On the Lookout

Diphtheria is a serious bacterial infection that affects the respiratory system. It causes fever, nasal discharge, and a thick gray membrane on the tonsils and throat that makes it difficult to swallow and breathe. The diphtheria toxin can spread to other organs and be life threatening. Thanks to the DTaP vaccine, in the United States diphtheria is now very rare, with only a few cases per year from unvaccinated individuals who travel to other countries. Before the vaccine, diphtheria was a much-feared disease that caused suffocation and was generally considered a death sentence. Even with modern medicine today, the fatality rate for respiratory diphtheria remains between 5-10%, with higher death rates (up to 20%) for children under 5 and people over 40 years of age.

With this context, one can imagine the fear Dr. Curtis Welch must have felt in January 1925, when a three-year-old boy and seven-year-old girl died under his care with symptoms of diphtheria. Dr. Welch was working at Maynard Columbus Hospital in Nome, Alaska which had 975 settlers of European descent and 455 Alaska Native residents. Nome is a remote port town on the Bering Sea located two degrees south of the Arctic Circle. The treatment for diphtheria at the time was a horse-derived antitoxin, which greatly reduced mortality if administered early. But the serum supply at Dr. Welch’s hospital had all expired. On January 22^nd 1925, he sent urgent telegrams to all major towns in Alaska and to the US Public Health Service requesting emergency assistance:

“An epidemic of diphtheria is almost inevitable here STOP I am in urgent need of one million units of diphtheria antitoxin STOP Mail is only form of transportation STOP I have made application to Commissioner of Health of the Territories for antitoxin already STOP There are about 3000 white natives in the district.”

The town of Nome went under quarantine while the governor of Alaska, the territorial board of health, and the US Public Health Service quickly organized a plan. There are no roads to Nome, the port was closed by ice, and severe storms made it too dangerous for planes to fly. The only way to deliver the needed medication was to use dog sled teams, a form of transportation historically relied on by the Native Athabascan people in this region of Alaska. The serum would only last six days under the freezing conditions of the trail, and every hour was needed to save the lives of the patients in the hospital. The 674-mile-long trip from the town of Sewart to Nome would typically take 30 days, so they organized a relay. A team of 20 mushers and 150 dog sled dogs raced across the Alaskan tundra and the shifting ice of the Bering Sea, passing the serum from team to team. It was a record freezing winter. The temperatures dropped below −50 °F, with a wind chill of −70 °F. The snow drifts were over 10 feet tall, and they mostly traveled in the dark due to the limited hours of daylight that time of year in the Arctic Circle. The sledders suffered frostbite in the blizzard conditions and many of the dogs collapsed and died.

On February 2, 1925, at 5:30 am, the musher Gunnar Kaasen completed the final leg of the journey and arrived in Nome. The serum made the 674 mile journey in a record-breaking 127.5 hours, or a little over 5 days. The medication was immediately thawed and given to patients. Not one of the vials were broken in the perilous journey. The mushers and Siberian husky dogs became a media sensation for their endurance and bravery, especially Balto, the dog that led the final leg of the journey, and Togo: the lead dog that completed the longest and most dangerous route. There is a statue of Balto in Central Park, New York City. Today, the annual Iditarod Dog Sled Race from Anchorage to Nome follows the same route to commemorate this history. “The Great Race of Mercy” is remembered by public health as a testament to determination, courage, and collaboration in providing care to rural frontier areas. The story helped raise awareness of the diphtheria vaccine and galvanized mass immunization across the United States.