Chesapeake Quarterly Volume 6, Number 1: Why Did People Get Sick?

On a Friday morning in August 1997 he climbed aboard a large van in Baltimore and got ready to give his first Pfiesteria speech. On board with him was a team that he'd recruited from the medical schools at the University of Maryland and Johns Hopkins University. By 7:30 they were threading their way through rush hour streets headed for rural Somerset County, the last county down on the tail end of Maryland's Eastern Shore. Watermen along the Pocomoke River were telling the press they were getting sick, and a local doctor named Ritchie Shoemaker was backing them up. They thought the culprit could be a mysterious microbe in the water named Pfiesteria piscicida.

By the time the van hit the Bay Bridge, Morris was deep into his speech. A trim, calm-spoken professional with dark hair and a beard that was going gray, Morris leaned across the seat and gave his team their charge. "The state needs an answer," he told them. "Is there or is there not a human health effect associated with Pfiesteria? It's a yes or no sort of thing."

One week later, on the last Friday in August 1997, he announced the team's spectacular findings. Their answer was a Yes: Watermen and state workers exposed to the Pocomoke River had developed "profound" neurocognitive deficits, primarily problems with short-term memory.

The culprit could be Pfiesteria piscicida, a dinoflagellate in the river that was suspected of releasing a toxin that could cause sick fish — and now sick fishermen. Exposure to waters with Pfiesteria or its unnamed, look-alike cousins could be a health risk to people working, boating, or living around the Bay.

Back in 1997, Glenn Morris had three days to recruit a team of doctors and one neuropsychologist from the medical schools of the University of Maryland and Johns Hopkins University. Their job: examine watermen and state workers suffering odd symptoms from, they thought, exposure to the Pocomoke River. Was there a health effect caused by Pfiesteria or some other biotoxin lurking in the river? Photograph by Michael W. Fincham.

Glenn Morris in his office by file cabinets - by Michael W. Fincham

fish with a lesion - photo by Michael W. Fincham

Tommy East motored out of a small harbor in Shelltown in an open boat and headed down the Pocomoke River in the pre-dawn twilight. His early morning commute — in good weather, at least — was enviable. Under a brightening sky, he glided past woodlands, scattered homes and farms, and then broad stretches of tital marsh.

Three miles downstream, where the river widens into Pocomoke Sound, East went to work as the sun came up, wrestling with a dip net to pull fish out of large, roped-off fish pounds. He usually dumped shad and perch into his boat along with croaker and stripers. Ten years ago he kept finding fish — a lot of fish — with ugly red lesions. He would drop to his knees in the bottom of the boat and start throwing sick fish overboard. Photograph by Michael W. Fincham.

The medical report was a "bombshell" going off in newsrooms, said a reporter for The Baltimore Sun. "It was feast time," said a reporter for The Washington Post. The press responded with an explosion of coverage that churned out thousands of newspaper and television stories over the next year. The media barrage led to public confusion, political controversy, and economic loss. Charter boat captains lost customers. Tourists stayed home. Swimmers stayed off the beaches. Many anglers and boaters stayed off the Bay, as did some water-skiers and windsurfers and sailors. Sales of Maryland seafood plummeted, causing an estimated $40 million in lost income.

Last year, in 2006, after a decade of follow-up research, Morris announced another spectacular finding. But now his answer was a No. "The bottom line was we could find no evidence that having Pfiesteria in the water was having any effect on health," said Morris. Exposure to waters with Pfiesteria — in the Pocomoke or any other river in the Chesapeake — was probably not a threat to people who live or work around the water.

This kind of "good news" medical report was not a bombshell in any newsroom. The Baltimore Sun, which once carried over 170 Pfiesteria stories in one year, now gave the new report one short article. The Washington Post, which carried over 130 stories in one year, competing neck and neck with The Sun, decided to give the report one (even shorter) story. Reporters and editors who once feasted on the "bad news" about Pfiesteria seemed to have a long-term memory deficit.

The new medical finding, though barely mentioned in the press, begs this question: How did a Yes turn into a No?

And this question also: If Pfiesteria is not a serious threat, then what really happened ten years ago on the Pocomoke River?

The Road to Shelltown

As the big state van carried his medical team south down the Eastern Shore, Glenn Morris looked out the window and saw a television truck also headed for Somerset County. The press had immediately played up the idea of a medical dream team from the big city invading rural Maryland, ready to give locals what one reporter called "the mother of all medical exams." The exam would answer the question: Was something in the river making people sick?

Map showing location of Shelltown and Crisfield on the eastern shore of Maryland

Tom East on his boat near his traps - photo from The Pfiesteria Files

For much of the spring Tom East kept throwing away 30 to 40 percent of his catch. And he kept getting sick. A waterman with pale red hair, a healthy build, and a history of hard work, East found himself struggling with headaches, a crampy stomach, and breathing troubles. The watermen working with him, could see he was losing weight.

He was also losing his memory. He could remember jobs from 10 years ago, but he couldn't remember conversations from 10 minutes ago. In the middle of a job — cleaning a boat or repairing an engine or patching a net — he would pull up short like a boxer taking a rib shot and suddenly go blank. He'd stand there wondering what he was doing. He'd never been like that before. Photograph from The Pfiesteria Files.

Morris thought he already knew the answer — and it was No. As chairman of the Department of Epidemiology at the University of Maryland School of Medicine, he had studied the existing evidence about Pfiesteria piscicida, a dinoflagellate so small it could only be seen under a microscope. In North Carolina, the microbe had been blamed for killing fish and for making scientists sick during laboratory experiments. It had been found several times in Maryland waters, but only once around fish nets with sick-looking, lesioned fish. Watermen, prodded by the press, said Pfiesteria might also be making them sick. Morris, however, thought the health problem was probably an episode of mass panic. This might simply be "Pfiesteria hysteria," he told his van load of doctors.

Pfiesteria and other Hysterias

"Pfiesteria hysteria" became a popular catch phrase in the summer of 1997, both with the press and the general public, often as a way of dismissing watermen's worries as simple mass hysteria. In the growing medical literature, however, mass hysteria is far from simple, either as a definition or a diagnosis. It's usually called "mass psychogenic illness," a term that describes episodes where groups of people develop the same physical symptoms — but where medical exams reveal no organic causes for those symptoms.

When professionals talk of "mass psychogenic illness," they are never being dismissive. "It is very difficult to explain to people affected by mass psychogenic illness that they aren't crazy, that they aren't imagining their symptoms," says Tim Jones, an epidemiologist and author of a report in the New England Journal of Medicine. "These are real symptoms," he adds. "They are not malingering or making this stuff up to get out of work." Pains with no physical cause are still pains. Disabilities are still disabilities.

The history of mass psychogenic illness stretches back to the Middle Ages with hundreds of accounts of demonic possession, often striking nuns in convents or suspected witches living in villages like Salem, Massachusetts. The preferred treatments in the past were exorcism or execution. In recent centuries, mass episodes have been reported in factories and cotton mills and more frequently in schools — many of them girls' schools — in Europe, America, Asia, and the Middle East.

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