Diphtheria

Diphtheria, a bacterial disease of children, spread most frequently by person‐to‐person contact, is characterized by the formation of a pseudomembrane in the throat that can lead to death by suffocation.The diphtheria bacillus also secretes an exotoxin that can cause other symptoms such as inflammation of the heart.

Diphtheria has probably existed since classical antiquity, but it was not identified as a specific disease until 1819. During the 1880s, scientists in Germany and France isolated the pathogen, the bacillus that caused the disease; developed means of laboratory diagnosis; and discovered the exotoxin. This disease is especially significant in modern medical history because diphtheria antitoxin, produced in a Berlin laboratory in 1890 and available on a commercial scale shortly thereafter, was the first effective therapeutic developed through bacteriological research.

The earliest notable diphtheria epidemic in America was probably the New England “throat distemper” of 1735–1740. Samuel Bard of New York reported another outbreak in 1771. In the 1850s diphtheria established itself as an endemic disease, and it emerged as the leading killer of children in the 1880s. Fear of the disease then justified measures ranging from placarding houses to forced isolation of patients in special institutions.

In 1892, the bacteriologist Hermann Biggs (1859–1923) established the New York City Health Department's laboratory of pathology and bacteriology, the first such facility in the world. Here, under the direction of William H. Park, diphtheria diagnosis and antitoxin production and distribution soon became the principal activities, and this innovation was quickly adopted elsewhere. The development of the diphtheria antitoxin also spurred the growth of the American pharmaceutical industry.

Although contemporaries had reason to question the efficacy of antitoxin in its early years, product standardization and further scientific developments soon led to dramatic declines, first in case mortality and later in the incidence of diphtheria itself. For most of the twentieth century, diphtheria in the United States was successfully controlled by childhood immunization and the availability of effective antibiotics.
See also Medicine; Public Health.

Bibliography

Ernest Caulfield , A True History of the Terrible Epidemic Vulgarly Called the Throat Distemper: Which Occurred in His Majesty's New England Colonies between the Years 1735 and 1740, 1939.
Terra Ziporyn , Disease in the Popular American Press: The Case of Diphtheria, Typhoid Fever, and Syphilis, 1988.
Evelynn Hammonds , Childhood's Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880–1930, 1999.

Edward T. Morman