The Cruelest Miles: the Heroic Story of Dogs and Men in a Race Against an Epidemic

by Gay Salisbury

  Instead, Welch rummaged through his pharmacy and pulled out all the old-fashioned remedies doctors had used to treat diphtheria before the invention of antitoxin in 1891. In a series of treatments, he gave Billy stimulants to strengthen his heart against the possible onslaught of toxin, which circulated in the bloodstream and attacked vital organs. He swabbed the child's throat with chloride of iron, an astringent that effectively broke up the lesions. These were not surefire cures, but in conjunction with the body's own immune system, they might provide a fighting chance.

  1. There is some debate over Welch's notion about the inefficacy and the instability of the antitoxin. His fears that administering the antitoxin would weaken the boy were probably unfounded.

  The treatment seemed to work for a while: just hours after Welch swabbed the child's throat, the lesions had sloughed off and the color had returned to his cheeks. He was sleeping more comfortably and appeared stronger by the hour, and Welch recalled that the child's general condition became almost normal.

  Then, by around 4:00 p.m. on Tuesday, Billy had taken a turn for the worse. Looking in on his young patient, the doctor faced his worst fears. It was diphtheria, clear and simple. The child was the very picture of the advanced stages of the disease: sunken eyes, an expression of unrelenting despair, dark lips the color of wild berries, like the ones the children brought in from the tundra. Each time Billy Barnett tried to draw air into his lungs, he coughed up blood.

  At 6:00 p.m., the nurses called Welch back to the boy's bedside, and he saw that Billy was turning blue from a lack of oxygen and laboring ever harder for breath. He was in a state of collapse. Without using the antitoxin, there was nothing Welch could do. By now, it was even questionable whether an injection of fresh serum could save the child, given the late diagnosis and advanced stage of the disease. Welch had no alternative but to stand by and watch the boy shut down. Billy stared back up at him in fear. As the end approached, the child's windpipe clogged up and they could hear a faint, high-pitched trill, as if someone was slowly letting the air out of a balloon.

  It was over. Welch made arrangements for the body's disposal, and went home. There was little else he could do that night, but in the morning he would have to make a full report to the town fathers. The coffin to hold the 40-pound body was a little over three feet long.

  The short walk home down Front Street from the hospital on C Street and Second Avenue was tiring and cold: it was late and 14 degrees below, and most of Nome was already home, sitting close to the stove with a winter cache of books and old newspapers, or a stack of cards. The clapboards rattled and you could hear the ice popping out at sea, and on the street there was the sound of Eli Nicholi's horse as the man made his nightly rounds emptying the outhouse honey buckets.

  Welch was not the first doctor to be caught off guard by diphtheria. Its onset was similar to other ailments of the throat, particularly tonsillitis, and its symptoms were varied, depending upon the severity of the outbreak and the health of the child. An outbreak in any community would have been a heavy weight for any small-town doctor, even one with sufficient antitoxin at hand; denial would not have been an unusual reaction. "In several cases I had to change the diagnosis and use the antitoxin after I had tried to make myself believe it was 'tonsillitis,'" wrote one Iowa doctor in 1896. For many, the diagnosis was simply too horrifying to accept.

  In 1925, most doctors relied on visual aids to diagnose diphtheria. If there was any doubt, they then performed a throat culture, which could positively identify the rod-shaped diphtheria bacilli and determine the presence of toxin. Welch had little, if any, firsthand experience visually diagnosing diphtheria and even less making throat cultures. While Maynard Columbus may have been the best-equipped hospital in the region, its technology was of the most basic sort and its resources were limited at best. Electricity was unreliable and there was neither a laboratory nor an incubator for cultures. It had been years since Welch had done this type of work, and as he himself would admit, "I hardly feel competent."

  Through his medical journals, Welch had access to information about the symptoms of diphtheria and its various outbreaks across the United States. Despite the development of antitoxin, epidemics of diphtheria continued to occur in the 1920s, although at a much slower pace, infecting about 150,000 people annually and claiming 15,000 lives.

  Before antitoxin, the death toll from diphtheria was dramatically higher, and it was one of the major causes of death in the United States as well as a leading killer of young children. The disease had wiped out communities in Europe and the Middle East; in 1735, an outbreak of a "plague in the throat" occurred in the American colonies, and continued for five fatal years. One historian estimated that 2,500 people out of every 100,000 died from the epidemic, a death toll that led to fears that the disease would destroy the colonies. Some towns lost nearly half of all their children.

  The pious colonists struggled to explain how and why they were being stricken by diphtheria. The disease appeared to strike at random. No one understood that it could be spread by a healthy carrier, and when no amount of vigil, prayer, or good behavior could the save the children, at least one minister concluded that the mysterious plague was one of "the woeful effects of Original Sin."

  Jonathan Dickinson of Massachusetts, an influential religious leader in the colonies, described the struggles his patients underwent:

  It frequently begins with a slight Indisposition, much resembling an ordinary Cold with a listless Habit, a slow and scarce discernible Fever, some soreness of the Throat and Tumefaction of the Tonsils: and perhaps a running of the Nose, the Countenance pale, and the eyes dull and heavy. The patient is not confined, nor any Danger apprehended for Days, till the Fever gradually increases, the whole Throat, and sometimes the Roof of the Mouth and Nostrils are covered with cankerous Crust...When the lungs are thus affected, the Patient is first afflicted with a dry hollow Cough, which quickly succeeded with an extraordinary distressing asthmatic Symptoms and difficulty of Breathing, under which the poor miserable creature struggles, until released by a perfect Suffocation, or Stoppage of the Breath.

  For the few who survived under Dickinson's care, the road to recovery was frightening and often left them with severe secondary infections and complications. "All that I have seen get over this dreadful Symptom...," the minister wrote, "have by their perpetual Cough expectorated incredible Quantities of a tough whitish slough from their Lungs, for a considerable Time together. And on the other Hand, I have seen large Pieces of Crust, several inches Long and near an Inch broad, torn from the Lungs by the vehemence of the Cough..."

  Over the course of the next two decades, diphtheria continued to strike fear into the hearts of parents and physicians. The disease became endemic in many cities, and outbreaks were common. Physicians and researchers focused their attention on diphtheria, but no matter how well they understood its whims and manifestations, there was no cure. In sickbeds and in doctors' offices across the country, a child with a common sore throat could become an object of fear and panic.

  Doctors tried every available salve, but most of these served only to prolong the patient's suffering or to hasten his or her death. Some physicians injected mercury, others swabbed or injected carbolic acid into the membrane or tried to forcibly remove the membrane with forceps, leaving behind a raw and bleeding surface upon which the bacteria fed. The more desperate resorted to sucking out the alien membrane to clear the airway of a suffocating child.

  In the early 1820s, doctors began trying out a new procedure called tracheotomy, cutting through the muscles of the neck and into the airway. This was often as fatal as the disease, and the practice was discontinued in the 1880s after a New York doctor, Joseph O'Dwyer, developed small hollow tubes that could be inserted through the mouth into the windpipe. The O'Dwyer tube reduced the mortality of laryngeal diphtheria, a severe form of diphtheria, from virtually 100 percent to 75 percent.

  A 75 percent mortality rate, however, was small comfort. T
he tubes were difficult to use. In addition, a child who could now breathe with the use of the tube could still suffer from the shutdown of the renal, respiratory, and eventually pulmonary systems caused by circulating toxin. As doctors labored, mothers who had watched the suffering of their loved ones sent letters to Louis Pasteur at his institute in Paris, urging him to find a cure. "You have done all the good a man could do on earth," one mother wrote. "If you will, you can surely find a remedy for the horrible disease called diphtheria. Our children to whom we teach your name as that of a great benefactor, will owe their lives to you."

  Finally, a Prussian army surgeon named Emil Behring, building upon the work of the Pasteur Institute, developed an "anti-toxic" that could neutralize the diphtheria toxin. It was first used on a child in 1891, and it saved the child's life.

  Welch knew the odds were stacked against him if he did not find a fresh supply of serum. The disease was highly contagious. The bacteria were resilient and could survive for weeks on a piece of candy, a countertop, or a mitten. With a single touch, the bacteria could move from one warm body to the next; a single sneeze or a cough could carry the disease through the air; and a simple inhalation could mean death. In every corner of Nome, bacteria could be lying in wait for the touch of a child; every windowsill or schoolbook was a potential landing zone.

  Welch also realized that the disease could move quickly beyond the town's boundaries and on to other coastal villages. As acting assistant surgeon of the U.S. Public Health Service and the territory's assistant commissioner of health, he was responsible for the welfare of some ten thousand people in Northwest Alaska, with jurisdiction reaching as far north as the Arctic coast and as far south as the Yukon River delta.

  Most northwestern Alaskans were Eskimo, and they were at greatest risk. They had little natural resistance to any of the bacterial or viral illnesses brought in by seafarers or miners, and over the past one and a half centuries—since the first contact with Europeans—an astonishingly large portion of the population had succumbed to measles, tuberculosis, and flu.

  Welch had witnessed the flu pandemic of 1918-19, which obliterated entire villages and settlements throughout Seward Peninsula. "The Natives showed absolutely no resistance," said the then Alaskan governor, Thomas Riggs. By the time the scourge was over, 8 percent of the total Native population in Alaska and 50 percent of the Native population in Nome had died. Those who survived continued to suffer from weakened immune systems.

  During other epidemics of smallpox, measles, and typhoid fever, Welch's predecessors has set up quarantines and pest houses to monitor and care for sick Natives. Native Alaskans had a well-grounded and paralyzing fear of disease. Eskimos believed in the spirit of death and feared that if a person died in their home that spirit would claim them next. A death often caused family members to panic and flee, and this only served to spread the disease.

  Welch worried that Nome's Native population would react in the same way and that, in their attempts to flee, they would spread the bacteria through the town and down the coast.

  ***

  The next morning, on Wednesday, January 21, Welch was shaken from his troubled sleep well before dawn. The daughter of Henry Stanley, an Eskimo on the Sandspit, was very sick and needed immediate attention. The family lived a mile and a half away; Welch decided it might be faster to walk than to hitch up the dogs and drive there. Gathering up his medical kit and his squirrel-skin parka and white cotton anorak with the red trim, he ran down the stairs and out onto the street.

  The Sandspit was a long, thin strip of beach that ended at the mouth of the Snake River on the west side of town. Most Natives lived in single-room sod houses made of driftwood, whalebone, sod, scraps of tin, and whatever else they could salvage from the beach. Some of the homes were still lit by seal-oil lamps and the air inside was thick with the smell of seal, dried salmon, sweat, and damp fur. Welch was used to the smell and he had learned, over the years, to accept and even to admire the "strong, elemental" nature of these Natives. "They know how to be loyal, how to love, if not how to use table knives," he had written.

  Seven-year-old Bessie Stanley lay in the back of the igloo, dark eyes peering out from a hollow-cheeked face, her chest heaving beneath an invisible weight. Welch took her temperature and found that the girl was feverish. Beads of sweat had broken out on her butter-colored skin, cutting rivulets through the grime.

  Welch hovered over the girl, and as soon as he pried open her mouth, he could smell the stench. The inside of Bessie's mouth had become "one mass of fetid, stinking membrane," and when he touched the membrane, it bled profusely.

  By late evening, the girl would be dead, and there was little doubt in Welch's mind that they were face to face with a catastrophic epidemic: the town was hovering on the edge of the abyss. 2

  2. Reports in the Nome Nugget at the time erroneously refer to this child as Richard Stanley. Medical records, however, show that a little girl named Bessie Stanley passed away.

  He reached the apartment just as Lula was preparing lunch, and he sat down and covered his face with his hands. It took him a moment or two to gather up his thoughts and regain his professional composure. He told Lula what was happening, then picked up the phone and asked the operator to get the mayor, George Maynard, on the line as quickly as she could. Then he told Maynard to gather up the town council, every one of them, and immediately head on up to the hospital. There was no time to lose.

  3: Quarantine

  NOME ALASKA JANUARY 22, 1925

  CUMMING PUBHEALTH WASH DC

  AN EPIDEMIC OF DIPHTHERIA IS ALMOST INEVITABLE HERB 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

  WELSH RELIEF STATION 295

  The telegram telling the world that icebound Nome had been stricken with diphtheria. (U.S. Public Health Records, National Archives RG 90)

  "Their [Alaskan Natives'] country is being over-run by strangers, the game slaughtered and driven away, the streams depleted of fish, hitherto unknown and fatal diseases brought to them, all which combine to produce a state...which must result in their extinction. Action in their interest is demanded by every consideration of justice and humanity."

  - President Theodore Roosevelt, message to Congress, December 7, 1904

  It was a comfortable office by Nome's standards, with a big bay window, a row of potted plants tenderly cared for by Head Nurse Emily Morgan, and shelves filled with the well-thumbed volumes of Welch's medical library. The room faced south onto the street and had a clear view of traffic. Welch often sat there and watched the whole town go by.

  He knew every member of the town council. He had treated each of them, and their families as well, and on several occasions he and Lula had been invited to their homes for dinner. Most of them had children and none of them realized what was about to happen.

  George Maynard was there, the burly publisher of the Nome Nugget and the town's mayor, and so was Mark Summers, superintendent of the Hammon Consolidated Gold Fields. The attorney Hugh O'Neil was also present, along with G. J. Lomen, the former mayor of Nome and now a judge, whose family was one of the most prominent in town.

  Summers, thoughtfully, had shut down operations over at the Hammon mining camps so that his employees could take the day off to mourn young Billy's death and pay their respects to the child's father, who was a company employee.

  Welch took a deep breath and began to explain what had taken place over the past few months, beginning with the numerous cases of sore throat he had begun to notice after the Alameda had sailed off and navigation shut down, moving to the young Eskimo child from Holy Cross, then on to the death of Margaret Eide. He had come to the conclusion that all of Nome's children were at risk. Billy Barnett had died of diphtheria, and there was every, indication that out on the Sandpit the Eskimo girl, Bessie Stanle
y, was suffering from the same illness and would soon face the same fate. Welch could not say how any of them had contracted the disease, but it was clear to him that Nome now had an epidemic on its hands.

  Furthermore, Welch fully expected that, given the contagious nature of the disease, new cases would begin to appear within twenty-four hours. The only treatment available for diphtheria was serum, he told them, and he had only enough for about six patients, at best. To make matters worse, those estimated 80,000 units were already six years old. Welch had ordered a fresh supply over the summer, but the units had failed to arrive on board the Alameda, and he could not expect another delivery until spring.

  That morning, despite his earlier misgivings about the effects of the aged serum, he had injected Bessie Stanley with 6,000 units. He doubted this would have much effect because the girl had been treated too late after the symptoms had first appeared. In that regard, he was right: Bessie died several hours later.

  To properly fight the epidemic, Welch said, he needed at least 1 million units.

  Welch did not need to argue his case. It had been seven years earlier, in the fall of 1918, when the influenza virus was carried aboard the Victoria and brought ashore amidst the confusion of crates and supplies.

  Time had literally stopped during the epidemic: the man responsible for winding the Segerstrom & Heger clock in front of the jewelry store had either died or left on the last boat, and no one bothered to reset it. The judge, the fire chief, the U.S. Marshal—even the town doctor who preceded Welch—had all become infected and soon became too sick to work. (The other doctor fled aboard the Victoria.) Those who remained healthy were paralyzed with apprehension.