Diphtheria has now been largely eradicated in developed countries. In the US, for example, preschool children typically receive multiple doses of the DPT vaccine, which immunizes them against diphtheria, pertussis (whooping cough), and tetanus. Children who are not immunized, especially those who are in close proximity to other non-immunized children, are most prone to the disease, even in places where it was previously under control. For example, after the fall of the Soviet Union a lapse in enforcement of the immunization programs resulted in outbreaks in several its former states. In 1924, though, the children of Nome had not been immunized against diphtheria. Indeed, the vaccine had only been successfully tested the previous year for the first time. Antibiotics were not available to treat the disease until after World War II.
Prior to 1891, a child with diphtheria could be expected to die within a few days of falling ill. Diphtheria was a dreadful disease, highly contagious and had a mortality rate of nearly one hundred percent. Children are the most vulnerable targets of this bacterium, although it can infect and kill adults, too. In a single outbreak between 1735 and 1740 diphtheria killed as many as 80% of the children under 10 years of age in some New England towns.
In the 1880s a method of intubation was discovered that prevented victims from suffocating, but this method did not stop the toxic effects of the bacteria. The mortality rate fell to 75%, which was small comfort when the disease attacked a community.
In the 1890s, however, a Prussian physician, Emil von Behring, developed an antitoxin that did not kill the bacteria, but neutralized the toxic poisons that the bacteria releases into the body. The first Nobel Prize in Medicine went to Dr. von Behring for this discovery and the development of this serum therapy for diphtheria. It was this serum Nome so desperately needed.
Six of Nome’s children had died of diphtheria by January 22, 1925, the day the telegram was sent pleading for serum. Two days later, two more children had died, Welch had confirmed diphtheria in 20 children, and 50 more were at risk of contracting the disease because of exposure to sick siblings.
The only ground-based link to the rest of the world during the winter is the Iditarod Trail, an established mail route used by the mushers and their teams of dogs. The trail stretches 938 miles from Seward on the southern coast of Alaska, across several mountain ranges and the vast tundra of the Alaskan interior before reaching Nome, situated on an icy port just two degrees south of the Arctic Circle. Because the cockpits of airplanes were open in 1925, the only way mail and supplies could get to Nome was the dog sled.
Nome, Alaska, sits at the top of the world. In January, the coldest month of the year, temperatures hover in single digits much of the time. In late January 1925, though, a series of winter storms were blasting across northern Alaska, pushing temperatures 30, 40 and 50 degrees below zero. It was through these strong winds and driving snows, and through the perpetual twilight of the Arctic winter, that the dogs and their mushers would have to transport the serum.
It was decided that the serum would travel by train to Nenana, as far as the tracks could take it. A teams of dogs would meet the train and take the serum to Nulato, approximately half the distance between Nenana and Nome. Leonhard Seppala, a Norwegian musher based in Nome, would take delivery of the serum and transport it back to Nome. Seppala and his dogs were famous for having won races across the Alaskan interior, and it seemed logical that he should hurry the serum to Nome.
Now that there was a plan for transporting the serum, Dr. Welch waited to hear that sufficient serum had been located and could be sent to Nome. In the meantime, as more children and adults developed the gray membrane of diphtheria, Dr. Welch began administering the expired serum that he had on hand. Possibly the confirmed case that worried Dr. Welch the most was that of Nome’s school superintendent, who was also a teacher. Every child in the Nome area would have been exposed to diphtheria through him. Dr. Welch hoped that the million units of serum he had requested would be enough to treat the entire population.
News finally came that 1.1 million units of the serum had been located at hospitals along the west coast of the US, but it would take until January 31 for the serum to arrive in Seattle to begin the trek to Nome. The serum was gathered and began its trek north. Having confirmed diphtheria on January 20, Dr. Welch knew that if no serum arrived until well into February, it would be too late for many of the children of Nome.
A few days later, 300,000 units of serum were located at a railway hospital in Anchorage. It wasn’t enough to save the town, but it was a start. Anchorage’s supply of serum would reach Nome long before the serum being sent from Seattle. The serum was packed in as much cushioning as possible to protect it from the jarring of the sled. The doctor in Anchorage pinned a note to the blanket surrounding the crate of serum instructing the mushers to warm the serum for fifteen minutes at each stop along the trail. He delivered the crate to the railroad and sent it north to Nenana. The serum would arrive in Nenana on January 27, a week after little Billy Barnett had died of diphtheria.
Next: the dogs…..