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HCA415 Ashford University Week 3 11 Blue Men Worksheet

Week 3 – Assignment 111 Blue Men[WLOs: 1, 2] [CLO: 2]Read Chapter 6: Epidemiology in your textbook and complete the Happy Town Crisis Interactive and Epidemic and Endemic and Pandemic, Oh My! Learning Activities before reading the 11 Blue Men story. Then complete the following:Read the Eleven Blue Men (Berton Roueché) (Links to an external site.) storyDownload the Eleven Blue Men Worksheet and address the questions in the worksheet using complete sentences.To complete the worksheet,Create a timeline (must be drawn, not text-only) indicating the 11 Blue Men presented symptoms.Timelines show patterns quickly. You will draw a timeline using the tool of your choice. It must be more than just text on a page. There are several free online timeline creation tools, like Vizzlo’s Timeline Chart (Links to an external site.). You may also want to review How to Make a Timeline in Microsoft Word (Links to an external site.).Describe the key symptoms and incubation period.Describe each step of an outbreak investigation.Identify three questions that Dr. Greenberg and Dr. Pellitteri asked the patients.Identify three questions that the epidemiologists asked the Eclipse Cafeteria employees.Identify the final culprit and how it was discovered.Explain why these specific men were more affected than other people.Please know that although this is not a formal written paper, you must still use APA formatting.The 11 Blue Men assignment,Must use double-spacing with 1-inch marginsMust include a separate title page with the following:Title of paperStudent’s nameCourse name and numberInstructor’s nameDate submittedFor further assistance with the formatting and the title page, refer to APA Formatting for Word 2013 (Links to an external site.).Must document any information used from sources in APA style as outlined in the Ashford Writing Center’s Citing Within Your Paper (Links to an external site.)Must use at least two additional scholarly, peer-reviewed, credible sources in addition to the course text and case study itself to support your answers to the case study questions. The Ashford University Library is a great place to find resources. Watch the Ashford University Library Quick ‘n’ Dirty (Links to an external site.) tutorial for research tips.

ARTBEAT
MEN
U
Eleven Blue Men (Berton Roueché)
Posted on October 12, 2014 by Admin
At about eight o’clock on Monday morning, September 25, 1944, a ragged, aimless old man of eightytwo collapsed on the sidewalk on Dey Street, near the Hudson Terminal. Innumerable people must
have noticed him, but he lay there alone for several minutes, dazed, doubled up with abdominal
cramps, and in an agony of retching. Then a policeman came along. Until the policeman bent over the
old man, he may have supposed that he had just a sick drunk on his hands; wanderers dropped by
drink are common in that part of town in the early morning. It was not an opinion that he could have
held for long. The old man’s nose, lips, ears, and fingers were sky-blue. The policeman went to a
telephone and put in an ambulance call to Beekman-Downtown Hospital, half a dozen blocks away.
The old man was carried into the emergency room there at eight-thirty. By that time, he was
unconscious and the blueness had spread over a large part of his body. The examining physician
attributed the old man’s morbid color to cyanosis, a condition that usually results from an insufficient
supply of oxygen in the blood, and also noted that he was diarrheic and in a severe state of shock.
The course of treatment prescribed by the doctor was conventional. It included an instant gastric
lavage, heart stimulants, bed rest, and oxygen therapy. Presently, the old man recovered an
encouraging, if painful, consciousness and demanded, irascibly and in the name of God, to know
what had happened to him. It was a question that, at the moment, nobody could answer with much
confidence.
For the immediate record, the doctor made a free-hand diagnosis of carbon-monoxide poisoning –
from what source, whether an automobile or a gas pipe, it was, of course, pointless even to guess.
Then, because an isolated instance of gas poisoning is something of a rarity in a section of the city as
crammed with human beings as downtown Manhattan he and his colleagues in the emergency room
braced themselves for at least a couple more victims. Their foresight was promptly and generously
rewarded. A second man was rolled in at ten-twenty-five. Forty minutes later, an ambulance drove up
with three more men. At eleven-twenty, two others were brought in. An additional two arrived
during the next fifteen minutes. Around noon, still another was admitted. All of the nine men were
also elderly and dilapidated, all had been misery for at least an hour, and all were rigid, cyanotic, and
in a state of shock. The entire body of one, a bony, seventy-three-year-old consumptive named John
Mitchell was blue. Five of the nine, including Mitchell, had been stricken in the Globe Hotel, a
sunless, upstairs flophouse at 190 Park Row, and two in a similar place, called the Star Hotel, at 3
James Street. Another had been found slumped in the doorway of a condemned building on Park
Row not far from City Hall Park, by a policeman. The ninth had keeled over in front of the Eclipse
Cafeteria, at 6 Chatham Square. At a quarter to seven that evening, one more aged blue man was
brought in. He had been lying, too sick to ask for help, on his cot in a cubicle in the Lion Hotel,
another flophouse, at 26 Bowery, since ten o’clock that morning. A clerk had finally looked in and
seen him.
By the time this last blue man arrived at the hospital, an investigation of the case by the Department
of Health, to which all outbreaks of an epidemiological nature must be reported, had been under way
for five hours. Its findings thus far had not been illuminating. The ‘investigation was conducted by
two men. One was the Health Department’s chief epidemiologist, Dr. Morris Greenberg, a small,
fragile, reflective man of fifty-seven, who is now acting director of the Bureau of Preventable
Diseases; the other was Dr. Ottavio Pellitteri, a field epidemiologist, who, since 1946, has been
administrative medical inspector for the Bureau. He is thirty- six years old, pale, and stocky, and has
a bristling black mustache. One day, when I was in Dr. Greenberg’s office, he and Dr. Pellitteri told
me about the case. Their recollection of it is, understandably, vivid. The derelicts were the victims of a
type of poisoning so rare that only ten previous outbreaks of it had been recorded in medical
literature. Of these, two were in the United States and two in Germany; the others had been reported
in France, England, Switzerland, Algeria, Australia, and India. Up to September 25, 1944, the largest
number of people stricken in a single outbreak was four. That was in Algeria, in 1926.
The Beekman-Downtown Hospital telephoned a report of the occurrence to the Health Department
just before noon. As is customary, copies of the report were sent to all the Department’s
administrative officers. “Mine was on my desk when I got back from lunch,” Dr. Greenberg said to
me. “It didn’t sound like much. Nine persons believed to be suffering from carbon-monoxide
poisoning had been admitted during the morning, and all of them said that they had eaten breakfast
at the Eclipse Cafeteria, at 6 Chatham Square. Still, it was a job for us. I checked with the clerk who
handles assignments and found that Pellitteri had gone out on. It. That was all I wanted to know. If it
amounted to anything, I knew he’d phone me before making a written report. That’s an arrangement
we have here. Well, a couple of hours later I got a call from him. My interest perked right up.”
“I was at the hospital,” Dr. Pellitteri told me, “and I’d talked to the staff and most of the men. There
were ten of them by then, of course. They were sick as dogs, but only one was in really bad shape.”
“That was John Mitchell,” Dr. Greenberg put in. “He died the next night. I understand his condition
was hopeless from the start. The others, including the old boy who came in last, pulled through all
right. Excuse me, Ottavio, but I just thought I’d get that out of the way. Go on.”
Dr. Pellitteri nodded. “I wasn’t at all convinced that it was gas poisoning,” he continued. “The staff
was beginning to doubt it, too. The symptoms weren’t quite right. There didn’t seem to be any of the
headache and general dopiness that you get with gas. What really made me suspicious was this: Only
two or three of the men had eaten breakfast in the cafeteria at the same time. They had straggled in all
the way from seven o’clock to ten. That meant that the place would have had to be full of gas for at
least three hours which is preposterous. It also indicated that we ought to have had a lot more sick
people than we did. Those Chatham Square eating places have a big turnover. Well, to make sure, I
checked with Bellevue, Gouverneur, St. Vincent’s, and the other downtown hospitals. None of them
had seen a trace of cyanosis. Then I talked to the sick men some more.
I learned two interesting things. One was that they had all got sick right after eating. Within thirty
minutes. The other was that all but one had eaten oatmeal, rolls, and coffee. He ate just oatmeal.
When ten men eat the same thing in the same place on the same day and then all come down with the
same illness . . . I told Greenberg that my hunch was food poisoning.”
“I was willing to rule out gas,” Dr. Greenberg said. A folder containing data on the case lay on the
desk before him. He lifted the cover thoughtfully, then let it drop. “And I agreed that the oatmeal
sounded pretty suspicious. That was as far as I was willing to go. Common, ordinary, everyday food
poisoning – I gathered that was what Pellitteri had in mind – wasn’t a very satisfying answer. For one
thing, cyanosis is hardly symptomatic of that. On the other hand, diarrhea and severe vomiting are,
almost invariably. But they weren’t in the clinical picture, I found, except in two or three of the cases.
Moreover, the incubation periods – the time lapse between eating and illness – were extremely short.
As you probably know, most food poisoning is caused by eating something that has been
contaminated by bacteria. The usual offenders are the staphylococci- they’re mostly responsible for
boils and skin infections and so on – and the salmonella. The latter are related to the typhoid
organism. In a staphylococcus case, the first symptoms rarely develop in under two hours. Often, it’s
closer to five. The incubation period in the other ranges from twelve to thirty-six hours. But here we
were with something that hit in thirty minutes or less. Why, one of the men had got only as far as the
sidewalk in front of the cafeteria before he was knocked out. Another fact that Pellitteri had dug up
struck me as very significant. All of the men told him that the illness had come on with extraordinary
suddenness. One minute they were feeling fine, and the next minute they were practically helpless.
That was another point against the ordinary food- poisoning theory. Its onset is never that fast. Well,
that suddenness began to look like a lead. It led me to suspect that some drug might be to blame. A
quick and sudden reaction is characteristic of a great many drugs. So is the combination of cyanosis
and shock.”
“None of the men were on dope,” Dr. Pellitteri said. “I told Greenberg I was sure of that. Their
pleasure was booze.” “That was O.K.,” Dr. Greenberg said. “They could have got a toxic dose of some
drug by accident. In the oatmeal, most likely. I couldn’t help thinking that the oatmeal was relevant to
our problem. At any rate, the drug idea was very persuasive.”
“So was Greenberg,” Dr. Pellitteri remarked with a smile.
“Actually, it was the only explanation in sight that seemed to account for everything we knew about
the clinical and environmental picture.”
“All we had to do now was prove it,” Dr. Greenberg went on mildly. “I asked Pellitteri to get a blood
sample from each of the men before leaving the hospital for a look at the cafeteria. We agreed he
would send the specimens to the city toxicologist, Dr. Alexander O. Gettler, for an overnight analysis.
I wanted to know if the blood contained methemoglobin. Methemoglobin is a compound that’s
formed only when anyone of several drugs enters the blood. Gettler’s report would tell us if we were
at least on the right track. That is, it would give us a yes-or-no answer on drugs. If the answer was
yes, then we could go on from there to identify the particular drug. How we would go about that
would depend on what Pellitteri was able to turn up at the cafeteria. In the meantime, there was
nothing for me to do but wait for their reports. I’d theorized myself hoarse.”
Dr. Pellitteri, having attended to his bloodletting with reasonable dispatch, reached the Eclipse
Cafeteria at around five o’clock. “It was about what I’d expected,” he told me. “Strictly a horse
market, and dirtier than most. The sort of place where you can get a full meal for fifteen cents. There
was a grind house on one side, a cigar store on the other, and the ‘L’ overhead. Incidentally, the
Eclipse went out of business a year or so after I was there, but that had nothing to do with us. It was
just a coincidence. Well, the place looked deserted and the door was locked. I knocked, and a man
came out of the back and let me in. He was one of our people, a health inspector for the Bureau of
Food and Drugs, named Weinberg. His bureau had stepped into the case as a matter of routine,
because of the reference to a restaurant in the notification report. I was glad to see him and to have his
help. For one thing, he had put a temporary embargo on everything in the cafeteria. That’s why It
was closed up. His main job, though, was to check the place for violations of the sanitation code. He
was finding plenty.
“Let me read you a few of Weinberg’s findings,” Dr. Greenberg said, extracting a paper from the
folder on his desk. “None of them had any direct bearing on our problem but I think they’ll give you
a good idea of what the Eclipse was like – what too many restaurants are like. This copy of his report
lists fifteen specific violations. Here they are: ‘Premises heavily infested with roaches. Fly infestation
throughout premises. Floor defective in rear part of dining room. Kitchen walls and ceiling encrusted
with grease and soot. Kitchen floor encrusted with dirt. Refuse under kItchen fixtures. Sterilizing
facilities inadequate. Sink defective. Floor and walls at serving tables and coffee urns encrusted with
dirt. Kitchen utensils encrusted with dirt and grease. Storage- cellar walls, ceiling, and floor encrusted
with dirt. Floor and shelves in cellar covered with refuse and useless material cellar ceiling defective.
Sewer pipe leaking. Open sewer line in cellar.’ Well .. .” He gave me a squeamish smile and stuck the
paper back in the folder.
“I can see it now”, Dr. Pellitteri said. “And smell it. Especially the kitchen, where I spent most of my
time. Weinberg had the proprietor and the cook out there and I talked to them while he prowled
around. They were very cooperative. Naturally, they were scared to death. They knew nothing about
gas in the place and there was no sign of any, so I went to work on the food. None of what had been
prepared for breakfast that morning was left. That, of course, would have been too much to hope for.
But I was able to get together some of the kind of stuff that had gone into the men’s breakfast, so that
we could make a chemical determination at the Department. What I took was ground coffee, sugar, a
mixture of evaporated milk and water that passed for cream, some bakery rolls, a five-pound carton
of dry oatmeal, and some salt. The salt had been used in preparing the oatmeal. That morning, like
every morning, the cook told me, he had prepared six gallons of oatmeal, enough to serve around a
hundred and twenty-five people. To make it he used five pounds of dry cereal, four gallons of water –
regular city water – and a handful of salt. That was his term – a handful. There was an open gallon
can of salt standing on the stove. He said the handful he’d put in that morning’s oatmeal had come
from that. He refilled the can on the stove every morning from a big supply can. He pointed out the
big can- it was up on a shelf- and as I was getting it down to take with me, I saw another can, just like
it, nearby. I took that one down, too. It was also full of salt, or, rather, something that looked like salt.
The proprietor said it wasn’t salt. He said it was saltpetre – sodium nitrate – that he used in corning
beef and in making pastrami. Well, there isn’t any harm in saltpetre; it doesn’t even act as an antiaphrodisiac, as a lot of people seem to think. But I wrapped it up with the other loot and took it
along, just for fun. The fact is, I guess, everything in that damn place looked like poison.”
After Dr. Pellitteri had deposited his loot with a Health Department chemist, Andrew J. Pensa, who
promised to have a report ready by the following afternoon, he dined hurriedly at a restaurant in
which he had confidence and returned to Chatham Square. There he spent the evening making the
rounds of the lodging houses in the neighborhood. He had heard at Mr. Pensa’s office that an
eleventh blue man had been admitted to the hospital, and before going home he wanted to make sure
that no other victims had been overlooked. By midnight, having covered all the likely places and
having rechecked the downtown hospitals, he was satisfied. He repaired to his office and composed a
formal progress report for Dr. Greenberg. Then he went home and to bed.
The next morning, Tuesday, Dr. Pellitteri dropped by the Eclipse, which was still closed but whose
proprietor and staff he had told to return for questioning. Dr. Pellitteri had another talk with the
proprietor and the cook. He also had a few inconclusive words with the rest of the cafeteria’s
employees — two dishwashers, a busboy, and a counterman. As he was leaving, the cook, who had
apparently passed an uneasy night with his conscience, remarked that it was possible that he had
absent-mindedly refilled the salt can on the stove from the one that contained saltpetre. “That was
interesting,” Dr. Pellitteri told me, “even though such a possibility had already occurred to me, and
even though I didn’t know whether it was important or not. I assured him that he had nothing to
worry about. We had been certain all along that nobody had deliberately poisoned the old men.”
From the Eclipse, Dr. Pellitteri went on to Dr. Greenberg’s office, where Dr. Gettler’s report was
waiting.
“Gettler’s test for methemoglobin was positive,” Dr. Greenberg said. “It had to be a drug now. Well,
so far so good. Then we heard from Pensa.”
“Greenberg almost fell out of his chair when he read Pensa’s report,” Dr. Pellitteri observed
cheerfully.
“That’s an exaggeration,” Dr. Greenberg said. “I’m not easily dumfounded. We’re inured to the
incredible around here. Why, a few years ago we had a case involving some numskull who stuck a
fistful of potassium-thiocyanate crystals, a very nasty poison, in the coils of an office water cooler, just
for a practical joke. However, I can’t deny that Pensa rather taxed our credulity. What he had found
was that the small salt can and the one that was supposed to be full of sodium nitrate both contained
sodium nitrite. The other food samples, incidentally, were O.K.”
“That also taxed my credulity,” Dr. Pellitteri said.
Dr. Greenberg smiled. “There’s a great deal of difference between nitrate and nitrite,” he continued.
“Their only similarity, which is an unfortunate one, is that they both look and taste more or less like
ordinary table salt. Sodium nitrite isn’t the most powerful poison in the world, but a little of it will do
a lot of harm. If you remember, I said before that this case was almost without precedent – only ten
outbreaks like it on record. Ten is practically none. In fact, sodium- nitrite poisoning is so unusual
that some of the standard texts on toxicology don’t even mention it. So Pensa’s report was pretty
startling. But we accepted it, of course, without question or hesitation. Facts are facts. And we were
glad to. It seemed to explain everything very nicely. What I’ve been saying about sodium-nitrite
poisoning doesn’t mean that sodium nitrite itself is rare. Actually, it’s fairly common. It’s used in the
manufacture of dyes and as a medical drug. We use it in treating certain heart conditions and for high
blood pressure. But it also has another important use, one that made its presence at the Eclipse sound
plausible. In recent years, and particularly during the war, sodium nitrite has been used as a
substitute for sodium nitrate in preserving meat. The government permits it but stipulates that the
finished meat must not contain more than one part of sodium nitrite per five thousand parts of meat.
Cooking will safely destroy enough of that small quantity of the drug.” Dr. Greenberg shrugged.
“Well, Pellitteri had had the cook pick up a handful of salt – the same amount, as nearly as possible,
as went into the oatmeal- and then had taken this to his office and found that it weighed
approximately a hundred grams. So we didn’t have to think twice to realize that the proportion of
nitrite in that batch of cereal was considerably higher than one to five thousand. Roughly, it must
have been around one to about eighty before cooking destroyed part of the nitrite. It certainly looked
as though Gettler, Pensa, and the cafeteria cook between them had given us our answer. I called up
Gettler and told him what Pensa had discovered and asked him to run a specific test for nitrites on
his blood samples. He had, as a matter of course, held some blood back for later examination. His
confirmation came throug…

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