The disease began in various ways, but commonly with chills and heats, pressure and pain in the head, soreness of throat and hoarseness, some cough, sickness of the stomach, frequent vomiting and purging. These symptoms occurred more frequently in children
and were then very severe in adults. They were less emphatically expressed, commonly on the uvula, tonsils, vellum platinum, and back part of the pharynx, several whitish or ash colored spots appeared scattered up and down, which oftentimes increased very fast, soon covering one or both of the tonsils. These eventually proved to be the sluffs of superficial ulcers. The tongue, at this time, though only white and moist at the top, was very foul at the root and covered with a
thick yellowish or brown coat. The breath also now began to be very nauseous. The offensive smell increased hourly, and in some instances became quite intolerable even to the patients themselves. By the second or third day, the sleuths were much enlarged and of a darker color, and the surrounding parts tended much more to a livid hue. The breathing became more difficult, with a kind of rattling stirter, as if the patient was actually strangling, the voice being exceedingly hoarse and hollow.
Wow.
Yeah, it's pretty intense. So is the sound like to you?
Sounds like diphtheria.
That's right, the topic of today's episode.
All right, Hi, I'm erin Welsh and I'm erin Almond Updyke, and.
You are listening to this podcast Will Kill You Dip Theory Edition.
Yep, So I'm really excited.
I am really thrilled.
You've been talking about this one for a while now, I know.
And there's also there's been something in my part that I have been dying to tell you about, and I've been keeping it secret and.
Keeping it safe, keeping it secret, keeping it safe. I can't wait to hear it good.
I guess though, that we should start first.
With our quarantines.
So what do we have to drink tonight?
Tonight we're drinking the Strangling Angel. Oh that sounds menacing. It's a little bit, but it's also quite delicious. It's actually quite good. It's a kind of a variation on a penicillin which who knew that was a real cocktail.
Maybe we should have We do, now we do.
It's got what whiskey, lemon bourbon rye and lemon juice, ginger liqueur, and a little maple syrup. And in addition to our quarantinies, this episode will also be making what are we calling them, plus ey burritos, Yeah, plussy burritos. Guys, come up with a better name for that. And we'll be posting the full recipe for the quarantinies and the plussy bo ritos. We'll be posting those non alcoholic versions online as well on all of our social media channels.
You guys can find those and drink along with us.
Yeah. So, so now that that's out of the way.
Let's get started. So, diphtheria is caused by a bacterium known as Karini bacterium diphtheria. And I did, in fact look up how to pronounce that. Oh good, that's like the first time for me. Ever, Well, it's a it's a strange spelling. Yeah, I looked at it and I was like, I'm gonna look this one up. Karini Bacterium diphtheria. It's a gram positive rod so it's shaped like a little tube, not a.
Ball, like a little good and plenty.
Yeah, good and plenty. That's a great one actually. And one thing that's interesting about this disease is that the disease that we associate with diphtheria is not caused by the bacterium itself. It's caused by a toxin. And this toxin is produced by a virus, a bacteria phase that actually infects the bacterium. What. Yeah, So a lot of the toxins we talked about toxins in the MRSA episode, A lot of the toxins that bacteria that quote unquote
bacteria produce are actually produced by viruses. So it's this little mutualism or yeah, commensalism I haven't really seen. I mean, presumably, at least in the case of humans, which are the pretty much only reservoir for diphtheria, you might be getting more sick. So I guess if that's beneficial, then you could call it a mutualism. But I don't know if that actually, like, I don't know that the bacteria survives
any better with this bacteria phase or not. Okay, so maybe someone else who knows can tell us.
That's really interesting though, yeah.
So it's not the bacterium itself. So there are strains out there that are what are called non toxogenic strains. Those can still infect you. They can still cause some disease, but they only don't cause as severe of disease and not the type of disease that we might associate with diphtheria. Okay, so ready, uh huh, so diphtheria, and from now on, whenever I talk about it, will just assume that it's a toxogenic strain of the bacterium. So it's making toxin,
it's trying to kill you, gotcha. It's transmitted via aerosols, so coughing, spitting, sneezing, et cetera.
Lovely.
The incubation period is two to five days, so if I cough on you two to five days later, you're going to be getting sick most likely. And historically not to step on your toes or anything.
No worse my toes are saying.
But historically diphtheria has been a disease of childhood, very specifically of childhood, meaning babies didn't usually get it and adults didn't usually get it. Do you have a guess as to why?
Hmmm, I'm guessing that in babies it would have to do with maternal antibodies from breast milk.
Nailed it.
And adults, I would assume that most of the adults would have had been asymptomatic and been exposed.
To it and then developed immunity or just had it and survived it. Yeah, exactly, So they definitely were exposed and either got the infection and survived it, or they were asymptomatic carriers, which is very common in diphtheria, meaning just because someone looks healthy doesn't mean they are.
Dun't dun dull.
All right, So let's get into what actually happens when you get infected. Okay, So the first place that diptheria tends to colonize is your naso pharynx, so that means your nose and your throat.
Okay.
It is possible to only infect your nasal passages, in which case the disease that it causes is more like the common cold. It's not as severe. You get a lot of bloody mucus and puss coming out of your nose.
Yeah, that's pretty gross.
But it's less common. More commonly, it's actually going to kind of go straight to the back of your throat, and that's its sort of favorite spot to infect. So the progression of the disease I saw described as insidious, which is not a good No. You don't want something in your body to.
Be negative connotation to that word canny negative.
So here's how it begins. You start with a fever, but not like a crazy high fever, so maybe not one that makes you go, I need to get to the doctor. Right, you're running like one hundred maybe one hundred and one max. So you're feeling crappy, You're feeling tired, maybe weak, You've got just generally like malaise. You're like, God, I'm coming down with something. Maybe it's the flu, I don't know. And then your throat, like it really hurts.
It hurts pretty bad. So then because you're feeling crappy and your throat hurts, you've got anorexia. Right, You don't want to eat anything, you don't want to swallow, and you just feel bad.
So is just just means not wanting to eat anything?
Yeah, exactly, you're not eating, and so you're like, Wow, maybe it's strub throat. Maybe that is that what I've got. I don't know. But then within two to three days you're not getting better. And at the back of your throat you'll see this thing and it starts out white, just sort of attached to like the roof of your mouth and like back near your tonsils, and then it gets bigger.
I don't like this.
It just keeps getting bigger and it starts out white, but as it grows to cover your entire soft palate, it can turn green or gray or black, god black. Yeah, And it's not really puss because puss you can kind of spit that out right, like mucus. You could sort of put your finger back there and scrape it off. Oh, you can't do that with this because it's stuck gone. And if you try, like if you really really try in there, you're just gonna cause yourself to bleed a
lot because it's stuck on there. Oh. And at this point, it might be getting kind of hard for you to breathe. So if you finally were to go to the doctor and they put a stethoscope up to you, they'd hear a sound something like this.
Was that good? Oh my god, I am feeling like the need to breathe very deeply. This is I'm feeling very stressed right now.
Aaron's really I've made her very anxious.
I am highly anxious.
So that sound that I mimicked, I'm pretty proud of myself for that I practiced. It was excellent, thank you. It's called streider. It's not a good sign. It's a very very bad sign. So at this point, if you've progressed this far, you have two fates. Either you recover somehow or you die. It's pretty much a fifty to fifty chance the end.
Just kidding, I'm just letting this sink in because I have read obviously, like it's come across my research about sort of the membrane and the dying. But it's it's.
Ugh when you hear the whole When.
You hear the whole thing, and you just imagine this. Well, first of all, I'm going to be terrified for every time I get a cold from here on out, I'm gonna be constantly checking the back of my throat.
You don't need to do that, You've been vaccinated here.
Some of us are just nervous by nature, yeah, not naughty by nature.
So yeah, So this thing that's on the back of your throat is called a pseudo membrane. I don't know why they call it that, but that's what they call it. It seems like a pretty real membrane and not a pseudo one, but that's what they're calling it. And basically what happens, and one of the very common ways that you end up dying from diphtheria is that this thing grows so large and then your surrounding lymph nodes will also swell up that basically your airway is blocked off
and you suffocate. Oh now that's not the only way that you can die from diptheria. But before we talk about the other ways that you can die, will take a step back and let's talk about what's actually going on inside your body. Why are these specific symptoms happening. So, like I said, the primary thing that's actually causing this disease is a toxin, diphtheria toxin, not the bacterium itself. So what happens is this, this toxin is released from
the bacterium made by the bacteria phage inside. Released from the bacterium into your body, it enters your cells, so it can actually attach to certain receptors on your cell and get inside of your cell. And once it's in your cells of like the epithelium of your throat, right, it basically inhibits protein synthesis. One of the main things that cells do is make protein. If your cells cannot make protein, they will die.
Yeah, so inhibiting that seems pretty bad.
It's not good, So it basically causes cell death. So this toxin gets into your cells, stops them from doing their job, and then results in their death. The pseudo membrane that you're actually seeing on the back of somebody's throat is a direct result of this toxin. It's made up of a whole bunch of dead cells that have been infected by this toxin and then killed. And then what happens is because the bacteria are also there, right,
so there are colonies of bacteria. You've got macrophages and neutrophils, which are white blood cells that are coming in to try and eat the bacteria and also clean up after all these dead cells that are now in the back of your throat. And when there's dead cells, what they do is they lay down this stuff called fibrine, which is like scar tissue. And so that's why it's adherent to the back of your throat. It's not like when you get sick with another like strep throat, for example,
and you might have a bunch of mucus. That mucus is also just white blood cells and bacteria. The difference here is that because you have a bunch of cell death, you have fibrin being laid down, and that's everything is attached still to your healthy, living tissue.
That makes sense and is also that much more horrifying.
Yeah, definitely, yeah, because there's no just like, oh, let me just hack cough really hard and hack this thing up right. You can't. You can't hack it up, and it suffocates you, suffocates you.
I feel claustrophobic.
I can tell. It's a small room. But like I said, asphyxiation is not the only way that you can die.
Cool.
So, the toxin is released into your bloodstream, and your naso pharynx, especially the back of your throat is just rife with blood supply, which means that this toxin can make it into your blood supply and then it can go to the rest of your body.
Cool cool, cool, cool cool.
It can travel to your heart, where it will do the same thing that it does in the back of your throat, so it's going to infect your heart cells cause sell death and then fibrosis or scarring. And what happens when you have scarring on the muscles of your heart is the conductance, the electrical activity that controls your heart is impaired. So you've got a bunch of scars
from everywhere where. You've got dead cells because this toxin killed your cells, and now your heart can't send impulses, so it can't pump correctly, so you end up with arrhythmias. Your heart's not beating in sync with itself, so you can die because your heart stops beating correctly. You can also die. There's more.
You can you can just you can just your heart will just stop beating.
Yeah, you go into like like a like a tachycardia or an a arrhythmia where your heart is not beating correctly, like maybe you're gonna have atrial fibrillation, which means the top part of your heart is like like, say what my hands are doing because I can't what do you call this? V I don't know.
I mean that looked like jellyfish tendrils.
Okay, so it's kind of like that, like like instead of being like dunk dunk, dun't dunk. Your heart's like it's fluttering. Yeah, exactly, So that can happen, and that'll kill you, right, because if your heart's not dunk dunking, it's not pushing blood out. That's what dunk dunk is. Right. You also could just become paralyzed. Cool, because it can infect your nervous tissue. And if it infects your nerve cells and then your nerve cells die, then you can't
transmit electricity. Yeah, so it's pretty gnarly. You also can get cutaneous diphtheria, which is basically a giant ulcer on your skin. It's pretty it's pretty gnarly looking. We should post a picture, but I don't know if we should post a picture because I we.
Can do like a like to see graphic content.
Yeah, because it's pretty gross.
Now, is that again with the fibrine.
No, it's actually usually a non toxogenic strain that infects your arms, well, not just arms, but your skin. Not exactly sure why, but I have some good news because it looks like you could use it.
Yeah. I'm very tense right now. My arms are folded. She's very well. I feel like my heart is a rhythmic.
Right now, untreated, I guess I have a little more bad and then we'll get to the good. Untreated, the mortality rate is up to fifty percent, so about half of people who get infected and do not have any treatment will die from diptherea high. It's pretty high. Treated, so we do have a treatment. Treated, the mortality is between five and ten percent, which is still kind of high, and in young children it's actually as high as twenty percent.
And the thing that's really sad is this case fatality rate has not improved over the last fifty years, so we're not any better at treating it now than we were in the nineteen forties and fifties. That's scary, yeah, but you want to know how we treat it, it's kind of cool.
Yeah. Yeah.
So there's two things that you have to do. The first is give an anti toxin. You do that to actually treat the symptoms. The thing about this treatment, the anti toxin, is that it only works on toxin that is not already bound to your cells, So you have to be treated very very early in the course of disease because any cells that are already infected with the
toxin are screwed. And then on top of that, you also treat with an antibiotic, and that's both to kill the bacterium itself so it stops making more, and to protect those around so to make sure that you don't spread this disease to anybody else. And the best news is that there is a vaccine, but we'll talk more about that later. So tell me how did we get here?
Excellent question? Diph theory? Where to begin? Before I started researching this, the word dip theory didn't really mean much to me on its own right. It was more just like part of a vaccine, lumped in with other diseases that you don't really hear much about it anymore, except more recently with the whole anti vaccine movement, which I'm
sure we'll get into a bit later. Yeah. Anyway, but as I read more about the history of this disease, I found that the mention of diphtheria in a village or a city could cause a huge panic.
Wow, and it was.
Yeah, it was one of the most feared diseases in pre vaccine times for a few reasons. One, it attacked children, primarily, so it causes horrible slow suffocating death that you just talked about, Yeah, which just sounds so awful.
Yeah, you just like watch your kid suffocate.
Yeah, like I cannot imagine.
Yeah, it's pretty bad.
And also too it would show up suddenly and tear through an entire town or village and nothing seemed to stop it. So let's just check off the etymology of this disease before going into any more of its gory historical details. Diphtheria didn't get its name until eighteen twenty six.
WHOA, that seems super late.
Yeah, and so in this year, a French pathologist named Pierre Bretoneau came up with diphtherite or something like that, which is from the Greek root diphthera, meaning leather, which is of course what that tough membrane in the throat resembled.
Leather, leather, second football.
Yeah, and apparently it smelled really bad according to the first hand account.
Okay, I really think that was just poor hygiene.
I saw every like, there were so many first hand accounts that I read that were like it smelled discs.
It does make sense because it's just like a bunch of dead stuff in the back of your throat, But like some of that description in the first hand account was like its tongue was brown. I'm like, bro, that's you man.
Okay, well, fair enough, but it was one of the when in reading some of this it seemed like there was a characteristic diphtheria smell. Yeah, but the naming itself was really important in the history of diphtheria because before this, outbreaks of sore throat were called by a bunch of different names, which made tracking and monitoring outbreaks difficult, not to mention developing any kind of treatment that was reliable
or consistent. Right, Okay, so the name didn't come about until the nineteenth century, but this wasn't a new name given to a new disease. This disease has really characteristic signs like extreme sore throat, leathery membrane. So you would think that tracing the history of diphtheria would be somewhat easy, at least compared to diseases like staff, which was much.
More right, it's like everywhere and everything and causes so many different types of disease exactly.
Yeah, but it actually doesn't have that much of a history before the seventeen hundreds.
What.
Yeah, at least that I found, and I could be wrong, and I could be looking in the wrong places, But there were some mentions. In the fifth century BCE, Hippocrates writes about a disease that sounds an awful lot like diptheria. And there's another mention a few hundred years later by Aretaeus the Cappadocian, in which he describes ulcers in the throat and warns that quote, if it spreads to the thorax by the windpipe, it occasions death by suffocation within
the space of a day. Yep. And that quote children until puberty especially suffer yep.
So it does sound a lot.
Like probably, And that's really more or less the last mention of the disease until the late fifteen hundreds and early sixteen hundred.
It's weird.
And so that's when there was a series of epidemics of sore throats resulting in suffocation that swept through Spain and parts of the New World. This epidemic was referred to as Alao de los gartios, essentially meaning the year of strangulations. That was one translation I found for that chill.
But yeah, it sounds terrifying, a year of drangulation. Yeah, but it remains a bit of a mystery as to why there's no mention of this disease for over a thousand years, and so I was starting to wonder, well, are we just missing historical accounts or did it not really act as an epidemic disease for all that time, or were the ancient descriptions of the disease actually something else that just happened to resemble diptheria.
Yeah.
I couldn't really find a whole lot of information on that on this missing puzzle piece, but I did see somewhere that the bacterium is thought to have come from domestic herbivores, which means it probably has ancient origins, right, Maybe the incorporation of the bacteria phase was more recent and then the toxin more recent, but.
I don't know. Yeah, And the thing is that it's like humans, from what I read, are the only reservoir, so these aren't. It's not like currently a zoonotic disease, So that would further point to an ancient origin exactly.
I don't know. Weird. In any case, diphtheria emerged with a vengeance in seventeen thirty five, when outbreaks of the illness occurred in New England, Great Britain, France and the West Indies. People called it throat distemper. Yeah, and sufferers either died from suffocation by the thick grayish membrane covering their throat.
She's gonna say that like one hundred more.
This is the most horrible thing to me. I don't know why or if they survived that they could just drop dead a week or two later. Yep, as we've heard, yeah, cool cool, cool, cool love it. This outbreak disproportionately affected children, and some families lost all of their kids, like entire families, just kids all gone. I know.
It is quite infectious, and so it does make sense that if you've got a bunch of kids, it's going to go like chicken pox from one to the next to the next and then yeah, boom boom boom awful.
In Kingston, New Hampshire, a third of all children in this town died from the disease. Whoa a third of all the children and the state itself lost five percent of its entire population.
So that's really crazy because that means it's not just like always there. It's like coming into these communities wiping them out and then moving on exactly, because if otherwise, you would just have like low levels of death all the time.
Right, weird. Never, it's an epidemic disease, it's not an endemic, So then.
It's even weirder that there's not more accounts of it.
Yes, what I know? Oh sounds like yeah, yeah, it's it's bizarre.
That is super bizarre.
Obviously, with such a huge loss of life comes people seeking answers or at least where they can point fingers, and many Puritan ministers said that the people had brought it on themselves by straying too far from the religious path, which I'm sure is exactly what they needed to hear, as they have lost their entire children.
Oh god, it's your own fault. Mother's right, the wanton mother, the wanton mother.
Ridiculous anyway, So, after this first big diphtheria epidemic in seventeen thirty five, outbreaks showed up every twenty five years or so, whoa yeah, And it slowly shifted from this epidemic rural disease to a more endemic cosmopolitan disease by the mid eighteen hundreds, and it seemed to increase in virulence the entire time. Yeah, it was during these outbreaks in the eighteen hundreds that diptheria got its name, the strangling Angel, which is the name of our quarantine if
you remember. In an outbreak in New York City in eighteen fifty seven, the case fatality rate was forty two percent, which is I mean, as we know, that's that's just what you said, but that's still so hot. Yeah, I mean that's almost bubonic plague.
You And it's children, right, children, So you've got a school house with one hundred kids in it, They're all going to get infected, right, and like realistically, forty two of them are going to die. Yeah, you now have fifty eight kids in your class. Yeah, right, that's right, thank you, that's what.
Yeah. And no amount of therapy or supportive treatment could save the lives of those suffering, and so they died this slow, terrible death. God. So physicians deeply feared diptheria
because they felt pretty much helpless against it. Yeah, and even more helpless than the parents, because the parents would take their children to them, expecting this person to try to make things better and no, so it was it was a parent's absolute nightmare to watch their child suffering so horribly, and for this reason, dip theoria played a prominent role in the development of germ theory in the eighteen hundreds.
Our fave.
Oh yes, all right, so it's the mid eighteen hundreds. Okay, let's take a minute to consider some of the prevailing thoughts on what caused disease.
Your bad sexual habits. Okay, wait, that's actually true, My bad, I'm sorry, let me try that again. Not praying enough.
Actually I don't really have that in here. I think by that time it was not so it wasn't so much about the morality. Okay, it was bad air, yes, absolutely, so miasma that kind of thinking, which if you remember from John Snow and the Cholera Broadstreet.
Cholera Outbreak, episode four, if you haven't listened to it.
Yes, that was all thought to be miasthma.
So.
And then there's also humorism or humoralism, which we've talked about during Tuberculosis episode nine. And then there's germ theory. Yes, so the idea that many diseases are caused by microorganisms. So this idea was around, but not necessarily widely accepted quite yet, because humorism was still kind of the prevailing thought, but it pretty quickly fell out of favor as formal medical research focused on specific tissues or cells as indicators
of disease. Importantly, they started asking whether if a specific tissue or organ was inflamed, there could be multiple causes for the same symptom For instance, diphtherias, scarlet fever, and stripped throat all result in inflammation of your throat. Does that mean that they are one disease or many. This is a big shift in the way that people thought about disease, so the answer might be obvious to us now. Of course, these are different diseases, they have different symptomology,
blah blah blah. But back then, before germ theory had taken hold, this wasn't straightforward, and the concept of multiple causes for the same disease symptoms was really huge, and it partially paved the way for germ theory, especially the one germ, one disease concept. With dip theory, one thing seems certain. It was contagious. If it showed up at a school in one kid, it was only a matter of time before the entire class, as we illustrated, was
sick at home or in the hospital or dead. Now that we knew it was contagious, it was like, okay, well, we need to know which microbe caused a disease, which was difficult to do because the mouth and throat normally contains this really diverse array of microbes, so being able to say that one specific microbe was the cause of a disease wasn't simple, but there was at least a
jumping off point the membrane. By the late eighteen hundreds, this dude named Clubs found two types of microbes in the membrane.
Clubs like Clibsiella.
It might oh exciting, but he didn't know which bacterium was responsible. So that question was solved a few years later in eighteen eighty four by a dude named Friedrich Loeffler.
Oh.
He also discovered that the bacillus was only found in the membrane and didn't invade deeper into the body. But diphtheria also causes effects in the more distant parts of your body, so he figured that the distant effects of disease could be caused by a toxin.
Wow, what a smart guy, right, we.
Had the causative agent, but there was still the mystery of why an outbreak of diph theory would suddenly show up without any warning and sweep through a village or school. Where did it come from?
Yeah?
Well, a couple of years after the causative agent of diph theoria was identified, there was an epidemiological survey of children in Berlin that showed that five percent of healthy children carry the bacterium in their throats. So this was the first evidence that carriers of the disease existed. And this was a big deal because it helped to explain the mystery of these sudden outbreaks. And it also led to forced quarantine for people who were suspected to be carriers.
Yeah.
People were held for months in isolated hospital units. There were quarantine stickers or plaques to put on people's houses if there was an outbreak of diptheria in a certain house. Yeah.
Soon after the discovery of diphtheria carriers, peer Paul email Ru, who was Loeffler's assistant, found the diptheria toxin by showing that if you passed bits of diphtheria secretions like from the membrane, threw a superfine filter that would keep the bacteria out in other cells and then injected the filtrate into an animal, you could cause diphtheria like symptoms in the animal. Wow.
That's cool. I mean not cool for the animal.
But it's kind of like boom toxin got it proof in hand. When a couple other microbiologists named Emil von Behring and Shibasa Burro Kitasato heard about the discovery of the diphtheria toxin, they were like, we know what to do with this information, because if we can fight the toxin, we can fight the disease. So they began working towards developing the diptheria antitoxin, which was first used in the
eighteen nineties. Wow. Yeah, And for this research, Van Bhring was awarded the first Nobel Prize for Medicine in nineteen oh one.
What Yeah, for diphtheria antitoxin.
Oh cool. Dip theoria was a big deal. Yeah.
I definitely had no idea that it was such a big deal.
Yeah, Like it was.
It's just the d in in t Depp exactly. It's all it was to me. Yeah, it was a lot more, and it really left a mark. And it's it's kind of funny because it seems like so much of diptheria's history is squeezed into just a few decades. It was only in the eighteen fifties that the disease became endemic in cities, and within fifty years the bacterium had been identified, its toxin isolated, and immoderately effective treatment produced.
Wow boom boom boom. But diphtheria was in no way defeated or forgotten. It was still one of the illnesses that most terrified parents and racked up a hefty death toll. Even with the advent of antiitoxin, it remained the number one killer of children in some countries, killing thousands of children every year. For instance, in the US, thirteen thousand to fifteen thousand children died every year from diphtheria. This is in the early nineteen hundreds.
Oh my god.
And in January nineteen twenty five it would take the front page of so many newspapers in a dramatic race against time, race against time. Okay, let's take a quick trip to Nome, Alaska. Yes, do you know where this is going? No? Okay, great, In nineteen twenty four, Nome is still a baby city. It had been founded only
twenty seven years earlier. By a few gold prospectors, which then led the way for hundreds more to rush to this extremely remote part of Alaska, which was still just a US territory and not a Statenome is just a couple of degrees south of the Arctic Circle and extremely far west on the Steward Peninsula, and we'll post a map. In nineteen twenty four, it was one of the most remote cities on Earth. Gnome was closer to Siberia than it was to any other major town in Alaska. Whoa.
Its population had shrunk from around twenty thousand during the peak of the gold rush to around fifteen hundred brave or crazy people that made it their home in nineteen twenty four.
Wow.
For most of every year, from around October or November to July, Nome was more or less shut off from the rest of the world. The port was inaccessible due to freezing water. No train reached that far west, and planes hadn't yet been designed to withstand the extremely harsh winters.
Oh my god, yeah until July. Yeah, no, thank you. I think that's like when the ice melt was uh uh, I'm complaining about fifties over here.
So that left sled dogs as the only reliable way to get around, So before those ships left for the winter, you really had to make sure that you had everything you needed or wanted for that long winter and spring and half of summer ahead of you. In the summer of nineteen twenty four, Nome's only doctor, Curtis Welch, sent a request from war dip theory antitoxin after he noticed
that the units that he had were expired. But when the last ship of the year came and went without any new antiitoxin, he crossed his fingers and hoped for the best. Being so isolated might protect them from any outbreaks coming their way. And they had been lucky avoiding diptheria in previous years, but the nineteen eighteen flu still lingered on everyone's minds. I don't know if I mentioned this in our flu episode, since it was like one hundred years ago.
Oh, it was about a year ago.
But this part of the world suffered some of the highest death rates during the flu. In Gnome, fifty percent of the population of Alaska Natives died.
You know you did mention that, Okay, I.
Thought so, because it's such an intense it was such a high mortality rate. Yeah, and so. On Christmas Eve nineteen twenty four, when doctor Welch heard of a seven year old girl who had a very sore throat, he worried if this was diphtheria. Gnome was on its own with enough expired antiitoxin to help just a handful of people, and in particular, he worried about the thousands of Alaska Natives living in the area who had lower resistance to diphtheria.
Oh no.
A few days later, on December twenty eighth, the girl died and several more cases of sore throat began popping up. Welch didn't officially diagnose anyone with diphtheria until mid January, and by this time at least five children were dead of the illness. This isn't a really small, super isolated town. Yeah, so now is the time to panic. He sent out a telegram to the US Public Health Service pleading for
antiitoxin some way, get it Tonome please. Getting together that much antiitoxin wasn't a problem, but the issue was getting it too Gnome by sea was impossible because of ice. By plane was considered too dangerous, but by a sled dog was another story. Oh my god, this still doesn't sound familiar to you. No, okay, wait.
Wait wait wait is this a book or something.
Well, it is a book, but it's also a movie.
It's it Bolto.
Stop. Yes, this is Balto.
Yes, Balto's active theory.
Yeah, that's why I was so thrilled.
Your face is so happy right now, it's like so satisfying.
Oh I love it. Well, Balto was so bloodmobile. Who provides all the music for this episode and all of that episodes is my brother Dan, and we've blown his cover. I think we already said that he was obsessed with Balto, like we had to watch it over and over and over again. So yes, I've always loved it.
Okay, So she's still so happy.
And anyway, so officials decided that they would use a relay of dog sleds to transport the serum the six hundred and seventy four miles or one thousand and eighty five kilometers nice from Nanana to Nome. Wow, you're not as close to Fairbanks, okay. The heroic efforts of the sled dogs and their handlers were on the front page of every US newspaper. God and much of the population waited anxiously to see whether the antiitoxin would successfully make
it to Gnome. These handlers, most of whom were Alaska natives, and their dogs had to endure extreme winter conditions. Dogs lost their lives, people lost their fingers or suffered permanent damage from frostbite. But in just five and a half days, so an area of six hundred and six hundred and seventy four miles.
Of frozen frozenz.
This is in January, over ae thousand kilometers in genus in.
Midge ask, oh my god.
Yeah, the anti toxin arrived in Nome carried by Gunner Cosson and his lead dog, Balto Balto, about whom the movie was made. But I want to do my part to clear up a historical misrepresentation about Balto and the serum race. Even though Balto and Cosson were the ones to deliver the serum to Nome, they were only the last ones in a long relay which involved many more dogs and handlers. Among these is the dog considered the true hero of this story, Togo Togo and his handler
Leonard Seppola. Togo ran more than two hundred and sixty one miles.
Oh my goodness.
Four hundred and twenty kilometers during this relay, and his leg of the relay was ninety one miles one hundred and forty six kilometers, which was more than twice any other team. He safely led his team through some of the worst conditions and across the treacherous Norton Sound, which is this frozen inlet of the Bearing Sea, so over frozen seawater.
Oh my god.
Yeah, but Togo didn't get any of the recognition, or at least not nearly as much, especially right after the serum got there that Balta received, which like there's a statue of Balto in New York City's Central Park and Seppola, who was the handler, was super salty about this.
Well, yeah, I would be too, because he was with him.
Yeah, I know. The outbreaking gnome was small. Only six or seven children died and maybe five hundred to one hundred people were infected with diphtheria, but the numbers could have climbed a lot higher had the serum race not been successful. And maybe Togo will finally get the recognition he deserves because apparently there's it's a live action Disney movie in the works called Togo Stop It in which Willem defote everyone's favorite hero. What we'll play Leonard Ceppala, No no Veto.
Oh well we'll see, sorry Will.
I'm definitely gonna keep an eye out for that though. So I tell this story about Gnome and Togo and Balto to underline just how scary this disease was.
Right, people were willing to go to pretty extreme lengths to protect this tiny little town.
And they were captivated like this was on the cover of every newspaper. A few years after the Nome serm race, a diph theoria vaccine was created using the toxoid, which was the inactivated form of the toxin, and it went into wide use in the nineteen thirties and the disease really dropped off to where most doctors today have no idea what a dip theoria membrane looks like.
Only in pictures or smells like. I think that's why we don't like it's not in a picture.
Yeah, exactly. We talk scratch and sniff.
Yeah, there's We talk a lot about smells of some bacteria, specifically that that like the bacteria make a smell, right, But with this, my guess is that it's just like a bunch of dead miss that is making the smell.
I just want to repeat again what I said about a scratch and sniff book.
Scratch and sniff pseudo membrane.
Scratch and sniff medical textbook.
Oh, grody dude.
Not that I would not buy, No, but somebody would buy it for you.
Yeah, that's true.
That's basically all I've got.
So is it.
Yeah, you're done.
And then they made a vaccine story over.
Well, that's because I think that's where you pick it up and you tell me about how the anti vaccine movement might be a changing thing.
Okay, let's do it. So just because we invented a vaccine doesn't mean we've pulled a smallpox. This has not been eliminated from the world. It has not been eliminated from the United States. Still exists, but in the United States it is actually a pretty huge success story. So, for example, in nineteen twenty one in the United States, so before there was any kind of vaccine, there were two hundred and six thousand cases of diphtheria reported.
That's a lot.
Yeah, there were also overted fifteen thousand deaths.
Oh my, I know, most children games.
Yeah, But since nineteen eighty. Okay, there have not been any double digit year cases, So no double digit cases. This is a weird way to say it. A fewer than ten. There you go, and in many years, zero cases in the United States have been reported. That's great,
it's very great. It's not so across the globe. So the World Health Organization, and I'll actually post this because I think I don't think I'm the only one who'll find it interesting, has little fact sheets about the number of cases of all of the vaccine preventable diseases, of which diphtheria is one, and how many or what percentage of people are actually vaccinated across the world. So this is aggregated all of the countries of the world, how many actual case reports there have been of all of
these diseases. So keep in mind as always that you know, it's just the reported cases. There's a lot of underreporting and many places who might not report it at all, et cetera, et cetera. But the numbers have been generally getting better for the most part. In nineteen eighty, worldwide, there were over ninety seven thousand cases of diphtheria reported. Well hold on nineteen eighty nineteen eighty ninety seven thousand, ninety seven thousand, Okay, nineteen ninety that number had dropped
to twenty three thousand. Holy crap, way to go world.
Right, that's that's because of the vaccine.
I mean, the vaccine has been in use since the you know, twenties. But sure, but I mean like vaccination or rates. Yeah, they went up from thirty one percent in nineteen eighty worldwide to eighty eight percent in nineteen ninetyl. Yeah, that's for one dose of the vaccine. So one thing I will say is that the vaccine for diphtheria, it's usually given in combination with tetanus and pertussis. So you might hear people say DTP or t DAP or d TAP.
There's a lot of different versions of it. Yeah, So these are all different combinations of diphtheria toxoid, which is just a inactivated toxin, tetanus toxoid, inactivated tetnus toxin, and pertessis either the whole bacterium or parts of the bacterium. And because in all of those cases you're giving a killed toxin and not a live bacterium, your immune system only mounts a partial response to it. So one dose
is not enough to actually give you full immunity. So in the US, children actually get five doses of d TAP okay, up until they're about six years old, and then after that it's recommended that you get a booster every ten years. Worldwide, one of the biggest challenges is making sure that people get all of the recommended doses of vaccines like the DTP vaccine, because giving just one is good, but giving three or four or five is
a lot better. So globally, the rates of like giving, the rates of children who have received at least one DTP vaccine is pretty high, but the rates that have received at least three, which is what's recommended by who, is a bit lower. Okay, So where were we We were in nineteen ninety right, with twenty three thousand cases worldwide? Yeah, cut to two thousand, still doing great, only eleven thousand cases,
right all right? Twenty thirteen, four thousand. What twenty fourteen, seven thousand must have been a fluke, twenty fifteen, back down to four thousands. What's up twenty sixteen seven thousand? Okay, twenty seventeen eighty eight hundred.
Not a fluke, Not a fluke.
It's not great. It's hard to say for sure what the cause of this is because globally, vaccination rates, at least reported vaccination rates have not changed globally, that is not true in the United States. But what it basically means is that at least over the last five years, we haven't really gotten better, right, We haven't made we haven't made huge strides in the last few years in terms of actually reducing the burden of diphtheria. And it
definitely still exists. And something that I thought was really interesting that I definitely didn't realize is that if you were to like randomly screen a whole bunch of people's noses or naso pharynxes in the United States, even in areas where you have relatively hi or I suppose what someone would think would sound relatively high vaccination rates like say eighty percent, which sounds high, but for vaccination rates
is actually not good. Yeah, you can you can find a lot of people colonized with diphtheria in the United States. So this bacteria still exists here. So even though we haven't had a case of diphtheria in the United States since in twenty twelve, we had one and before that it was two thousand and three. Okay, we had one. So even though the case rates of diphtheria in the United States are very low, that doesn't mean that it's not here. Right, The are not of diphtheria is six
to seven, which is really highly high. It's second to like measles, which we haven't for How have we not talked about measles yet.
Because we had because there are tons.
Of isis okay, but we need to put But yeah, so it's really high. So what that basically means is that, yeah, for every one infected kid, you could potentially infect six or seven more kids.
That's crazy.
It's crazy, It's it's scary. It's really scary. Especially also because so the T dep DETAP whatever you call it, vaccine, they're different vaccines, but whichever vaccine it is is recommended for pregnant women. And that's because since you have this waning immunity, you want to make sure that a pregnant woman is immune so that she passes on those immunoglobulins
to her baby. Because babies don't actually get vaccinated until two months old, So for those first two months, they're super super susceptible.
Gotcha, if you.
Don't give a if a woman maybe doesn't have access to prenatal care or doesn't have health insurance or things like that and doesn't get that, then you can potentially have babies that are completely susceptible. And so that's why this whole vaccination thing becomes really important, is that it's
not just about like your individual risk. It's about the fact that there are a lot of people in the community that either are too young to be vaccinated, are very old so they just don't have a good immune system left, right, are already immunal compromised, whether it's from something like HIV or leukemia or other immune disorders, so they can't be vaccinated right. And so those are the people who are most at risk when you have low levels of vaccination in a population.
It just it blows my mind, after reading about this disease and hearing about this disease from you and the progression of disease, that there are people who choose to go nah, I'm just gonna take my chances.
I think the thing is, though, that we don't hear about this. It's not on the front stage of our newspapers. Because one kid has gotten it since.
Twenty twenty US.
But it's also it's not in everyone's face, and it's not every day, and it's not everywhere, So it's very easy individually to say that problem is elsewhere and it's not going to affect me. I mean, I think that's why it's it's just about making sure that people are aware that these diseases still do exist, and that's why these vaccines are important.
It's scary that the disease itself is scary. What's the scariest thing is that there are people who can be protected against it and can by doing that, protect other people against it, and they're choosing to not do that. Yeah, that's the scariest part to me.
Yeah, yeah, it is.
It's scary.
It is scary. Well, I wish I had some happy note. I mean, worldwide vaccine coverage is about eighty five to ninety percent. She's great. Yeah, that's good old diphtheria. Who knew Quite honestly, I didn't know most of this stuff.
Yeah, yeah, there's I feel like there's there's a lot more to diptheria than I knew was going to be out there, and I'm really glad that we covered this.
Yeah, and thanks Balto, I mean Togo, thanks Togo. Sources.
Yeah, I have a few. Okay, so the story of Balto and the whole sled dog race and the race for the anti toxin. It's called The Cruelest Miles and it's by Gay and Laney Salisbury. And I also used the Cambridge World History of Human Disease, The Epidemic Streets by Anne Hardy, and a couple of papers. But I also wanted to plug I used. I read this book in middle school and when it came up in the searches, I was like, I definitely recognize that cover and it's
called Running out of Time by Margaret Peterson Haddocks. It is quite dark, so no wonder I loved it. Anyway, you should definitely read it Running out of Time.
I want to read it.
Yeah you should.
Also, we'll definitely add that book to our Goodreads list, which as a reminder, you can find all of our sources, including all of the articles and books that we read for each episode, as well as links to our Goodreads list on our website This podcast will kill You dot Com.
Thank you as always to Bloodmobile, also Balta's number one fan YEP, and to all of you for listening.
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Well, until next time, wash your hands, you filthy animals.
Bon bon bas bon ba, bon ba bonb