Hey Seppala, a chunk of your face just fell off

I just finished reading The Cruelest Miles by first cousins Gay Salisbury and Laney Salisbury. This book documents the 1925 diphtheria epidemic in Nome, Alaska and the ensuing feats of heroism that enabled the antitoxin to arrive in Nome safely before the entire population succumbed to the frightful disease. The whole book was fascinating, especially if you have a love for adventure stories and an appreciation for the arctic. A few things struck me as especially poignant.

I didn’t know much about diphtheria prior to reading this book. In the words of the incestual authors:

Diphtheria is an airborne bacterium that thrives in the moist membranes of the
throat and nose and releases a powerful toxin that makes its victims tired and
apathetic. In two to five days, other, more deadly symptoms would appear: a
slight fever and red ulcers at the back of the throat and in the mouth. As the
bacteria multiplied and more toxin was released, the ulcers thickened and
expanded forming a tough, crusty, almost leathery membrane made up of dead
cells, blood clots, and dead skin. The membrane colonized ever larger portions
of the mouth and the throat, until it had nowhere left to go and advanced down
the windpipe, slowly suffocating the victim.

As anyone who’s ever suffered from tonsillitis or mononucleosis can attest to, severe sore throats rank among the worst of physical afflictions. I’ve had my fair share of broken bones, third degree burns, and gruesome skateboard accidents, but without hesitation, I’d include throat issues among the worst of my experiences. When you have to muster every ounce of courage within yourself simply to swallow saliva, things are pretty bad. I can’t imagine the plight of these (mostly) children who battled with diphtheria, only to meet their end in a losing battle with asphyxiation.

Considering the threat of diphtheria has retreated into the annals of history, I’ve never found motivation to research its effects. Pondering this reality, I was reminded of how easily I dismiss the modern threat of contagious illnesses/diseases. Leaning upon an oft-subconscious, yet all-encompassing faith in modern medicine, I neglect the all-too-real threat of those pathogens surpassing a critical threshold and morphing into a pandemic. This might be in the form of SARS in Asia; AIDS in Africa, India, Russia, and urban America; Marburg in Angola; or even an influenza outbreak when the flu shot supply issues we experienced last year are magnified many times over. AIDS is already wiping out whole populations in Africa, and a cure has yet to materialize. Containment of the less scary ones hinges on constant medical vigilance, while the more pernicious examples have no known remedy. Although I cherish the ease of international travel, I can’t help but fear the repercussions this might entail should an outbreak escape our monitoring, or if the carriers of such an illness/disease don’t develop symptoms for months or years subsequent to contraction.

It’s funny how a book can have peripheral affects like this. Judging by the prologue and after-comments, drawing attention to such issues was not their primary or explicit goal in writing the book. Their depiction of entire Alaskan villages falling victim to influenza (1918-19, which also devastated many other parts of the world) and only narrowly escaping the same fate with diphtheria, however, made such ruminations unavoidable after spending a good chunk of last year in Alaska. While this is all well and good, it still bothers me that my sense of empathy wanes as geographical distance grows between a devastating event and my own sphere of experience…something I’d like to continue to reverse.

Aside from all that nasty stuff, however, the book documented just how intrepid both mushers and dogs (not too many historical accounts afford individual dogs a sizeable chunk of text) were to brave the perils of Alaskan winters. I would have preferred even more attention paid to the individual mushers’ experience during their legs of the relay. [Side note: contrary to popular belief, the dogsled portion of the antitoxin delivery consisted of 20 different mushers covering a total of 674 miles from the interior town of Nenana to coastal Nome. Both the relay aspect and the course itself differs from the modern Iditarod race which starts in Anchorage and covers 1,049 miles….actually, the distances for the North and South legs of the Iditarod course are 1158 and 1163 miles, respectively, but the traditional distance of 1049 represents that the race always extends longer than 1,000 miles and that Alaska is the 49th state.] Furthermore, the relatively short personal accounts represent only a handful of the participating mushers. According to the authors themselves, the many native Alaskans who participated in the middle segments of the relay either balked at recounting their stories for the press or were never asked at all. I’d love to hear these stories sometime. The stories that did make the final edit recounted blistering cold, unforgiving winds, precipitous climbs and plunges, and treacherous ice (the water threats constituted some of the most fascinating material, in my opinion…imagine falling through the ice on the Yukon river, only to find that the water underneath had retreated and you were left in an empty cavern of frozen riverbed 20 feet deep and 150 feet wide). Most of these guys did this stuff for a living. Every day!

One more juicy tidbit worthy of mention was the lively debate concerning whether sled teams or airplanes would deliver the serum. History could have played out quite differently had the Governor of Alaska decided to transfer the serum via plane, instead of by sled dog teams. Aviation in the north had yet to find a firm foothold, and only a group of bold pioneers and military units explored the skies in the Last Frontier. The miniscule collection of planes in interior Alaska consisted of World War I vintage biplanes that were dismantled for the winter, had open cockpits, and had water-cooled engines that were unreliable in cold weather. Regardless of these formidable barriers to safe aerial transfer, the national and international press still harangued the Governor and the Board of Health for choosing a much slower means of transportation riddled with its own perilous obstacles. To the benefit of the both the governor and the ailing population in Nome, the sled dog teams competed TWO successful relays and saved innumerable lives. Although the contingent pressing for an air delivery lost in the short run, they won in the long run. National attention focused upon the insufficiencies in northern air travel and an era of rapid development in this industry followed on the heels of the 1925 diphtheria outbreak.

But the dogs had their day. I’m going to stop writing now. If you’d like, you should read the book. I highly recommend it. Just try to disregard the fact that the title came from a modified Ronald Reagan quote.