Diphtheria: The Plague Among Children

Peter Semple and Mayme (Zebio) Muir's daughter, Pearl Ivy, died at the age of 7 of diphtheria. Had Pearl gotten sick just a few short years later, she likely would have been treated or even vaccinated, and lived to adulthood.

Last year in the United States no cases of diphtheria were reported; it is routinely prevented by vaccine and treated with antibiotics. However, it was once a major cause of illness among children. The year before Pearl's death, the U.S. recorded 206,000 cases, resulting in 15,520 deaths. Effective immunization against diphtheria became widely available in the 1920s, just a few years after Pearl died.

Children were most vulnerable to diphtheria. In 1925 an outbreak in Nome, Alaska, made national news as the antitoxin was rushed to the remote city by dog sled. The event is now celebrated annually by the Iditarod Trail Sled Dog Race. Balto, the lead sled dog became a famous canine celebrity and news coverage helped spur the inoculation campaign that dramatically reduced the threat of diphtheria.

Statue of Balto in Central Park, New York; photograph
courtesy of Wikipedia

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'Balto Statue,' Wikipedia
History of Vaccines, http://www.historyofvaccines.org

Black Lung Disease

Dr. Archibald Makeller wrote a paper in 1846 about Black Phthisis, or Black Lung Disease.

"Among the many diseases incident to the coal miner, none come oftener under medical treatment, than affections of the respiratory and circulating organs. While the collier is subject -- during his short but laborious life -- to the other diseases which afflict the laboring classes in this country, such as inflammations, fevers, acute rheumatism, and the various eruptive diseases, he, at last, unavoidably, falls victim to lesions within the cavity of the chest, arising from the nature of his employment. In the present communication, it is proposed to lay before the profession a series of remarks, which I have been enabled to put together, with a view to elucidate the cause and progress of that very peculiar pulmonary disease, incident to coal miners, which I shall denominate Black Phthisis.

The rise and progress of the malady may be thus sketched: A robust young man, engaged as a miner, after being for a short time so occupied, becomes affected with cough, inky expectoration, rapidly decreasing pulse, and general exhaustion. In the course of a few years, he sinks under the disease; and, on examination of the chest after death, the lungs are found excavated, and several of the cavities filled with a solid or fluid carbonaceous matter."

Coal miners; photograph courtesy of Kentucky Coal
Mining History

Coal mining was a dirty occupation. The dust got in miners' clothes and in their lungs. Before Black Lung Disease was well understood, causes of death would include almost any description of respiratory or circulatory illnesses. Most common were broncho-pneumonia, pulmonary phthisis, and later emphysema.

Tuberculosis: Greatest Killer in History

Dr. Frank Ryan in his book, Tuberculosis: The Greatest Story Never Told, called tuberculosis "the greatest infectious killer in history."

Tuberculosis, or TB (short for tubercle bacillus), has also been called phthisis, phthisis pulmonalis, or consumption. It is in many cases a fatal, infectious disease, which attacks the lungs as well as other parts of the body. It is spread through the air when people who have an active tuberculosis cough, sneeze or transmit respiratory fluids through the air. In the middle of the 19th century tuberculosis accounted for approximately one in eight of all deaths in Scotland.

While the coal mines and textile factories provided work for our Muir ancestors, the industrial developments in many areas of Scotland were so rapid that provisions for public health did not keep pace. A typical family might include ten to fourteen people who lived in single-room homes with rudimentary facilities for hygiene. This made for some unhealthy living conditions. Until the late 1800s most health care was provided by local authorities and was haphazard at best. Homes and workplaces were incubators for disease, especially tuberculosis.

It was not until 1882 that doctors and scientists understood tuberculosis was caused by an infectious agent. The invention of the X-Ray machine in 1895 enabled doctors to diagnose and track the progress of the disease. The United Kingdom considered tuberculosis its most pressing health problem at the turn of the 20th century. An international health conference was convened Berlin in 1902. Among the proposals arising from the conference was using the Cross of Lorraine as the international symbol of the fight against the disease.

Famous poster designed by Ernest Hamlin Baker; image courtesy of
U.S. National Library of Medicine

National campaigns swept across Europe and North American to try to curb the rise of tuberculosis. Many of these campaigns incorporated the Cross of Lorraine. In Great Britain there were campaigns to stop spitting in public places and the infected poor were pressured to enter sanatoria that often resembled prisons. Surgical interventions were also conducted with doctors collapsing an infected person's lungs in order to allow it to rest.

It was not until 1944 when streptomycin was isolated and an antibiotic developed that tuberculosis was brought under some sort of control. In 1948, George Orwell wrote about the drug while in Hairmyres Hospital, Scotland, being treated for tuberculosis:

"This disease isn't dangerous at my age, and they say the cure is going on quite well, though slowly...We are now sending for some new American drug called streptomycin which they say will speed up the cure."