Saturday, September 3, 2016

The strangler.

Last year I picked up a book on medical satire from 1915 from a bookfair for $4.  I was already pretty stoked.  (More on that book later hopefully).

Then I found this inside.



My stoked-o-meter officially went through the roof.


Diphtheria is a highly contagious illness caused by the Corynebacterium diphtheriae  bacteria.  It spreads via droplet from person to person with an individual remaining infectious for two to three weeks.  It affects the upper airway and less commonly the skin.  Symptoms are typical of an upper respiratory tract infection including sore throat, fever and cough.  However diphtheria is classically known for a grey-green pseudomembrane that forms over the nose, tonsils and larynx.  This psuedomembrane is composed of toxins and waste products produced by the bacteria.  These toxins can also enter the blood stream where they can cause nerve paralysis and heart failure. 

The death rate from diphtheria is around one in fifteen cases.  Historically it has been a disease that has primarily affected children.  In children under five the death rate can be as high as one in five. 

Diphtheria had been recognised worldwide for many centuries with references consistent with its presentation noted in medical literature as early as the 16th century. It did not receive its name, however, until 1826 from the French physician Pierre Bretonneau who named it diphterite or leather in recognition of the psuedomembrane.  Bretonneau was also the first to successfully use a tracheotomy in a diphtheria patient (after several attempts in which the patients died.) 

The causative bacteria was first identified in 1883 by Edward Klebs, it was cultivated in 1884 by Friedrich Loeffler and in 1888 Roux and Yersin were able to show that the toxins produced by the bacteria caused symptoms of diphtheria in animals. 

In 1890 Emile von Behring and Shibasaburo Kitasato successfully immunised guinea pigs with heat treated diphtheria toxin.  The first successful treatment of a human occurred in 1891.  Von Behring went onto collaborate with Paul Ehrlich to develop a vaccine and an anti-serum which could be safely used in humans.  

Controversially it is said that von Behring managed to manoeuvre to exclude his clinical partners from receiving their fair of the considerable profits generated by the vaccine. In addition he was the only one awarded the Nobel prize for medicine in 1901 for the work on diphtheria.  

In Australia the diphtheria vaccination had a limited introduction between 1921 and 1928.  In 1932 a school based vaccination program had commenced and this extended to an infant program in 1940.  

In 1953 the diphtheria tetanus pertussis vaccination was introduced in the more familiar form we know it today.  An infant schedule of three vaccines (again similar to today's schedule) was introduced.  (My flyer, you will note, is from 1953 and this is the program it is advertising).

In 1975 the national immunisation schedule was introduced and this was when vaccinations became wholely funded by the government.  

And the program worked.  The following graph, which shows notification of diptheria cases between 1917 and 1999 in Australia, says it all.





There has unfortunately been a death in the last few years in Australia from diphtheria, in an unimmunised adult.  So unusual was this death, it made national news.  

Vaccines are amazing. Stoked I tell you.


https://www.betterhealth.vic.gov.au/health/healthyliving/diphtheria
http://www.ncirs.edu.au/assets/provider_resources/history/Diphtheria-tetanus-pertussis-history-March-2016.pdf
http://www.historyofvaccines.org/content/timelines/diphtheria
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-diphtheria
http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2406-cdi2406f.htm

2 comments:

  1. That's fascinating - I knew of diphtheria but I didn't actually know what it was until now. I think the problem, as it were, with vaccines is that they've worked so well people believe these diseases have been eradicated. Their success is amazing.

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