0:01

On July nineteenth, during dinner,

0:03

announcement was made of the departure of Sister

0:05

Rogers after an illness of eight days.

0:08

This was the beginning of a great time of sorrow

0:11

for Bethabara and for me. A

0:13

strange kind of fever had broken out

0:15

amongst us, and most of those living in

0:17

Bethabara had it in more or less

0:19

a serious form. My doctor

0:21

was much worried, for the usual treatment for fever

0:24

gave little relief. Of those

0:26

who left us, Sister Rogers was the first,

0:28

but not the last. Next

0:31

came Catherine's Sidle, and it seemed

0:33

almost impossible that only a few

0:35

short weeks before she had traveled south

0:37

with us. Her husband missed her

0:39

sadly, and it was only a few days

0:41

later that he returned from a visit to Bethania,

0:44

oppressed by the feeling of utter weariness,

0:47

which we were learning to recognize as the first

0:49

symptom of the disease. He did

0:51

not seem very ill at first, but when

0:53

hope was expressed for his recovery, he shook

0:55

his head.

0:56

And so it was.

0:58

And then my Martin, perhaps because

1:00

of his unremitting efforts for others, he

1:03

was seriously ill from the first he

1:05

saw what was coming. His

1:07

pain was intense, as it always was

1:09

in the earlier stages of the fever. His

1:12

request was stay by me and

1:14

hold my hand, hold it tight. And

1:16

when the fever mounted, when the terrible

1:19

red splotches broke out on his body, when

1:21

delirium came, he still felt

1:23

my presence and was quieted as I

1:25

held his hand in mine spoke gently

1:27

to him or saying some of our best loved

1:30

hymns. Then he became unconscious

1:32

of pain or weariness, but we were still

1:34

hand in hand when the call came that took

1:37

him back to the eternal home. Others

1:39

were laid to rest beside him, but I was

1:41

stunned and rebellious, and nothing seemed

1:43

to matter much. The fever that

1:45

took Martin from me persisted until late

1:48

in the fall, though with decreasing violence,

1:50

and we heard that it was prevalent in many parts of

1:52

North Carolina and Virginia.

2:37

WHOA, Yeah,

2:40

that's a sad story. It's

2:43

really sad.

2:44

So that is from

2:47

an account from seventeen fifty nine,

2:50

and I found it in a paper referenced

2:52

in a book that I read. The paper

2:54

is titled a seventeen fifty nine spotted

2:57

fever epidemic in North Carolina.

3:00

Before we go any further, it's

3:03

debated this, Like the whole purpose

3:05

of this paper is to, you

3:08

know, say, this might be an instance of

3:11

spotted fever or Rocky Mountain spotted fever.

3:14

It's not certainty, but I.

3:16

Liked the account so much that

3:18

I wanted to read it.

3:20

It was a really good account. Right,

3:22

it's heartbreaking by

3:24

everything that you that was

3:27

in that account. It certainly could be

3:29

Rocky Mountain spotted fever.

3:31

There are a few things that are like, as we'll

3:34

talk about that seem a little

3:36

bit off to me. I mean the fact that, like, was

3:38

it contagious. It seemed to be all

3:40

at once. It's not contagious anyway.

3:43

So yeah, okay, maybe

3:45

we should maybe we should

3:48

pump the brakes. Yeah, because

3:51

Aaron, what are we this

3:54

is this podcast will kill

3:56

you.

3:57

I'm Aaron Welsh and I'm Aaron Olman Updike.

4:00

Welcome. Wow, we did

4:02

that all weird and backwards. Yeah, that

4:04

was backwards, but we're professionals.

4:07

Oh totally, We've done this before. We've

4:09

done this before. Fifty oh

4:11

my lost count already. This

4:13

is fifty five

4:16

or six? No, yeah,

4:18

I thought it was fifty two. Antibiotics

4:22

was last week?

4:26

Oh gosh, Well, this

4:28

week we are covering Rocky

4:31

Mountain spotted fever or Rickettsia

4:34

RICKETTSI. I yes, spotted

4:36

fever group Rickhetsia.

4:40

I am very excited about

4:42

this episode, Aarin.

4:44

I didn't start out that way, but

4:48

I've come around and now I'm

4:50

thrilled.

4:51

I have known that this was going

4:53

to be a great episode since we

4:55

literally decided to make a podcast.

4:57

Okay, oh okay,

5:00

and I guess the two reasons why?

5:02

Uh okay, yeah, please guess them.

5:04

Are there two reasons why? First to allow, but

5:07

please guess them? Okay.

5:10

Number one is because of the Quarantini

5:12

name. So what's our quarantini name? Aaron,

5:16

that's segue. Oh

5:18

my god, we're being so obnoxious. Okay.

5:21

Our quarantini is cold

5:25

is the Rocky Mountain spotted Fever.

5:28

That's the most clever name that we could come up with. It's

5:30

so good. We came up with that quarantiny

5:34

literally the same moment that we came

5:36

up with a podcast idea.

5:38

Yeah, it was on our list

5:40

that very first day original at

5:43

the picnic of like what

5:45

are we or at the barbecue?

5:47

Yep? Exactly what are the quarantini names? So

5:50

in this quarantine, of course you

5:52

have to have Core's light not sponsored.

5:57

Because the logo is called as the Rockies.

6:00

Just in case anyone has forgotten.

6:02

And well, basically we're making a shandy out

6:04

of it. Okay, yeah, super simple,

6:07

delicious. We'll post a full

6:10

recipe for that quarantine as well as

6:12

a non alcoholic plus see Burta

6:14

on our website. This podcast will kill you dot com

6:16

and all of our social media channels, Yes

6:19

we will. So, Aaron, what's the second reason

6:21

that you knew I was going to be excited

6:23

about this episode because

6:26

we.

6:26

Get to tell the story of Oh

6:28

Brett possibly

6:31

having Rocky Mountain spotted fever.

6:35

Genuinely forgot about that. I

6:37

mean I didn't forget about that. I just I forgot

6:39

that aspect of it.

6:41

I can't rememberative moment of

6:43

our friendship.

6:44

Oh, it absolutely

6:46

was. I will never forget the

6:49

moment. Okay, I

6:51

just meant I forgot that we're going to get the opportunity

6:53

to talk about it.

6:54

Oh right, right, right, Okay,

6:56

So why did you think it was going to be such

6:58

a great episode From the.

6:59

Very Oh mostly

7:01

the quarantine name. Oh yeah,

7:04

yeah, yeah,

7:06

excellent. But as

7:08

I was researching for this episode, I

7:12

you know, I also was having a

7:14

really busy week and I was like, oh gosh,

7:16

I have to do research. But then the very

7:18

first paper that

7:21

I came across to do research for

7:23

this episode, the first line

7:25

of the biology section, I was

7:27

like, Oh, this is this is gonna be a

7:29

good one. Aaron. I had to google two

7:32

words in the first sentence. What

7:35

were they? Fastidious

7:37

and pleomorphic? Ooh

7:40

yeah, it's a good sentence. I'll read it to you later.

7:44

Also, I have to say that the

7:46

book that I read, the very first

7:49

line, like of the chapter,

7:52

so you know how like chapters start with like a quote

7:54

from whatever.

7:55

M hm. It literally it

7:57

made me go, oh, this is gonna be

7:59

good, and I put it in my notes. Look

8:02

at us both we are the same person.

8:08

Oh man, Oh my gosh, that's

8:10

really funny.

8:11

So do we get to just like, you

8:13

know, do the episode now or do we have that

8:16

business.

8:18

We've got new merch

8:20

coming out soon. Yeah, keep

8:22

an eye out for that.

8:24

It's very literally the most

8:26

exciting thing.

8:27

We love it. Yeah, love love

8:29

is not a strong enough word. What's

8:32

a stronger emotion, really

8:37

love? Okay,

8:43

I don't think we have any other business to attend

8:45

to, Aaron, So let's let's

8:48

take a short break and then get into the biology

8:50

of this.

8:51

Oh my gosh, let's do it.

9:26

Okay, So here it goes quote ricketsia

9:30

ricketsi I is a fastidious

9:33

small pleomorphic gram

9:35

negative coxo bacillis. Okay,

9:39

okay, So I

9:42

feel okay that description.

9:45

It's why people don't like reading scientific

9:47

papers, oh for sure. And

9:50

I the reason that

9:52

it made me excited for this episode

9:55

is because I was like, I really like that.

9:58

This is how if you read that, you'd be

10:00

like, oh snooze, I don't want

10:02

to learn anymore. So now I'm going to take

10:04

that and make it a lot more exciting and

10:07

tell you why you should be excited about rikkeetsia

10:09

ricketsia I. Okay, oh

10:11

yes, please, Okay. So here's

10:14

what that boring sentience

10:17

means. We're talking today

10:19

about a very very

10:22

tiny, like so tiny that it

10:24

lives inside of our

10:27

cells, bacterium

10:32

that is very difficult

10:34

to grow in medium. And the reason it's

10:36

difficult to grow is because it lives inside

10:38

of cells. Is that the fastidious

10:40

part. That's what festidious means.

10:42

Yep.

10:42

Okay, when you're talking about

10:45

fastidious organisms, okay uh.

10:48

And the pleomorphic part means that not every

10:51

single coxobacillas, not every single

10:53

cell looks exactly like every

10:55

other. So they kind of when you look at

10:57

them stained inside of another

10:59

animal's cell, they look like a bunch

11:01

of little, little and bigger

11:04

dots, if that makes sense. Okay,

11:06

why that's a really good question that

11:08

I don't know, because they divide the same

11:10

way that anything else divides, right like

11:12

just by sciently. That's

11:15

fascinating, all

11:17

right. So let's get into the disease

11:20

that Ricketsia ricketsiai

11:23

causes Rocky Mountain spotted fever. So

11:26

this is a tickborn disease. OKAYO,

11:31

we get excited about these. So

11:34

humans get infected. Humans are essentially

11:37

dead end hosts, okay,

11:40

So we're not part of the normal life

11:43

cycle necessarily of this pathogen.

11:46

But humans get infected when we

11:48

are bitten by an infected tick.

11:51

Specifically, in a number

11:54

of different species, but most commonly

11:57

in most of the US, it's derma center

11:59

very abolises. That's the dog

12:01

tick, the American dog tick. But

12:04

there's also the Rocky Mountain wood

12:06

tick Derma center andersnii.

12:10

The those live in the Rocky Mountains in

12:12

Canada, the brown dog

12:14

tick rifacephalous

12:17

sanguinosis noeus

12:21

Rifocephalus sanguineous in Mexico,

12:24

and of course aarin Ambloma

12:27

cayanens or Amblioma

12:29

mixta. I was waiting for you to go

12:32

correct, correct, correct me as.

12:34

I got corrected at an academic conference.

12:37

Yes, it is now amblomicayan

12:40

and say species complex?

12:42

Okay, great, and

12:44

that's in Is that throughout Central America?

12:47

That species complex? Yes?

12:49

Central? Yeah, Central and South America?

12:51

All right, So now we also

12:54

know where this disease is found, right, This

12:56

is a disease of the New World essentially,

12:58

so North America, Central America and then

13:00

down into South America. Okay.

13:04

And like many other tickborn diseases,

13:07

in order to get infected, the tick does have

13:09

to be attached for a relatively long

13:12

period of time, usually a

13:14

minimum of four to six hours, but sometimes

13:16

up to twenty four hours. And

13:19

the reason that the tick has to be

13:21

attached for a long period of time

13:23

is because although these bacteria

13:26

are already in the salivary glands

13:28

of the tick. When

13:31

they're in the tick, I get I'm getting

13:33

excited. When

13:35

they're in the tick, they're basically

13:37

not in a virulent state,

13:41

right, So then they have to bite a

13:43

host and then something happens

13:45

within the salivary glands of the tick

13:48

to reactivate these

13:51

bacteria and make them

13:53

virulent, make them able to actually

13:55

infect our cells.

13:59

It's so.

14:02

Amazing, and when weird don't

14:05

know how it happens, and

14:07

it also like, oh my gosh, yeah,

14:09

yeah, you're right. This is a thrilling, a

14:12

thrilling disease.

14:12

Absolutely thrilling. Okay that is

14:15

I didn't know that either before researching

14:17

this, and I think that's just super fascinating.

14:21

Okay, So then you have activation,

14:25

it gets somehow becomes

14:27

virulent again, and then it will exit

14:29

the salivary glands and then enter underneath

14:33

our skin. Okay. So then,

14:35

because we know that this is a life cycle, right, how

14:38

does the tick then get infected? How do we end

14:40

up with infected ticks? As it turns out,

14:43

there's two ways that a tick can

14:45

become infected. One

14:49

one is the way that we know

14:51

of ticks getting infected from past tickborn

14:54

disease episodes, and that is that a tick

14:57

takes a bite of an infected host

15:00

and then in that blood meal they

15:02

suck up some bacteria,

15:04

okay, and then those bacteria

15:07

go on to replicate, and like

15:09

many tick born diseases, once

15:12

a tick is infected, they

15:14

remain infected for their entire

15:16

life. So even if they get infected

15:18

as a larvae, then when they

15:21

transition to a nymph, they remain infected.

15:24

When they transition to an adult, they remain

15:26

infected. But here's where

15:28

it gets interesting. I

15:31

know where you're going. Infected

15:36

female ticks transmit

15:40

transoverially and

15:42

lay infected eggs,

15:46

so you can have larval

15:48

tick bombs that burst out

15:50

already full of Ricketsia just

15:53

waiting to infect their first blood

15:55

meal host. Let's put an

15:57

asterisk on this. I'm great. Well,

16:01

I actually have a question for you

16:03

about this, okay, because

16:05

my understanding from what I read, and you

16:08

are much more of an expert if you guys

16:10

didn't know listeners. By the way, Aaron

16:12

literally did her PhD research on

16:15

Ricketsias in Central America.

16:18

So on on pathogens

16:20

in tics in Central America, which happens

16:23

to.

16:23

Be a lot of Rikkeetzias. Did you

16:25

hear her trying to ask risk her way out of that.

16:28

Well, I'm not an expert, okay,

16:33

So my question is my understanding is

16:35

that for humans

16:37

it's really only adult tics

16:39

that go on to infect humans. Is

16:42

that just behavioral? Is that just because

16:44

these ticks species don't tend to bite us

16:46

unless they're adults, or is that something

16:49

to do with infectious dose? What

16:51

is why is that? I

16:53

don't I mean, honestly, I don't know. Possibly

16:57

behavioral. I mean, so.

17:00

Different ticks species will have different

17:02

host preferences overall, So

17:05

like this tick species might like you

17:07

know, deer and mammals

17:11

more, and this tick species might like reptiles

17:13

more. But even within a tick species,

17:15

you see a lot of differences in terms of like

17:18

what they like to feed on at different stages.

17:21

And so there's a trend.

17:23

It's not one hundred percent, but there

17:25

is a trend where as

17:28

you go to the older life

17:30

stages, so like from larva to adult,

17:33

the host range narrows. And part

17:35

of that is like a mate seeking phenomenon,

17:37

because if you're trying to find a mate,

17:40

you want to be like, all right, I

17:42

want to get on this horse because I know

17:44

that other you know, ticks,

17:47

adult ticcks of my species are going to be on this horse,

17:49

but like you might not be like, oh or

17:51

maybe that squirrel or maybe that

17:53

monkey or maybe that sloth. Like

17:56

you're going to be focused in, right

17:58

because anyway, So it might

18:00

be behavioral as far as the

18:02

bacterial load overall across the

18:04

life stages, that might be a factor. But

18:07

another factor might be that

18:09

as you're in, if you're an adult tick, you've

18:12

taken two blood meals, and so just

18:14

the chance that you have acquired the

18:17

pathogen is greater than if

18:19

you have taken just one blood

18:21

meal.

18:22

It's an imful tick, right, that makes sense.

18:24

Yeah, But the asterisk that

18:26

I want to add to the trans of aerial

18:29

transmission is that it's

18:32

fairly rare, oh for

18:34

Ricketzia ricketsii, Like it doesn't happen

18:36

all that often. And actually the

18:39

Racketzi ricketsii I negatively

18:41

affects the reproductive output of the

18:43

tick.

18:44

The female six. Yeah,

18:46

so that's I mean good news in a way.

18:48

So if you look at horizontal

18:50

transmission, so getting it from an infected

18:53

animal versus

18:55

trans of aerial transmission or vertical transmission

18:57

getting it from mom, it's much less

18:59

like to get.

19:00

It from mom.

19:02

And then the third way that might be possible

19:05

is co feeding.

19:07

Oh does cofeeding

19:09

mean the same thing for ticks as it does for kissing

19:11

bugs.

19:12

Probably they're like two bugs feeding close

19:14

to one another and then they oh

19:17

what does it mean for.

19:18

Kissing Sometimes the adult

19:20

kissing bugs will come back to the nest

19:22

and then the nymphs will feed on

19:25

the adult like from their

19:28

blood meal. Beautiful

19:30

and horrifying. Yeah it is.

19:33

That's that's my esthetic, literal

19:37

lifeblood co feeding.

19:38

So then if you have say an infected adult

19:41

feeding very close by to another

19:44

uninfected nymph, then

19:47

they could that's fascinating.

19:49

Oh yeah, that happens with

19:52

tick born encephalitis virus as well.

19:54

I think occasionally you get you do get

19:56

co feeding events, and this is really important when

19:58

you have cocurrent

20:02

stages existing or

20:04

emerging. So if you have larvae that are emerging

20:06

at the same time as a.

20:07

Nymphs, yeah, then yeah,

20:10

very cool. Well

20:12

that was very fascinating. Okay, so

20:15

now we understand fully the

20:17

transmission dynamics

20:20

of this bacterium. So let's

20:22

talk about what happens if you

20:24

get infected. Okay, what

20:26

are the symptoms. It starts

20:29

with aaron wait for it,

20:32

with a fever. Oh

20:37

okay. So in general,

20:39

the incubation period after you get

20:41

infected is about seven days

20:44

on average, it can range from about two

20:46

to fourteen, and the first symptom

20:48

is often a rather sudden

20:50

onset of fever, pretty

20:53

substantial malaise and body

20:56

aches, and very commonly

20:58

a headache, which very often people

21:00

will describe as the quote worst

21:02

headache they've ever had. Is what one

21:04

paper said. Interesting,

21:07

I will say in med school, we don't learn

21:10

Rocky Mountain spotted fever as the worst

21:12

headache you've ever had. You learn that for a

21:14

brain bleed. But that's okay.

21:18

The point is it's a very severe headache. It's

21:20

not just like I feel a little dehydrated

21:22

headache. It's like a bad headache. Okay,

21:25

okay. You can have a

21:27

lot of other pretty non specific

21:30

symptoms as well, things like anorexia

21:32

because your stomach doesn't feel good, anarexia

21:35

meaning you just don't want to eat, not like

21:37

an eating disorder, nausea,

21:40

vomiting, abdominal pain is fairly

21:42

common. So, especially

21:44

early on in the course of this disease,

21:47

it's very potentially

21:49

easy to mistake it for a kind of

21:52

viral syndrome. Okay, you

21:54

feel crappy, but it's very non

21:57

specific. And then comes

21:59

the third of what's

22:01

often called the classic clinical

22:03

triad of rocky mountain

22:06

spotted fever. There's actually

22:08

two different triads, which I think is silly

22:10

depending on what paper you read. Okay,

22:13

within two weeks of a tick bite,

22:17

almost always, in like eighty

22:19

to ninety percent of cases, you

22:21

see this third symptom,

22:24

and that is the

22:27

spots of rocky mountain spotted

22:30

fever. There we go. It's

22:32

a rash. This rash

22:34

starts out as small what are

22:36

called macules, which just means flat

22:39

red spots, little ones,

22:41

maybe like less

22:44

than the size of your pinky nail.

22:48

And these tend to start on your wrists

22:51

and your ankles. They're

22:53

a blanching rash. It doesn't itch,

22:55

usually it doesn't hurt. So

22:58

if you press on them, then the co would drain

23:00

from them. Okay, oh that's what a

23:02

blanching rash. Wow, yeah,

23:05

cool new word. New word. Then

23:07

this rash, which starts on your ankles

23:09

will begin to spread. It will spread

23:11

up approximately like up your arms

23:14

and up your legs to your trunk. But

23:17

It also spreads down down

23:19

to your palms and your souls,

23:22

which you may remember from our episode

23:24

on syphilis is a very uncommon

23:27

place to have a rash.

23:30

The palms of your hands and the soles

23:32

of your feet really don't get

23:34

rashes except in a

23:37

few infectious diseases.

23:39

Okay, it was syphilis, syphilis, hand

23:43

foot mouth Cocksacki virus,

23:45

and Rocky Mountain spotted fever.

23:47

Rocky Mountain spotted fever. Is that it?

23:49

That's it? There are you know? You could

23:51

get fungal infections on your palms

23:53

or souls. You could get contact

23:56

dermatitis and things, but in terms of infectious

23:58

diseases, those are the three big ones, and

24:01

it would be all like both hands,

24:03

both feet, both hands, both feet exactly. Yeah.

24:06

But it's not itchy, not itchy usually,

24:09

and not painful. Not painful. Well

24:12

that's that's nice. Yeah, well not

24:14

really. I

24:17

spoke too soon. Spoke too soon. Okay,

24:20

So this rash is now spreading. By

24:22

the end of about a week of having this

24:24

rash, the rash becomes raised, so

24:27

it's now what we call maculo popular.

24:29

So it has red flat spots

24:32

with little dots raised

24:34

bumps in the middle. And

24:36

then in the center of these lesions you can

24:39

sometimes get patikia, which are little

24:41

pinpoint purple spots that usually

24:43

are a sign that you're having some kind of issues

24:46

with your blood clotting. And

24:49

so that is kind of the

24:51

general course of disease.

24:54

It doesn't sound that bad,

24:57

right, Well, that

25:01

was a leading question. I

25:03

mean it doesn't though, Right, It's like headache, fever,

25:05

you're feeling crappy, you get a rash.

25:08

But then, as it turns out, this

25:11

disease is about okay

25:13

without treatment. And before we had treatment

25:16

for it, it was on average

25:18

about twenty five percent fatal. But

25:21

that fatality rate ranged a

25:23

lot from about twenty percent

25:25

to maybe up to eighty five percent

25:28

depending on where geographically

25:30

you got infected. Yep,

25:33

so this is a highly fatal

25:36

illness.

25:37

Right if your average,

25:40

if your lower level is still

25:42

over what did you.

25:43

Say, twenty five percent?

25:45

Yeah, If the average is twenty five percent,

25:49

that's I mean, think about

25:51

the other ones that we've had that have been twenty five

25:53

percent, right, it's not that many exactly.

25:55

That that's a huge case fatality rate.

25:58

Yeah, So the

26:01

question is what are you dying from?

26:03

Right, You've got a rash. How

26:05

is this killing you?

26:07

Well, I feel like the petitia or

26:09

whatever, the blood clotting issue, that

26:11

might be an indication.

26:13

Yeah, so that's one sign. So let's talk

26:15

about kind of the actual pathophysiology

26:17

of how this makes you sick. What's going on when

26:20

you have this rash? Okay, So

26:23

this is a tickborn disease. So, like

26:25

many other tickborn diseases, when

26:28

that tick spits the bacteria underneath

26:31

your skin, those bacteria travel

26:34

through your lymphatic system to end

26:37

up in their host cells.

26:40

And even though this is a bacterium,

26:43

it acts a little bit more like a virus

26:45

in that it has to invade our

26:48

cells. It's an intracellular bacteria

26:51

in order to replicate. It does not have

26:53

the machinery to replicate outside

26:56

of a host cell, much

26:58

like a virus.

27:00

So isn't there some sort of like

27:02

isn't it thought that ricketsia are

27:06

might be closely related to mitochondria?

27:10

Yes? I believe so they think that mitochondria

27:12

came from something, whether a precursor

27:15

to a ricketsia or something similar.

27:17

Because they're like, yep, yes,

27:19

I just think that's so cool. Oh, it's so cool.

27:22

It's so cool. Their genomes are tiny. Okay,

27:25

So in the case of ricketsia

27:27

ricketsia, the cells

27:29

that they invade, the cells

27:31

that they replicate in are

27:34

our vascular endothelium.

27:37

So those are the cells that line

27:40

our blood vessels. Okay, the

27:42

inside lining of our blood vessels.

27:44

Okay, you see where we're going with this, I

27:46

mean, yeah, yeah. Unfortunately, So

27:49

what happens when they enter our cells and

27:51

start to replicate, They they

27:54

do a very good job replicating. They replicate

27:56

by fission. They also have these

27:58

ways of mood from

28:00

cell to cell to sell without

28:03

necessarily damaging our cells

28:05

directly as they move from cell to

28:07

cell, so they can kind of just

28:09

spread along your blood vessels,

28:12

just jumping from cell to sell to sell. And

28:15

because they're in your blood vessels,

28:18

they are literally anywhere

28:20

and everywhere in your body because everywhere

28:23

needs blood, right. And

28:26

then they start to cause direct

28:28

damage to the cells that they infect,

28:31

and they do this in a few different ways. One

28:33

is free radical induced injury, which

28:36

I feel like we're experts on now

28:38

after our radiation episode, Okay,

28:44

and then they also release a number of different

28:46

enzymes that cause damage to these cells.

28:49

So if you are damaging

28:51

the cells that line your blood vessels.

28:54

What do you think is going to happen to the

28:57

fluid that is supposed to be in your blood

28:59

vessel.

29:01

Well, it's gonna create a little leaky

29:03

pipeline, A.

29:03

Little leaky pipeline erin exactly.

29:06

Okay, So this cell damage

29:09

causes exactly that, not frank

29:12

hemorrhage. Okay, they're not like, it's

29:14

not gross enough damage that you're going to be

29:16

bleeding out necessarily.

29:18

Who's frank hemorrhage?

29:25

I'm sorry?

29:31

Uh oh did.

29:33

You like that? I really did so,

29:37

not actual hemorrhage. But

29:39

this damage does cause increase

29:42

in the permeability of that

29:44

membrane essentially, so that means you're

29:46

going to get fluid plasma leaking

29:48

out. This is going to also

29:51

cause you to lose protein because as

29:53

you damage that membrane, proteins

29:56

are usually kept in your blood

29:58

vessel in part by a charge

30:00

differences. So you mess up that membrane,

30:03

you mess up those charges, so

30:05

then protein can leak out more easily,

30:07

which then just draws more liquid

30:09

out with it.

30:10

Okay, so it's like this cascading

30:12

horrible exactly, positive feedback.

30:15

Loop exactly, And let's talk about positive

30:17

feedback loops. Okay, Because,

30:20

like we talked about in the radiation episode,

30:23

when you have this free radical damage

30:26

that happens to these cells, our

30:28

body mounts a response to that,

30:30

right, and that's an inflammatory response. And

30:33

in responding to that, part

30:36

of what our body does to try and

30:38

fight off the inflammation

30:41

and damage that's caused by things like

30:43

free radicals and these enzymes

30:46

is that they will vasodilate our blood

30:48

vessels in order to get more white

30:50

blood cells to the areas that they need

30:52

to be to try and fix this damage. That

30:55

vasodilation means you have more flow,

30:57

which means you have more vascular

31:01

permeability, which means

31:03

you have more leakage. So

31:06

this will eventually lead to edema,

31:09

so swelling outside liquid

31:11

outside of our blood vessels, and

31:13

eventually hypovolemia where you don't

31:15

have enough volume in your blood vessels.

31:19

On top of that, if it happens

31:21

to be important organs like your brain

31:23

or your lungs that get involved in

31:25

this, this is called a vasculitis

31:28

where you have inflammation of

31:30

your blood vessels. If

31:32

it's somewhere like your brain or your lungs,

31:35

you don't have a lot of good lymphatic drainage

31:37

to drain that fluid away, so

31:40

you have pressure that builds up because

31:42

of that in that interstitial space.

31:45

So what's interesting

31:47

about this is that none

31:50

of the papers that I read really

31:53

clearly outlined what the

31:55

exact cause of death tends

31:58

to be in Rock Mountain

32:00

spotted fever. But

32:02

it is essentially organ failure.

32:05

What organ it is that ends up failing

32:07

kind of just depends on what organ happens

32:10

to be the most affected. A

32:12

very large proportion of people have hippatomegaly

32:16

on necropsy or on autopsy after

32:19

they've passed, so your

32:21

liver is very commonly involved,

32:23

at least in fatal cases. Many

32:25

people also have renal failure, so

32:27

kidneys might fail. Your

32:30

lungs can certainly be involved, so you

32:32

could die maybe just from not being able to

32:34

breathe from respiratory failure because

32:36

of all the fluid around your lungs. But

32:39

there's not like a one single

32:42

thing that tends

32:44

to be the ultimate cause of death necessarily.

32:47

But pathophysiologically we know that

32:49

it's this diffuse vascular damage

32:51

that leads to hypovolemia,

32:54

so not enough volume and eventual

32:56

shock. So yeah,

33:00

terrible, really terrible.

33:05

Another thing that I did want to point out that

33:07

I think is really really important about this

33:09

disease is that the mortality rates

33:12

still today, It's non trivial.

33:15

It usually hovers around five percent

33:17

even with treatment. And there is very

33:19

good treatment for this. Doxycycling a

33:22

few days worth clears infection,

33:25

but delays in diagnosis

33:28

are strongly associated with

33:30

poor outcomes. So not

33:32

getting to a doctor fast enough, or

33:35

a doctor failing to make the correct diagnosis

33:38

or get the treatment initiated quickly,

33:41

is very strongly associated with a

33:43

vastly increased risk of death, and

33:46

especially in the US, this disproportionately

33:49

affects black individuals.

33:53

And you know, there

33:55

was a limited amount of discussion

33:57

in the papers that I read as to why it's

34:00

exactly that is, whether it's you

34:02

know, people not seeking

34:04

care and things like that. But

34:07

my guess, and some of the papers

34:09

also said this, is that we

34:11

are really bad at diagnosing

34:14

rashes on black skin. It's

34:17

yeah, it's a huge issue.

34:20

When you google pictures of this, I

34:22

haven't seen a single picture of Rocky Mountain

34:24

spotted fever on a black skinned person.

34:27

Yeah, it's yeah.

34:28

I came across that as well in the

34:30

research and how it's like historically it's been

34:32

it's been like that as well.

34:33

Yeah, and I mean it's not just for this, but this is a

34:36

very fatal disease that's also very treatable

34:38

if you diagnose it properly. And

34:41

so the thing is, we don't have good

34:43

tests, like laboratory tests to diagnose

34:46

this. It's a clinical diagnosis, which

34:48

means you make that diagnosis

34:50

based on history and physical

34:52

findings, including a rash.

34:55

So if we don't know what a rash is supposed to

34:57

look like, because no one's taking

34:59

pictures of it, no one's you know, it's not in

35:01

our textbooks, et cetera, then

35:03

people are dying unnecessarily, which is a

35:05

huge, huge failure of

35:08

the medical system. So

35:11

absolutely, So, yeah,

35:14

that's the biology of Rocky Mountain spotted

35:17

fever. Well,

35:21

it's a terrible disease.

35:22

And that is that's a point that I saw made

35:24

in a lot of different papers in terms of like how

35:28

important this disease is and how

35:30

overlooked it tends to be despite

35:33

the fact that things like landscape

35:35

change and climate change are going to

35:38

greatly shift our exposure,

35:40

our risk, you know.

35:42

Yeah, and I mean it's it's the kind of case where

35:44

it directly results in like people

35:47

dying, you know, but

35:50

it is, it is. It's a difficult thing because

35:52

it is so rare. And I think

35:54

that you know, we'll talk later

35:56

about where you see this geographically,

35:59

but I think a lot of people well maybe don't know or

36:01

don't know to think of it, you

36:04

know, when they're when they're kind of listing their

36:07

their differentials in their head, it could easily

36:09

look like a viral illness. It's like, oh, you've

36:11

got a fever and a headache and you're feeling crappy.

36:14

You know.

36:15

Well, and in the history section,

36:18

I don't talk much about like the name

36:20

itself, but if you look at

36:22

so many different ricketzial diseases they

36:25

tend to have, particularly the arthropod born

36:27

ones, they tend to have location

36:31

specific name. Yeah, And so in

36:33

one place it's Rocky Mountain spotted

36:35

fever, in another place it's something

36:37

else. And so you have like all over the world, you

36:39

know, different species of pathogetic Rikeetsia

36:43

called by different names, and that

36:45

has created a lot of confusion, particularly

36:48

with Rocky Mountain spotted fever. Since we're talking

36:50

about it, like, yes, it occurs

36:53

in the Rockies in the Western States, but

36:56

the eastern seaboard is like bam,

36:59

South America bam, right Central

37:01

America bam.

37:02

Like it's there too.

37:05

And so there was a huge push at one

37:07

point to just call it spotted

37:09

fever or spotted fever group

37:11

of KEETSI but that never really caught on.

37:13

So RMSF is what it

37:15

is. So

37:18

well, tell me more, Aerin about this history.

37:20

How did we get here? Where

37:22

did this thing come from? Okay,

37:25

I cannot wait.

37:26

We will take a quick break first, Aaron,

37:51

you started off biology with a

37:53

quote, and I laughed because

37:57

I'm starting off history with a quote.

38:00

I love it.

38:02

You started off with the quote from the first

38:04

paper you read, and I'm

38:06

starting off with that quote from the book

38:09

from the very beginning. Okay,

38:12

here we go, the

38:15

unwritten history of the investigational

38:17

work in connection with Rocky Mountain Spotted

38:19

Fever, if written would

38:21

read like a romance.

38:26

I mean you see why. I

38:28

was like, what what is this? Okay?

38:35

So yeah, I mean

38:37

why is that? Yeah? Hopefully

38:39

I'll tell you.

38:41

Hopefully I'll do a good enough job that you'll

38:43

understand what that quote means. I'm not sure that I do

38:46

anyway.

38:47

So.

38:48

I mean, and I before researching

38:51

this, I didn't know there's

38:54

quite a bit of like lore

38:57

or fame or infamy

38:59

around owned Rocky Mountain Spotted fever

39:01

research.

39:02

There was a movie.

39:03

Called green Light starring

39:05

Eryl Flynn from nineteen thirty seven, and

39:08

one of the subplots it tells the story

39:10

of the researchers involved on the

39:12

Rocky Mountain Spotted Fever project. What

39:16

Yeah, and the disease itself plays

39:18

a major role in the nineteen

39:20

forty seven movie Driftwood. I

39:22

haven't seen either of these, so I can't vouch

39:25

for their accuracy or how much romance

39:27

they have in them or whatever. But

39:30

I have now read about the history of Rocky Mountain

39:32

Spotted Fever, especially

39:34

the history of its research, and that

39:36

does contain a fair amount of drama

39:39

and romance.

39:41

To start the story, we.

39:44

Don't have to go all that far back,

39:46

actually, so the first hand account

39:48

that I read in the beginning of the episode, as I mentioned,

39:50

is from seventeen fifty nine. But

39:53

like I said, it's not one hundred percent accepted

39:55

to be Rocky Mountain Spotted Fever.

39:58

In any case, there were likely k of

40:01

our msf Rocky Mountain spotted fevers scattered

40:03

throughout the Americas for hundreds

40:05

of years at least, But the real

40:08

story begins only in the late eighteen

40:10

hundreds. We don't

40:12

have written records for anything

40:14

earlier. Yeah, So around

40:16

this time, starting in maybe the

40:18

eighteen sixties or the eighteen seventies,

40:21

a mysterious illness was seeming

40:23

to pop up in the bitter Root Valley

40:25

in Montana. So this

40:28

if you can picture Montana in

40:30

your head, go to the far

40:32

far west, kind of the southwestern

40:36

part of the state. If

40:38

you know where Missoula is, it's like the

40:40

very north end of the valley.

40:42

I don't know where that is, but I can

40:45

picture Montana, So Okay.

40:48

So this valley, the Bitterroot Valley,

40:50

runs about ninety five miles long,

40:52

and it's sandwiched in between the bitter Root

40:54

Mountains and the Sapphire Range, with the

40:57

bitter Root River winding its way through

40:59

the valley. Historically,

41:01

the Salish tribe of the Flathead Nation

41:04

lived in Bitterroot Valley,

41:06

and while the region experienced some settlement

41:09

throughout the eighteen hundreds, Lewis and

41:11

Clark passed through in eighteen oh five, it

41:14

lagged behind other parts of the West,

41:17

but then the discovery of gold in California

41:19

and then the increasing number of Mormon settlements

41:22

in Utah eventually led

41:24

to people striking out to find a

41:26

piece of land of their own, and in the

41:28

second half of the nineteenth century, Montana

41:31

grew enormously in popularity.

41:35

The Bitterroot Valley in the second

41:37

half of the eighteen hundreds in particular,

41:40

was super popular because it had these ample resources

41:42

for lumber and fertile farmland

41:45

for livestock and apple

41:47

orchards were really popular, and

41:50

as you can guess, the increasing number of

41:52

white settlers meant that more

41:54

land had to be found. So what

41:56

was the natural solution to this problem

42:00

genocide? Well,

42:02

at least forceful removal, So the government

42:05

removed the Salish, for whom

42:08

this was their ancestral home, of course,

42:10

and so in the eighteen seventies, with the Salish

42:12

driven out, the land of the bitter Rup was

42:15

ripe for clearcutting and apple farming,

42:18

and it was also apparently ripe for the emergence

42:21

of a seemingly new tickborn disease.

42:24

All this clear cutting to make room for

42:26

orchards and farms led to proliferation

42:29

of scrub habitat, which was

42:32

great for sheep grazing, but also

42:34

great for mice and other

42:36

small mammals, which happened to be excellent

42:39

bloodmeal host for ticks. The

42:41

first case of what we now know is

42:43

Rocky Mountain spotted Fever that we can

42:46

trace back for sure, occurred in eighteen

42:48

seventy three in Montana.

42:50

Consequences man consequences

42:53

for our actions,

42:56

and this case was not a one off.

42:58

So from that first case more followed,

43:00

and not just in Montana, Colorado,

43:03

Oregon, Idaho, Wyoming. A

43:06

lot of other places grew aware

43:08

and wary of the disease rightfully

43:10

so, and I

43:13

have to include another side note here. So for

43:15

a while it was thought that the Salish Indians

43:17

had warned the incoming white settlers

43:19

of Rocky Mountain spotted fever by

43:21

saying certain canyons in the spring in the

43:23

bitter Root were full of evil spirits. But

43:26

this is no longer thought to

43:28

be in relation to the disease.

43:31

Okay, So rather

43:33

what, at least in this book, it was

43:36

thought that the disease probably wasn't super

43:38

prevalent before the white settlers

43:41

clear cut the land and allowed for the

43:43

super proliferation of ticks.

43:46

And so anyway, with this alarming rise of

43:48

an extremely fatal disease, combined

43:51

with like the daughter and son

43:53

in law of the Montana governor dying of the

43:55

disease, the state feared

43:57

that they would lose out on prospective land

43:59

by because of this pesky

44:02

fatal illness, and

44:04

so they told the

44:07

Montana State Board of Health to do

44:09

something, and that's

44:11

exactly what they did, starting

44:14

in nineteen oh two by

44:16

appointing two young pathologists named

44:18

Louis Wilson and William Chowning to

44:21

see what they could figure out about

44:23

the disease. And that same

44:25

spring, a bacteriologist named

44:28

Earl Strain suggested a connection

44:30

between the disease and a tick bite because

44:33

he was there touring to kind of see,

44:35

oh, you know, like what can I figure out about this disease,

44:38

and he visited someone who had

44:40

Rocky Mountain spotted fever and noticed a

44:42

tick embedded in the genitals

44:46

of the sick person.

44:48

Very interesting that he just happened

44:51

to see a tick, because almost

44:53

certainly if that person was suffering

44:55

from Rocky Mountain spotted fever

44:58

and they happened to have a tick, that tick was not,

45:00

in fact the perpetrator of their

45:02

illness.

45:03

I think it speaks to the high levels

45:06

of infestation.

45:08

Around the bitter Root at the time. I no,

45:10

but I mean that's and that would explain why

45:13

you know, you had such a huge increase in cases

45:15

if oh, yeah, you know, you were just getting bit

45:17

left and right and genitals.

45:21

Well, and if you think about like the occupations

45:24

of people who were settling in the bitter

45:26

Root at this time, you're outdoors,

45:28

right, You're outdoors, especially

45:31

during that time of year, and so it's

45:33

almost unavoidable.

45:35

Yeah.

45:35

Yeah.

45:36

So so

45:38

William and Chowning took note of Strain's

45:40

observation when they were planning their research season,

45:43

which they had to do basically right away because

45:46

Rocky Mountain spotted fever season is actually

45:48

pretty short, which is great

45:51

news if you're at risk for the disease,

45:53

but a little bit challenging if you're researching

45:56

it. Joys of fieldwork

45:59

and they covered their bases,

46:01

they performed autopsies, they did epdemiological

46:04

surveys, lab studies, and

46:06

what they found was concerning. Between

46:08

eighteen ninety five and nineteen o two,

46:11

there were eighty eight cases in the Bitterroot

46:13

valley with sixty four deaths.

46:15

Wow, it's a seventy two.

46:17

Point seven mortality rate. And

46:20

they concluded that it was not contagious

46:22

from person to person and not

46:25

a result of melted snow water, which

46:27

was the leading hypothesis

46:30

at the time.

46:30

Okay, well, a good thing, right,

46:34

it would.

46:34

Be hard to avoid melting snowwater. Yeah, melted

46:36

snowwater. And so they suspected instead

46:39

that it was caused by a protozoman that

46:41

they had found in some of the tick samples that

46:43

they had dissected and stuck under

46:45

a microscope. Interesting, and so by

46:47

the end of this first season of their research

46:50

they had a nice little disease ecology cycle

46:52

all laid out. The woodticks

46:54

transmitted the protozoan to humans, and

46:56

ground squirrels aka gophers

46:58

were the disease reservoirs. This

47:02

was an untested hypothesis, but that

47:04

didn't stop reports of it in the news because

47:06

people were hungry for

47:09

information about it. They were like, we

47:11

want to know how to protect ourselves. But

47:14

just knowing or thinking that

47:16

ticks were responsible for the disease

47:19

didn't really do that much because

47:22

ticks were absolutely everywhere

47:25

in the spring in the bitter Root, and so

47:27

the only way to avoid them would be to not

47:30

live or work there, which was not the solution

47:32

that the state was looking for. And

47:35

the only practical step, in their eyes,

47:37

which wasn't really practical at all, was to

47:39

eliminate the ticks themselves or

47:42

the gophers ever.

47:43

Thought to be the hosts. Oh gosh.

47:46

So in the spring of nineteen oh

47:48

four, the residents of the bitter Root took

47:50

this to heart.

47:50

They burned, and they burned.

47:52

Vegetation, and they set out poisoned

47:55

grain to kill the gophers, which

47:57

actually killed a lot of game animal gamers

48:00

and other animals.

48:02

And they also got.

48:03

A bunch of sheep to eat the grass that

48:06

the tall grass that they thought was

48:08

the ticks habitat. Oh dear,

48:11

But it's nearly impossible

48:13

to get rid of ticks. You

48:16

need possums, Sarin, We

48:18

need possums to

48:20

set loose.

48:21

The possums don't do that.

48:23

I feel like maybe we shouldn't gamble

48:27

through the ecological dye in that way.

48:31

So the next best thing, though,

48:33

was just to remove a tick as soon as

48:35

you saw it attached, right, and

48:38

people were encouraged to treat it.

48:40

Like a snake.

48:40

Bite like a venomous snake bite, dab

48:43

some carbolic acid on the side of the bite right

48:45

away. So then people had a lot of acid

48:47

burns, accidental spills.

48:50

Infections, et cetera.

48:52

I mean, basically, the bottom line is that, you

48:54

know, though these efforts had led to some

48:56

fundamental knowledge being gained, the

48:58

application to prevention simply

49:01

wasn't there, right, And so

49:04

more help was called in in the form

49:06

of Charles Wardell Styles.

49:08

Does that name sound familiar to you, Yeah, it sounds

49:11

very familiar. What else did he do? Hookworm?

49:14

Oh, that's right.

49:18

He discovered or

49:21

identified the second species of hookworm

49:24

in the Americas. Yeah,

49:26

and he I think he played a role in

49:29

I don't remember, but I think he played a role in determining

49:31

that it was the cause of the widespread anemia

49:33

in the South.

49:34

Ah. And he's Harry Styles

49:36

is great grandpa exactly

49:39

exactly. I'm

49:41

so hip just

49:44

dropping those names.

49:47

My god.

49:49

Okay, So anyway, so Styles

49:52

set out to basically test the ground

49:54

squirrel tick protozoan

49:57

life cycle that Wilson and Chouning had laid

49:59

out. He was enthusiastic

50:02

about the hypothesis early on, but he

50:04

was a little bit close minded when it came

50:06

to any challenge to the accepted

50:08

dogma of the time, which

50:12

was and this is news to me, but apparently

50:14

for a while it was believed that that

50:17

arthropods could transmit protozoa,

50:21

but were not capable of transmitting

50:24

bacteria other than accidentally,

50:27

like a fly could accidentally, I

50:29

don't know, give you an infection because

50:32

they.

50:32

Stepped in poop or something exactly.

50:35

But mosquitoes and ticks and whatever

50:38

weren't capable of actually completing

50:41

the life cycle I bacteria.

50:43

Am that's so interesting.

50:47

Yeah, So when he searched for

50:49

this, this supposed protozoan in

50:51

the ticks and the blood of the victims, he

50:54

came up empty handed again and again.

50:57

But instead of saying, you know, well

50:59

the may have something to do with it, but

51:02

the protozoan probably doesn't, he

51:04

openly refuted and

51:07

dismissed the existing hypothesis.

51:10

And he was started to say,

51:12

like, oh, you know what, these people or

51:14

these residents are overreacting. Ticks

51:17

aren't involved. It's probably snowmelt

51:19

all along. So

51:23

and it's in a way, this

51:26

contemptuous criticism actually

51:29

was beneficial for the research of Rocky Mountain

51:31

Spotted Fever because it drew

51:34

such attention from other researchers,

51:37

including a pathologist from the University

51:40

of Chicago named Howard

51:42

Taylor Ricketts.

51:45

Ricketts RICKETSS.

51:49

Rickets set up a correspondence

51:51

with Chowning, saying that he believed

51:54

their hypothesis had gotten unfair

51:56

treatment by Styles, and

51:58

Chowning was like, I agree.

52:00

Also, I've been doing some side experiments

52:03

in my spare time, including a little bit

52:05

of medicalized torture.

52:07

Oh great.

52:08

So he had obtained quote

52:10

consent from two people to

52:13

attach ticks to them which

52:15

had been feeding on a man who died of

52:17

Rocky Mountain spotted fever. Oh,

52:20

they both got sick with the disease

52:22

and recovered, And so

52:25

Chowning was like, must be ticks.

52:29

So anyway, Ricketts when

52:31

he told Rickets about this, Rickets just didn't

52:33

acknowledge it. Apparently okay' denounce

52:36

them, but he didn't acknowledge it. And he was like, I'm

52:38

gonna do my own research. And

52:41

so he went to Montana, okay, But

52:43

the state had no money to give him, and

52:45

so he and Wilson and Chowning had to

52:47

find their own way to pay. So they like

52:49

cobbled together a bunch of resources,

52:52

and in nineteen oh six, Ricketts set up

52:54

a laboratory in a tent on

52:57

the grounds of the Northern Pacific Hospital

52:59

in Missoula.

53:01

So he was just like in a tent.

53:03

And that spring and summer proved

53:05

very productive for Rickets and another

53:08

researcher named Walter King, who joined

53:10

in on the research. But it must

53:12

be said that this wasn't a super collaborative

53:16

project each one of these

53:18

men for the most part, maybe you know, Chouning

53:21

and Wilson worked together, but like Rickets

53:23

and King were very much

53:26

like, this is my project, and I want

53:28

to do it my way, and I want research, and

53:30

I want publication priority, and I want

53:32

blah blah blah.

53:34

So anyway, and.

53:37

So first they found Ricketts

53:39

and King found that they could cause the disease in

53:41

a guinea pig by injecting serum

53:43

into the animal, and they could sustain

53:46

the infection by alternating infecting

53:48

a guinea pig and then a monkey, and then a

53:50

guinea pig and then.

53:51

A monkey, which then enabled

53:54

year round research. Okay,

53:56

that makes sense.

53:58

Yeah, Then at the very end of this botted

54:00

fever season, both Ricketts and King demonstrated

54:02

that ticks can cause infection, and

54:05

they did this by attaching a tick to a guinea

54:07

pig and then disease

54:09

resulted. Ah

54:11

and this was a super exciting finding, but

54:15

it came at just the wrong time for

54:17

them because it was the end of

54:19

the season and soon there would be no more ticks

54:21

to be found. Back

54:24

in Chicago and Washington, Rickets

54:26

and King tried to keep these tick experiments

54:29

going by advertising

54:31

in like Montana papers for anyone

54:34

who could find a tick, a live

54:36

tick to send it their way. At

54:39

one point they offered a financial incentive

54:41

of ten dollars in gold for anyone

54:43

who could deliver fifty or more live ticks.

54:45

Oh my gosh, citizen science.

54:50

But they never got any. They had to wait until the spring.

54:53

Okay, and mid April nineteen

54:55

oh seven saw the first victim, a twenty

54:57

six year old lumberman whose family

54:59

refus used to allow Ricketts to draw any

55:01

blood. Ricketts was peeved

55:04

about this, and so he asked the secretary

55:06

of the State Board of Health to do

55:08

something about it, And so he

55:10

drew up an official looking document saying

55:13

that the family must cooperate with the

55:15

investigation and

55:17

then he told Rickets,

55:20

hey, don't let anyone get too close

55:22

to look at this because in truth, I

55:24

have no authority to issue it. So

55:29

you know, oh

55:31

my gosh, and people wonder

55:34

why there's deeply rooted mistrust

55:36

in.

55:37

The medical establishment and

55:39

the government research and authority.

55:42

Yeah, okay, goodness.

55:44

So anyway, in nineteen

55:46

oh seven, Rickets concentrated

55:49

on finding out the pathology of the infection

55:51

in ticks, still without knowing what

55:53

the causative agent was, and he determined

55:56

that a small proportion of female

55:58

tics could transmit the path into their offspring,

56:01

so larval takes.

56:02

Could be infectious. Awesome, which

56:04

is a great finding.

56:05

And then in January of nineteen oh nine

56:07

he seemed to finally hit the jackpot when

56:10

he published a paper in which he described

56:12

the teeny tiny basillis cox

56:14

of bacillis that was the causative

56:16

agent of Rocky Mountain spotted fever. He

56:19

had detected ample amounts

56:22

of the bacteria and eggs of infected females,

56:24

and while he was unable to culture

56:27

the bacteria, he was confident in his

56:29

finding.

56:30

Yeah. Yeah,

56:33

it's I mean, it's pretty cool.

56:35

His achievements, Like people were psyched

56:37

about this because he had done

56:39

I mean, he had done microbiological research,

56:41

he had done ecological research, he

56:43

had done some medical research, and

56:46

so his achievements won him praise and

56:48

opportunities left and right, and even

56:51

the state of Montana recognized his

56:53

work by writing in a bill in

56:55

nineteen oh nine that would fund

56:58

a bunch of his research on unspotted

57:00

fever over the next couple of years. Unfortunately,

57:04

though, the funds were suspended

57:06

when the state realized that they had allocated

57:09

more money than they were going to collect

57:11

in revenue, and

57:13

so Ricketts's work was put on hold.

57:16

Oh Man, and even though his colleagues in

57:18

Montana encouraged him to stick

57:20

around get private funds to bridge

57:22

the gap, Ricketts was like, no,

57:25

I've got so many opportunities here. I'm

57:27

going to Mexico to solve the question

57:30

of another spotted fever like disease,

57:33

typhus.

57:34

Ah.

57:35

So then he went down to Mexico City.

57:38

But it was only after he arrived in

57:40

Mexico City in December of nineteen

57:43

oh nine when he learned that

57:45

the big puzzle pieces of Typhus

57:47

had already been put together. The

57:50

vector animal model.

57:53

You know, it was a lot of the stuff

57:55

that had drawn him to study it

57:58

was already discovered, identified,

58:01

done, but he gamely

58:04

stayed on and tried to figure out the causative

58:06

agent, which he suspected might

58:08

be very similar to Rocky Mountain spotted

58:10

fever.

58:12

So then in early nineteen.

58:13

Eleven, Ricketts got word that

58:16

it finally looked like the Montana funds

58:18

were coming through, and he was super

58:20

happy, but he was not incredibly

58:23

eager to leave, despite

58:25

you know that he was working under very

58:28

dangerous conditions. There was like no protection

58:30

against Typhus. In his letters

58:32

to his friends, he wrote, like, my

58:34

wife is very upset with me.

58:36

She's very scared for me. Like if she

58:39

knew what I was doing, she'd be

58:42

wanting me to come back. But

58:46

he wanted to see the project through to

58:49

the end. And so just as tick season

58:51

was starting in Montana, just as he was like

58:54

trying to get up there, he came down

58:56

with Typhus and died May

58:58

third, nineteen ten, at the age of thirty

59:01

nine.

59:02

No.

59:03

Yeah, his death

59:06

was a huge blow to spotted

59:08

fever research, and it also

59:10

established a very tragic pattern.

59:15

If the first decade of the nineteen

59:18

hundreds was characterized mostly by

59:20

research on the causative agent and medical treatments

59:22

for Rocky Mountain spotted fever. The second

59:24

decade looked towards the tick for

59:26

answers by the late

59:29

nineteenth century, when the focus on Rocky Mountain spotted

59:31

fever was heating up. Entomology

59:33

and medicine were two

59:36

totally different fields, particularly

59:39

in North America. Research

59:42

combining the two was conducted

59:44

only rarely, such as with like

59:46

yellow fever research in Panama, for instance.

59:50

Largely entomologists played the role

59:52

of helping combat agricultural

59:54

pest arthropods or

59:56

doing like academic foundational

1:00:00

biology research, and

1:00:02

medical doctors and researchers dealt

1:00:04

with human diseases, how

1:00:06

it worked in the body, how to control it,

1:00:09

and there often wasn't a lot of opportunity

1:00:12

for overlap. Rocky

1:00:14

Mountain spotted fever, however, required

1:00:16

a full understanding of the vector

1:00:19

tixie cology, like its life

1:00:21

cycle, hosts, behavior, etc.

1:00:23

As well as the characteristics of the disease

1:00:26

bacteria, pathogenesis, etc.

1:00:29

And you might.

1:00:30

Instinctively think that public health

1:00:32

researchers or physicians and

1:00:34

entomologists working together would

1:00:37

be the best way to make progress. But

1:00:39

then maybe you forgot about ego. After

1:00:44

Ricketts met his untimely end,

1:00:47

there was maybe a bit of a vacuum in the Rocky

1:00:49

Mountain Spotted Fever research arena in Montana.

1:00:53

The head the secretary

1:00:56

of the state Public Health Department, whose name

1:00:58

was Tuttle, appointed a thing physician

1:01:00

named mcclintick to continue work

1:01:02

on the project. But then when

1:01:04

he arrived, he found an entomologist

1:01:07

named Robert Cooley had rudely started

1:01:09

on a bunch of control efforts on

1:01:11

his own, and neither was

1:01:13

willing to seed any ground for publication

1:01:16

priority or research area.

1:01:19

And apparently neither was willing to work together.

1:01:21

Oh my gosh, I know, get

1:01:24

over yourselves. Get over it.

1:01:26

So the physician McClintic believed,

1:01:29

because it's a human disease, it's a physician or.

1:01:31

A public health problem.

1:01:32

And then entomologist was like, no, it's

1:01:34

a tick transmitted disease, so that

1:01:36

calls for a tick control expert.

1:01:39

No, it's all of these just

1:01:41

were together. Uh

1:01:43

good, I know.

1:01:44

Oh, it's just like goes on and on, this

1:01:47

sparring over funds. It's actually

1:01:49

spilled over to the federal level and

1:01:52

resulted in Cooley the entomologist, losing

1:01:54

support for his work. Oh so

1:01:57

then mcclintick, who was the physician,

1:01:59

was like, a right, I'm gearing up to do some

1:02:01

tickwork, setting up giant vats to

1:02:03

dip the livestock in

1:02:06

to try to prevent tick infestations on livestock.

1:02:09

And I'm going to initiate a massive project to

1:02:11

identify the reservoir of the bacterium.

1:02:14

But that second project was

1:02:16

mostly just destroying all small

1:02:19

wild mammals like pine squirrels,

1:02:21

yellow billy chipmunks, wood rats, woodchucks,

1:02:23

weasels, badger, and of course the infamous

1:02:25

gopher.

1:02:26

Cool cool, that's

1:02:28

not the way you do it, by the way to control

1:02:31

ticks. That doesn't work.

1:02:34

And so while he was able

1:02:36

to rule out several of the species is playing

1:02:39

a major role in the infection cycle, such as badgers,

1:02:42

he had a hard time finding a single

1:02:44

smoking gun species responsible

1:02:46

for the disease.

1:02:48

And he would never.

1:02:49

Find it because

1:02:51

he died of Rocky Mountain spotted fever.

1:02:53

In nineteen twelve.

1:02:54

Oh my god, just a year after

1:02:56

starting his research in Montana.

1:02:58

Oh that's sad.

1:03:00

It's really sad. Once

1:03:02

again, spotted fever research in Montana

1:03:04

was left without a leader. Maybe

1:03:07

this was an opportunity for a fresh start

1:03:10

to bring together physician and entomologist.

1:03:13

I have a feeling it's not going to happen. Erin, No,

1:03:16

it didn't happen.

1:03:17

The budget and the land would be split. The

1:03:20

north part of the valley went to the US Bureau

1:03:22

of Entomology with COOLi in charge,

1:03:25

and the south part of the valley would be designated

1:03:27

as US Public Health Service land.

1:03:29

Kind of an interesting way to do it, Huh,

1:03:31

isn't it so fascinating?

1:03:34

Who did better? Well?

1:03:37

Great question.

1:03:38

So the entomologists on the

1:03:40

north side of the valley were set on just

1:03:43

livestock dipping and basically

1:03:46

taking a cattle submerging them into

1:03:49

a caroside or a pesticide to kill

1:03:52

the ticks. And so these entomologists

1:03:54

were like, all right, that this is

1:03:57

the key killing small rodents.

1:03:59

That's wayted effort. And the

1:04:01

public health folks on the other hand, were like, no,

1:04:04

we're gonna dip and kill

1:04:06

small mammals and also

1:04:08

not allow cattle to feed in

1:04:11

the western on the western side of the river, which

1:04:14

was the only side that was infected.

1:04:16

By the way. Oh yeah.

1:04:19

And so whether the dipping was

1:04:22

actually effective was called into question

1:04:24

as well. So from nineteen thirteen to nineteen

1:04:26

eighteen, the number of ticks supposedly

1:04:29

declined eighty to ninety percent, while

1:04:31

the number of cases had been reduced from eleven

1:04:34

to three. But these numbers are far

1:04:36

from conclusive, like eleven to three

1:04:39

is super.

1:04:40

Could just be seasonal variation or

1:04:42

whatever.

1:04:43

Exactly exactly, And

1:04:46

eradication, which was the promised

1:04:48

end of these projects, was not

1:04:50

on the horizon. The

1:04:53

tick must be destroyed. Killing

1:04:55

small animals wasn't doing it. Dipping

1:04:57

cattle wasn't doing it. Maybe a vaccine

1:05:00

could work.

1:05:01

By the way, that's our title.

1:05:04

The

1:05:12

before Ricketts died, he published

1:05:14

his preliminary findings of this bacterium,

1:05:17

but the debate continued with

1:05:20

still the protozoan leading the pack.

1:05:22

Gosh, I know.

1:05:24

The pathologistes Bert

1:05:26

Wallbach.

1:05:29

Like Wallbachia. Oh that's

1:05:31

exciting. Yeah.

1:05:33

He decided to give it a shot, and

1:05:35

he also observed teeny tiny

1:05:37

bacteria like things in the ticks, their

1:05:39

eggs, and the blood of humans and animals

1:05:42

that had spotted fever. Okay, but

1:05:44

he wasn't sure that they were actually bacteria

1:05:47

because he was like, it doesn't make sense,

1:05:49

they live entirely within the

1:05:51

cells of the animals. So

1:05:54

this has got to be some new kind of micro

1:05:56

organism somewhere in between protozoa

1:05:59

and bacteria.

1:06:00

I mean yeah, I mean wrong,

1:06:03

He's not wrong.

1:06:04

Like, and

1:06:08

even though he was pretty certain he had discovered

1:06:10

the causative agent, which he called dermo

1:06:12

CenTra zenus rakhetzi, others

1:06:14

weren't convinced, chiefly because he was

1:06:16

unable to culture the organism in.

1:06:19

Media in a lab. Of course he was,

1:06:22

he.

1:06:22

Was, like, he was like, listen, like,

1:06:25

I understand that these postula its are important, but

1:06:27

like we have to evolve, like we're

1:06:29

learning new things.

1:06:30

Maybe we should look at different criteria. Yeah,

1:06:34

he was right, He's right.

1:06:39

But then the discovery of the causative agent

1:06:41

of Typhus forced researchers

1:06:44

to accept that these intracellular

1:06:47

microbes might actually be real and

1:06:50

maybe a new type of microbial life,

1:06:52

or at least a new version of

1:06:55

what we've already seen. And eventually

1:06:57

the name that Wollback had given for the spotted fever

1:06:59

back Bacterium was changed to Rakkeetzier

1:07:01

rakeetzii, giving rise to a whole

1:07:04

new genus of pathogenic intracellular

1:07:06

bacteria cool. So

1:07:09

by the nineteen twenties, the causative

1:07:12

agent of Rocky Mountain spotted fever had been discovered

1:07:15

and the life cycle had been outlined.

1:07:17

But this knowledge didn't translate

1:07:20

into live saved yet again. Rather,

1:07:23

the incidents of the disease, as well as its

1:07:25

mortality, seemed to be on the rise.

1:07:28

For instance, in nineteen twenty one, all

1:07:30

eleven cases of Rocky Mountain spotted

1:07:32

fever died. Land

1:07:35

prices reflected this. They were

1:07:37

dropping from one hundred and twenty five dollars

1:07:39

per acre to fifteen dollars

1:07:41

per acre in some places. Oh also,

1:07:44

fifteen dollars per acre.

1:07:46

Can even imagine should

1:07:48

have bought erin actually missed out?

1:07:51

We did, and

1:07:54

tourism obviously plummeted.

1:07:56

No one wanted to go to a place where you could catch

1:07:59

spotted.

1:07:59

Fever and one hundred percent of you would die.

1:08:02

Yeah, yeah, And matters

1:08:04

were only made worse when the

1:08:06

first state bacteriologist, Arthur

1:08:08

McCrae, died of Rocky Mountain

1:08:10

spotted fever in nineteen nineteen.

1:08:12

Oh my gosh, eron, how many people are going to

1:08:14

die from this? There's more?

1:08:17

Okay, So

1:08:20

panic was at an all

1:08:22

time high, so the

1:08:24

state finally acquiesced to providing

1:08:26

funds to create a laboratory whose

1:08:28

main focus was to stop the problem

1:08:31

of spotted fever.

1:08:33

The quote Schoolhouse Lab was established

1:08:36

in an abandoned schoolhouse a couple

1:08:38

of miles from Hamilton, Montana, in

1:08:40

the Bitterroot Valley. There,

1:08:43

lab and ecological facilities were

1:08:45

built or cobbled together

1:08:47

where researchers could actually do the work

1:08:49

that they had been doing in their spare time in

1:08:52

makeshift tents and distant university

1:08:54

labs for years. And to

1:08:56

head this new research venture, two

1:08:59

people were appointed, physician Roscoe

1:09:01

Spencer and entomologist Ralph

1:09:03

Parker.

1:09:04

Parker, I all right, another

1:09:07

physician and another entomologist.

1:09:10

Are they going to work together this time? Well,

1:09:13

this is where the romance comes in.

1:09:15

Just going at

1:09:17

first, the old time rivalry

1:09:19

between these two professions seemed like

1:09:21

it was going to rear its ugly head yet again,

1:09:24

and they were like, oh, you know, before

1:09:26

they before they arrived in Montana,

1:09:28

I was like, oh, what about publication priority?

1:09:31

What about this? What about that?

1:09:32

But then they met in person and they were like,

1:09:35

let's work together. All of our research will

1:09:37

be published jointly.

1:09:38

So isn't that nice?

1:09:41

Is how you do it? That's how you do it.

1:09:44

So Parker, the entomologist,

1:09:46

he had set his sights on big picture

1:09:49

ecological studies like huge,

1:09:51

what do we how do we find out the links between

1:09:54

ticks and these animals and spotted fever

1:09:56

and the behavior and seasonality

1:09:58

and all of these like just the

1:10:00

most fun questions, right, And

1:10:03

Spencer's like.

1:10:04

I'm gonna do a vaccine.

1:10:06

And so there had been.

1:10:08

Some research by Hideo Nogucci

1:10:10

at the Rockefeller Institute that was

1:10:13

promising in terms of spotted

1:10:15

fever vaccines, and in nineteen

1:10:17

twenty three, Nogucci had declared

1:10:20

that he had developed an effective vaccine. It

1:10:22

just needed to be tested in humans. So

1:10:25

who better to volunteer than some of

1:10:27

the laboratory staff at the Schoolhouse

1:10:29

Lab in Hamilton. For sure, incidents

1:10:32

of the disease was disturbingly high.

1:10:35

The vaccine was not.

1:10:37

Without side effects, but

1:10:39

it seemed to be effective and at least reducing

1:10:42

the severity of illness if exposed

1:10:44

to the disease. All right, But

1:10:47

because the efficacy of Nogucci's vaccine

1:10:49

remained doubtful, Spencer, the

1:10:51

physician involved in the project continued

1:10:54

his own work on a vaccine, work

1:10:57

which ended up being delayed because

1:11:00

tularimia, another disease,

1:11:02

started popping up in the Bitter Root

1:11:04

Valley.

1:11:05

Oh my gosh, this does not make me want

1:11:07

to visit this part of Montana.

1:11:09

Oh my gosh. What I mean?

1:11:12

First of all, Okay, that

1:11:15

was not the

1:11:18

image I was trying to portray with this

1:11:20

history, and I feel now very bad

1:11:22

about it because it is absolutely

1:11:24

beautiful. And yes

1:11:26

there are ticks, but we know a lot more about

1:11:28

Rocky Mountain spotted fever. We know a lot more about

1:11:31

how to protect ourselves and if

1:11:34

there's ever an area where

1:11:36

the physicians are probably keyed

1:11:38

into, Yeah, that makes sense.

1:11:41

Signs you symptoms, you'd get doxycycling.

1:11:43

If you walked in and said I had a fever.

1:11:46

You're like, I went hiking in the bitter Root. Here's

1:11:48

some doxy ceco.

1:11:50

I'm just kidding. You don't give it prophylactically,

1:11:52

but anyhow.

1:11:56

So okay, tularimia

1:11:58

popped up. Both as Ann

1:12:00

Parker, the heads of the project, became ill,

1:12:03

and they wouldn't be the last to fall

1:12:05

during this work.

1:12:07

No, Aaron, I don't know if my heart

1:12:09

can take this. I'm so sorry.

1:12:11

This is the whole romance. This is

1:12:14

not that.

1:12:14

I think it was like romance, meant in

1:12:17

the way that was like.

1:12:20

Tragedy. Oh yeah, those are

1:12:22

two different categories of

1:12:24

film. I

1:12:26

don't know, are they? Like a tragic movie

1:12:28

could be romantic at the same time and vice versa

1:12:33

Romeo and Juliet. Yeah, I don't like

1:12:35

that one.

1:12:36

Well, anyways, regardless,

1:12:39

let's learn more about the fallen researchers.

1:12:42

Okay, student research assistant

1:12:45

William Geddinger died in nineteen

1:12:47

twenty two of spotted fever. Field

1:12:49

assistant George Henry Cowan, who had

1:12:52

worked for over a decade on the

1:12:54

disease, died in nineteen twenty four,

1:12:56

and another student researcher named Albert

1:12:58

Curley died in nineteen twenty eight

1:13:01

of spotted fever. In

1:13:03

nineteen twenty five alone, six

1:13:06

people working at the Schoolhouse Labs

1:13:08

became infected with either

1:13:11

spotted fever or tularimia.

1:13:13

Oh my goodness.

1:13:14

The Schoolhouse Lab was

1:13:18

notoriously and

1:13:20

deservedly so, an incredibly dangerous

1:13:22

place to work because there was no

1:13:25

biocontainment facilities and

1:13:27

spotted fever ridden ticks were crawling

1:13:30

all over the place. Oh no, Like they would

1:13:32

have rabbits that they would infect and then the ticks

1:13:34

would just be like your tick falls off and then

1:13:36

it could go and.

1:13:37

Oh get up on a lab worker.

1:13:39

Dogs wandered in and out, bringing ticks

1:13:41

with them. I mean they didn't

1:13:44

have the best facilities, right. Part

1:13:46

of it was funds, Like if

1:13:48

there's a lesson here, and it's about funding

1:13:50

disease research as

1:13:52

usual. There's

1:13:55

a famous book called Microbe Hunters by

1:13:57

Paul Dacreefe that tells

1:13:59

the romantic and swashbuckling tales

1:14:02

of like early microbiologists and well

1:14:05

micropunters, and it

1:14:08

includes the story of the Rocky Mountain spotted fever

1:14:10

researchers, which enraged the

1:14:12

residence of the Bitter Root because it portrayed

1:14:14

them all as like cowering in their cabins

1:14:17

hiding from this dreaded disease. But

1:14:20

I mean people were rightfully scared of spotted

1:14:22

fever, and so when Spencer rolled out testing

1:14:24

of his vaccine in nineteen twenty five,

1:14:27

people like both workers

1:14:30

at the lab as well as residents

1:14:32

eagerly volunteered and

1:14:34

it seemed effective in at least reducing

1:14:37

the duration and severity of the illness.

1:14:39

Okay, so overall, retrospective

1:14:42

studies showed that vaccinated people had a

1:14:44

seventy five percent lower fatality

1:14:47

rate than those who were unvaccinated.

1:14:49

What that's amazing.

1:14:51

Yeah, yeah, so you

1:14:54

know, but the

1:14:56

hazardous working conditions remained

1:14:58

a concern, and so the state finally

1:15:01

put together funds to build new facilities.

1:15:04

But where should they go? Should they move to Missoula,

1:15:06

where the University of Montana was located,

1:15:08

But maybe that was too far from the field, and

1:15:11

so we should keep it close to

1:15:13

Hamilton, And so it was

1:15:15

decided that it was that it would be built on

1:15:17

the east side of the river in Hamilton,

1:15:21

which had always been spotted fever

1:15:23

free.

1:15:23

Oh no.

1:15:26

This caused quite a bit of

1:15:28

a stir as people became concerned

1:15:30

that the disease would become established

1:15:32

on the east side, or that infected

1:15:34

ticks would escape, or children playing

1:15:37

in the yards of the lab would get infected. But

1:15:40

tons of special precautions were put in place,

1:15:43

including like amoat and heavy

1:15:45

duty sterilization procedures WHOA

1:15:47

and work began. Ultimately,

1:15:51

the residents of Hamilton warmed to the lab

1:15:53

and they would occasionally like lead out of

1:15:56

town visitors through the building. And then that

1:15:58

became problematic because the recent were

1:16:00

like, you're putting yourselves at risk. We

1:16:03

need to shut this down, like you

1:16:05

need to sign in, you need to have somebody

1:16:08

supervising this. So but

1:16:10

anyway, the availability of a vaccine

1:16:12

also alaid some of these fears. But

1:16:15

the vaccine was not a permanent solution because

1:16:17

in order to make it, researchers

1:16:19

had to collect or rear thousands

1:16:22

of ticks, get them infected,

1:16:24

and then grind them up and then

1:16:26

turn that into a vaccine.

1:16:28

Oh that's what they were using. Okay,

1:16:30

mm hmm.

1:16:31

And there wasn't much work that had been

1:16:33

done on streamlining the production process,

1:16:36

and nor would there probably be,

1:16:39

since the market for the vaccine was relatively

1:16:42

like low, only in the Western States.

1:16:44

Yeah, or was it so?

1:16:49

Throughout the nineteen thirties, a mysterious

1:16:51

typhus like illness was noted along

1:16:54

the eastern seaboard of the US as well

1:16:56

as in Brazil, and it seemed to be associated

1:16:58

with.

1:16:59

A tick bite.

1:17:00

And while initially it was thought to be a disease distinct

1:17:02

from spotted fever, like doctors

1:17:04

would say, oh, I would say this is spotted fever

1:17:06

if I were in Montana. But

1:17:09

ultimately microbiological research showed

1:17:11

it to be one and the same. And this

1:17:13

development was pretty crucial since it came

1:17:16

around the same time as the Great

1:17:18

Depression was sinking its teeth into

1:17:20

everything, including

1:17:23

scientific research funding. So

1:17:26

funding for the Rocky Mountain

1:17:28

Laboratory was threatened. And

1:17:31

in response to this, one

1:17:33

person, one researcher replied quote,

1:17:36

and I'm including this quote because I think it's relevant

1:17:40

to.

1:17:41

Today and always.

1:17:44

If the government should discontinue this activity

1:17:46

in the light of our present knowledge, the

1:17:48

person's responsible for such action would,

1:17:51

in my opinion, be morally

1:17:53

responsible for the deaths which will

1:17:55

occur as a result of the lack

1:17:57

of material. I may

1:17:59

add that only a few days ago

1:18:02

a request was received from the Army

1:18:04

for a large quantity of this material

1:18:06

to be used for the protection of its forces

1:18:09

in the field.

1:18:11

So sounds strangely

1:18:14

familiar in our affurent climate.

1:18:19

And that's all I'm going to say about that.

1:18:22

It's like the government doesn't want to fund this anymore,

1:18:25

but yet they want it so

1:18:28

anyway.

1:18:30

Fortunately, you know.

1:18:31

Maybe this has cause for optimism. The

1:18:34

funds were preserved the lab

1:18:36

stayed and placed, and actually

1:18:38

some Civilian Conservation Corps

1:18:40

CCC camps, which was like part of the whole,

1:18:43

you know, Roosevelt's New Deal,

1:18:45

were established in the bitter Root

1:18:47

to help collect ticks and

1:18:49

to do this research for vaccine

1:18:51

productions. They had tons of people coming

1:18:54

in to work there, which was

1:18:56

actually also a problem because there wasn't

1:18:59

enough vaccine to vaccinate.

1:19:00

The newly arrived workers. But anyway,

1:19:04

so until the mid nineteen.

1:19:05

Thirties, research at the Spotted Fever Lab

1:19:07

in Hamilton had focused on just

1:19:10

that, hence its name, which

1:19:12

is the Spotted Fever Lab. Maybe

1:19:14

some dips into tularimia, but developments

1:19:17

in the mid nineteen thirties would greatly

1:19:19

expand its role and give it the name Rocky

1:19:21

Mountain Laboratory.

1:19:23

But that, like Rocky Mountain Labs, is

1:19:25

still a thing today.

1:19:27

Oh yeah, these

1:19:29

are its roots.

1:19:30

Yeah that. I never knew that. And when

1:19:32

you said Rocky Mountain Labs earlier, I was

1:19:34

like, I never

1:19:36

would have. I don't know how I never would

1:19:38

have made a connection between Rocky

1:19:41

Mountain, Spotted Fever and Rocky Mountain Labs. I

1:19:43

never I never made that connection before.

1:19:45

Oh my gosh, and it's it's so wild

1:19:47

because like that's always been like

1:19:50

well throughout my PhD. I was like, Oh, that's

1:19:52

that's my dream place to work. I want to work on

1:19:54

racketzias in Rocky On in

1:19:57

RML.

1:19:57

Yeah, in beautiful ham.

1:20:00

And But like I didn't know

1:20:02

any part of this history, and I also didn't

1:20:05

know the incredible significance

1:20:07

that this lab has had, like

1:20:09

not only on Rocky Mountain spotted fever research,

1:20:12

but as we're about to find out even

1:20:14

more research.

1:20:15

Ooh

1:20:18

okay.

1:20:19

So in nineteen thirty

1:20:21

six, a researcher at Rocky

1:20:24

Mountain Laboratory named Harold Cox had

1:20:26

been experimenting with different ways

1:20:28

to grow ricketzier outside of ticks,

1:20:31

because he was like, I want to put together

1:20:33

a better method of vaccine production. One

1:20:36

day he ran out of the tissue that

1:20:38

he had been using mid experiment, and

1:20:42

rather than scrapping the whole thing, he

1:20:44

reached for some yolksac that

1:20:47

he had put in the fridge. You

1:20:49

have that just like I guess

1:20:51

well, they were doing like egg yambrane

1:20:54

whatever, And the next day

1:20:56

he found it teeming with ricketzia.

1:20:59

He was like, oh my gosh, what

1:21:02

he wrote to everyone.

1:21:03

People were super skeptical and then they saw it in

1:21:05

person and they were like you kidding me.

1:21:07

Good job.

1:21:10

And this accidental

1:21:12

discovery had huge implications

1:21:15

but not just for spotted fever research,

1:21:18

but other riquettsial diseases. And

1:21:20

I know that, like we haven't done a Typhus

1:21:22

episode, but like Typhus

1:21:25

is really bad. Yeah, I mean

1:21:27

you talk about one of the big killers of

1:21:29

especially like you know, wartime

1:21:32

and any sort of like civil unrest

1:21:34

areas, Like Typhus was

1:21:37

massive. Yeah, so it's

1:21:39

still it's still massive.

1:21:42

Yeah.

1:21:42

Yeah, So Typhus was

1:21:44

was a huge one, and so so

1:21:46

spotted fever. Yeah, across the US

1:21:49

and inter Central and South America, incidents

1:21:51

of it ran pretty low. Of course, it was very

1:21:53

deadly and so that was a huge cause for concern.

1:21:56

But of even more interest was this

1:21:59

the big killer typhus, Especially

1:22:02

as World War two began and

1:22:04

as US soldiers began to be stationed

1:22:07

in regions where it was endemic.

1:22:11

Cox's yolksac method

1:22:13

provided a cost efficient way to

1:22:15

produce the volume of vaccines that

1:22:17

had long been sought after huh.

1:22:20

This discovery turned Rocky

1:22:22

Mountain Laboratory into a national

1:22:25

vaccine factory for typhus and

1:22:27

yellow fever and others during

1:22:29

World War two. Like it turned into

1:22:31

just pumping out vaccines.

1:22:33

Wow, I did not know that.

1:22:35

And it played such a hugely important

1:22:38

role during World War two that there were

1:22:40

armed guards like from

1:22:43

you know, armed forces around

1:22:46

there around the clock twenty four to seven

1:22:48

to make sure that like nothing happened to the lab

1:22:51

in old Hamilton, Montana, like tiny

1:22:54

town.

1:22:54

So anyway, super cool.

1:22:57

And then while at Rocky Mountain Laboratory,

1:23:00

Cox also developed the complement

1:23:02

fixation test, which allowed

1:23:04

for diagnosis of ricketzial diseases.

1:23:08

Wow, that's a big deal.

1:23:10

That's a very big deal. So VACU

1:23:12

Mountain Lab, Rocky Mountain Lab.

1:23:17

The discovery of antibiotics that were

1:23:19

effective against ricketzial diseases

1:23:21

in the nineteen forties and the nineteen fifties,

1:23:24

they took some of the urgency out of the

1:23:26

preventative or treatment research programs

1:23:29

for spotted fever. Researchers

1:23:31

could now focus on understanding the physiology

1:23:34

of ricketzier and the microbiology

1:23:37

of these bizarre tiny

1:23:39

bacteria, and the

1:23:42

miracle of antibiotics, as we had discussed

1:23:45

a few episodes ago, led to

1:23:47

this unfortunate decline in some

1:23:49

of the more fundamental medical entomology

1:23:51

research that had been the hallmark of the

1:23:53

Rocky Mountain Laboratory in its early decades.

1:23:57

With the combination of a vaccine

1:23:59

and antibiotics, fear of spotted

1:24:01

fever declined throughout the fifties

1:24:03

and the sixties, despite the fact

1:24:06

that it continued to pop up in new locations

1:24:08

and with increasing incidents like

1:24:10

it. If you look at a chart

1:24:14

of the cases over time, it's like

1:24:16

increasing, increasing in the late eighteen hundreds,

1:24:19

early nineteen hundreds, and then plummets, and

1:24:21

then throughout the sixties and seventies it's like

1:24:23

on the rise.

1:24:24

Oh just wait, Aaron, just okay, wait.

1:24:27

I'm very interested,

1:24:29

Okay. And

1:24:32

then budget cuts in the nineteen

1:24:35

seventies eliminated the medical

1:24:37

entomology research program at Rocky

1:24:39

Mountain lab And I don't

1:24:41

know if it's if it's back up or not. I should have checked

1:24:43

that, But and the tick collection was

1:24:45

shipped to the Smithsonian.

1:24:47

Huh.

1:24:48

Work on Ricketsie continued, and

1:24:51

Rocky Mountain.

1:24:51

Laboratories is still a

1:24:54

hugely.

1:24:55

Important side of research in general, as we mentioned,

1:24:58

and a few more pieces of the spotted

1:25:00

fever puzzle fell into place

1:25:03

during this time. For instance,

1:25:05

the recent resurgence in cases in the nineteen

1:25:08

seventies was traced to the

1:25:10

encroachment of humans into previously

1:25:12

wooded areas allah lime

1:25:14

disease surprise, surprise, and

1:25:18

most interestingly, the long

1:25:20

standing mystery of why the

1:25:22

east side of the Bitterroot River remained

1:25:24

protected from the west side

1:25:28

was solved okay by

1:25:30

Willie Burgdorfer Burgdorfer.

1:25:35

Of our lime disease episode.

1:25:39

Yet Okay, we

1:25:41

don't know.

1:25:42

So I'm so excited that I

1:25:44

get to tell you this.

1:25:45

Oh I'm so excited too, because I really was expecting

1:25:47

this story to go And then they built a lab

1:25:49

and then released infected ticks and

1:25:51

now they're everywhere, Like that's one hundred

1:25:54

percent what I expected.

1:25:55

So that's not what happened. And

1:25:58

here's why. So he

1:26:00

discovered that on

1:26:03

the east side of the river. He

1:26:06

was doing a bunch of, you know, microbiology

1:26:08

essays of these ticks, and he discovered

1:26:11

that they were infected with Ricketsia,

1:26:14

but it was a non pathogenic one,

1:26:17

and the Ricketsia in those ticks

1:26:19

prevented Racketzia ricketsii,

1:26:22

the pathogenic one from colonizing

1:26:24

the ticks interference

1:26:26

phenomenon.

1:26:27

Okay, oh

1:26:30

my god, I'm getting like chills.

1:26:33

I know, I know.

1:26:35

So researchers

1:26:38

had long made the observation that animals freely

1:26:40

passed from the east side to the west side of the river. Animals

1:26:43

were found on both sides. Like it didn't

1:26:45

make sense, right, So if

1:26:47

a tick that is infected with this non pathogenic

1:26:50

Ricketsia bites an animal

1:26:52

that is infected with spotted

1:26:55

fever Racketzia Ricketsia I, that

1:26:58

spotted fever can't establish

1:27:00

in that tick, right because the other bacteria

1:27:02

is just already there and

1:27:04

so and this bacteria also has

1:27:07

better transoviial transmission, so

1:27:10

it will not hurt the tick

1:27:13

as it's passed from female

1:27:15

tick to eggs. This

1:27:18

is so interesting, Aaron tick biology

1:27:20

is so amazing.

1:27:22

It really is very so amazing.

1:27:24

That is so bizarre.

1:27:26

So, this this interference phenomenon

1:27:28

people have like it's been discussed,

1:27:31

this type of thing, We've talked about it with Wolbacchia,

1:27:33

and like, yeah, maybe we haven't, but like we've

1:27:35

referenced it at least or alluded to it

1:27:38

in terms of like finding the certain

1:27:41

microbes that can prevent pathogenic

1:27:44

ones from establishing in a vector.

1:27:45

We talked about it with then gay fever.

1:27:48

Oh yeah, yeah, so anyway,

1:27:51

Burgdorf, Yeah, So,

1:27:53

even though Rocky Mountain spotted fever

1:27:55

has been heavily studied for over

1:27:58

one hundred years, there's

1:28:00

still a lot that we don't know about it, m

1:28:02

M, particularly when it comes

1:28:04

to the disease, reservoirs, strain

1:28:07

differences, geographic differences, climate

1:28:09

change, like the list goes on and

1:28:12

on and on, seasonality. Fortunately

1:28:15

for researchers now it's a lot

1:28:17

safer than it used to be to study.

1:28:19

And I repeat again, I

1:28:22

hope, hope, hope.

1:28:23

I haven't discouraged anyone from visiting

1:28:25

the Bitterroot Valley because you definitely

1:28:28

should do so. It's gorgeous, it's

1:28:30

amazing and anyway,

1:28:33

and you could go see Rocky Mountain Labs

1:28:36

and you could go see

1:28:38

the infamous, the famous,

1:28:40

the amazing Rocky Mountain Labs. Okay,

1:28:45

well erin, tell

1:28:47

me what's going on with Rocky Mountain

1:28:49

spotted fever today.

1:28:50

Oh oh, I'm really thrilled

1:28:52

too. After that history, we'll take

1:28:55

one quick break first. I'm

1:29:29

going to start off not where I expected

1:29:32

to start off. Because I

1:29:35

want to ask you questions.

1:29:37

Erin, Okay, Okay, I

1:29:41

want to start off with vaccine.

1:29:44

We don't have one, Erin, No,

1:29:47

there is none.

1:29:49

The one that they had developed, the

1:29:51

Parker Spencer vaccine that

1:29:54

was used, I don't know how,

1:29:56

like it's not been used for several decades

1:29:58

now, Yeah, and I I think ultimately

1:30:01

it caused some

1:30:03

side effects and possibly infection in

1:30:06

some.

1:30:06

People, if that makes sense. If they were just grinding

1:30:08

up ticks, then that would that would be Yeah.

1:30:11

It seems like Riquetsier in

1:30:13

general are a tricky bunch

1:30:15

to make vaccines for.

1:30:17

Yeah, I don't I don't know, I

1:30:20

don't know, but we don't

1:30:22

have a vaccine honestly,

1:30:25

from what it sounds like, and I'm

1:30:27

I'm sure that this is the case, it's largely

1:30:29

just because of a lack of funding and a lack

1:30:32

of interest, not just from

1:30:34

like a research standpoint, but from a pharmaceutical

1:30:37

standpoint. There

1:30:39

are not enough cases essentially

1:30:41

per year to produce

1:30:44

a vaccine. It's not like financially

1:30:46

viable, for better or for worse. It

1:30:49

is true that patients who survive

1:30:51

infection do mount a very

1:30:53

good and long lasting immune response

1:30:56

and We've also identified a number

1:30:59

of the surface protein an egen,

1:31:01

so it's certainly theoretically possible

1:31:03

to develop a vaccine. But

1:31:06

when you you know, I usually

1:31:08

use Google scholar that's

1:31:10

my preferred search website

1:31:15

for finding my papers. And

1:31:17

when you search Rocking Mountain spot of

1:31:19

Fever vaccine, you the first

1:31:22

entire page of results. There is

1:31:24

not a single paper from past nineteen

1:31:26

ninety on that page.

1:31:30

So yep, and some of

1:31:32

them are from nineteen twenty five. They're

1:31:35

probably some of the ones referenced

1:31:37

in your book. Oh my gosh's Parker

1:31:39

sponsor, right, But that

1:31:41

doesn't mean that no one's doing research on it. I

1:31:43

did find a recent paper that

1:31:46

was looking at and did

1:31:48

develop an effective wholesale vaccine

1:31:50

that they tested in dogs. I will

1:31:52

link to it, but like, I wouldn't

1:31:54

read that paper again. It was very depressing.

1:31:57

They killed a lot of dogs. Oh

1:32:00

my god. Yeah, but

1:32:02

they made a vaccine. So

1:32:05

anyways, that's the current

1:32:08

research. Let's talk about the epidemiology.

1:32:10

Okay, yes, all

1:32:13

right, So in the United States,

1:32:16

Rocky Mountain spotted fever has

1:32:18

been a nationally notifiable

1:32:20

disease since the nineteen twenties.

1:32:23

Since twenty ten, they've been calling

1:32:26

it a different name and therefore reporting

1:32:28

it a little bit differently. It's now reported

1:32:31

as spotted fever ricketziosis.

1:32:34

And the reason is we don't

1:32:36

have a good way to differentiate the

1:32:38

clinical syndrome that is caused

1:32:40

by Ricketzia RICKETSII from

1:32:43

the clinical syndromes that are caused by a

1:32:46

number of other Ricketzial pathogens,

1:32:49

including Ricketzia, Parker eye,

1:32:51

which we briefly said

1:32:54

those words earlier, ricketzial

1:32:57

pox, and a few others.

1:33:01

So kind of that's the background

1:33:03

I think to keep in mind as I'm going to talk

1:33:05

about these numbers, because this gets really

1:33:08

interesting, Okay, Okay, so

1:33:11

let's talk about you said that cases

1:33:14

were increasing, you know, through

1:33:16

the late nineteen nineties or

1:33:18

through the late nineteen hundreds right

1:33:21

after that drop off. Well,

1:33:24

if you look at the graphs of cases

1:33:27

since the year two thousand, it's

1:33:30

terrifying. It is.

1:33:33

It's an exponential growth curve, which

1:33:35

everyone is now very familiar with. We've

1:33:37

all seen a lot of those

1:33:39

these days. Okay, The

1:33:43

number of cases has increased steadily

1:33:46

just about every year. Twenty

1:33:49

eighteen was a little better than twenty seventeen,

1:33:51

but in twenty seventeen, there were over six thousand

1:33:53

cases reported, and that's up

1:33:55

from five under five hundred in the

1:33:57

year two thousand.

1:33:59

What okay, that's like

1:34:02

And I'm so embarrassed because this is literally

1:34:05

what I did my PhD on.

1:34:06

Yeah, you did it in Panama. Okay,

1:34:09

it's fine, Okay, you didn't need to

1:34:11

know these numbers. So, but here's the question.

1:34:14

We're seeing these huge increases in cases.

1:34:17

How many of these are the

1:34:20

very deadly Rocky Mountain spotted fever versus

1:34:22

other ricketzia and

1:34:25

it's really hard to say, And also how

1:34:27

much of it is Are we getting better at recognizing

1:34:29

it, are we getting better at reporting it?

1:34:33

Or are there an increase in

1:34:35

infections? I

1:34:38

think this is me thinking,

1:34:40

but also like based on what I

1:34:42

read, uh, it's likely

1:34:44

a combination of both as usual. But

1:34:47

the increase is so large over

1:34:49

such a short period of time, Like we're talking

1:34:51

twenty years, right from two thousand you

1:34:53

have under five hundred cases to over six

1:34:56

thousand in seventeen years.

1:34:58

That's massive. And this is a disease

1:35:01

that's been notifiable since

1:35:03

the nineteen twenties, and

1:35:06

our diagnostic tools are

1:35:08

not much better today than they

1:35:10

were twenty years ago.

1:35:13

Okay, the

1:35:15

case fatality rate has drastically

1:35:20

dramatically decreased

1:35:22

since the nineteen forties, since the introduction

1:35:25

of tetracyclines for treatment.

1:35:28

So in clinical reviews like

1:35:30

worldwide, even after tetracyclines

1:35:33

were introduced for treatment, case

1:35:35

fatality rates still usually

1:35:38

are about five to ten percent, usually

1:35:40

around five percent. But

1:35:43

the current case fatality rate in the

1:35:45

US, according to surveillance data,

1:35:47

is as low as zero point five

1:35:50

percent. What that's excellent.

1:35:53

It is excellent, but it bears

1:35:56

the question, is this rocky

1:35:58

mountain spotted fever or is this something

1:36:00

else? So let's look in other

1:36:02

parts of the world, what's

1:36:05

going on there? Well,

1:36:07

turns out that's hard to do. There's

1:36:12

not very good surveillance data

1:36:14

for much of the rest of the world. But

1:36:17

I did find some really good data for Mexico.

1:36:20

So in Mexico throughout

1:36:22

the two thousands, the incidence

1:36:25

of disease has also been increasing,

1:36:28

also dramatically. I don't have

1:36:30

an exact number. However,

1:36:33

unlike in the US, the case fatality

1:36:36

rate has also been increasing

1:36:39

rather than decreasing. Really,

1:36:41

the aggregate case fatality rate has been

1:36:44

between fourteen to eighteen percent

1:36:46

depending on the region of Mexico, but in

1:36:48

some years the case fatality rate

1:36:51

has been as high as forty percent.

1:36:53

Ooh, so

1:36:55

then I think, you know, there's a lot of questions

1:36:58

as to what is this.

1:37:00

Does this mean that we're looking at different diseases

1:37:03

or does it just mean that we're looking at drastic differences

1:37:05

in lack of availability of good

1:37:07

diagnostic tests, delays

1:37:10

in reaching a doctor to get

1:37:12

diagnosis or to get treatment. Another

1:37:16

issue is that a large proportion

1:37:18

of cases, not just in Mexico,

1:37:20

but in Mexico and also in the US, are

1:37:23

in children, because kids are running

1:37:25

around outside getting bitten by ticks, and

1:37:28

usually tetracyclines aren't used

1:37:30

as treatment for children because

1:37:33

it can permanently damage and discolor

1:37:35

your teeth. So

1:37:37

a lot of physicians might be hesitant

1:37:40

to prescribe doxycycling for kids.

1:37:42

But it turns out that for Rocky Mountain spotted fever,

1:37:44

it's a short enough course that it doesn't actually

1:37:46

increase the risk of tooth

1:37:48

discoloration. But maybe

1:37:51

you don't know that, and so then a kid

1:37:54

is delayed in getting the appropriate treatment

1:37:56

or receives the wrong kind of treatment,

1:37:59

and you have an increase in case

1:38:01

fatality rate, but

1:38:04

overall it's

1:38:07

less than one percent of spotted

1:38:10

fever group or keetsioses that are reported

1:38:12

in the United States are actually lab

1:38:14

confirmed.

1:38:16

Okay, so it's all

1:38:18

based on the trial.

1:38:21

Yeah, exactly. Oh and

1:38:23

the other triad piece is

1:38:26

often a tick exposure. So

1:38:28

some people say the triad is fever,

1:38:31

rash, tick exposure, or history of tick

1:38:33

exposures rather than the fever,

1:38:36

headache, and rash.

1:38:40

But not everyone reports tick

1:38:43

exposure, right, and that doesn't mean

1:38:45

that they weren't exposed, They just might never

1:38:47

have known it. Mm hmm, comforting

1:38:50

thought. Yeah, so

1:38:53

that's spotted

1:38:57

fever group, riquetsiosis, Rocky Mountain,

1:38:59

spotted fever. Today.

1:39:05

We never told Brett's.

1:39:06

Story, Okay, okay,

1:39:08

now we need to tell Brett's story. Cast

1:39:11

your mind back to twenty thirteen,

1:39:14

twenty thirteen, twenty.

1:39:16

Fourteen, twenty fourteen,

1:39:19

the summer, the summer of twenty

1:39:22

fourteen. Okay, listen, the rainy season

1:39:24

in Panama everyone, June.

1:39:27

As we mentioned, Aaron

1:39:29

Welsh did her research on tickborn

1:39:33

disease in Panama. That

1:39:35

was what her thesis was on. Our lab

1:39:38

is a disease ecology lab. We

1:39:41

studied tick

1:39:43

and other vector borne diseases.

1:39:46

Okay, my focus in particular,

1:39:48

well, my focus was the general

1:39:51

ecology of tics

1:39:54

and their pathogens as it related

1:39:56

to the climate gradient

1:39:58

across the isthmus and seasonality and

1:40:01

different animals and blah blah blah. But

1:40:05

you know, in all the research proposals

1:40:07

I ever wrote during

1:40:09

my PhD, I

1:40:12

always mentioned rakhetzi RACKETSI I, of

1:40:14

course, because it is

1:40:16

present there and it is a cause for concern

1:40:19

to So you want to understand where

1:40:21

they are, what the ticks are, and you

1:40:23

want to increase awareness of

1:40:26

a tick bite and a rash,

1:40:28

a fever and.

1:40:30

A possible headache. So June

1:40:34

of twenty fourteen, Brett,

1:40:37

my now husband, and I

1:40:39

flew back from Panama after my first

1:40:42

field season down there, to

1:40:44

California to stay with family for

1:40:46

a short time. And

1:40:49

on the plane ride back, he started

1:40:52

feeling crappy. Okay,

1:40:55

he did. He felt unwell. We

1:40:59

made it back to my brother's house

1:41:02

and I believe he had a fever,

1:41:05

but I'm sure we didn't have a thermometer. But

1:41:07

he felt he felt sick, like

1:41:09

he just really didn't feel good. And I was

1:41:11

like, gosh, like I hope you didn't come down with something,

1:41:14

you know. But he had

1:41:16

no respiratory symptoms. He wasn't coughing,

1:41:19

he didn't have you know, like

1:41:22

sore throat, any of the normal kind of

1:41:24

things I would associate with flu or a

1:41:26

cold. He just felt achy,

1:41:29

he felt unwell. He had a headache,

1:41:31

a fever. And

1:41:33

this lasted for a couple of days,

1:41:36

and then he

1:41:39

went to the bathroom. Is

1:41:43

he gonna be? Did

1:41:45

you tell him that you were going to tell this? Yes, I told him.

1:41:48

He goes, I knew as soon as you said you

1:41:50

were doing rocking Mountain spotted fever. He's

1:41:52

like, I've been waiting for this for three

1:41:54

years. Finally here. So

1:41:57

then he came out of the bathroom

1:42:00

room and he said, I

1:42:03

just I pulled

1:42:05

something. I pulled something

1:42:07

off of my

1:42:09

my the top of my butt crack.

1:42:12

And I said what and he was like yeah,

1:42:15

it was like there was a bunch of blood and some black

1:42:17

stuff. And I said

1:42:19

what. And then I grabbed

1:42:21

his arms and on his

1:42:24

wrists was a rash,

1:42:28

a red, blanching,

1:42:31

macular rash

1:42:34

that did not hurt and did not itch. And

1:42:36

oh, he also had one on his legs

1:42:38

that he hadn't even fully noticed up

1:42:41

to the blood. Okay, And

1:42:43

then he said, I pulled this thing off the top

1:42:45

of my butt. It was I. I

1:42:47

saw it. I squished it. There

1:42:50

was blood and then

1:42:52

black things, and I went and

1:42:54

I threw it in the toilet

1:42:57

and I flushed, and

1:43:01

I said, you just flush

1:43:03

a tick. You have a

1:43:05

ricketsia. You need to first

1:43:07

of all, go to the doctor. And second of all,

1:43:09

I can't believe that you threw the tick

1:43:12

in the toilet. I

1:43:14

was devastated. Oh, we all were.

1:43:16

Our whole lab knows this story. He's

1:43:19

also probably going to be like, you told it entirely

1:43:22

incorrectly, but I didn't.

1:43:24

This is how it happened.

1:43:26

Yeah, this is the This is the myth

1:43:28

as I know it now. At this point, it's legendary

1:43:31

status.

1:43:31

It was classic. I mean,

1:43:34

as soon as like and I can't I

1:43:36

will say, I can't remember if he if he had

1:43:38

the rash before he pulled

1:43:40

a tick off, or if if I didn't see

1:43:42

the rash until after he told me about pulling the

1:43:44

tick off. But as soon as he told me about that, I

1:43:47

looked and he had this rash, and I was like,

1:43:49

I knew that it

1:43:51

was. I was like, this is either racketzia

1:43:54

rakhetsi I and you're going to die,

1:43:57

or it's a lesser one, but either way, you need

1:43:59

to go get treatment. And he wouldn't listen

1:44:01

to me until we went

1:44:03

to go visit his parents, and I had to tell his

1:44:05

mother and she's the one who forced

1:44:07

him to go to the doctor and get

1:44:10

treatment because he wouldn't listen to me. So

1:44:13

thank you, Chris, because otherwise

1:44:15

he might be dead. So you went to

1:44:17

the doctor and he said that the doctor

1:44:19

like he told the doctor that

1:44:22

he thought he had rocommend and spot if you've readen, this

1:44:24

is why. And then apparently the doctor like

1:44:26

went and took his phone and then came

1:44:29

back in with his phone and was like, well, we

1:44:31

could do a test, but I think I should

1:44:33

just give you some antibiotics. And Brett

1:44:35

was like yep, and

1:44:38

he was better in a couple of days.

1:44:40

Oh well, I

1:44:43

am very glad that Brett

1:44:45

was better.

1:44:45

I'm still I'm still puzzling.

1:44:47

Over where you picked it up because you had.

1:44:49

Just been it' scuba diving

1:44:52

or something. We had been at Koiba,

1:44:54

so it could have been Koiba because we had hiked around

1:44:56

that a little bit, but also could have just been in Gamboa

1:44:59

because we went up to the ridge or whatever.

1:45:01

And well, yeah,

1:45:03

we'll never know because he threw

1:45:06

the tick in the toilet. Even