Mark Pendergrast’s book, now available in paperback, has a little bit of everything.  History, politics, adventure in distant lands, men & women putting themselves in harm’s way for the good of mankind, epidemics, outbreaks and (I know this is gross) lots of diarrhea.  It’s hard to know where to begin. Officers in the Epidemic Intelligence Service specialize in tracking diseases and epidemics, on the ground, as they occur.  They excel in fieldwork – their logo features the worn sole of a shoe – and Pendergrast obviously sees them as the Indiana Jones-es of disease.  Inside the Outbreaks is a frenetically paced overview of the history of this agency and its greatest hits.

The Epidemic Intelligence Service was begun in 1951, the brainchild of Alexander Langmuir, and is now a part of the CDC (Center of Disease Control & Prevention).  Pendergrast keeps events in chronological order – dividing the book into 3 parts: 1951-1970, 1970-1982 & 1982-PRESENT.    In the beginning this made for unwieldy reading  (particularly on a Kindle).   The  EIS is an incredible multi-tasker.  At any given minute agents are in dozens of countries, researching a multitude of symptoms – with  mixed outcomes.   While this is a testament to the dedication of the agents, the constant jumping back and forth makes keeping track difficult.  In addition to the history of the diseases, you’ll read about the politics and the heartbreak of epidemiology:  who carried a grudge against who, what it was like to be the spouse of an agent, the slow rise of minorities in the EIS, who lives, who dies.   Pendergrast is fair, presenting the good with the morally repugnant (testing performed on the mentally handicapped, African-Americans, orphans and prisoners).  Trial and error is the underlying theme. Agents frequently build on their predecessors’ work.  Admittedly, it took me until the 1970’s to feel I had a grasp on what I was reading – but once there I was riveted and loathe to put the book down for even a second.

It was clear that the Biafran enclave would soon fall, and the U.S. Department of State wanted someone from the CDC to conduct a nutritional survey.  On October 14 Karl Western flew into Biafra with a State Department diplomatic team.  The Biafrans, focused on negotiating a peace settlement, did not want a nutritional survey done. “I anticipated this,” Western recalled.  “I had brought two jerry cans of petrol, a letter of introduction from Bill Foege, and somewhiskey for the missionaries.”  He slipped away from the negotiations and hitched a ride by holding up a jerry can.  Since gas was rare, the driver stopped.

Western conducted a random population survey in thirty-six widely distributed sites in eight provinces of Biafra.  Of the 2,676 villagers he examined, 31.4 percent were severely malnourished.  There were few very young or elderly villagers, since most had died.  “The most important question was how many people were in the enclave,” he recalled.  “Some said one million.  Some said ten million.” Western found that 67.2 percent of his sample had smallpox scars.  Knowing that over a million doses of smallpox vaccine had been administered in the area during the campaign, he extrapolated to estimate the total Biafran population was 3.23 milliion.  Of those, roughly a million suffered from advanced protein malnutrition.  Amazingly, Western accomplished all of this in less than two weeks.

All your big name diseases make an appearance: polio, measles, small pox, malaria, Reye’s & toxic shock syndrome, Hep B, influenza, Ebola… I’d go on but I hate to name drop.  Even if you have only a passing interest in science and medicine I recommend this book.  Inside the Outbreaks is inspirational and for my money a better real life adventure story than the more popular The Lost City of Z.  The original dust jacket featured a comic book style superhero – whereas the new cover is a much more somber view of a slide under a microscope.  The former is better.  There is definitely an episodic, graphic novel, quality to Pendergrast’s writing.  It also reminded me of the old black & white news reels  – complete with the booming voiced, up-beat narrator.  You probably think I’m mixing metaphors here, but what both graphic novels and black & white newsreels have in common is that each installment tells a self-contained story, the threads of which are picked up and expanded on in later installments and eventually become part of an even larger story arc.   It can be difficult at first to wrap your head around the fact that this is not a book about a specific disease but one dedicated to an agency that deals in diseases.  Instead of Batman, Inside the Outbreaks gives you the whole Justice League.

Note: you can find a simplified CDC timeline here of the history of the EIS.

Publisher: Mariner Books, New York (2011).
ISBN:  978 0 54 752030 8