Three More Eponymous Diseases: Arthropod Bites

These diseases - West Nile Virus, Lyme disease, and Rocky Mountain Spotted Fever - are named for the places where outbreaks happened. But they're also all things you get from being bitten by mosquitoes or ticks.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Holly Frey?

  This is an iHeart Podcast. Guaranteed Human. A rare disease diagnosis can change your life, but it doesn't have to define your future. In season seven of Untold Stories: Life with a Severe Autoimmune Condition, host Martine Hackett continues the conversation with people living with MG, CIDP, and the broader rare disease community, exploring what comes after diagnosis through stories of hope, progress, and connection. Produced by Ruby Studio in partnership with Argentix. Listen on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 0:35Tracy V. Wilson?

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• 1:10Holly Frey?

  We've all tumbled down an internet rabbit hole trying to self-diagnose, and it leaves us more anxious than informed. Our feeds are full of wellness trends, but how do we know what's real, what's exaggerated, and what's just wrong? Health vs. Hype from the American Medical Association breaks it all down. Emmy-nominated science communicator Trace Dominguez talks to doctors, influencers, and real people trying these trends, not to cancel them, but to understand them. Because when it comes to your health, who you listen to matters. So listen to Health vs. Hype wherever you get your podcasts.

• 1:42Tracy V. Wilson?

  The Old Gays are back with Silver Linings, their lovable podcast from iHeart's Ruby Studio in partnership with ViiV Healthcare. Robert, Mick, Bill, and Jessa strut back down memory lane for season two, sharing lessons on life, love, and loss. These are the kind of insights that only come from experience. So tune in to Silver Linings with The Old Gays on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 2:10Holly Frey?

  Welcome to Stuff You Missed in History Class, a production of iHeart Radio.

• 2:20Tracy V. Wilson?

  Hello and welcome to the podcast. I'm Tracy V. Wilson.

• 2:24Holly Frey?

  And I'm Holly Frey.

• 2:25Tracy V. Wilson?

  A little more than a year ago, we did an episode on eponymous diseases, which I kind of thought might only be interesting to me. But we got some emails from folks in the audience who seemed to really like it. So we are doing another one. Last time, we talked about three diseases that were all named for the place where a notable outbreak happened, which led to their being identified and named. And today's really similar. These are named after places again. But this time, these are all diseases that you get after being bitten by something specifically mosquitoes and ticks.

• 3:04Tracy V. Wilson?

  And since both of those feed on blood, this also feels just a little bit like a precursor to October episodes. The diseases that we are going to talk about are West Nile virus, Lyme disease, and Rocky Mountain spotted fever. I was originally going to put them in chronological order. But the Rocky Mountain spotted fever story turned out to have a couple of twists in it that made it feel like putting anything after that would seem a little anticlimactic. Also, just to note, there is various animal experimentation in this episode.

• 3:41Holly Frey?

  So first, we have West Nile virus. West Nile virus is part of a large family of viruses, many of which cause disease in humans, including dengue fever, Zika, and Japanese encephalitis. And the story of how it was discovered and named is pretty straightforward, although it happened during research into a different disease, that being yellow fever. This research was conducted through the Yellow Fever Institute, which was established by the Rockefeller Foundation's International Division in 1936.

• 4:15Tracy V. Wilson?

  By the late 1930s, researchers had isolated the virus that causes yellow fever. And they had determined that there were multiple strains of it circulating in parts of Africa and South America. And they also knew that people who recovered from yellow fever were typically immune to it afterward. And in a large region of Central and Western Africa, a lot of people had this post-infection immunity.

• 4:42Tracy V. Wilson?

  The institute was conducting research along the edges of this endemic zone where people were less likely to already have immunity, so they could try to isolate and study different strains of the yellow fever virus.

• 4:56Holly Frey?

  In December of 1937, a physician from the institute named A.W. Burke saw a woman from the West Nile District of northern Uganda. She had a fever of 100.6 degrees Fahrenheit, that's about 38.1 degrees Celsius, but she said she wasn't having any other symptoms. Her blood was drawn, and three months later, she returned to have another blood draw. And at this follow-up, she said she hadn't had any other signs of illness around the time of her prior visit. Researchers isolated a different virus from the blood they drew at her first visit, and she had antibodies to that virus at her follow-up three months later.

• 5:37Tracy V. Wilson?

  Yeah, so they were looking for yellow fever, but this was something else. The researchers did a bunch of experiments with this virus that involved inoculating mice with it. They ultimately found that it was lethal 100% of the time when a mouse's brain was exposed to it, but it was a lot less lethal in exposure through the skin. They also did research on other animals. Rhesus monkeys developed encephalitis when they were exposed through their brains or their noses, but they had milder illnesses when they were given a subcutaneous inoculation. Other monkeys had only a mild illness, no matter how they were exposed to the virus, and rabbits didn't develop any signs of illness at all.

• 6:22Tracy V. Wilson?

  This was similar to research that was being conducted with the various strains of yellow fever virus that the institute had isolated from other patients.

• 6:31Holly Frey?

  The team published their research on this newly-isolated virus in the American Journal of Tropical Medicine and Hygiene in 1940. In their paper, they named it the West Nile Virus after the district of Uganda where they encountered this patient.

• 6:47Tracy V. Wilson?

  So at this point, it really doesn't seem like this virus was causing a lot of illness in humans. If it was, it wasn't causing illnesses that really stood out. It's not completely clear whether it made that first patient feel sick. The paper's authors speculated that she might have said she wasn't having any symptoms because she didn't want to be hospitalized, which in my opinion is pretty reasonable. And they also stated that, quote, "She was not altogether cooperative and it is possible that she withheld pertinent facts." It is reasonable to have some skepticism about this characterization of her, but it is also possible that she might have had symptoms that she chose not to tell the doctors about.

• 7:32Holly Frey?

  More than a decade passed between the identification of the virus and the next time it was isolated in patients. This involved three apparently healthy children in Egypt. And it wasn't until the 1950s and 60s that there were large enough outbreaks for researchers to really study the virus in human patients rather than in lab animals. Most of these outbreaks were in places around the Mediterranean. Symptoms included fever, headache, muscle pain, rashes, abdominal pain, and vomiting. Smaller numbers of patients had swollen lymph nodes, chest pain, and diarrhea.

• 8:09Tracy V. Wilson?

  Research in the Upper Nile Delta in 1951 started looking for signs of West Nile in non-human animals in the wild, as well as evidence of whether it could be transmitted by insects. The virus was found to be capable of infecting a wide range of animals, and it seemed to be particularly fatal in horses and other equines. The virus was first identified in birds in 1953, and today, birds are considered to be the virus's primary host.

• 8:41Tracy V. Wilson?

  The research also found that West Nile could be isolated from mosquitoes, but not from some other insects. And today we know that it is transmitted mostly through mosquito bites.

• 8:52Holly Frey?

  Until the late 1950s, cases of West Nile were usually relatively mild and self-limiting. In some places, the majority of children had evidence of being infected at some point, and it seemed almost like a routine childhood illness. The research that first identified the virus had suggested that it could cause encephalitis, and it's related to other viruses that do, but that wasn't really happening in human patients.

• 9:20Tracy V. Wilson?

  That started to change in 1957, when an outbreak in Israel affected several elderly people, and many of them developed severe neurological symptoms. After this outbreak, it became more common for people with West Nile virus to develop encephalitis, meningitis, or some other kind of serious neurological issue, and to die from the disease.

• 9:45Holly Frey?

  There was another shift in 1996 with an outbreak in Bucharest, Romania, which was the first major outbreak in a primarily urban area. Most people in Bucharest did not have air conditioning, so they kept the windows open, and many of those windows did not have screens. Another factor was that many people were living in apartment buildings that had flooded basements, and of course, that created a breeding ground for mosquitoes. A lot of patients in this outbreak had some kind of involvement of their central nervous system. This was also the first outbreak in which one particular mosquito, the common house mosquito, or Culex pippians, became recognized as a vector.

• 10:28Tracy V. Wilson?

  After this outbreak in Romania, outbreaks of West Nile virus disease started happening in more places, far away from equatorial Africa and the Mediterranean, with a greater proportion of the patients having more severe symptoms.

• 10:44Tracy V. Wilson?

  For example, an outbreak in Russia in 1999 had 183 confirmed cases, with more than half of those people developing acute meningioencephalitis, and there were 40 deaths. More than 75% of the deaths were in people 60 years old and older.

• 11:03Holly Frey?

  That same year, West Nile virus was reported in North America for the first time. This was in New York City, and it was initially suspected to be St. Louis encephalitis. That is also related to West Nile virus. The strain of West Nile virus that was isolated in this outbreak was similar to one that was circulating in and around Israel at the time. It is not definitively known exactly how the virus arrived in New York, but two possibilities are mosquitoes that found their way onto international flights, and illegally imported birds. It was not spread by sick humans. While humans can get West Nile virus, it doesn't reach a high enough level in our blood to infect a mosquito,

• 11:48Holly Frey?

  and it doesn't spread from person to person, except very rarely through things like blood transfusion and organ donation.

• 11:56Tracy V. Wilson?

  Within three years of its arrival in New York, West Nile virus had been detected in 44 states and the District of Columbia, and it has since spread to Mexico and Central and South America. A subtype of West Nile virus called Kungjin virus was first isolated in Australia in 1960, but it was not classified as a strain of West Nile until a lot later.

• 12:22Holly Frey?

  Today, most people who contract West Nile virus have minor symptoms or even no symptoms at all. But about 1% of patients develop West Nile virus neuroinvasive disease, which is a severe and serious illness that can involve meningitis, encephalitis, or acute flaccid paralysis, and it can be deadly. There is no treatment for the virus itself, only for some of the symptoms and issues that it can cause.

• 12:50Tracy V. Wilson?

  There are some veterinary vaccines for West Nile virus, including one for horses, but there's not a human vaccine yet. Part of that has to do with the virus itself and how it mutates. But it's also connected to the fact that West Nile virus outbreaks in humans can be kind of random in their size and severity and location. Ideally, if someone was doing efficacy testing for a vaccine, they would be able to administer it to a population before an outbreak actually started so they could see whether that population was protected. But the unpredictability and seasonality of major outbreaks makes that hard to do with this specific illness.

• 13:33Tracy V. Wilson?

  So prevention is largely based on avoiding mosquito bites and on mosquito control and health authorities taking screening steps for blood and organ donation when there is an outbreak. Uh, we have more fun disease talk coming up, but first we're going to pause for a sponsor break.

• 13:54Speaker 02

  First thought is like, wow, how are we going to do all this?

• 13:57Tracy V. Wilson?

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• 14:25Tracy V. Wilson?

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• 14:32Speaker 03

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• 14:37Tracy V. Wilson?

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• 14:45Speaker 02

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• 14:49Tracy V. Wilson?

  AT&T, connecting fans to what they love. Connecting changes everything. AT&T.

• 14:55Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. Tune in for season seven of Untold Stories: Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenx. Hosted by public health and policy expert Dr. Martine Hackett, Untold Stories: Life with a Severe Autoimmune Condition pushes the conversation within the rare disease community forward. Featuring guests living with MG, CIDP, myositis, SMA, and other rare autoimmune conditions, each episode explores hope, progress, and connection. How does research create new opportunities? How do shared experiences help light the way forward? How do we best show up for each other?

• 15:39Holly Frey?

  Tune in to find out. Listen on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 15:50Speaker 04

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• 17:16Tracy V. Wilson?

  In May of 2014, research was published in the journal Historical Biology that described fossilized ticks preserved in Dominican amber that had Spirokeet-like cells in their digestive tracts. The size and shape of these cells strongly resembled bacteria from today's Borrelia species. Borrelia burgdorferi is one of the bacteria that caused Lyme disease, and according to research published in the journal Nature Ecology and Evolution in 2017, its family tree is at least 60,000 years old. Research on the 5,300-year-old mummy known as Atsya the Iceman, who has made many appearances

• 17:59Tracy V. Wilson?

  on our show and on installments of Unearthed, also found DNA evidence of Borrelia bacteria in his bone marrow.

• 18:09Holly Frey?

  Written descriptions of symptoms that are associated with Lyme disease started in the late 19th and early 20th centuries. In 1883, German physician Alfred Buchwald described a chronic skin condition typically affecting the hands and feet that sounds like something that can happen in late-stage untreated Lyme disease. Almost 40 years later, Swedish dermatologist Arvid Avzellius described a rash that frequently occurs in Lyme disease, which can be shaped like a bull's eye. In the 1920s, two doctors in France, C. Guerin and A. Boujardou, described a patient who developed a rash and neurological symptoms after a tick bite, which is sometimes described as the first clinical description of Lyme

• 18:52Holly Frey?

  disease. But the patient also had other symptoms that were not consistent with Lyme.

• 18:58Tracy V. Wilson?

  But the name Lyme disease, today also known as Lyme borreliosis, is way newer than any of that. It is only 50 years old. In 1975, Polly Murray and Judith Mensch, who lived in Lyme, Connecticut, each contacted the State Department of Health in Hartford, Connecticut.

• 19:19Tracy V. Wilson?

  Polly Murray's husband and two of her children were having recurring issues with rashes, headaches, muscle pain, and swollen joints. Judith Mensch's daughter had been diagnosed with osteomyelitis after experiencing severe knee swelling. And then that diagnosis was changed to rheumatoid arthritis after it didn't resolve with antibiotics. In addition to what was going on in both of these women's families, they knew about and had heard about other people, including other children in their neighborhoods who had been diagnosed with rheumatoid arthritis or with a similar condition. It was enough that it seemed unusual and concerning, and both women wanted answers.

• 20:02Holly Frey?

  Murray and Mensch were not the only people to notice a cluster of this kind of disease. There were also reports from Cape Cod in the 1960s, and researchers on Long Island in New York were studying what was locally called Montauk Knee. But Murray and Mensch's advocacy led to a surveillance study in the communities of Old Lime, Lime, and East Haddam, Connecticut, which ultimately led to the disease being identified and named.

• 20:29Tracy V. Wilson?

  These three communities had a combined population of about 12,000 people, and researchers found 39 children and 12 adults who had symptoms that were similar to rheumatoid arthritis. But that was an unusually large percentage of the population to have RA, especially when it came to juvenile RA. But beyond that, the cases were not spread out evenly among these three communities. They were very heavily concentrated in specific areas. A lot of them were in people who lived in wooded areas along the same few roads. On some roads, as many as 10% of the children were affected.

• 21:13Holly Frey?

  The State Department of Public Health and Yale University worked together to try to work out what was going on, including running blood work and getting family medical histories from the people who were affected. It seemed like most people's symptoms started in the late summer or early fall. About a quarter of the patients remembered having a rash that was shaped like a bullseye. Their rheumatoid arthritis-like symptoms also seemed similar to a collection of symptoms that were being reported in Europe.

• 21:43Tracy V. Wilson?

  Soon, a hypothesis emerged that this might be an illness that followed some kind of bite. In August of 1976, Connecticut Commissioner of Public Health Douglas S. Lloyd issued a circular to the state's Directors of Health that said in part, quote, "The seasonal and geographic distribution of cases and the association with a skin lesion suggests that a virus carried by a biting insect may be responsible for this disease."

• 22:13Holly Frey?

  By that point, researchers were calling the disease Lyme arthritis, and they had pointed to the bullseye rash, which is known as Erythema migrans, or EM, as a leading symptom. Over the next few years, other cases were documented elsewhere in the United States. Most of these cases were still clustered together: in the northeastern US, in Wisconsin, and in California and Oregon.

• 22:39Tracy V. Wilson?

  By 1978, the search for the disease's vector was focused not on insects but on arachnids, specifically ticks. Among other things, researchers in Connecticut started noticing that this disease seemed to be more prevalent in areas that had more ticks.

• 22:57Holly Frey?

  Swiss-American medical entomologist Wilhelm Bergdorfer, known as Willie, worked out of Rocky Mountain Laboratories, which had been established to study Rocky Mountain Spotted Fever, and later became part of the National Institute of Allergy and Infectious Diseases. He and his team were studying Rocky Mountain Spotted Fever on Long Island. Ticks can carry multiple diseases, and people who regularly encounter ticks can wind up with more than one. So this research on Rocky Mountain Spotted Fever was overlapping with research into other tick-borne pathogens, and some of the patients had EM.

• 23:35Tracy V. Wilson?

  This research involved collecting large numbers of ticks and studying the microorganisms that were in their bodies. One of the microorganisms that they found was a Spirochete. After finding this Spirochete in the bodies of ticks, researchers also spotted it in the blood of patients with Lyme disease. In 1982, this Spirochete was named Borrelia burgdorferi in honor of Willie Burgdorfer, so it is eponymous both for Lyme, Connecticut, and for him.

• 24:06Holly Frey?

  Today, Lyme disease is found primarily in North America, Europe, and Asia, and there are multiple species of Borrelia bacteria that can cause it. Different species are prevalent in different parts of the world. It's most often spread by ticks in the genus Exodes, with the exact tick, again, varying from one region to another. In eastern North America, it is usually the black-legged tick, also called the deer tick, or Exodes scapularis.

• 24:34Tracy V. Wilson?

  Whether these ticks actually transmit Lyme disease varies from place to place, depending on what animals the ticks are feeding on, and whether those animals carry the bacteria. For example, in the northeastern United States, the ticks usually feed on rodents in their larval and nymphal stages, and those rodents often carry the bacteria. But in the southwest, ticks at those stages of their lives are often feeding on lizards, which do not.

• 25:06Holly Frey?

  In North America, Lyme disease is also associated with deer, but deer don't contract the disease, and they don't pass it on to ticks. Instead, deer are a primary food source for adult ticks, with those adults producing the next generation of ticks, which start that cycle over again by picking up Borrelia bacteria from infected rodents when they feed as larvae and nymphs.

• 25:31Tracy V. Wilson?

  Researchers believe this connection to deer is why Lyme disease really started to become an issue in the mid-20th century in North America, and that traces back to the ecological history of the continent. There's evidence that Borrelia bacteria existed in North America prior to the arrival of European colonists, and so did rodents and deer and humans, all the ingredients that are needed for Lyme disease transmission. But it is also likely that there were a lot fewer deer in North America then than there are today, since there were earlier on, a lot more large predators like wolves and more people hunting deer for food and other resources.

• 26:16Tracy V. Wilson?

  Indigenous land stewardship practices like controlled burns may have also helped reduce the population of ticks.

• 26:23Holly Frey?

  Then, as Europeans started colonizing the Americas, deer were driven nearly to extinction through overhunting and habitat loss. At the start of the 20th century, there were as few as 300,000 white-tailed deer across all of North America. Because of a combination of conservation laws, changes in land use, and changes in hunting patterns, the population of deer rebounded dramatically over the first half of the 20th century. And it's estimated that there are between 30 and 35 million white-tailed deer in North America today. Warmer winters due to climate change also mean that fewer ticks are dying over the

• 27:04Holly Frey?

  winter, so it's likely that a person living in suburban New England is living in proximity to more deer and more deer ticks than people in the same region were prior to colonization.

• 27:15Tracy V. Wilson?

  In the 1990s, a vaccine for Lyme disease was introduced in the United States, but it was withdrawn from the market in 2002. This vaccine required a dose roughly every other year, and while it definitely reduced a person's risk for developing Lyme disease, it was reported to be about 75% effective.

• 27:37Tracy V. Wilson?

  There were, of course, people who wanted that number to be higher. There were also some concerns about whether the vaccine could trigger autoimmune arthritis, although an investigation into those concerns could not confirm any kind of connection. Lyme disease was also a lot less prevalent in 2002 than it is today, so there just was not as much demand for a vaccine, especially one that people felt like didn't give them complete protection. Like, it definitely, as we said, reduced the risk of the disease, but there were people for, as sort of consumers, wanted it to be 100%. However, there is a new vaccine that is now in phase three clinical trials with the results

• 28:22Tracy V. Wilson?

  of those trials expected by the end of this year.

• 28:26Holly Frey?

  That means prevention for Lyme disease is all about avoiding tick bites. It's believed to take at least 24 hours of attachment for a tick to transmit the spirochete to a person. So, people who spend time outdoors are advised to thoroughly check themselves for ticks and immediately remove them. People are also advised to seek medical attention if they are bitten by a tick, regardless of whether they develop that bull's eye rash or develop other symptoms. The rash develops in most cases, but not all of them, and it is also a lot harder to see on people that have darker skin. Lyme disease is treated with antibiotics, most often doxycycline.

• 29:08Tracy V. Wilson?

  Yeah, my primary care doctor's, uh, my chart landing page has a big thing that's like, have you been bitten by a tick? Press this button. A couple of quick notes before we take a break. There is a conspiracy theory that Lyme disease escaped from a research facility, but as we have discussed, there is a lot of established evidence that the bacteria that caused Lyme disease existed in multiple parts of the world for decades or centuries before that could have happened. In addition to what we've already talked about, the bacteria have also been found in 19th and early 20th century rodents and ticks

• 29:48Tracy V. Wilson?

  in museum collections in North America, which I find a fascinating way to look at that. Let's go back to the taxidermied animals and the preserved ticks and see what they've got in their bodies.

• 30:01Holly Frey?

  Also, there are people who continue to have symptoms related to Lyme disease after going through treatment, including cognitive issues, fatigue, and body aches. For a long time, people called this chronic Lyme, but the current recommended terminology within the medical field is post-treatment Lyme disease syndrome, because people experiencing these symptoms don't have signs of the actual pathogen still in their bodies. There's been a ton of discussion and controversy around these symptoms and the terminology around it for years. It's been called the Lyme wars. That is how contentious it is. This is way beyond what we can really sort through as laypeople on a history podcast,

• 30:43Holly Frey?

  but a lot of it has been rooted in the fact that people still have symptoms, but that doctors can't find evidence of what could be causing those symptoms. However, since the COVID-19 pandemic and the existence of long COVID, it does seem like there has been more awareness of potential long-term symptoms following an infection.

• 31:04Tracy V. Wilson?

  We will talk about Rocky Mountain spotted fever after we have another sponsor break.

• 31:12Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. Tune in for season seven of Untold Stories: Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenx. Hosted by public health and policy expert Dr. Martine Hackett, Untold Stories: Life with a Severe Autoimmune Condition pushes the conversation within the rare disease community forward. Featuring guests living with MG, CIDP, myositis, SMA, and other rare autoimmune conditions, each episode explores hope, progress, and connection. How does research create new opportunities? How do shared experiences help light the way forward? How do we best show up for each other?

• 31:57Holly Frey?

  Tune in to find out. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 32:07Speaker 06

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• 34:36Tracy V. Wilson?

  The first reports of the illness that became known as Rocky Mountain Spotted Fever were in Bitterroot Valley, Montana, in 1873. At the time, most of the people living in this region were either white settlers or indigenous people, including the Bitterroot Salish, who settlers called the Flathead, although head flattening is not a Salish practice. Symptoms of this illness included a fever and a rash, as well as joint pain, nausea, and vomiting, and it was very frequently fatal. People started calling this new disease "black measles," and since it seemed to strike in the spring and summer, people thought it might be caused by drinking meltwater runoff

• 35:21Tracy V. Wilson?

  from the mountains.

• 35:23Holly Frey?

  There were tensions and violence between the white newcomers and the Salish during this period, and the Salish would eventually be forcibly removed to the Flathead Indian Reservation, which is also home to the Upper Pend Oreille and the Kootenay. But white people also recognized that the indigenous peoples of the area might have some knowledge of this disease. So, early researchers asked indigenous people, as well as white trappers, traders, and missionaries who had had lots of interactions with them. And based on these conversations, it seemed like this illness was something new.

• 35:59Tracy V. Wilson?

  Over the 1880s and 90s, cases were also reported in the Quinn River Valley in Nevada and in other parts of Montana. In 1899, physician Edward E. Maxey of Boise, Idaho, wrote what is regarded as the first clinical description of the disease in a paper titled "Some Observations on the So-Called Spotted Fever of Idaho." Quote, "A febrile disease characterized clinically by a continuous moderately high fever and a profuse or purpuric eruption in the skin, appearing first on ankles, wrists, and forehead, but rapidly spreading to all parts of body."

• 36:40Tracy V. Wilson?

  By the early 1990s, the disease had also been reported in Washington, California, Arizona, and New Mexico.

• 36:47Holly Frey?

  The prevalence and seriousness of this disease was an influence on the creation of the Montana State Board of Health in 1901, two years after Montana attained statehood. Understanding and trying to prevent or treat this disease was one of the board's biggest priorities from its inception. On July 1, 1902, the board issued a paper authored by W.M. Chowning and L.B. Wilson that suggested ground squirrels as a possible host for the disease and ticks as a potential vector. The disease appeared and disappeared along with when ticks were most active and a lot of patients had a tick bite in their history.

• 37:28Tracy V. Wilson?

  The following year, bacteriologist John F. Anderson studied the epidemiological data that was available and confirmed that most documented cases of this disease were in people who had a tick bite before the start of their symptoms. His paper was also the first written use of the name Rocky Mountain Spotted Fever. A lot of the places where the disease was being reported were in and around the Rocky Mountains.

• 37:55Holly Frey?

  In 1906, pathologist Howard Ricketts found infected wood ticks in the Bitterroot Valley and showed that their bites could sicken guinea pigs. In 1908, the Rocky Mountain wood tick was named Dermocentor Andersoni after John F. Anderson, and in 1909, a bacterium that Ricketts isolated from crushed tick bodies, which causes Rocky Mountain Spotted Fever, was named Rickettsia rickettsii after him.

• 38:23Tracy V. Wilson?

  Like Lyme disease and West Nile virus, Rocky Mountain Spotted Fever was happening mostly seasonally when the ticks were feeding, so the research into it was really focused on the summer months. As the summer of 1910 approached, Howard Ricketts was not sure if he was going to get funding for that summer, so he went to Mexico City to work on an epidemic typhus outbreak. Typhus is another disease caused by bacteria in the genus Rickettsia. That's Rickettsia prowzecii, named for Stanislaus von Prowzec.

• 38:58Tracy V. Wilson?

  Stanislas von Prowazek and his colleague Enrique de Rocha Lima discovered this bacterium, and they both died of typhus, which they both contracted in the course of their work. Howard Ricketts also contracted typhus while working in Mexico City, and he died there on May 10, 1910, at the age of only 39.

• 39:20Holly Frey?

  With the Rocky Mountain Spotted Fever bacterium and its vector both identified, the next big focus was on trying to stop the disease. Today, doxycycline is the typical treatment for several diseases in the Rickettsia genus, including both Rocky Mountain Spotted Fever and epidemic typhus. But the first true antibiotic, penicillin, wasn't isolated until 1928, and doxycycline wasn't patented until 1957. So in the early 20th century, the focus was on trying to control ticks.

• 39:55Tracy V. Wilson?

  Researchers had pinpointed a number of animals that were susceptible to Rocky Mountain Spotted Fever and were often bitten by tick larvae and nymphs. That included various squirrels, chipmunks, and rats. But the bigger concern from a public health perspective was the animals that were being bitten by adult ticks and also bringing those ticks into close proximity with humans. Those were mostly cattle and other livestock.

• 40:26Holly Frey?

  And this is where things got wild. Dr. Robert Cooley was head of Montana State College's Department of Entomology and Zoology. He was inspired by the work of Howard Ricketts, and two of his colleagues had gotten Rocky Mountain Spotted Fever in the course of their work and had died. Cooley's proposal was to reduce the number of ticks that humans were exposed to by reducing their numbers in cattle. He worked with the Montana State Board of Entomology to develop a dipping program. Dipping stations would be set up around the affected area and filled with vats of pesticide, and ranchers would drive their cattle to those stations where they would swim through the liquid in the vats.

• 41:09Holly Frey?

  This effort was funded by the federal government and the state of Montana.

• 41:13Tracy V. Wilson?

  The solution that the cattle were going to swim through was made from arsenic, soap, kerosene, and water.

• 41:22Tracy V. Wilson?

  Obviously, since the point was to kill ticks, the solution needed to include substances that would be toxic, and arsenic and kerosene both fit that bill. Today, we know that arsenic is a carcinogen, but at the time, the more immediate and the known concern was that if the concentration of arsenic was too high in this dip, it would burn the cattle. It would especially burn them on parts of their bodies, like their udders, that were not as densely covered in hair. Authorities had to work out the best proportions of arsenic through trial and error.

• 42:01Holly Frey?

  Also, Montana ranchers weren't exactly people who were known for being excited about complying with the government. Being ordered to do something that could hurt their cattle made that already existing conflict even worse. Many ranchers refused to have dipping vats located on their land, worried not just about their own cattle, but about ticks being brought in on other ranchers' cows who were coming to be dipped. In June of 1913, someone smashed the dipping vat in Hamilton, Montana, with a sledgehammer. And about a week later, someone blew up the vat in Florence, Montana with dynamite. The rancher whose Hamilton property the first vat was on

• 42:44Holly Frey?

  was tried and acquitted for malicious mischief. And afterward, he sued the officials who were running the program.

• 42:51Tracy V. Wilson?

  Eventually, authorities did develop a formulation for the dip that seemed safe enough for the cattle, although the arsenic was still a carcinogen, something not really understood until later. Within a few years, there was less resistance to the dipping program, and most cattle in the area were being dipped, as well as sheep, horses, and goats. The number of Rocky Mountain spotted fever cases started to drop, although there was a case of two children who had been helping at the dipping station on their family's land contracting the disease and dying.

• 43:28Holly Frey?

  The presence of Rocky Mountain spotted fever and the efforts to control it led to the establishment of Rocky Mountain Laboratories, which we mentioned earlier in our discussion of Lyme disease. In 1921, the US Public Health Service started renting an unused schoolhouse west of Hamilton, Montana, to function as a laboratory, rather than disease researchers having to work mostly out of tents and sheds. In 1926 and 1927, a dedicated entomological lab was built in Hamilton, and people in the area were so worried about disease-carrying ticks escaping from the facility that it was also surrounded by a moat, although that moat was never filled with water.

• 44:11Holly Frey?

  The decision to build a moat followed a series of lawsuits people filed to try to stop the facility from being built at all.

• 44:18Tracy V. Wilson?

  By then, Doctors Roscoe Spencer and Ralph Parker had developed a vaccine for Rocky Mountain spotted fever using tissue from infected ticks that was then treated with phenol. This vaccine was in use in humans by 1927. It was at least somewhat effective.

• 44:39Holly Frey?

  In 1937, Rocky Mountain Laboratories became part of the National Institutes of Health. That same year, the movie Greenlight, starring Errol Flynn, told the fictionalized story of a surgeon studying Rocky Mountain spotted fever in Montana. Errol Flynn is, of course, better known for his more swashbuckling roles like various Pirates and Cowboys and even Robin Hood.

• 45:02Tracy V. Wilson?

  Today, as we said earlier, Rocky Mountain Laboratories is part of the National Institute of Allergy and Infectious Diseases. It is today also home to one of the United States' maximum containment laboratories, known as a biosafety Level 4 facility. It no longer has a moat.

• 45:21Holly Frey?

  We should bring back moats. Despite its name, today in the US, Rocky Mountain Spotted Fever is most common, not in the Rocky Mountains, but in the southern and central Atlantic states. More than 60% of cases are reported in North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri. It's also present in other parts of the world that are home to the various species of ticks that can carry it. And in some of those places, it has its own eponyms, including Sao Paulo Fever and Brazilian Spotted Fever in Brazil. There is no commercially available vaccine today, and while it can be treated with antibiotics, it can be hard to diagnose, especially if someone doesn't recall being bitten by a tick.

• 46:06Holly Frey?

  As with Lyme disease, the main method for prevention is avoiding tick bites.

• 46:12Tracy V. Wilson?

  That vaccine that had been developed back in the 20s, once antibiotics came on the market, was no longer really made. The tips for avoiding tick and mosquito bites are pretty much the same for all of them. Wear long sleeves and long pants and use insect repellent. That's the big stuff. Try to stay out of very tall grass for ticks. Also, try not to be around, outside around dawn and dusk for most breeds of mosquito. Some breeds of mosquito don't really care about that, though, and they will come try to bite you at any time.

• 46:41Holly Frey?

  They don't have watches. They don't know when their schedule begins.

• 46:45Tracy V. Wilson?

  When I was living in the Atlanta area, my neighborhood had a lot of Asian tiger mosquitoes, and they were out at all times of the day. And they would bite me between getting out of the car and getting into the house after I got home from work.

• 46:58Holly Frey?

  It's a full-time job being an Asian tiger mosquito.

• 47:01Tracy V. Wilson?

  Yeah, I was not a fan of them. Anyway, we'll talk more about these things on Friday. I have an email for our listener mail from listener Stephanie, and Stephanie wrote, "Hello, Tracy and Holly. The phrase 'do your own research' is one commonly heard or posted online. This has led me to wonder how, in the age of AI-generated responses, crowdsourced Wikipedia pages, and self-proclaimed experts on YouTube and TikTok, does one find reliable sources online that provide factual and supported information?"

• 47:36Tracy V. Wilson?

  Since so much of your work involves research, I thought you might be able to point me toward some resources. My goal is eventually to take a class or course to learn more about how to conduct proper research from credible sources. My ultimate goal is to teach my young son to differentiate fact from opinion and credible sources from dubious ones. Thank you for the many years you have kept me company during long commutes, sleepless nights, and painful Excel-based work projects. As a lifelong learner, I hope to hear your voices for many more years to come. Sincerely yours, Stephanie.

• 48:11Tracy V. Wilson?

  Stephanie did not have pet pictures to share and instead sent a little human made completely from scratch. Unfortunately, the little human picture did not come through for whatever reason. I will assume this human is adorable. Thank you for this email, Stephanie. I first want to acknowledge that the rise of large language models and generative AI has made this a lot harder.

• 48:39Holly Frey?

  So much so.

• 48:41Tracy V. Wilson?

  I'm going to say thing number one. Currently, I am still using Google to do a lot of searching. There are other search engine options. They all have pros and cons. In Google, if you put minus AI at the end, you should stop getting an AI summary at the top, and I highly encourage this.

• 49:06Holly Frey?

  Do you, for clarity, are you typing out the word minus, or are you using?

• 49:13Tracy V. Wilson?

  The minus sign.

• 49:14Holly Frey?

  The dash.

• 49:15Tracy V. Wilson?

  The dash, yeah. Dash AI to mean minus. The AI summary is often wrong.

• 49:22Holly Frey?

  Yeah.

• 49:24Tracy V. Wilson?

  And when I have not put that in there, I have had laughably wrong AI summaries in things related to.

• 49:32Tracy V. Wilson?

  To work when I'm doing research. And something I really would like everyone to understand is that when it comes to things like ChatGPT and other generative AI, the process by which they give correct answers is the same as the process by which they generate things that are plausible but wrong. This is not something that AI developers can fix. It is inherent into how these models work. They will always be giving wrong answers that sound right. Do not ask ChatGPT for information on stuff is my opinion, because it might give you the right answer, but it might give you the answer that sounds right and is wrong.

• 50:16Holly Frey?

  It's a dice roll.

• 50:18Tracy V. Wilson?

  It is. It really is.

• 50:21Tracy V. Wilson?

  Also, on a less serious note, if you, like me, play video games and sometimes you need a hint for something because you're stuck,

• 50:31Tracy V. Wilson?

  if you don't put in the minus AI at the end, the AI summary is just going to show you the full-on answer. It might be the right answer, it might not, but like, it's not going to give you, it's not going to point you to a page where someone has written a discreet hint that can help you toward the right answer. It's going to show you the right thing in your face. I don't like that.

• 50:53Holly Frey?

  I'm laughing because do you remember for a minute what people were advising before minus AI was to put a swear word at the end of your query?

• 51:02Tracy V. Wilson?

  Oh, funny.

• 51:03Holly Frey?

  Because it wouldn't, it would automatically throw that out. But I ran into the problem where I was ending up on websites that I did not need to be visiting.

• 51:14Tracy V. Wilson?

  Sure.

• 51:15Holly Frey?

  Ever.

• 51:16Tracy V. Wilson?

  Yeah.

• 51:17Holly Frey?

  And I was like, oh, now I'm on the cagey part of the internet.

• 51:23Tracy V. Wilson?

  There are also plugins that will strip out the AI summaries and other browsers that just don't do AI summaries, but just circles back around, don't rely on the AI summaries. The, a lot of the other tips are the same as they were prior to the evolution of generative AI, which is figuring out who is responsible for a piece of content and what their reasoning is for doing it. So like confirming that the byline on the piece or the name that the person has given in their YouTube or TikTok video, like confirming that is a real person.

• 52:06Tracy V. Wilson?

  Do they work for, for example, a college or a university? When I used to train people on this as part of my job, we talked about the use of government sources. A lot of those government sources are now being deliberately undermined. We've already talked on the show before about like public health expertise being stripped out of the health and medicine-related government agencies to be replaced with literal quacks. So I can't really advocate for that anymore the way that I used to. But a good starting point is often to like confirm who this person is. Read their, you know, their biography, their brief bio on

• 52:50Tracy V. Wilson?

  whatever. Do they, where do they work? What is their background? Why are they writing about this? And over time, you can kind of develop list of sources that you trust who, you know, if someone has an agenda, that agenda is to get real factual, accurate information, not to, for example, cherry pick badly constructed studies to say that Tylenol causes autism. It doesn't. This is actually well established through many years of research that have happened in multiple places around the world, specifically looking at whether Tylenol, also called acetaminophen, I don't remember what the name is in most of the rest of the

• 53:32Tracy V. Wilson?

  world, but like we've already studied this. We know that it does not cause autism. And once again, even if it did cause autism, People are talking about autism as though it is like the worst thing in the world when

• 53:48Holly Frey?

  Right.

• 53:49Tracy V. Wilson?

  Autistic people are human beings whose minds work and process information a little differently than people who aren't autistic. And it's also a spectrum. There are bajillion things I feel like we have to say every time this comes up.

• 54:03Holly Frey?

  I know. The other thing, right, is that autism is incredibly complex and there's

• 54:10Tracy V. Wilson?

  Yeah.

• 54:10Holly Frey?

  No one thing that causes it.

• 54:15Tracy V. Wilson?

  Right.

• 54:16Holly Frey?

  Often, there are guesses about many layers of things that may have led to it.

• 54:22Tracy V. Wilson?

  Right.

• 54:23Holly Frey?

  But there's no, there's no one thing where you go, oh, it's this. We went through this with the vaccine thing a million years ago, and yet here it is again.

• 54:33Tracy V. Wilson?

  Yeah, yeah, we, we know for sure that there is no causal relationship between vaccines and autism, or acetaminophen during pregnancy and autism.

• 54:47Tracy V. Wilson?

  And yet it's being trotted out again.

• 54:49Holly Frey?

  Also, acetaminophen during pregnancy is one of the few things you can take for a fever. And a fever that goes unchecked during pregnancy can actually cause some very real problems. And that is studied and documented.

• 55:02Tracy V. Wilson?

  Yes.

• 55:03Holly Frey?

  I have very strong feelings about this for someone that neither has nor wants children.

• 55:07Tracy V. Wilson?

  Right.

• 55:08Holly Frey?

  But I really don't like making parents feel like they're doing it all wrong. But most parents just want to do the best for their kids.

• 55:14Tracy V. Wilson?

  Right, right, right. So, um, yeah, I, I don't know. I, I feel like we are still figuring out what all the best steps to take are regarding how to get information that's accurate in the age of, uh, large language models and chatbots and generative AI. But the broad sweeping things are.

• 55:45Tracy V. Wilson?

  Don't trust AI-generated stuff, whether it's video or audio or text. It is likely to be wrong and the process of coming up with wrong answers is the same process that yields right answers in other cases.

• 56:00Holly Frey?

  And destroys the environment in the process.

• 56:03Tracy V. Wilson?

  Yeah, it's not, it uses a lot of electricity. A lot of places that have data centers for these nearby are really struggling with their energy use and energy bills. And boy, do I hate it when there's like an, everybody, please don't run your air conditioning so much when it's 97 degrees while we are actually going to give some tax breaks to the giant data center that is causing an inordinate use of electricity.

• 56:33Tracy V. Wilson?

  Anyway, that's not actually related to Stephanie's question.

• 56:36Holly Frey?

  Stephanie, you've, you've opened Pandora's box.

• 56:39Tracy V. Wilson?

  You, yeah, we're both having a time over here today. So yeah, a big, big part of it is just figuring out who wrote something? What is their background? Why did they write it? And that continues to be true, even as so much more stuff on the internet and elsewhere is being generated by a chatbot of some sort.

• 57:04Tracy V. Wilson?

  If you would like to send us a note about this or any other podcast, we're at [email protected]. If your email is about how large language models are great and we should stop being Luddites, I want you to listen to our episode about Luddites and what that word really means. And then better yet, just keep the email to yourself. You can subscribe to our show also on the iHeartRadio app and anywhere else you like to get your podcasts.

• 57:36Tracy V. Wilson?

  Stuff You Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 57:50Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. In season seven of Untold Stories: Life with a Severe Autoimmune Condition, host Martine Hackett continues the conversation with people living with MG, CIDP, and the broader rare disease community, exploring what comes after diagnosis through stories of hope, progress, and connection. Produced by Ruby Studio in partnership with Argenx. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

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