If you have to come down with a strange disease, this town of 23,000 on the wide-open prairie in southeastern Minnesota is a pretty good place to be. The Mayo Clinic, famous for diagnosing exotic ailments, owns the local medical center and shares some staff with it. Mayo itself is just 64km east in Rochester. And when it comes to investigating mysterious outbreaks, Minnesota has one of the strongest health departments and best-equipped laboratories in the country.
And the disease that confronted doctors at the Austin Medical Center here last fall was strange indeed. Three patients had the same highly unusual set of symptoms: fatigue, pain, weakness, numbness and tingling in the legs and feet.
The patients had something else in common, too: all worked at Quality Pork Processors, a local meat-packing plant.
The disorder seemed to involve nerve damage, but doctors had no idea what was causing it.
At the plant, nurses in the medical department had also begun to notice the same ominous pattern. The three workers had complained to them of "heavy legs," and the nurses had urged them to see doctors. The nurses knew of a fourth case, too, and they feared that more workers would get sick, that a serious disease might be spreading through the plant.
"We put our heads together and said, 'Something is out of sorts,' " said Carole Bower, the department head.
A crisis in the making
Austin's biggest employer is Hormel Foods, maker of Spam, bacon and other processed meats (Austin even has a Spam museum). Quality Pork Processors, which backs onto the Hormel property, kills and butchers 19,000 hogs a day and sends most of them to Hormel. The complex, emitting clouds of steam and a distinctive scent, is easy to find from just about anywhere in town.
Quality Pork is the second biggest employer, with 1,300 employees. Most work eight-hour shifts along a conveyor belt - a disassembly line, basically - carving up a specific part of each carcass. Pay for these line jobs starts at about US$11 to US$12 an hour. The work is grueling, but the plant is exceptionally clean and the benefits are good, said Richard Morgan, president of the local union. Many of the workers are Hispanic immigrants. Quality Pork's owner does not allow reporters to enter the plant.
A man whom doctors call the "index case" - the first patient they knew about - got sick in December 2006 and was hospitalized at the Mayo Clinic for about two weeks. His job at Quality Pork was to extract the brains from swine heads.
"He was quite ill and severely affected neurologically, with significant weakness in his legs and loss of function in the lower part of his body," said Daniel Lachance, a neurologist at Mayo.
Tests showed that the man's spinal cord was markedly inflamed. The cause seemed to be an autoimmune reaction: his immune system was mistakenly attacking his own nerves as if they were a foreign body or a germ. Doctors could not figure out why it had happened, but the standard treatment for inflammation - a steroid drug - seemed to help. (The patient was not available for interviews.)
Neurological illnesses sometimes defy understanding, Lachance said, and this seemed to be one of them. At the time, it did not occur to anyone that the problem might be related to the patient's occupation.
By spring, he went back to his job. But within weeks, he became ill again. Once more, he recovered after a few months and returned to work - only to get sick all over again.
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