How an epidemic was found, fought in Philadelphia

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by Hugh Gilmore

A review of “Anatomy Of An Epidemic: The True Story of a Town, a Hotel, a Silent Killer, and a Medical Detection Team,” by Gordon Thomas and Max Morgan-Witts. Published in 1982

I’ve long had an affection for the old Bellevue Stratford hotel (now renamed The Hyatt at the Bellevue). My mother worked there in the 1930s. I attended dances there. I enjoyed my honeymoon in its Mary Cassatt suite. I still eat at XIX (19 Restaurant) on special occasions.

But I also remember it as the site of one of America’s most baffling medical epidemics. The current coronavirus pandemic stirred me to revisit “Anatomy of an Epidemic,” a book I’d read years ago. It describes (in somewhat breathless prose) the frightening emergence of Legionnaires’ disease a few decades ago and the fascinating quest to discover its cause and prevention. The book was written by a pair of prolific, slick writers and is not regarded as the final word on its subject, but the story and its telling are quite interesting. They’re a good place to start if you’re interested in the medical forensics used to identify this disease.

The “town” mentioned in the title of this gripping nonfiction story is Philadelphia. The year was 1976 and the hoopla for America’s Bicentennial celebration had been going on for half a year. One of the biggest celebrations began on July 21 at Philadelphia’s famed Bellevue Stratford Hotel on south Broad Street, where the American Legion met for its annual three-day convention. More than 2000 Legionnaires attended in honor of the 200th anniversary of the signing of the US Declaration of Independence at Philadelphia in 1776. The convention ended with a proud and happy march of Legionnaires through center city.

By August 2, however, more than three dozen of the legionnaires were home and suffering from a mysterious respiratory illness whose symptoms included severe coughs, diarrhea, muscle aches, headaches, severe chest pain and very high fevers. Twelve of them died. By the time the official count finished there were 182 cases of this mysterious disease – thirty-three of them not legionnaires, including a bus driver, elevator operator, a prostitute, and a few persons who’d simply walked past the hotel. Soon there was a known total of 29 deaths.

Several hometown doctors whose patients included a few of the afflicted men noticed the pattern and called the Pennsylvania State Health Department. The Center for Disease Control sent nearly two dozen epidemiologists to investigate. The hunt for the source of this as yet unnamed ailment was on. So were the media frenzies, the conspiracy theories and the bureaucratic stalling.

Summer ended, then fall, and the bacterial agent that caused the disease had still not been identified. In late December one of the heroes of the story, Dr. Joseph Mc Dade, giving up his Christmas vacation to stay in the lab, finally succeeded in discovering the the bacterium. Its scientific name became Legionella pneumophila, but it’s better known as Legionnaires’ disease.

Dr. McDade’s press conference in January of 1977 led TIME magazine to run a lurid cover: “Found: The Philly Killer, Perhaps.” But that was misleading in that discovering a disease agent is not the same as figuring out how it works. In “Anatomy of an Epidemic,” the authors provide a fast-paced and detailed medical detective story of the painstaking investigation of where and how the bacteria found their way out of its natural environment and into the human body.

The medical forensics teams assigned to the Bellevue examined very room, looked at the elevators, scoped the hotel’s restaurants from freezer to toothpicks to water pitchers. To no avail. Not until another, smaller outbreak happened in 1977 did they discover that legionella thrives in shallow, warm water, such as the rooftop trays used us collection pans under the cooling towers and air conditioning systems of buildings. One of the few assuring things the investigators found, during a year in which fears of swine flu and parrot fever were frightening the public, was that legionella was not contagious (i.e. not spread from person to person). Discovering that the ventilation system could spread it, however, was not so reassuring. In fact a few people on the sidewalk had contracted the disease simply by walking into the faint mist falling ever so lightly from the rooftop.

In the late 1970s guidelines were established for designing HVACs that did not promote the growth of bacteria in their collection systems. The Bellevue Stratford closed its doors in November of 1977, and reopened in 1978 under new management as The Fairmount. Resold, it opened again in the 80s as Bellevue-Stratford. Today it is owned as a mixed-use building, known as the Hyatt at the Bellevue, reserving its top floors only as a hotel. It remains, despite it all, a fine place to stay and eat, but is hardly ever referred to anymore as “the Grand Dame of Broad St.”

Legionella remains with us in warm lakes, ponds, hot tubs, abandoned buildings where water collects, and in faulty HVAC units. Small outbreaks occur nearly every year.

A final note: Bob Dylan wrote a song called “Legionnaires’ Disease” around 1978, but never recorded it. Covers can be found on YouTube. Dylan’s version does not seem to be about the disease, but about the negative effects of war on the legionnaire’s psyche.

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