“The Strangling Angel of Children”

Diphtheria: Part One of a Two Part Series

Last fall, we began a series of posts on dreaded diseases that were the main causes of death in the 1800s and early 1900s, diseases which caused the death of many of those buried in the Mt. Washington Cemetery. Last October, we took an in-depth look at tuberculosis.

Diphtheria was another terrifying disease until the 1920s. Hippocrates was the first to describe the disease in the fifth century. He noted how the disease caused the formation of a “pseudomembrane,” a layer of mucous membranes in the throat. The modern name for the disease, diphtheria, comes from the word diphthera, the Greek term for leather hide.

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. It is transmitted in much the same way as the common cold: through respiratory droplets from coughing or sneezing, either through direct inhalation or from touching a contaminated object.
In the 1730’s, an outbreak in New England killed a third of all children under 10. Before the development of treatments and vaccines, diphtheria was widespread and mostly affected children under the age of 15. It was particularly deadly to those under 5 years of age who were infected; the disease killed up to 20% of this age group.

After being infected with the bacteria, there is an average incubation period of 5 days before symptoms appear. The infected person may experience fever, chills and headache, as well as nausea and vomiting. The lymph nodes at the front of the neck enlarge, as does the soft tissue in the neck, often giving a “bull neck” appearance. The heart rate increases.

Within a couple of days, the bacteria begin to produce a toxin that kills the cells lining the respiratory pathway. These dead cells conglomerate into a thick, gray sheet at the back of the throat, which makes it difficult to swallow. If the membrane extends to the larynx, the patient becomes hoarse and can develop a barking cough. The membrane can cause an obstruction of the airway, making it difficult or impossible to breathe, resulting in death by suffocation.

Furthermore, the toxin gets taken up by the bloodstream and is distributed around the body’s tissues. The toxin can cause inflammation of the heart muscle, potentially resulting in heart failure. The heart problems usually appear 10 to 14 days after the start of infection, although the heart damage may take weeks to appear. About 5% of patients developed nerve damage, which could lead to paralysis of the eye muscles, limbs and diaphragm, leading to respiratory failure.

Diphtheria is an example of how quickly late 19th century researchers moved from identifying microbes as the cause of certain diseases to developing ways to treat and immunize people. In 1883, Edwin Klebs, a Swiss-German pathologist, identified and described the bacterium that causes diphtheria. A year later, German bacteriologist Friedrich Loeffler became the first to cultivate Corynebacterium diphtheriae, the bacterium that causes diphtheria. He also showed that C. diphtheriae produces a toxin.

Soon after these discoveries were made, the first treatment for diphtheria was developed. It involved giving a toned-down form of the disease to horses in order to get their bodies to make an anti-toxin that could be used to treat people with the disease. That was a huge advancement and Emil von Behring won the first Nobel Prize in Medicine for this work. Research in this area continued until the first large-scale vaccination efforts began in the 1920s.

Another highlight from diphtheria’s history was a 1925 outbreak in Nome, Alaska, which created an urgent need for diphtheria antitoxin. The antitoxin was available hundreds of miles away in Anchorage, but couldn’t be delivered by any means but dog sled. The unlikely team of medical professionals and dog sled mushers saved numerous lives, inspiring the modern-day Iditarod. If any of you readers have children, you have probably seen the movie “Balto.” Balto was a Siberian husky who led his sled dog team on the final leg of the diphtheria antitoxin run to Nome, Alaska.

In researching this post, I came across an excellent blog entry written by Diana Staresinic-Deane, who writes a blog called “Unearthing Stories on the Prairie.” In a 2011 post called “Lessons from a Kansas graveyard: What a 1903 outbreak of diphtheria can teach us today,” she wrote about the O’Marra family, who lost eight of their nine children when a particularly awful strain of “black” diphtheria hit their household in 1903. The story is very well-researched and well-written. I highly recommend it. Here is the link: https://dianastaresinicdeane.wordpress.com/…/lessons-from-…/

Sources: Demystifying Pediatrics blog, Dr. Chad Hayes
“What is diphtheria? What causes diphtheria?” Markus MacGill, Medical News Today website