruled out as sources of the poison, as more people would be sick if this were the case. That leaves the salt.
On the same shelf as the can of salt is another can full of white grains. The doctors ask the chef what this is; he responds that this is saltpetre, used to preserve meats. Its main component is sodium nitrate. The chef also mentions that once, he accidentally refilled the salt can with saltpetre, before realising his mistake and replacing the saltpetre with the real salt.
After testing the saltpetre, they find that instead of sodium nitrate, the can contains sodium nitrite. This minor difference is almost unnoticeable, as they both look and taste just like table salt. Both are used to preserve meat, but the levels present in food are closely monitored. However, sodium nitrite is extremely toxic.
The can of salt in the kitchen still contained some grains of the sodium nitrite when the chef refilled it with salt. This in itself was not enough to poison the men, otherwise many other men would have gotten sick that day. The men must have received a second dose from somewhere. The doctors realise that some people like to put salt on their oatmeal. The extra sodium nitrite in the salt in a table salt cellar could provide this. They test the salt cellars and find one that contains enough to poison the men. If all the men had used this salt cellar, this could be the cause of their poisoning.
Unfortunately, the men have all left the hospital by the time the doctors get back to confirm their hypothesis. It is left uncertain how they got poisoned, but they also mention that they may all have used a lot of salt because heavy drinkers have a low blood salt concentration.
In addition there are stories of tetanus
, psittacosis
, typhoid fever
, trichinosis
and food poisoning.
described the book as "fascinating" and "superbly written". The Mystery Writers of America
gave Eleven Blue Men, and Other Narratives of Medical Detection a Raven Award as best book in a mystery field outside the regular categories of crime novels and crime reporting. Eleven Blue Men, and Other Narratives of Medical Detection is one of the top ten favourite books of author Kaye Gibbons
.
.
Berton Roueché
Berton Roueché was a medical writer who wrote for The New Yorker magazine for almost fifty years. He also wrote twenty books including Eleven Blue Men , The Incurable Wound , Feral , and The Medical Detectives...
and published in 1953. Each story, including the titular story Eleven Blue Men, was originally published in the "Annals of Medicine" section of The New Yorker
The New Yorker
The New Yorker is an American magazine of reportage, commentary, criticism, essays, fiction, satire, cartoons and poetry published by Condé Nast...
between 1947 and 1953.
Eleven Blue Men
The short story which gives its name to the title of the collection, Eleven Blue Men, was Berton Roueché's first medical story and it is arguably his most famous. It was originally published in The New Yorker in 1947 and was also included in Roueché's later collection of short stories The Medical Detectives. Eleven Blue Men formed the basis of the pilot of the television program Medical InvestigationMedical Investigation
Medical Investigation was an American medical drama television series that began September 9, 2004, on NBC. It ran for 20 one-hour episodes before being cancelled in 2005...
.
Plot Summary
A man collapses in a Manhattan street and is taken to a doctor; he has abdominal cramping, retching, confusion and an alarming bluish hue to the skin. The doctor is understandably confused, and at first diagnoses carbon monoxide poisoning, which is known to cause cyanosis (a blue colour to the extremities due to oxygen deprivation). The hospital prepares for a mass poisoning due to a gas leak or other possible cause; they are right. Another ten men turn up at the hospital with the same symptoms, making the eponymous eleven blue men.At this point, it becomes an epidemic and the Department of Health is called in to investigate. The two investigators recognise the case as similar as an extremely rare poisoning. Only ten recorded outbreaks have happened, and up until then the largest number of people affected in each one was four. This had become the worst incidence in history.
By the time they reach the hospital, one man has already died. The others have begun to recover, but the Department of Health is determined to find the underlying cause. They quickly rule out gas poisoning – they don't have one of the main symptoms, and it took too long to present. Instead, after questioning the men, they discover that the men all got sick soon after eating the same food in the same place: oatmeal in a cafeteria.
This suggests food poisoning, but of an incredibly rare type that the doctors have never seen before. The men do not have the main symptoms of food poisoning: diarrhoea and vomiting. Also, the incubation period is too short for the most common bacterial poisonings. They also suspect recreational drugs, but the men deny this, saying that they drink quite heavily but nothing else. This brings them back to the oatmeal. Did it have something in it that could cause this reaction?
The other possibilities are a chemical contaminant. The men are given a blood test and the doctors also visit the cafeteria where they had eaten shortly before becoming ill. They meet someone from the Bureau of Food and Drugs, who finds multiple violations of the health code in the cafeteria – it is infested with vermin and has open sewage lines, amongst other things.
They ask the cook how he made the oatmeal that morning and he explains how he uses dry cereal, water and a handful of salt. The cereal is a generic brand and the water is municipal; these are ruled out as sources of the poison, as more people would be sick if this were the case. That leaves the salt.
On the same shelf as the can of salt is another can full of white grains. The doctors ask the chef what this is; he responds that this is saltpetre, used to preserve meats. Its main component is sodium nitrate. The chef also mentions that once, he accidentally refilled the salt can with saltpetre, before realising his mistake and replacing the saltpetre with the real salt.
After testing the saltpetre, they find that instead of sodium nitrate, the can contains sodium nitrite. This minor difference is almost unnoticeable, as they both look and taste just like table salt. Both are used to preserve meat, but the levels present in food are closely monitored. However, sodium nitrite is extremely toxic.
The can of salt in the kitchen still contained some grains of the sodium nitrite when the chef refilled it with salt. This in itself was not enough to poison the men, otherwise many other men would have gotten sick that day. The men must have received a second dose from somewhere. The doctors realise that some people like to put salt on their oatmeal. The extra sodium nitrite in the salt in a table salt cellar could provide this. They test the salt cellars and find one that contains enough to poison the men. If all the men had used this salt cellar, this could be the cause of their poisoning.
Unfortunately, the men have all left the hospital by the time the doctors get back to confirm their hypothesis. It is left uncertain how they got poisoned, but they also mention that they may all have used a lot of salt because heavy drinkers have a low blood salt concentration.
Other Narratives of Medical Detection
The remaining eleven stories include:- "The Fog", an account of the 1948 Donora smog, which (together with "A Pig From New Jersey") won Roueché the 1950 Albert Lasker Medical Journalism AwardLasker AwardThe Lasker Awards have been awarded annually since 1946 to living persons who have made major contributions to medical science or who have performed public service on behalf of medicine. They are administered by the Lasker Foundation, founded by advertising pioneer Albert Lasker and his wife Mary...
. - "A Man from Mexico", an account of the 1947 New York smallpox outbreak.
- "The Alerting of Mr. Pomerantz" details the discovery of the disease RickettsialpoxRickettsialpoxRickettsialpox is an illness caused by bacteria of the Rickettsia genus . Physician Robert Huebner and self-trained entomologist Charles Pomerantz played major roles in identifying the etiology of the disease after an outbreak in 1946 in a New York City apartment complex, documented in medical...
. - "A Lonely Road" recounts the tale of a leper from Harlem.
- "Something Extraordinary" discusses antibiotic research.
- "A Perverse, Ungrateful, Maleficent Malady", an examination of goutGoutGout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
.
In addition there are stories of tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
, psittacosis
Psittacosis
In medicine , psittacosis — also known as parrot disease, parrot fever, and ornithosis — is a zoonotic infectious disease caused by a bacterium called Chlamydophila psittaci and contracted from parrots, such as macaws, cockatiels and budgerigars, and pigeons, sparrows, ducks, hens, gulls and many...
, typhoid fever
Typhoid fever
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica, serovar Typhi...
, trichinosis
Trichinosis
Trichinosis, also called trichinellosis, or trichiniasis, is a parasitic disease caused by eating raw or undercooked pork or wild game infected with the larvae of a species of roundworm Trichinella spiralis, commonly called the trichina worm. There are eight Trichinella species; five are...
and food poisoning.
Reception
The book was widely praised by critics for being accessible to general public without compromising on the integrity of the medical work presented. A review in the journal the Archives of OphthalmologyArchives of Ophthalmology
The Archives of Ophthalmology is a monthly professional medical journal published by the American Medical Association. Archives of Ophthalmology publishes peer-reviewed, original articles on such topics as epidemiology and biostatistics, mechanisms of ophthalmic disease, ophthalmic molecular...
described the book as "fascinating" and "superbly written". The Mystery Writers of America
Mystery Writers of America
Mystery Writers of America is an organization for mystery writers, based in New York.The organization was founded in 1945 by Clayton Rawson, Anthony Boucher, Lawrence Treat, and Brett Halliday....
gave Eleven Blue Men, and Other Narratives of Medical Detection a Raven Award as best book in a mystery field outside the regular categories of crime novels and crime reporting. Eleven Blue Men, and Other Narratives of Medical Detection is one of the top ten favourite books of author Kaye Gibbons
Kaye Gibbons
Kaye Gibbons is an American novelist. Her 1987 debut, Ellen Foster, received the Sue Kaufman Prize for First Fiction from the American Academy and Institute of Arts and Letters, a Special Citation from the Ernest Hemingway Foundation, and the The Louis D. Rubin, Jr. Prize in Creative Writing from...
.
Legacy
Eleven Blue Men was required reading for many years for those training at the Centers for Disease Control and Prevention's Epidemic Intelligence ServiceEpidemic Intelligence Service
The Epidemic Intelligence Service is a program of the United States' Centers for Disease Control and Prevention . Established in 1951, due to biological warfare concerns arising from the Korean War, it has become a hands-on two-year postgraduate training program in epidemiology, with a focus on...
.