ROCHESTER, Minn. -- According to the archives, January 20, 1936, was the coldest day of the year.
"Mercury Dives to 17 Below," a headline told the readers of the Minneapolis Star. It was seven years into the Great Depression. Up in Bismarck, the temperature had dropped to 26 below. King George V was on his deathbed, the Marx Brothers were showing at the local movie house, 62% of those polled were against the New Deal, and my grandmother was about to deliver twins.
They came along right before dinner, a boy and a girl, and the girl would grow up to become my mother.
Courtesy of the local merchants, the hospital gave out new-baby journals to keep track of all the happy milestones. Exactly 84 years to the day, everyone in this story is now gone except for those momentos, which sit here on my desk as I type these words. My mother's baby book has advertisements for iceboxes, coal-fired furnaces, bassinets, and entries describing her first words, birthday and Christmas.
My uncle's baby book, however, is mostly blank pages.
We know his hair was brown, and that his grey eyes were turning hazel. My grandmother also recorded that her second boy was christened in March of '36, and that she saw his first smile in April. But the reason the rest of this keepsake is largely empty can be explained by the other book that got passed down through the years, a black folio my grandparents were given later that year.
"Never sick a day," my grandmother wrote in this slim memorial booklet. "Never a cold. Always hungry." Though the boy she had named John Phillip had more than doubled his birthweight in four months, his story ends abruptly in the following three facts: "June 1st -- took sick. Sick 24 days. Died June 24, 1 a.m."
He would have passed away at home.
My mother and her twin had come down with bordetella pertussis, otherwise known as whooping cough. A bacterial infection known as The Cough of 100 Days in seventh-century China, bordetella pertussis was named for Jules Borde, a Belgian scientist who identified the microbe in saliva from his children, investigative work that would lead to a Nobel prize and the first bordetella vaccine, saving the lives of millions. By then it had become endemic within Persia in 1484 and Paris in 1578.
At 265,00 cases, 1934 marked a high point for pertussis in the United States. According to the Minnesota Department of Health, there were 1,705 cases of whooping cough in the state when my mother and her twin got sick in 1936, leading to 34 deaths. These numbers more than doubled the following year, with 4,851 cases and 74 deaths, a record that still remains. The health system was helpless in the face of whooping cough, and in many respects remains helpless today.
"It's a horrible disease," says Dr. Donald Thea, professor of global health at the Boston University School of Public Health. "Essentially what's happening is that the child gets infected, and the bacteria multiply in the nasopharynx and the respiratory tract, (but) it doesn't cause inflammation...it produces toxins that make it very difficult for the young child especially because of their anatomy to be able to stop coughing."
"They get paroxisms of 10, 15 coughs in a row, until they are essentially starved for oxygen, and they have to breathe in extremely forcefully, and that is what is known as the whoop. Eventually they can get so tired from coughing they can basically peter out and stop breathing...its a disease that can essentially suffocate the child to death."
Mayo Clinic has posted a video on YouTube of an infant girl suffering from whooping cough. It's almost unbearable to watch for more than a few moments. It's also hard to imagine who is suffering more, the child, or the mother who is helpless to do more than offer comfort.
"It's horrible to watch an infant cough that hard," says Dr. Robert M. Jacobson, medical director for the Population Health Science Program at Mayo Clinic. "I've cared for babies who have died of whooping cough, and I've cared for babies who've managed to survive despite how hard the disease is on them. I've cared for infants who were hospitalized at Christmas time with pertussis and weren't discharged until October or November of the next year."
Pertussis doesn't respond to antibiotics. An infant essentially has to fight off the infection, even today, often for months on end. Prior to the assistance of modern cardio-respiratory equipment, the cure lay in isolating the child and hoping for the best. In his funeral book, my grandmother thanked my uncle's doctors and nurses, saving special gratitude for an early supplier of oxygen tanks, acknowledging "Mr. Eide of the Puritan Gas Corporation, whose generosity gave Phil the only real comfort he had during his prolonged illness."
The return of pertussis
Today, despite widespread use of vaccines and lifesaving hospitalization tools, whooping cough cases have been climbing since the mid 1990s, hitting over 15,000 nationally as of 2018, and causing five deaths in that year. North Dakota saw 51 cases in 2019, and Minnesota saw 397, including 25 among infants. In November of last year, Minnesota saw its first death from the illness since 2013, an infant who had been hospitalized for three months.
The question often arises why whooping cough is on the return, and why pregnant women are encouraged to become vaccinated if they were vaccinated as children. As Thea reported in 2017, some now believe the so-called acellular pertussis vaccines introduced in the late 1990s prevent sickness but not transmission. In effect, this view says, our current vaccines protect us from the illness, but we still remain carriers.
Jacobson, who disagrees with the theory, believes the reason pertussis is rising is due to better identification and waning immunity. He believes pertussis could be far more widespread than is realized, given that the characteristic "hoop" is usually not present in non-infants.
"Some studies suggest that as high as 10% of people who have a chronic cough they can't explain have pertussis," he says. "Those people are going around the community and can expose a baby, or a babysitter that brings it to a baby, or a worker who brings it to a daycare."
Both theories underscore the importance of maternal Tdap vaccination to deliver pertussis antibodies to babies in utero, a recommendation in place since 2012 and aiming for a period between 27 and 36 weeks gestation, "ideally as close to 27 weeks as possible," says Jacobson.
"Infants are the population most vulnerable to suffering from whooping cough," he says, "but they cannot be vaccinated until they reach six months. For those first months of life, they can only get their pertussis antibodies passively, through the mother."
According to the MDH, 52% of births in 2017 were by mothers vaccinated with Tdap. At 38%, the main reason cited by pregnant women for not becoming vaccinated according to surveys is lack of awareness of the recommendation, with just 17 percent foregoing the vaccine out of concern for side effects. "Tdap vaccine has been extensively monitored and is considered safe during pregnancy," says the MDH's Doug Schultz.
"We need as a community to do everything we can to support that pregnant woman to do it," says Jacobson. "We all need to come together as a community to support vaccination in pregnancy. It's the best way to protect against pertussis deaths."
They say a twin always knows it has a twin.
When in her early 60s my mother developed stage IV breast cancer, we had a few brief, difficult conversations about what she wanted when she would be gone. She told me once that she wanted to be in the big cemetery by the lake. She also told me, on another occasion, that she had felt, for all of her life, like she was missing someone.
By then my parents had been split up for a couple of decades, and though she had raised seven children including two sets of twins, worked as a writer and music teacher, developed scores of friendships and lived to see the birth of six grandchildren, she was on her own. She knew that her twin, having died when the family was struggling financially, was buried in an unmarked grave across town. She asked if one day, we could possibly have him moved to be with her.
So we did.