Diphtheria and Theories of Infectious Disease: Centennial Appreciation of the Critical Role of Diphtheria in the History of Medicine
Peter C. English MD, PhD1
1 From the Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
Exactly 100 years ago, Friedrich Loeffler (1852-1915) published his masterful paper proving that a particular bacillus was the etiologic agent responsible for diphtheria.1 The next year, Joseph O'Dwyer (1841-1898), working at the Foundling Asylum of the Sisters of Charity in New York City (later the New York Foundling Hospital), pioneered intubation. It was the first successful means of treating suffocation, the leading cause of death in patients with diphtheria.2 In the last decades of the 19th century, diphtheria was unusual among infectious diseases because it was becoming more prevalent. William Osler, in Principles and Practice of Medicine (1892),3 wrote: It is a remarkable fact that while contagious diseases have diminished within the past decade, diphtheria, particularly in cities, has increased. Of note to medical personnel, Osler3 warned that "no disease of temperate regions proves more fatal to physicians and nurses [than diphtheria]." So worrisome was diphtheria to pediatricians that Luther Emmett Holt4 devoted the longest chapter in his textbook, The Diseases of Infancy and Childhood (1897) (57 of 1,117 pages) to this leading cause of infant mortality. Nearly 1% of all articles in the world's medical literature, listed in Index Medicus in 1892, addressed diphtheria, more than 100 times the relative number in 1982.
As widespread as diphtheria was in 1894, it has now virtually disappeared, except for isolated outbreaks among the unimmunized. Most pediatricians will never see a case, and even experts in infectious disease can rarely recall more than a handful of cases (Table 1). For most doctors, diphtheria remains only a word affixed to the immunization schedule.
Submitted on June 27, 1984
Accepted on August 9, 1984
