After the Alameda, the final supply ship of the season, pulled anchor and headed to warmer waters, Welch saw more sore throats than usual.  Tonsillitis was his initial diagnosis.  Late in December, one of the children with tonsillitis died.  The native parents didn’t allow Welch to do an examination. In January, Dr. Welch learned that two native children living outside of Nome had also died. 

Also in January, Dr. Welch admitted a three year old boy to the hospital who was suffering from  a sore throat, swollen glands, fever and fatigue.  Not long after being admitted, Dr. Welch observed grayish lesions in the boy’s throat.  These lesions were typical of diphtheria, a disease that was extremely contagious and preyed on children ages one thru ten. His diagnosis would soon shift from tonsillitis to diphtheria.

Welch considered administering the outdated serum to the three year old boy.  But physicians have long been guided by two principles when treating patients.  The first is do no harm.  The second is carefully weigh the benefits and risks of any treatment.  Welch feared that the expired serum had become unstable and so he decided against using it in favor of old fashioned remedies.  The boy initially showed improvement but later, with Welch at his side, the boy died. 

The next day, Welch examined a seven-year-old native girl who lived outside Nome.  Again he saw symptoms that appeared to indicate diphtheria.  At that point Welch realized that he was dealing with a disease that could take the lives of all the children in the community.  There was no time to waste.  He contacted Nome Mayor, George Maynard, and asked him to call a meeting of the town council.

Every member of the town council remembered the horrible devastation of the 1917-18 flu epidemic.  They agreed a total quarantine was absolutely necessary to curb the spread of the deadly disease.  They acted quickly, imposing a lock down – every school, church, movie house and lodge was ordered to close. 

Doctor Welch immediately sent this telegram to the Public Health service in Washington, D.C.:

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

With  the death toll at four, the quarantine in place and the urgent request for serum sent, Welch and the city fathers waited.  In this urgent crisis, no news was not good news.  If any man ever felt like an island, in these circumstances Dr. Curtis Welch would be that man.  His nearest physician colleague was 400 miles away so he depended on his four nurses for consultation and professional support.  Nurse Emily Morgan became his right hand.

Nurse Morgan, departing a practice on the Aleutian Chain, arrived in Nome in the fall of 1924.  Morgan was no stranger to challenging environments.   During WWI she served with the Red Cross at a mobile hospital on the western front in France attending to wounded and dying soldiers.  Her public nursing skills were well honed and she had firsthand experience with diphtheria.  Nurse Morgan had survived diphtheria and knew the disease personally from her own illness.  She took on the roll of quarantine nurse, visiting the sick in their homes providing care, encouragement and sympathy to grieving parents.

While community leaders anxious awaited word that serum had been located, Welch and Morgan continued to treat sick children.  They had decided to use the past date serum. It was their only hope, but the number of sick children far exceeded the amount of serum on hand.  It was carefully doled out to the sickest.  Eleven month old Jirdes Winther Baxter, admitted to the hospital on January 31st  was one of the sickest.

As he last surviver of the 1925 diphtheria outbreak,  Jirdes Winther Baxter was Iditarod’s Honorary Musher in 2005 on the 80th anniversary of the Serum Run.  As printed in the 2005 Race Guide, Jirdes recalls the story her mother told saying, “My mother and brother were also sick.  I got the next to last dose of the vaccine left in Nome and Dr. Welch wanted to give my mother the last dose.  My mother insisted that my brother get it as he was so sick.”

Since experiencing the COVID Pandemic of 2020, people around the world understand “lock-down” and “quarantine” from personal experience.  We also understand the challenge of extremely contagious diseases. While no one knows exactly how diphtheria reached Nome in 1925, diphtheria like COVID, could be spread by carriers of the disease who have no symptoms.  Might the disease have come to Nome via a sailor on the Alameda?  While it’s impossible to say, let alone prove, consider the uptick of sore throats after the Alameda departed Nome. 

Unlike COVID in 2020, when developing an immunization to protect the world’s population was top priority, a cure for diphtheria had been developed in 1891.  According to nobelprize.org the initial serum prevented diphtheria for only a short period of time.  More research improved the serum and in 1913 it was released as a toxin-antitoxin combination that was very effective.  If only the serum had come to Nome on the Alameda.

When would antitoxin be located and how would it get to Nome in time to save the children?  Assuming the serum would be sent north to the closest rail head in Nenana by train, the big question was how would it be transported the remaining 674 miles to Nome.  Conversations began even before serum was located so as to be ready when the serum reached Nenana.