00:00:06
in
00:00:08
1985 121 people in South Dakota and
00:00:12
Minnesota were struck with a mysterious
00:00:15
illness there had been only one outbreak
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like it and the last time it happened
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Medical detectives couldn't figure out
00:00:24
the cause
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[Music]
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[Music]
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Valley Springs South Dakota a tiny
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farming community of about 800 people
00:01:06
not far from the Minnesota border it's a
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community of farms and Suburban
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professionals many of whom work in the
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nearby city of sou
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Falls people here are accustomed to hard
00:01:18
work and the hard weather and aren't the
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type to complain so when some residents
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began suffering from irregular heart
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rhythms fevers weight loss diarrhea
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edginess and mysterious aches and pains
00:01:34
they wondered if it was more than a
00:01:37
coincidence I was just fidgety and
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nervous and uh not all the time I guess
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that's what threw you off it had been
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that steady you couldn't have put up
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with it heart would be you know you feel
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your pulse and it just pounding you
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could feel your heart pounding and you
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achd your legs and arms hurt real bad
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and I started getting chills then I'd
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get hot flashes then I couldn't eat and
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I'd be nauseated every everything was
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just happening really really fast at
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first doctors were confused about the
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symptoms Jane nad's Doctor thought she
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was having a nervous breakdown and put
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her in the hospital I'd never you know
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had any of this problem before with a
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mental problem so he put me on a mood
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elevator and about 8 hours later my
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heart was 160 beats per minute and I
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just knew I was going to have a heart
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attack it felt like it was just flying
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out of my yes 10 m down the road in
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lever Minnesota the stories were the
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same Tony dis Panet suffered heart
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symptoms too and immediately went to the
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emergency room certain he was having a
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heart attack well about 3:00 in the
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morning approximately three U I woke up
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with
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a a tightness in my chest like some it
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did it felt like somebody was sitting on
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it test revealed it wasn't a heart
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attack but he spent three days in the
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hospital as doctors tried to find out
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the cause some of the local Physicians
00:03:05
thought it was the flu or a virus but
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after weeks of suffering the residents
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started to compare notes there were
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folks that were sick and had been sick
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for a long time and a couple were had
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gone close to death and they couldn't
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figure out what was wrong with them and
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they didn't know if it was contagious if
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it was something in the water and they
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were all feeling these same symptoms and
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then they were hearing of other people
00:03:32
that were feeling these same symptoms
00:03:34
when Richard Jacobson went to his doctor
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he was told that his thyroid was
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malfunctioning and was sent to the
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area's leading thyroid specialist when
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Jacobson called The Specialist he had
00:03:46
just one question doc can you tell me
00:03:50
why there's five people in my small town
00:03:53
with the same condition Dr Michael
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McMillan has been a thyroid specialist
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in South Dakota for the past 30 years at
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first he thought Jacobson was
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exaggerating but just to make sure he
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decided to do a little of his own
00:04:08
investigating he went to the local
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hospital and looked through the x-rays
00:04:12
and medical records of some recent
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patients he discovered something
00:04:18
alarming there had been an increase in
00:04:21
the number of patients with thyroid type
00:04:23
complaints but there was a problem
00:04:26
because in every x-ray the thyroids were
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perfectly normal the thyroid is a small
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butterfly-shaped gland at the base of
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the neck which produces hormones that
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control both metabolism and growth an
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overactive thyroid floods the body with
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hormones disrupting the entire nervous
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system causing symptoms such as heart
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fluctuations weight loss diarrhea
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nervousness muscle aches and
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pains Dr McMillan searched the medical
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journals for Clues trying to find out
00:05:00
what could be causing an outbreak of
00:05:02
thyroid problems in the area and I came
00:05:05
across a title that said first ever
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epidemic of Silent thyroiditis York
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Nebraska well York Nebraska is about 120
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mil south of here the outbreak in York
00:05:18
Nebraska happened just one year earlier
00:05:21
residents complained of the same
00:05:23
symptoms heart problems fevers fatigue
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loss of appetite and weight loss so many
00:05:29
people were ill it threatened the
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economy of the small farming
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Community doctors from the Centers for
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Disease Control in Atlanta were called
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in to investigate but just as they
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arrived the outbreak of Silent
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thyroiditis Ended as mysteriously as it
00:05:48
had begun the residents recovered and
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the cause of the York outbreak was never
00:05:54
discovered Dr McMillan immediately
00:05:57
called the CDC to let them know it was
00:05:59
happening again Dr Michael McAn I'm
00:06:01
trying to get a hold of Dr Dan fishine I
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was knew that it was going to happen
00:06:05
again because I knew the one thing we
00:06:07
all admitted is even the people who
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thought it was a virus we didn't know
00:06:11
what virus we didn't know what it was
00:06:12
caused by so I knew that was going to
00:06:14
happen uh again and so I was uh not
00:06:17
quite expecting but certainly was not
00:06:19
surprised as the CDC prepared to
00:06:22
investigate this outbreak the number of
00:06:24
cases was Rising even if it just spread
00:06:27
to through Falls with all the people
00:06:29
here let alone Minneapolis or Detroit or
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something we would have a major medical
00:06:34
catastrophe on our
00:06:41
hands investigators needed to find the
00:06:45
cause of the outbreak before thousands
00:06:48
were
00:06:51
affected in June of
00:06:54
1985 there were 50 cases of the
00:06:57
mysterious thyroid outbreak con
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concentrated in two nearby towns lever
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Minnesota and Valley Springs South
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Dakota the Cent for Disease Control in
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Atlanta was called in to investigate
00:07:11
certainly one of the most puzzling
00:07:12
things about the outbreak is we didn't
00:07:14
know what it was due to um and this made
00:07:17
it incredibly difficult uh was it in the
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air was it in the water was it in the
00:07:22
food there there was just no way to know
00:07:24
investigators needed to know as much
00:07:27
about the outbreak as possible it was
00:07:29
striking both men and women equally all
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age groups were affected there appeared
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to be no occupational Association and no
00:07:38
work site or School clusters entire
00:07:42
families were affected was it possible
00:07:44
that the outbreak was being spread
00:07:47
person to
00:07:48
person everyone suspected of having the
00:07:51
disease was given a blood test and
00:07:53
interviewed about where or how they
00:07:55
might have contracted it you talk to
00:07:57
patients and you hope that by doing
00:07:59
unstructured interviews you'll get some
00:08:01
ideas one of the questions that I
00:08:03
thought was kind of cute that the
00:08:05
epidemiologist asked everybody was what
00:08:08
do you think causes
00:08:10
this and the most frequent
00:08:13
response there had been a lot of
00:08:15
tornadoes in this area the year before
00:08:18
the most frequent response was I guess
00:08:20
those tornadoes stirred up some
00:08:22
chemicals and that got got into our
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water
00:08:28
supply but in order to determine what
00:08:31
was causing the outbreak investigators
00:08:34
first had to figure out what the problem
00:08:37
was blood tests revealed that all of the
00:08:40
victims had an excess of thyroid hormone
00:08:43
in their system in some cases the levels
00:08:46
were 8 and 10 times above normal tests
00:08:49
of the drinking water did not reveal
00:08:51
anything which could have caused the
00:08:54
outbreak Dr Lewis Braverman is the
00:08:57
country's leading expert in thyroid
00:08:59
disease diseases he was asked to examine
00:09:02
some of the sick patients in South
00:09:03
Dakota we then went out to a small
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community called Beaver Creek if I
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recall and went into one household where
00:09:13
there were four
00:09:14
generations in the house who had all of
00:09:18
the signs and symptoms of
00:09:21
thyrotoxicosis and none of them from a
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four-year-old child to an 85 or 90y old
00:09:28
great grandfather had an enlarged
00:09:32
thyroid since the thyroid glands of
00:09:34
these victims weren't enlarged they had
00:09:37
no idea what was causing these
00:09:40
symptoms in the past enlarged thyroid
00:09:43
glands were so common in this part of
00:09:45
the country it was known as the goer
00:09:47
belt a goer is the term for an enlarged
00:09:52
thyroid this part of the country is
00:09:54
called the goer belt because there was
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iodine deficiency here uh there's no
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iodine in the soil uh there's nobody
00:10:01
eating seafood and so people used to get
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large iodine deficient goers the
00:10:07
condition was so common that in 1922 the
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Mayo brothers opened the Mayo Clinic in
00:10:14
nearby Rochester Minnesota offering safe
00:10:17
affordable surgery to alleviate the huge
00:10:20
number of thyroid problems in the region
00:10:24
over the years as diets improved the
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thyroid problems went away but this
00:10:30
outbreak was different all of the
00:10:32
patients had normal thyroids and for
00:10:35
some patients the condition was serious
00:10:39
one of the cases was a patient I had
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seen in the Intensive Care Unit here in
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the hospital and it was an older lady
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who whose heart had suddenly started
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beating irregularly and she'd gone into
00:10:51
heart failure to find out if this was
00:10:54
indeed a virus Health officials decided
00:10:56
to take throat and feal specimens for an
00:10:59
analysis but all of the tests were
00:11:01
negative then Dr McMillan noticed
00:11:04
something interesting the geographic
00:11:07
location of many of the victims here was
00:11:10
a community of Valley
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Springs and then 3 miles across the
00:11:15
highway was a community of garritson
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which was almost the same size there
00:11:20
were nine people in Valley Springs with
00:11:22
the disease and nobody in garon with the
00:11:24
disease how could those two communities
00:11:26
what what was what was the difference in
00:11:29
fact the epicenter of the outbreak was L
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Minnesota and there were no cases west
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of Valley Springs but that changed when
00:11:39
a resident of Sue Falls called Dr
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McMillan to say that she was suffering
00:11:43
from the thyroid disease her name Ronda
00:11:47
pesy her parents owned a grocery store
00:11:50
in Valley Springs where she occasionally
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purchased her groceries Dr McMillan
00:11:55
drove out to visit her parents Larry and
00:11:58
Margaret long and to to take a look
00:11:59
around their store the Longs did not
00:12:03
have
00:12:04
thyrotoxicosis but their daughter
00:12:07
did Dr McMillan wanted to know
00:12:14
why when Dr McMillan learned that the
00:12:17
daughter of a grocery store owner
00:12:18
developed thyroid toxicosis yet her
00:12:21
parents did not he decided to
00:12:24
investigate the grocery store owned by
00:12:27
Larry and Margaret long had a special y
00:12:29
item extra lean ground beef Dr McMillan
00:12:33
asked the Longs how often they ate the
00:12:35
ground beef themselves they laughed and
00:12:38
said never it was such a popular item
00:12:42
they were always sold out it was a great
00:12:44
meat it was uh it was running about 90%
00:12:48
lean but the long said their daughter
00:12:51
might have taken some with her on her
00:12:52
last
00:12:54
visit on a hunch McMillan took a sample
00:12:58
for analysis
00:13:00
by now there were more than 100 cases of
00:13:02
the mysterious thyroid outbreak and for
00:13:05
some the symptoms were troubling when I
00:13:08
had that thyroid scan a couple gals that
00:13:11
work in the hospital they thought I had
00:13:12
cancer is what they told me they told me
00:13:14
this personally that we thought you were
00:13:16
dying of cancer CU I'd look so bad when
00:13:18
I went for this thyroid scan then of
00:13:20
course the world's greatest
00:13:22
endocrinologists were called in and uh
00:13:25
and uh we had I remember the meeting
00:13:27
with them and we laid out out all the
00:13:29
data told everything and they sat there
00:13:31
and Shrugged their shoulders and said we
00:13:34
don't know what this is the only thing
00:13:36
they knew was that patients had eight or
00:13:39
10 times the normal amount of thyroid
00:13:42
hormone in their bloodstream causing
00:13:45
heart problems fatigue muscle aches and
00:13:48
pain investigators finally got a break
00:13:52
when they heard of an entire family with
00:13:55
thyrotoxicosis it was a large extended
00:13:57
family all of whom had confirmed cases
00:14:00
of the thyroid condition all except one
00:14:04
it must have been eight or 10 people we
00:14:06
bled everybody in the family did their
00:14:08
blood test and everybody had elevated
00:14:10
thyroid function tests except one person
00:14:13
and that was a teenager but how was the
00:14:16
teenager different from the other family
00:14:18
members who got sick the father told
00:14:21
investigators he worked at the local
00:14:23
meat packing plant and regularly brought
00:14:25
ground beef home for his
00:14:28
family it was the same plant which
00:14:30
supplied the Long's grocery store with
00:14:33
their specialty hamburger the extra lean
00:14:36
ground beef samples of the hamburger
00:14:39
were collected for analysis and taken to
00:14:41
a local pathologist using a cryostat a
00:14:45
portion of the hamburger was frozen in a
00:14:47
matter of seconds we convert the tissue
00:14:50
really into a block of ice that makes
00:14:52
the tissue firm enough that we can cut
00:14:54
thin sections stain them look at them
00:14:56
under the microscope and make a
00:14:57
diagnosis
00:15:02
under a microscope the pathologist
00:15:05
noticed something unusual something not
00:15:09
normally seen in ground beef bits of
00:15:13
animal thyroid mixed into the ground
00:15:16
meat animal thyroid contains extremely
00:15:20
high levels of thyroid hormones was it
00:15:23
possible that this was causing the
00:15:26
outbreak of
00:15:27
thyrotoxicosis in in the two small
00:15:30
communities to find out doctors
00:15:34
conducted an
00:15:35
experiment one can say well just because
00:15:38
you find it in the hamburger how do you
00:15:41
know that when the people eat the
00:15:44
hamburger that they're really absorbing
00:15:46
the thyroid hormones so our next step
00:15:50
was to feed the ground beef from
00:15:54
Minnesota to rats one group of rats were
00:15:57
fed the raw hamburger collected in
00:16:00
Minnesota and for comparison another
00:16:03
group was fed raw Burger purchased near
00:16:06
the laboratory in Worster Massachusetts
00:16:08
the rats which ate the Minnesota Burger
00:16:11
exhibited all the signs of thyroid
00:16:14
problems these rats were wild rats I
00:16:17
mean they were very jittery nervous and
00:16:19
this is compared to the rather tranquil
00:16:22
normal behavior of the rats fed the
00:16:25
Worcester hamburger so that there's no
00:16:27
question that these rats were if one
00:16:29
could use the Expression clinically
00:16:31
thyrotoxic but residents of Valley
00:16:33
Springs and Lou weren't eating raw
00:16:36
hamburger and cooking the meat usually
00:16:39
kills all bacteria and
00:16:41
microorganisms most of us eat cooked
00:16:44
hamburger and as a matter of fact people
00:16:47
in the midwest tend to cook their
00:16:49
hamburgers much more so than we do in
00:16:52
the Northeast investigators next step to
00:16:55
do some tests on humans they also wanted
00:16:59
to know how an entire family developed
00:17:05
thyrotoxicosis while their young son did
00:17:10
not when investigators from the CDC
00:17:13
found a large extended family who all
00:17:16
suffered from thyroid problems except
00:17:18
their young son they wanted to know
00:17:22
why interviews with the family revealed
00:17:25
that the boy didn't eat meat except for
00:17:28
an occasional pepperoni pizza I hate
00:17:31
meat I like this oh and he's my son this
00:17:34
was an important Discovery the next step
00:17:38
to confirm that the tainted hamburger
00:17:41
created elevated thyroid hormone levels
00:17:44
in humans as it did with the rats even
00:17:47
after it was cooked so that we did uh
00:17:50
obtain four young Physicians uh to
00:17:53
participate in the study and what we did
00:17:55
was essentially bring them in in the
00:17:56
morning fasting uh Drew their blood and
00:18:01
fed them an extremely well-cooked half
00:18:04
pound hamburger uh which they enjoyed
00:18:07
immensely since the was smothered in
00:18:09
onions and on toast so that it was a
00:18:11
very tasty uh breakfast the meat used in
00:18:15
the experiment was the same that was
00:18:17
sold in the local stores it came from
00:18:20
this local slaughtering house in L
00:18:23
Minnesota but how was the local meat
00:18:26
being contaminated Public Health
00:18:28
officials inspected the local meat
00:18:30
packing plant and learned something
00:18:33
interesting the plant had been a kosher
00:18:36
killing plant up until a few years
00:18:39
earlier when animals are killed kosher
00:18:42
they're actually bled to death and the
00:18:44
thyroid gland it has a real intense
00:18:46
blood supply and it's really red except
00:18:49
that if you bled the animal to death
00:18:51
then it would look white and it would
00:18:52
look completely different and when the
00:18:54
thyroid gland changed color it was
00:18:57
easier for the but to see and remove the
00:19:01
animal thyroid was then sold to drug
00:19:04
companies all of the meat packing
00:19:06
companies would carefully dissect the
00:19:08
thyroids out and sell them to the drug
00:19:09
company so they could make thyroid
00:19:11
extract U to treat other people but two
00:19:14
things happened first this Meat Plant
00:19:17
discontinued its kosher killing
00:19:19
production and with the development of
00:19:22
synthetic hormones drug companies no
00:19:24
longer purchased the animal thyroids
00:19:27
from slaughter houses the result since
00:19:30
the animal thyroid wasn't sold to the
00:19:32
drug companies it was included along
00:19:35
with the rest of the nect trim from the
00:19:37
animal's gullet and inadvertently passed
00:19:40
along for human consumption the gullet
00:19:43
basically is this part of the cow's neck
00:19:46
and the muscles that are trim that are
00:19:49
lowfat are these muscles here the the
00:19:51
sternomastoid muscles on humans the
00:19:54
thyroid gland sits right under those
00:19:56
muscles and if someone is not pain P
00:19:58
attention as they're trimming it's very
00:20:00
easy to clip off a bit of thyroid gland
00:20:03
as they take off the muscle when the
00:20:05
animal's thyroid gland was mixed in with
00:20:08
other ground meat for hamburger it
00:20:11
caused the highly elevated levels of
00:20:14
thyroid hormones in those who ate
00:20:17
it the Meat Plant was producing the
00:20:19
equivalent of 3600 hamburger patties
00:20:23
each day but as soon as the problem was
00:20:26
discovered they immediately Rec called
00:20:29
the beef and instituted safeguards to
00:20:31
prevent the problem from recurring well
00:20:34
it was almost like the Eureka type thing
00:20:36
we were we were really quite thrilled we
00:20:38
thought that we had at that point in
00:20:40
time discovered the cause of this
00:20:42
epidemic and uh was something relatively
00:20:46
simple a simple solution to a
00:20:49
complicated
00:20:51
problem after 7 months of
00:20:53
Investigation the cause of the outbreak
00:20:56
was finally discovered
00:20:59
and investigators believe that the
00:21:01
tainted meat also was the cause of the
00:21:04
outbreak in York Nebraska the year
00:21:07
before shortly after this outbreak the
00:21:10
US Department of Agriculture instituted
00:21:13
strict guidelines for the trimming of
00:21:15
meat from neck muscles and declared the
00:21:18
thyroid gland was to be considered unfit
00:21:21
for human consumption but the residents
00:21:24
of Valley Springs and L don't care much
00:21:27
about their place in medical history and
00:21:30
they aren't the type to hold a grudge
00:21:33
121 residents develop
00:21:36
thyrotoxicosis and all recovered
00:21:39
fortunately there were no fatalities
00:21:42
it's become one of cdc's major teaching
00:21:45
cases because it illustrates all sorts
00:21:47
of things that are really not usually
00:21:49
encountered but are very important
00:21:51
lessons for young
00:21:53
epidemiologists the outbreak was halted
00:21:55
promptly thanks to skill in intuition
00:21:59
and a little bit of
00:22:01
luck all are important
00:22:04
ingredients in a successful medical
00:22:07
investigation
00:22:08
[Music]
00:22:28
a
00:22:31
[Music]
