Because diphtheria used to fill the graveyards with children’s headstones, it struck terror akin to that of the coronavirus.

1.         Unlike COVID-19, which is caused by SARS-CoV-2 (a virus), diphtheria is caused by Corynebacterium diphtheriae, a bacterium. Both COVID-19 and diphtheria are spread by exhaled droplets. Like COVID-19, diphtheria can be spread by people who have no symptoms. Like COVID-19, diphtheria can seem to be a respiratory disease even while it’s sabotaging other body symptoms. Both diseases now have effective vaccines.

2.         The COVID-19 “body count” has been almost unimaginably horrific. Diphtheria’s has always been smaller. But its primary victims have always been children under the age of five.

3.         COVID-19 kills by defeating a variety of body symptoms, but mostly by attacking the lungs and, effectively, smothering its victims. Diphtheria was once known as the ”strangling angel of children.”

4.         As a last resort, COVID-19 can be treated by putting patients on ventilators that force air into their lungs. In the early 20th century, the last resort treatment for diphtheria was tracheotomy, which was a crude ventilation of sorts. Without anesthetic or antibiotic, a doctor sliced open the patient’s throat and inserted a tube into the trachea, into which an attendant pumped room air until the membrane crisis passed.

5.         This may be where many of the key similarities between the two diseases ends. Unlike the SARS-CoV-2 virus, the C. diphtheriae bacterium releases a toxin that kills healthy tissue in the mouth, nose, throat, and trachea. The dead tissue forms a leathery membrane that covers the damaged area. This membrane makes it difficult to breathe or swallow. Because children’s trachea are smaller than those of full-grown adults, a membrane can easily suffocate a child. If the toxin enters the blood stream, other organs can be damaged.

6.      Even with treatment, the overall fatality rate for diphtheria is about 10%, but the rate for children under age 5 and people over age 40 is twice that. Without treatment, about half of all symptomatic people die.

7.      There’s some evidence that diphtheria was around in ancient Egypt and Greece. It was documented in the American colonies in the early 1600s, when it was identified as a mysterious choking illness. It also may have been the illness underlying the condition known as “bladders in the windpipe” that the Boston minister Cotton Mather described in his history of New England. In 1734 and 1735 a “throat distemper” that was probably diphtheria swept through the town of Kensington, New Hampshire and killed 150 children. Town documents show that between 1744 and 1779 another 250 Kensington children died.

8.      By the 18th century, diphtheria was known as the “strangling angel of children.”

9.       The disease got its official name in 1826. “Diphtheria” is a derivative of dipthérie, the Greek word for “leather” or “hide.” Almost fifty years later, the diphtheria death rate in New York City was 125 per 100,000 people.

10.      Kitasato Shibasaburō was a Japanese physician and bacteriologist intrigued by both tetanus and diphtheria, for both diseases are caused by a bacterium that secretes a deadly toxin. He obtained the first pure culture of diphtheria. Kitasato worked in close collaboration with German physiologist Emil von Behring. In 1890, the two scientists found that, with both diseases, blood taken from an infected animal contains an antitoxin. It works as a treatment, spurring the body to quickly create more antitoxin.

11.      The antitoxin also worked as a vaccine, but provided only a few weeks of protection.

12.      Von Behring got most of the credit. For providing the means to defeat diphtheria, he became widely known as the “savior of children,” and was awarded the first Nobel Prize in Medicine.

13.      Even though the Nobel committee waved him on, Kitasoto was no slouch as a scientist. In 1894 he isolated the bacteria that causes bubonic plague.

14.      In 1924 a longer-lasting vaccine was developed from heat-treated toxin cultivated in horses. It was mixed with a little formaldehyde.

15.      In January of 1925 two children died of diphtheria in Nome, Alaska. Although Nome is a port city, it was icebound seven months every year. Fearing that every child —and possibly every person — in Nome would be dead by spring a local doctor put out a plea for toxin to be brought in. (This story of the serum relief race is as reported by The New York Times.)

16.      There was serum about 525 miles away in Anchorage. It was shipped by railroad to Nenona, but the last leg to Nome — more than 400 miles — had to happen by dogsled.

17.      The setting: five days of dogs, wind, constant dark, 85 degrees below zero, and almost unbearable fatigue. No wonder Disney and Universal both made movies about the race towards Nome. A driver named Leonhard Seppala and his lead dog Togo carried the horse serum for 261 miles. The governor of Alaska, worried that Togo and Seppala couldn’t make it all the way, arranged for their mission to be taken over by a series of other dogs. Even so, Togo and Seppala drove almost double the length of any other driver and lead dog.

18.      Gunnnar Kaasen was slated to be the second-to-last driver in the relay. Possibly realizing that the dog and driver to actually cross into Nome would be declared heroes, Kaasen arranged to sneak by the last driver and continue into Nome. He and his dog Balto were, of course, heaped with praise. The United States Senate commended them.

19.      Balto got a statue made for him in Nome. One went up in New York City’s Central Park, as well.

20.      And, of course, a Hollywood producer made a short, schmaltzy movie about Balto and Kaasen, and they got to make a few appearances with “America’s sweetheart,” silent screen star Mary Pickford.

21.      It took years before the world accepted the tales of the several other drivers in the Nome relay who claimed that, if there was any dog that deserved credit above all others for leading the team that delivered the serum, it was Togo.

22.      Togo died in 1929. Leonhard Seppala died in 1967. A 1995 animated movie named Balto perpetuated the heroic tale about the relay (and about the wrong dog and driver). It was a Universal Studios production. Kevin Bacon voiced the part of Balto.

23.      In 2019 Disney finally set the record straight in Togo, a live-action movie about Seppala and Togo. It stars William Dafoe as Seppala. Two dogs — Diesel and Riptide — play Togo. Two other dogs were Diesel and Riptide’s stunt doubles.

24.      Which is all to say that, unlike the COVID-19 vaccine, the diphtheria antitoxin has its own Universal Studios and Disney movies.

25.      Because the diphtheria antitoxin vaccine is a scheduled part of pediatric care in the United States, the disease is now very rare in America. According to the Centers for Disease Control and Prevention, adults need booster shots every 10 years. In undeveloped parts of the world where routine vaccinations are not available, diphtheria still surges.

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