Diphtheria

Back in December I was writing about The Clap and relayed the brilliant tag: "Gonorrhoea: hard to spell, easy to catch".  The cause of the disease Neisseria gonorrhoeae is clearly related to Neisseria meningitidis which is one of several causes of meningitis - an inflammation of the layers protecting the brain.  I mentioned this connexion in my Human Physiology class last week because we were wrapping up January's discussions on the Nervous System by talking briefly about the brain.  I like, if possible, to relate the theory of neurotransmitters and "efferent motor nerves passing through the ventral root" to something that the students might have heard about if not seen or experienced.

Diphtheria also features regularly on Spelling Bees, but it features now only exceedingly rarely in schools and other places where children gather in the Western World.  It is caused by Corynebacterium diphtheriae, but only if the bacterium (that's a Gram +ve, facultative anaerobe to my current microbiology class) is itself infected by a virus that carries the gene for diphtheria toxin.  Diphtheria is a terrible way to go because it affects the upper respiratory tract which develops a greyish partly detachable second membrane.  The inability to breathe, rapidly fatal as any fule kno, can be relieved with intubation or a tracheotomy.  Let me advise you, in case Angus Wallace isn't available to do the emergency surgery, that you can hold open the hole you push through someone's trachea below the obstruction with the outer case of a ball-point pen.

100 years ago diphtheria was a ravening killer, particularly of young children who had not been exposed to the toxin before.  As late as the 1920s, 100,000+ people were infected each year in the USA resulting in 15,000 deaths p.a.  That's when there were only 125 million US citizens.  But in the 1920s they began to get on top of the disease by developing an anti-toxin by immunizing horses.  This anti-toxin could effectively mop up circulating diphtheria toxin before it started work.  Essentially this therapy could carry out a holding action until the patient's own immune-system started to produce anti-bodies.  Accordingly, you wanted to administer the anti-toxin early, but you didn't want to lay it out willy-nilly on any sore-throat or tonsillitis.  But be warned, Diphtheria is waiting in the wings even now.  There were 1 million cases in Central Europe in the aftermath of WWII,  And in the break-up of the former USSR/СССР, critical medical infrastructure (like the availability of vaccination) slumped and there were 200,000 cases and 5,000 deaths in the CIS/СНГ.

Nome, Alaska is just South of the Arctic circle, so it doesn't have total Darkness at Noon in winter but the day is absurdly short and the temperature is briskly chilly at the best of times. 1925 was on the cusp of being recognisable as the same as today.  There were telephones and aeroplanes, cars and domestic electricity.  But there were also horse-drawn buggies, gas-lamps, dirt-roads and disease.  In January 1925, the local Nome doctor Curtis Welch was forced to recognise that the case of tonsillitis that he'd diagnosed the day before was actually the beginning of an epidemic of diphtheria.  The reserves of anti-toxin were beyond their sell-by date and he called for more to be delivered if possible before hundreds of people under his remote and isolated care succumbed to the disease and dozens died.

Canvassing the West Coast of the contiguous 48 states located 1,000,000 units of the anti-toxin that could be shipped to Seward on the South Coast of Alaska.  From there it could be sent to Nenana by train on the Seward to Fairbanks line.  It was proposed that the cylinder of toxin would be sent by US Postal dog-sled from Nenana to Nulato where it would be met by another team who would take it on to Nome. It is not true that all Alaskan place names begin with N: there's Nairbanks, Nuneau, Nitka, Nchorage

The local newspaper magnate, a man looking to the future, thought this plan was both absurd and retrograde when there were aeroplanes available which could do the delivery in a few hours.  But the available planes weren't up to the job, any more than petrol-driven tractors were for Captain Scott when he brought them to the Antarctic in 1912 as part of his bid for the South Pole.

The distance was more than 1000km and the weather was brutal - normal for the Alaskan Winter -, the accounts record at one point "the temperature had now risen to -50^oC".  The first musher "Wild Bill" Shannon set off from the train-station at 2300hrs on 27th January 1925 - why not? it's no darker then than at 0700hrs the next morning.  He covered more than 80km (double a regular day's journey) but killed three of his dogs from frozen lungs (a minimum of -60^oC was recorded) and turned his own face black from frostbite.  He handed over to another team and so it went on through adventures that would not have been believed if written as fiction by Jack "White Fang" London. One chap had to feel about with his bare hands in a snowdrift when the precious cylinder was fired off the sled in an upset - he too got frost-bitten.  Another forgot, in the rush, to cover his dogs' genitals with rabbit-skin overcoats and they got frostbite. My grandfather froze a lung in the First War as a naval gun spotter.  He was left up in a balloon for several hours during a sudden Winter storm when it was deemed unsafe to winch him back to the surface.  He survived and lived for another 40 years.

Eventually, after 18 intervening teams had relayed the anti-toxin stage by stage onwards, Gunnar Kaasen galloped into Nome at 0530hrs on 2nd February 1925.  The mail had got through!  The medicine was distributed effectively and the anticipated epidemic was nipped in the bud.  Hurrah!  Kaasen's lead dog Balto was made into a media hero, briefly surpassing the movie star Rin Tin Tin in headlines and attention.  In our winner-takes-all Harry Potter world, it is ever thus: the man who made by far the longest stage, Leonhard Seppala, was severely miffed that his lead dog Togo didn't get much of a look-in.  Both dogs were stuffed and mounted after their deaths, Togo in Alaska and Balto in Cleveland OH, where their husks can be viewed today.