Three Eponymous Diseases

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Speaker 1: Welcome to Stuff You Missed in History Class, a production of iHeartRadio.

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Speaker 2: Hello, and welcome to the podcast. I'm Tracy V.

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Speaker 1: Wilson, and I'm Holly Frye.

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Speaker 2: I am kind of riffing on Holly's beloved theme of eponymous foods, but maybe in a less fun direction, which is diseases that are named after places.

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Speaker 1: I like how you said, maybe like there's someone else going Yeah.

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Speaker 2: Somebody is excited about learning where disease names came from. If you saw the title of today's episode and you saw the word eponymous and you were expecting food treats and now you're disappointed, I'm very sorry. The word eponymous is I think most often used to describe something named after a person, but it can also describe something named after a place or a thing. And this episode is also inspired by an experience I had a few years ago when I went to visit family and the big, big local news story. While I was there was an outbreak of Legionnaire's disease connected to walking past a hot tub display at affair. I found all of that horrifying from a number of directions, and it made me, then, of course, want to do an episode on Legionnaire's disease. That's a totally normal response to this whole experience. I was not able to work that into a whole episode, and it just took me a while to kind of think, hey, there's a theme here. We are going to really be focused on the outbreak that led to these diseases being identified and named, so it won't be like a whole history of any of these three diseases. Two of the diseases we're talking about today are ones that people can contract through incredibly casual exposure, like walking past a hot tub display. The third requires a lot more pro longed direct contact with somebody who is acutely ill, but it can really still spread very rapidly in certain conditions. Although there will be some experimentation on animals mentioned in this episode and one of the most disgusting human experiments that I've ever encountered while working on this show. We're gonna talk about that just as delicately as possible, but it is gross. So first up, as Tracy alluded to, Legionnaire's disease, which is caused by Legionella bacteria. Multiple species of Legionella bacteria can cause disease, but most outbreaks are connected to Legionella numophila. Legionella numophila can actually cause two different diseases, Legionnaire's disease and pontiac fever. Both of these can cause flu like respiratory symptoms, but pontiac fever is generally milder and typically resolves on its own. Legionnaire's disease, on the other hand, can cause pneumonia and lead to hospitalization and death. It's not fully understood why the same bacteria causes two clinically different syndromes, or why outbreaks tend to cause one or the other. Legionnaire's disease is named for the American Legion convention that was held at the Bellevue Stratford Hotel in Philadelphia, Pennsylvania, in nineteen seventy six. I guess we could have a semantic argument about whether a convention is a place or not. I think it is, at least temporarily. The American Legion is a veterans organization that was chartered by Congress in nineteen nineteen, focused on service to veterans and to their communities. This nineteen seventy six state meeting in Philadelphia also ran alongside the US bi centennial, so there were a lot of other celebrations and festivities going on as well. The American Legion Convention took place from July twenty first through twenty fourth, and then on July twenty twenty seven, a retired Air Force captain who had attended the convention died of an apparent heart attack. Within days, other convention attendees had also died after reporting symptoms that included fevers, headaches, chest pain, and chest congestion. On the afternoon of Friday, July thirtieth, doctor Ernest Campbell of Bloomsburg, Pennsylvania, tried to alert the Pennsylvania State Public Health Department that some of his patients had become seriously ill after attending the convention, but he was told the office had closed for the day. Another doctor tried to report a similar pattern of illnesses to the health department on Saturday, which of course, was also still closed. By the time the office reopened on Monday, eighteen people had already died.

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Speaker 1: In addition to this delay in starting an investigation into what was going on, there were some specifics that made it hard to pinpoint where this illness had come come from. Medical staff who saw multiple patients all around Pennsylvania made a connection to the convention right away, but there were also people who got sick who had not gone to the convention or even been inside the hotel where it was held. One was a bus driver who had driven a marching band to Philadelphia for a parade, who had spent almost all of his time in Philadelphia on the bus. Another person was local to Philadelphia but had not been in the hotel for a while, investigators were classifying this as two different diseases, legionnaire's disease for convention attendees and broad Street pneumonia for everyone else.

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Speaker 2: Health authorities in Pennsylvania, once they had gotten those reports, contacted the Centers for Disease Control, and the CDC reported on the illness in its Morbidity and Mortality Weekly Report on Friday, August sixth, the same week that the illnesses had first been reported to the Pennsylvania State Public Health Department. According to this report, one hundred and fifty two people associated with the convention had become ill between July twenty second and August third, with most of those illnesses starting between July twenty fifth and thirty first. Twenty two of those one hundred and fifty two people had died, but there didn't seem to be an increase in respiratory diseases in Philadelphia more generally, and the illnesses didn't seem to have spread between these patients and their family members or other close contacts. The CDC included weekly updates in the Morbidity and Mortality Weekly Report until September third, at which point the outbreak was over. As of August thirty first, nineteen seventy six, there had been one hundred seventy nine cases and twenty eight deaths, including one hundred forty eight people who had been at the convention and thirty one who had not, but those had been either in or near the hotel at some point. The disease had been particularly lethal in people who had other conditions like heart disease, diabetes, or cancer, but this report did not include what had caused the outbreak because at that point they did not know. The CDC Epidemic Intelligence Service and the Pennsylvania Department of Health had carried out what was at the time the largest infectious disease investigation in CDC history. They had more than one hundred and fifty investigators and medical professionals involved. They looked for evidence of viruses and bacteria, heavy metals, environmental toxins, and other potential causes, without any success. They checked seemingly every surface and potential source of contamination at the hotel. Because there was this clear connection to an American Legion convention, there were even concerns that it had been an intentional poisoning carried out by anti war protesters, or maybe some kind of biological attack connected to the Cold War. Meanwhile, this outbreak had gotten a lot of press coverage. There had been an outbreak of swine flu at Fort Dix in New Jersey the previous winter, believed to be very similar to the virus that had caused the nineteen eighteen flu pandemic. This had led to fears of an impending pandemic and a huge emergency effort to vaccinate people. Although a pandemic had not developed, and various issues with this vaccine rollout had led the press to call it a fiasco. This had led to heightened anxieties around the idea of contagious illness. Also, this was an illness that had disproportionately sickened and killed veterans, a lot of them retirees during the celebration of the US bicentennial, so the whole thing had additional layers of emotional impact, like this is right on the heels of the Vietnam War, but a lot of the people that were that were sickened and killed had served in like World War Two and the Korean War, and people rea guarded them with like a slightly different nuance than how people were viewing the Vietnam War at the time. The fact that so many people died so quickly also made this outbreak particularly terrifying. On August sixteenth, nineteen seventy six, Time Newsweek and US News and World Report all had cover stories about the outbreak, and all three of them used the word killer in the headline.

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Speaker 1: By Christmas of nineteen seventy six, the Bellevue Stratford Hotel had closed in the aftermath of the outbreak, and the CDC had faced intense criticism for not figuring out the cause. This included CDC microbiologist Joseph McDade, who got a lecture about it at a Christmas party from a random man that he had never met before. McDade worked in the lab but was not a decision maker at the CDC, but over the week between Christmas and New Years, he started re examining slides from his initial work on the case. This research had involved exposing guinea pigs to pttential pathogens, and investigators had figured out that there was something in patient's lung tissue that could make the guinea pigs sick, but which then couldn't be transmitted from one guinea pig to another.

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Speaker 2: What they hadn't been able to do was to isolate and identify this pathogen.

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Speaker 1: A few things were working against them here. One is that the bacteria involved didn't respond to some of the stains being used to prepare the microscope slides. Another was how the CDC was focusing its efforts. Microbiologists had been trying to rule out specific pathogens using preparations developed to grow those particular pathogens. Some of these preparations used antibiotics to prevent contamination by other bacteria, but those antibiotics were also killing the bacteria that caused the outbreak. When McDade did new cultures without those antibiotics, he immediately saw clusters of bacteria under his microscope. Some additional steps can confirmed that this bacterium had caused the outbreak, and it was ultimately named lee Jionella numophila.

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Speaker 2: The CDC put out a special issue of the Morbidity Immortality Weekly Report on January eighteenth, nineteen seventy seven, to announce the discovery of this bacterium, and then a peer reviewed paper was published in the New England Journal of Medicine in December. McDade was a key part of this, but he did not do it all alone. He was one of six authors listed on the paper, along with the laboratory investigation team. The most likely scenario for how this bacterium sickened and killed so many people is that it had been growing in the Bellevue Stratford Hotel's air conditioning system. When a heat wave moved through Philadelphia in July of nineteen seventy six, the air conditioning system started working harder, and bacteria laden missed from the cooling towers made its way into the hotel and to the street and sidewalk below, which is why people who had not been in the hotel had also gotten sick. Identifying this bacterium also allowed investigators to go back and re examine other earlier outbreaks, going back to at least nineteen fifty nine. One of these outbreaks had taken place in Pontiac, Michigan, in nineteen sixty eight. Ironically, this outbreak took place at the health department and more than ninety percent of the employees had gotten sick. This included some of the CDC investigators who arrived to investigate the outbreak. This was a much milder illness, though, and everyone recovered, and that's why pontiac fever is given a separate name from Legionnaire's disease. These outbreaks led to efforts to better coordinate between the CDC and local health authorities and more stringent sanitation standards for things like air conditioning systems, swimming pools, and hot tubs. But there are still disease outbreaks caused by these bacteria, including the one in twenty nineteen at the Mountain State Fair in Fletcher, North Carolina that was the one that inspired this episode. The final report on that outbreak listed one hundred and thirty six cases of Legionnaire's disease with ninety six hospitalizations and four deaths, as well as one case of pontiac fever. Legionella bacteria occur naturally in soil and water. So some cases of Legionnaire's disease and pontiac fever have also been traced to things like potting soil. Let's take a little sponsor break, and then after that, we're going to be talking about an illness that's really not for the squeamish, and that also is going to include the particularly gross research. Next, we're going to talk about something that's not as deadly as Legionnaire's disease, but it can still cause serious illnesses and death, especially in older people, babies, and people that have other health conditions. However, it is miserable. It is neurovirus, also called Norwalk virus, and it's probably responsible for more than half of food borne illnesses worldwide. Neurovirus causes acute gastroenterritis, which is also known as stomach flu, although that is a totally different virus from influenza. Neurovirus is a highly infectious RNA virus that can live on surfaces for up to two weeks, and it's not killed by alcohol based hand sanitizer and is resistant to a lot of disinfectants, and that's how you wind up with stuff like at least two hundred and forty two people getting neurovirus after one player was sick court side on the first night of a basketball tournament and well meaning attendees did the cleanup without informing the custodial staff of what had happened. This virus has probably been around for centuries, but the first clear to description of the illness was by John Zahorski in nineteen twenty nine in a paper titled Hyperemesis higamis, or the Winter Vomiting Disease. So Horski was a doctor who described a cluster of cases he had seen in Saint Louis. He differentiated between respiratory diseases that could also cause gastro intestinal symptoms and a disease in which the gastro intestinal symptoms were the whole thing. He also noted that this disease tended to happen in the winter, although norovirus is more common in the colder months, outbreaks can happen at any time of the year. Norovirus is named for Norwalk, Ohio, where an outbreak struck an elementary school in October of nineteen sixty eight. A few people became ill on the evening of October twenty ninth, but then a lot more people got sick on October thirtieth and thirty first, making for a terrible Halloween for all of them. This outbreak ultimately sickened half the school that also spread to people's family members and their close contacts, with a wave of secondary cases from November first through third, and then additional illnesses continuing until November seventh. According to the CDC report on the outbreak, there were ninety nine primary cases and one hundred secondary cases. Everybody recovered, though, and nobody had to be hospitalized.

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Speaker 1: The CDC investigated this outbreak as well. An obvious possible source for an outbreak of gastro intestinal illness is food, but students who had brought their lunch from home got sick at about the same rate as students who got their lunch from the school cafeteria. Tests on the food and milk that were still on hand in the cafeteria did not show any signs of pathogens.

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Speaker 2: Another obvious possibility is water. The school had its own well rather than being on a municipal water system, and that well was routinely chlorinated. It was checked for coliform bacteria that did not reveal anything. A miss but it also wasn't enough to totally rule it out as a possible source of illness, so the school just used bottled water until the well was determined to be safe.

00:17:11
Speaker 1: When the CDC issued a report on this outbreak in the Morbidity and Mortality Weekly Report on November twenty third, no specific cause had been identified, but the overall conclusion was that the primary cases had all come from a single source, while the secondary cases had spread from person to person starting with those primary cases, and the suspected cause was a virus.

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Speaker 2: The CDC's write up also reflects some expectations around gender and parenting. Quote person to person spread was probably responsible for the secondary cases, and consequently one might expect a significantly higher attack rate in mothers, who have more intimate contact with sick children than in fathers, and a higher attack rate in larger families five or more members than in small doller families. Although the attack rate in mothers thirty seven percent was higher than in father's twenty two percent, this difference was not statistically significant. Furthermore, attack rates in large and small families were similar. Although researchers could not identify the pathogen right away, they did want to confirm whether there was an infectious agent at work that was shed by sick people and could infect others. This involved collecting and preparing what we are just going to call the inoculum, which was then given to volunteer test subjects.

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Speaker 1: This was not a new idea. The nineteen seventy one paper detailing this research cited three prior studies from the nineteen forties and fifties that had similarly showed that it was possible to transmit non bacterial gastroenteritis this way. Different versions of the inoculum were made from samples collected during four outbreaks of gastro intestinal illness at the elementary school in Norwalco, Ohio, aboard the US Navy ship Shenandoah while it was in the Caribbean, and in New Britain, Connecticut, and Bethesda, Maryland. The inoculum was presumed to contain something non bacterial that was going to cause gastrointestinal illnesses, but it also went through a bunch of cultures and safety tests to try to make sure that it did not contain any other known pathogen that could cause problems or other illnesses. Two groups of participants were part of this study. Some were men who were incarcerated at the Maryland House of Correction in Jessup, Maryland, and others were from the Clinical center of the National Institutes of Health. The paper detailing this work described all of these participants as volunteers who all gave informed consent before participating, but there are a lot of caveats around the idea of volunteering for medical research in the context of being incarcerated. The Maryland House of Correction was also vote notorious for violence and harsh treatment of the people incarcerated there.

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Speaker 2: Participants were given a complete physical exam, including lots of lab work and chest X rays, to confirm that they were in good health before being given the inoculum. They were also treated with gamma globulin injections to protect them in case there was some kind of hepatitis contamination in the inoculum that would not have shown up on tests. Participants at the prison were isolated in the prison's hospital ward, and participants in the clinical center of the nih were placed in isolation rooms there.

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Speaker 1: The only inoculum that produced illness in this experiment was the one that had been prepared from samples collected in Norwalk Ohio. Of the three volunteers who received this inoculum, two became ill. Then their samples were used to prepare additional inoculum, which was administered to additional test subjects. Seven of those nine people also became ill. When another round of innoculum was prepared from these patients, only one of the fore men who received it became ill.

00:21:08
Speaker 2: A paper detailing this research has been described as a landmark article in the study of viral gastroenteritis, and it created a pretty thorough picture of how this disease could spread and what symptoms it could cause, but it still was not clear what the actual pathogen was. The paper uses the term non bacterial, and some researchers thought the illness must be caused by a virus, but others thought a virus was unlikely because so many other acute gastro intestinal illnesses were caused by known bacteria, including E. Coli and salmonilla. The only thing that had been mostly ruled out was toxins, because it seemed unlikely that a toxin could progressively pass through multiple people's digestive systems to then sicken other people. Researchers using immuno electronic roscopy finally got a look at a particle measuring twenty seven nanometers in samples collected in Norwalk in nineteen seventy two. This made neurovirus the first viral gastroenteritis to be conclusively identified, and within a few years it was being connected to a lot of illnesses. One paper published in nineteen seventy nine suggested that a third of the acute gastroenteritis outbreaks that didn't have a known cause had likely been caused by Norwalk like viruses. Technological developments later in the nineteen seventies and into the nineteen eighties allowed researchers to study the virus further and some more easily detect and identify it in samples during outbreaks, and this also led to efforts to identify other viruses that could cause similar illnesses, including rotavirus, enteric dentovirus, and astrovirus. Neurovirus's whole genome was sequenced in the nineteen nineties, and today it is described as part of the Calisaveridae family of viruses. Studying neurovirus continues to be challenging, though it's only been within the last few years that researchers have found animal species that could potentially work as a model for human beings in terms of neurovirus, and it has also only been recently that researchers have figured out how to cultivate the virus in vitro. These are also some of the reasons why there's not yet a vaccine for neurovirus. As we said earlier, it can be deadly in some people, but for most people it's just an extremely unpleasant inconvenience that would be really nice to avoid. According to a paper published in the Journal of Infectious Diseases in twenty twenty, neurovirus outbreaks in the United States costs an estimated seven point six million dollars in direct medical costs annually, and then another one hundred and sixty five million dollars in loss productivity. Also just it's real unpleasant thing to have to go through beyond those economic numbers. In addition to all the difficulties in studying the virus itself, there are also multiple strains of it that shift very rapidly, and that makes the effort to create a vaccine even more complicated.

00:24:12
Speaker 1: So there are going to continue to be neurovirus outbreaks all around the world for the foreseeable future. They're particularly common in places like hospitals, schools, and restaurants. Gastro Intestinal illnesses, including neurovirus, are so common on cruise ships that the Centers for Disease Control has a whole vessel sanitation program to try to prevent and track outbreaks on board. Some outbreaks are almost counterintuitive, like there have been a number of outbreaks on long distance hiking trails like the Pacific Crest Trail and the Appalachian Trail, which are exacerbated by people using common latrines and shelters and often relying on hand sanitizer rather than soap and water. Let's take a quick sponsor break and then talk about on illness that's a lot dead than neurovirus, but also not nearly as easy to spread.

00:25:13
Speaker 2: The last disease we're going to talk about is one that is surrounded by a lot of stigma and fear, which is ebola virus disease. Ebolavirus disease is a hemorrhagic disease with a high mortality rate. The World Health Organization estimates the average at fifty percent, although different species of ebolavirus can have very different mortality rates, some of them much higher than that. People who survive ebola infection can also have long term physical and mental health effects afterward. All of this is genuinely scary, which has really contributed to that stigma in places that are affected by this disease. This includes people who have survived ebola who can continue to face stigma and ostrasis after recovering. Since Ibola is also found almost entirely in Central and Western Africa, there's also a lot of stigma and misinformation about it in other parts of the world, based on people's preconceptions and biases rather than any actual experience or knowledge about the disease.

00:26:19
Speaker 1: There were two concurrent outbreaks of a Bowla virus disease in nineteen seventy six, although at the time it was not known that these were caused by two different species of the virus, and it seemed like they were probably related. One started in the Southern Sudan Autonomous Region, which was then part of Sudan but is South Sudan's today. The other was in what's now the Democratic Republic of the Congo, which was then known as Zaire.

00:26:46
Speaker 2: The first cases in the first known outbreak of ebola were reported in workers at a cotton factory in Nzara, which is in what's now South Sudan. This is a town roughly twenty five kilometers nor the east of the border with the DRC. The cotton factory was part of a large agricultural cooperative, which was in Zara's primary employer. About four hundred and fifty people worked at the cotton factory, with about two thousand people employed at the agricultural collective overall. The first illnesses were reported in June and July of nineteen seventy six in men who worked as storekeepers at the cotton factory. These men were connected only through their jobs and didn't have any common contacts outside of work. The first to become ill eventually went to the hospital and died there on July sixth. His brother had taken care of him at home and got sick as well, but he recovered. The second man to get sick also died in the hospital on July fourteenth. His wife had taken care of him at the beginning of his illness, and she died at their home on July nineteenth. The third reported illness was in a man who worked in a cloth roam adjacent to the store who got sick in mid July, and he also had no other contacts with these other two men outside of work, but he had a much more active social life than either of them did. He had lots of friends, and his friends also had lots of friends, and this illness really quickly spread among all these friends and acquaintances as people looked after each other when they were sick and also just visited and checked in on one another. This included the virus being introduced into other areas when people traveled, often before they realized that they were sick.

00:28:38
Speaker 1: Emola spreads through contact with blood and other bodily fluids, and it also causes things like vomiting and hemorrhaging, so it can spread easily between patients and the people taking care of them, especially if those caregivers don't have access to things like protective equipment and disinfectants. This pattern of spread also meant that the outbreak in them Tizara eventually ended as people started avoiding one another out of fear of the illness, and the remaining patients and their caregivers either recovered or died. The last reported infection in Nazara was on October twenty seventh, nineteen seventy six, and there were sixty seven total cases there. By the end of this outbreak there thirty seven percent of the workers in the cloth factory had been infected. It's likely that the initial source of the infection was bats that were living in the roof space of the factory, or possibly rats that had contracted it from the bats. But on August seventh, abola had also been introduced to the town of Meridi, about one hundred and fifty kilometers away, when a patient was admitted to the hospital there. This patient had been close friends with the third worker from the Nazara cotton factory who became ill. A second patient from Nazara, who was a nurse, was also admitted to the Meridi hospital on Allfae August twenty ninth.

00:30:01
Speaker 2: And as this illness started to spread at the hospital, conditions there quickly broke down. This was a teaching hospital and a lot of the people who got sick were nurses and nursing students. By the end of the outbreak in Mariti, ninety three of two hundred and thirteen cases had been contracted at the hospital. With seventy two of those cases, or about seventy seven percent, being among hospital staff. This included the doctor in charge and about forty percent of the nursing staff, about half of whom died. Understandably, patients and staff alike started to be afraid to go to the hospital, and that meant the disease continued to spread out in the community as people were cared for by friends or relatives instead, as they became more and more ill, and people with other illnesses and conditions weren't able to get the care that they needed because of what was happening at the hospital. This disease he also spread in the community as people prepared their loved ones bodies for their funerals.

00:31:06
Speaker 1: As the disease was starting to spread in the hospital at Meridi, another outbreak began in the Yambuku Mission Hospital in what's now the Democratic Republic of the Congo. The headmaster of the Yumbuku Mission School was admitted to the hospital on August twenty sixth with what was believed to be a relapse of malaria. He had just returned from a two week trip to the area near the border with Sudan. He was treated with anti malarial medications by injection, and he was discharged on September first, but he returned on September fifth after developing a hemorrhagic illness, and he died the following day. Another man, whose identity is not known, had also been admitted to the hospital on August twenty eighth. He was experiencing nosebleeds, dysentery, and fever. He left the hospital two days later, even though he was serious ill and what happened to him after that is not known. Some sources conclude that the headmaster was the index patient in this outbreak, while others conclude that it was that unknown other patient. It is possible that the headmaster contracted abola during his treatment for malaria through a needle or a syringe that had been used on the other patient.

00:32:22
Speaker 2: Injections using contaminated needles and syringes became a major source of the spread of illness in this outbreak. At the time, it was a common practice at the hospital to administer a lot of medicines and supplements by injection, including things like prenatal vitamins. Some of this was cultural. People generally believed that medicines delivered by injection were more powerful and worked better than ones that were taken orally, so nurses administered more injections than they would have in other contexts. This was an impoverished area without a lot of resources, including a limited supply of needles and syringes. These were rinsed with sterile water between patients, and they were boiled at the end of the day, but neither of those steps was enough to effectively sterilize them. Roughly a quarter of the ebola patients at this hospital had no risk factors for the disease other than the injections that they received there. As had happened in Mariti, the disease also spread from patients to their direct caregivers at the hospital. Ultimately, thirteen of the seventeen staff at Yambuku Mission Hospital became ill, and eleven of them died. People in Yambuku also contracted the illness while preparing people's bodies for their funerals. This included the headmaster's mother, wife, mother in law, sister in law, and other loved ones. The disease also spread from Yambuku to the capital city of Kinshasa. In September of nineteen seventy six, doctor Gooi Mishola, who was the district's chief medical officer, visited Yambuku and wrote the first clinical description of this disease that with description was sent to health officials in Kinshase. On September twenty eighth, Belgian physician Jacques Corteat took a blood sample from a nun at a hospital in Kinshase. He sent this sample to the Institute of Tropical Medicine and Antwerp, Belgium, where it was analyzed in the microbiology department electron Micross because Vin Jakub spotted a Marburg like virus in this sample, and then the institute notified the World Health Organization. Marburg virus is named for Marburg, Germany, which was the site of an outbreak of another hemorrhagic fever in nineteen sixty seven. That nineteen sixty seven outbreak also involved Frankfurt, Germany in Belgrade, Serbia, and it was connected to contact with monkeys that were used in laboratory research.

00:34:56
Speaker 1: Officials from the World Health Organization arrived in Zayu on October nineteenth and in Sudan on October twenty ninth, and in both places went through similar efforts to work with local health officials and medical and nursing staff to investigate and contain these outbreaks. This included distributing personal protective equipment like gowns, masks, and gloves, and teaching staff how to use them Safely. Donning and doffing this kind of protective equipment without contaminating anything is a whole process. They also taught nursing staff how to thoroughly sterilize needles and other instruments, and worked with local leaders and chieftains to identify cases and, whenever possible, bring patients to isolation units at a hospital. An isolation bard had been built in Mariti just before the World Health Organization arrived. Since there was no known treatment for this illness, the World Health Organization also collected plasma from people who had recovered to see if it could be used for therapeutic purposes. This process took time, though, since they also needed to develop tests to confirm that this plasma didn't contain any active virus. Direct patient care was handled by healthcare workers from the local area, while the World Health Organization managed things like disease surveillance, tracking, education and support. Samples were also sent to facilities that had the ability to contain such a dangerous pathogen, including the Centers for Disease Control in Atlanta and Porting Down in the UK. The virus was eventually determined to be in the same family as Marbourg virus. The species of a bolovirus that were involved in these two outbreaks are now known as Sudan a bolavirus and Zayre a bolavirus.

00:36:44
Speaker 2: By the end of these outbreaks, three hundred eighty one people had contracted the disease in what's now the Democratic Republic of the Congo, and two hundred and eighty of them had died. In Sudan, there were two hundred and eighty four cases and one hundred and fifty one deaths. There was also one smaller outbreak in this same part of South Sudan in nineteen seventy nine, but then after that there was really no known ebola activity until nineteen ninety four. The nineteen ninety four outbreak kind of revived scientific and medical interest in studying the disease. The largest ebola epidemic in history took place between twenty fourteen and twenty sixteen, when the disease was introduced into more densely populated areas in western Africa that had no prior experience with it.

00:37:32
Speaker 1: There were more than twenty eight thousand suspected and probable cases and more than eleven thousand deaths during this outbreak. It was confirmed that a Bola virus can be transmitted sexually as well as through direct contact with blood and other bodily fluids.

00:37:48
Speaker 2: It's suspected that bats are the natural carrier of this virus, although other animals can carry it as well, and in addition to the types of transmission that we've talked about in this episode, it can also be transmitted when people have contact with animals, including when hunting and when butchering animals for their meat. Today, a bolavirus disease is treated with monoclonal antibodies and supportive care, and there are two licensed vaccines for zayre ebolavirus. Carl Johnson, who was part of the international commission that formed to investigate and worked to control this outbreak, suggested the name of Bolah for a river in the Northern Democratic Republic of the Congo. Locally, this river is more commonly known by its Bondi name of Lake Bala. This name was accepted in nineteen seventy seven Johnson reportedly suggested this name because he wanted to avoid bringing additional stigma to any of the villages, towns, or cities where this outbreak had taken place, and this is part of the thought process for how diseases are named today. In twenty fifteen, the World Health Organization released updated best practices for naming diseases and they specifically discouraged the use of geographic locations as well as people's names, industries, foods, and animals. And this is because these kinds of names for diseases can contribute to a lot of stigma and other unnecessary negative effects, including misinformation like monkey pox, which has been renamed empos doesn't have anything to do with monkeys other than that it had been identified in work that involved lab monkeys. The word monkey is connected to racist stigma, and then people were sort of folding that into their discussions of the disease. And we also all just lived through something like this at the start of the COVID nineteen pandemic, when people, mostly outside of the medical field, used the fact that it was first reported in China to stoke a lot of anti Asian racism. So there are a lot of these names that are still in use, but the best practice now is to just name things descriptions of what the illness is, rather than connecting it to like a place or a person, or an industry or anything like that.

00:40:13
Speaker 1: I have thoughts on this. We'll discuss that.

00:40:15
Speaker 2: Sure, Sure we may have another one of these episodes at some point in the future, because I found it interesting.

00:40:23
Speaker 1: Do you have listener mail for us?

00:40:24
Speaker 2: Yes?

00:40:25
Speaker 1: I have email.

00:40:25
Speaker 2: This email is from Carolyn, who wrote about Icelandic volcanoes and Norwegian corvids. Carolyn wrote, Hello, Tracy and Holly. Huge fan and second time emailer. I finished John Ben and the Lucky Fisher episodes yesterday on my commute and had to write in again. No pronunciation corrections this time. Carolyn is one of the folks who wrote in about how to say decalb.

00:40:52
Speaker 1: It's so hard to see it.

00:40:53
Speaker 2: I can't. Yeah, I have a hard time for me too. First, I also love and have already visited this year, so I won't be joining you. I do have a suggestion for another country for a future stuff you miss in history class road trip, But more of that in a minute. If you haven't already been to the Snifelessness Peninsula in Iceland. You may want to go there. I've attached two of my favorite seal pictures from our trip there earlier this year. I was so excited to hear you talk about the Locky Fissure because that was my very first introduction to Iceland before my husband and I went for the first time just before shut down in March twenty twenty. I read Island on Fire by Alexandra Vitz to do some quote light geology reading, history reading before arriving. I don't know if you use this book in your research for the episode, but I highly recommend it. I was fortunate to see the chapel dedicated to Jan Steinerson on another trip. It's small but cool, but it wasn't open when we stopped. I was also so grateful to meet you both in person at the recent live episode of and Indie, and Holly's mention of crow love reminded me that I hadn't yet sent the pictures of Norwegian hooded crows. I think they look like they're wearing fluffy vests. My husband is Norwegian and I have a lot of topic suggestions for you, and wonder if you've considered doing a trip there. It's really beautiful and full of history that definitely has not made it into many American history books. Carolyn then follows with some topic suggestions and says, since I sent pictures of my dog Penny, she loves kisses Holly and my granddog and kitties last time, my pet taxes some pictures of the beautiful hooded crows and icelandic seals, I hope you enjoy best. Carolyn, thank you so much for this email.

00:42:39
Speaker 1: Carolyn.

00:42:39
Speaker 2: I did not use that book as part of the research for the Locky Fissier eruption episode, but I did have a paper by that author that was part of it. There were just too many possible resources to use to be able to go through all of them. And man, these birds are definitely beautiful, and you're right they look like they have little white vests on this is I don't think this is a place that we visited when we were in Iceland last time, and I have not looked at a map to see if it is in the vicinity of where we will be in November. We have mentioned the trip we're taking to Iceland in November a couple of times recently. At last check that was sold out, but there is a waiting list, and if you're curious and maybe you want to see if you can get on that waiting list, it is at Defined Destinations dot com. So thank you again for sending these great pictures in this email, Carolyn. If you would like to write to us about this or any other podcast, or at History Podcast at iHeartRadio dot com, and you can subscribe to the show on the iHeartRadio app or wherever else you would like to get your podcasts. Stuff you Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.