January 25, 1925 The Great Race of Mercy

“It was literally the plague among children. Many families lost three of four children—many lost all”.

In the 4th century BC, Hippocrates of Kos identified an upper respiratory infection, characterized by the formation of a leathery white “pseudomembrane” on the tonsils, pharynx, and/or nasal cavities of its victims.  Early symptoms resemble a cold or flu in which fever, sore throat, and chills lead to bluish skin coloration, painful swallowing, and difficulty breathing.  Late symptoms include cardiac arrhythmia with cranial and peripheral nerve palsies.

German bacteriologist Friedrich August Johannes Loeffler first identified Corynebacterium diphtheriae in the 1880s, the causal agent of the disease Diphtheria.  Within ten years, researchers had developed an effective antitoxin.

Today the disease is all but eradicated in the United States, but diphtheria was once a leading cause of death among children and adults over 40.

Diphtheria is highly contagious and spread by direct physical contact and by breathing aerosolized secretions of its victims.  Spain experienced an outbreak of the disease in 1613. To this day the year is remembered as “El Año de los Garotillos”.  The Year of Strangulations.

A severe outbreak swept through New England in 1735. In one New Hampshire town, one of every three children under the age of 10 died of the disease. In some cases entire families were wiped out. Noah Webster described the outbreak, saying “It was literally the plague among children. Many families lost three of four children—many lost all”.

download (7)Dr. Curtis Welch practiced medicine in Nome, Alaska, in 1925. Several children became ill with what he first diagnosed as tonsillitis. More came down with sore throats, early sufferers beginning to die as Welch observed the pseudomembrane of diphtheria. Dr. Welch had ordered fresh antitoxin the year before, but the shipment hadn’t arrived by the time the ports froze over. By January, all the serum in Nome was expired.

There were 10,000 living in Nome at the time, 2° south of the Arctic Circle. Welch expected a high mortality rate among the 3,000 or so white inhabitants, but the 7,000 area natives: Central Yupik, Inupiaq, St. Lawrence Island Yupik and American Indians with lineage tied to tribes in the lower 48, likely had no immunity whatsoever. Mortality among these populations could be expected to approach 100%.

Five children had already died by January 25, while Dr. Welch suspected more in the remote native camps. A plea for help went out by telegram and an Anchorage hospital came up with 300,204 units of serum. Enough for 30 patients. A million units would be required. but, perhaps this would be enough to stave off epidemic. Until a larger shipment arrived, in February.

A 20-lb cylinder containing the antitoxin and wrapped in protective fur shipped as far as it could by rail, arriving at Nenana, 674 miles from Nome. Three vintage biplanes were available, but all were in pieces, and none could be started in the sub-arctic cold. The antitoxin would have to go the rest of the way, by dog sled.

On January 27, a US Marshal pounded on the door of Willard J. “Wild Bill” Shannon, begging for his help with the relay to Nome.   It was after midnight and −50° Fahrenheit , when Shannon and his nine-dog team received the serum. The temperature had dropped to −62°F by the time the team reached Tolovana, 24 hours later. Shannon himself was hypothermic, with parts of his face turned black with frostbite.  Three of his dogs had died on the way, victims of frostbitten lungs.

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Leonhard Seppala and his team took their turn, departing into gale force winds and zero visibility, with a wind chill of −85°F.  With Seppala’s 8-year old-daughter and only child Sigrid at risk for the disease, the stakes could not have been higher.

Up the 5,000′ “Little McKinley”, Seppala gambled on a shortcut across the unstable ice of Norton Sound.  The howling gale threatened to break up the ice, stranding the team at sea.  Visibility was so poor that Seppala couldn’t see his own “wheel dog” – the dog nearest his sled.  The 19-dog team struggled for traction on the glassy skin of the ocean water, returning to the coastline only hours before the ice broke up.

Much of the time, navigation in that black, frozen wilderness was entirely up to Seppala’s lead dog.  Most sled dogs are retired by age twelve, especially team leaders, but it was twelve-year-old “Togo”, who was trusted with the lead.

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Seppala and Togo ran 170 miles to receive the serum, returning another 91 miles to make the handoff on February 1. Together the pair covered twice as much ground as any other team, over the most dangerous terrain of the “serum run”.

Gunnar Kaasen and his team took the handoff, hitting the trail at 10:00 that night. A massive gust estimated at 80mph upended the sled, pitching musher and serum alike into the snow. Already frostbitten, Kaasen searched in the darkness with bare hands, until he found the cylinder. Covering the last 53 miles overnight, the team reached Front Street, Nome, at 5:30am on February 2. The serum was thawed and ready to use,  by noon.

seppala520 mushers and 150 dogs or more had covered 674 miles in 5 days, 7½ hours, a distance that normally took the mail relay 2-3 weeks. Not a single serum ampule was broken.

With 28 confirmed cases and enough antitoxin for 30, the serum run had held the death toll to no higher than seven.

Doctor Welch suspected as many as 100 or more deaths in the native camps, but the real number will never be known. An untold number of dogs died while completing the run.  Several mushers were severely frostbitten.

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Gunnar Kaasen and Balto

Gunnar Kaasen and his lead dog “Balto” were hailed as heroes of the serum run, the dog becoming the most popular canine celebrity in the country, after Rin Tin Tin. There was a nine-month vaudeville tour, and Hollywood produced a 30-minute silent film, “Balto’s Race to Nome,” starring himself in the lead role.

A bronze likeness was erected in New York’s Central Park in 1925, with Balto in attendance.  The statue stands there to this day, though Kaasen’s lead is depicted wearing Togo’s “colors” (awards).

Balto’s fame was a source of considerable bitterness for Leonhard Seppala, who felt that Kaasen’s 53-mile run was nothing compared with his own 261, Kaasen’s lead little more than a “freight dog”.  The statue was particularly galling.  “It was almost more than I could bear” he said, “when the ‘newspaper dog’ Balto received a statue for his ‘glorious achievements’”.

Togo lived another four years though the serum run rendered him lame, never again able to run. The real hero of the serum run spent the last years of his life in Poland Spring, Maine, and passed away at the ripe old age of 16.

Wild Bill Shannon disappeared in 1937, while prospecting for gold.  His bones were discovered four years later, perhaps a victim of exposure, or perhaps yet another “close call”, with a grizzly bear.

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Leonhard Seppala and Togo

Leonhard Seppala was in his old age in 1960, when he recalled his lead dog on the serum run.   “I never had a better dog than Togo. His stamina, loyalty and intelligence could not be improved upon. Togo was the best dog that ever traveled the Alaska trail.”

Today, the memory of the 1925 serum run lives on in the Iditarod Trail Sled Dog Race, held every March and run over much of the same terrain as the ‘Great Race of Mercy’.   Togo himself is stuffed and mounted,  standing watch at the Iditarod museum headquarters, in Wasilla, Alaska.

Afterward

Despite the decrepit condition of those three biplanes, pilots and mechanics thought they could have one ready to go, in three days.  The challenge was immense.  Ethylene Glycol wouldn’t be used as an automotive anti-freeze until the following year, and older methods such as Methyl Alcohol wrought havoc on internal engine components.

e16a10c46b80a325b8c6e8e4009c828c“The once tight fabric covering the wings and fuselage was weak from all the rough landings as well as the wind and rain. Dirt and oil caked the engine and prop. Wires for the rudders and elevators hung from the sides of the fuselage.” Even in such disrepair, the pilots and mechanics thought one of the planes could be ready to go Nome in just three days, a flight they thought would take no more than 6-hours”.

If unsuccessful, all would be lost.  Pilot, aircraft and serum.

The decision was a high stakes gamble, falling in the end to Alaska Governor Scott Bone, who decided on the twenty-team relay.  Good thing, too.  Multiple efforts to get one of those aircraft in shape for the second shipment, failed.

The Salisbury cousins Gay and Laney tell the tale in a harrowing account called The Cruelest Miles, if you’re interested in more reading.  I haven’t gotten to mine yet, but it sounds like a good read.

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April 12, 1955 Conquering Polio

Poliomyelitis tended to come out in the summer, disproportionately effecting children and young adults.

When I was a boy, I once asked my mother what polio was.  At the time, I didn’t understand the expression on her face.  What I saw that day, was her realization that her children would never have to fear a plague that had terrified her generation and those before it.

Imagine the impact of the AIDS virus. Now, instead of the well understood vectors by which that virus is transmitted, imagine all the terrifying finality of that disease combined with the randomness of the common cold.Wheelchair

The first major polio epidemic in the United States appeared in Vermont, when 132 cases were diagnosed in 1894. A larger outbreak killed 6,000 New York City residents in 1916, with over 27,000 cases diagnosed.

Poliomyelitis tended to come out in the summer, disproportionately effecting children and young adults. 58,000 cases were reported in the 1952 epidemic alone, 3,145 of them died and another 21,269 left with mild to disabling paralysis.

A President of the United States suffered from polio, as a younger man. The press did their best to treat the matter with delicacy, but the disease left him able to stand only with great pain and difficulty, dependent on a wheelchair for the rest of his life.

Others were doomed to 800lb monstrosities called “iron lungs”, seven-foot long, “negative pressure ventilators” which reproduced the movements of breathing.  The Smithsonian Institution estimated that 1,200 Americans were dependent on iron lungs in 1959.  Lattimore, North Carolina resident Martha Mason contracted polio at age 11, and spent 61 years in an iron lung before her passing in 2009.

Today, modern “biphasic” ventilators (alternating negative/positive pressure) are worn like the cuirass of the conquistadors, all but replacing the iron lung.  As of 2014, there were only ten individuals left, living their lives in one of the things.

Iron Lung

Early efforts to develop a vaccine, proved fruitless.  One New York University study produced no immunity whatever, at the cost of nine dead children.  Other vaccine trials used “volunteers” at state mental institutions.

Jonas Edward Salk was born on October 28, 1914, the son of Jewish immigrants of Irish descent. Daniel and Dora (Press) Salk were not themselves formally educated, but the Jonas-Salk-2couple kept their kids focused on school.

Salk attended City College of New York and New York University School of Medicine, taking the road less traveled on graduation from Med School. Instead of becoming a practicing physician, Salk went into medical research.

Salk accepted an appointment to the University of Pittsburgh School of Medicine in 1947, the following year beginning a project funded by the National Foundation for Infantile Paralysis, which later became the March of Dimes. The grant was funded to determine the number of polio types, but Salk took it several steps further. He saw it as an opportunity to develop a vaccine.

It’s not widely known that the American Revolution took place during a smallpox pandemic. George Washington himself was a proponent of vaccinating, which, as with rabies, was always done with live virus.Polio Trials

Live virus vaccination carries obvious risks, and Dr. Salk was interested in the way the body developed antibodies to killed virus. He and his team completed lab trials in 1954, when they injected themselves and a number of volunteers with inert virus. Having had no ill effects, they began field trials a short time later.

Field trials of Dr. Salk’s vaccine were some of the most extensive in history. 20,000 physicians and public health officials were involved in the trial, along with 64,000 school personnel, 220,000 volunteers, and over 1,800,000 school children.

News of the vaccine’s success was announced on April 12, 1955, and Jonas Salk was hailed as a miracle worker. David Oshinsky, history professor at New York University and author of Polio: An American Story, tells a story about that day. “The public was horribly and understandably frightened by polio,” he wrote. “There was no prevention and no cure. Everyone was at risk, especially children. There was nothing a parent could poliodo to protect the family. I grew up in this era. Each summer, polio would come like The Plague. Beaches and pools would close — because of the fear that the poliovirus was waterborne. Children had to stay away from crowds, so they often were banned from movie theaters, bowling alleys, and the like. My mother gave us all a ‘polio test’ each day: Could we touch our toes and put our chins to our chest? Every stomach ache or stiffness caused a panic. Was it polio? I remember the awful photos of children on crutches, in wheelchairs and iron lungs. And coming back to school in September to see the empty desks where the children hadn’t returned.”

Jonas Salk consumed over seven years of his life on his goal. When broadcast journalist Edward R. Murrow asked him “who owns the patent on this vaccine”, Dr. Salk replied: “There is no patent. Could you patent the sun?”

All those years, all that time, work and effort, and even in the end the man took no personal financial interest in the result. A mortal virus afflicted the children of his generation, and he was going to lift heaven and earth, if he had to, to stop it.Salk

In the late 50s, Salk became interested in building his own research institute. He searched for a site for over a year, until he met San Diego Mayor Charles Dail, himself a polio survivor. Dail showed Salk 27 acres on a mesa in La Jolla, just west of the proposed site for the new UC campus then planned for San Diego. In June of 1960, the citizens of San Diego overwhelmingly voted “yes”, to donate the land for Salk’s dream. Construction began with initial funding from the National Foundation/March of Dimes, and completed in 1967.

Jonas Salk died on June 23, 1995, at the age of 80. A memorial at the Institute bearing his name reads: “Hope lies in dreams, in imagination and in the courage of those who dare to make dreams into reality.”poliovaccina

By 1979, the disease was eradicated from the United States.  The worldwide effort to wipe out polio began in 1988, with the Global Polio Eradication Initiative.  20 million volunteers from virtually every country in the world have vaccinated over 2.5 billion children, at a cost of $11 billion. Worldwide, the incidence of new polio cases decreased by 99%.  Today, the only region where polio remains endemic, are northern Nigeria and the border between Afghanistan and Pakistan.

And so it is that those of us born after 1955 can go on in blissful ignorance, having no idea of the terrors our parents endured before us.