Diphtheria: The "Fell Destroyer" Comes to visit.

Chapter 5 of the book Your Baby's Best Shot opens with the following story: "On December 14, 1878, a sadly common tragedy played out in the halls of a castle in a small corner of Germany. Queen Victoria's second daughter, Alice, was dying of diphtheria. ... Her youngest daughter, May, passed away from the disease that had steadily stalked the family. Thirty-five-year-old Alice followed her little girl to the grave when he diphtheria membrane cut off her breathing and chocked her to death.
Diphtheria. Today, we are no longer familiar with it - cases are extremely rare. Between 1936 and 1945, an average of 21,053 Americans got it, and an average of 1822 died http://jama.jamanetwork.com/article.aspx?articleid=209448. The numbers were fortunately low, because the diphtheria vaccine was one of the earliest developed - at the end of the 19th century a new treatment - an anti-toxin - was offered, and by the 1920s a new toxin-anti-toxin injection conferred immunity, with very limited side effects, as long as it was properly manufactured.

Without immunization, Diphtheria could and did wipe out whole families in a short period. Here are two graphic depictions, both courtesy of https://www.facebook.com/RtAVM?fref=ts. One, a meme that include a picture of a grave stone. The picture mentions little Dannah Duff, who died at 1 year and  9 months; little Agnes Duff, who died at the age of 6 years and 4 months; young John Duff, who died at the age of 11; and young Edith Duff, who died at the age of 8 - all within 11 days of each other:

The other, a letter, describing the death in less than a week of four young children, Lilly, 3, Agnes, 5, M.E., 7, and A.J., 11 (as best as I can tell from the letter), killed by the "fell destroyer". Not surprisingly, the parents are  described as "disconsolate": 

In a recent article cited on ScienceofMom, a doctor told the story told by a woman about her experience with diphtheria http://kckidsdoc.com/diphtheria-vaccine.html: "She was in the main room, propped up on pillows in an old brown chair. I remember watching her breathe, her chest sinking deep with every inhale. Sinking in. Bouncing out. Sinking in. Bouncing out."

Diphtheria kills, and kills horribly. Here is how the CDC describes, in cold clinical terms, what the disease does: "Early symptoms include malaise, sore throat, anorexia, and low-grade fever. Within 2–3 days, a bluish-white membrane forms and extends, varying in size from covering a small patch on the tonsils to covering most of the soft palate. Often by the time a physician is contacted, the membrane is greyish-green, or black if bleeding has occurred. There is a minimal amount of mucosal erythema surrounding the membrane. The membrane is adherent to the tissue, and forcible attempts to remove it cause bleeding. Extensive membrane formation may result in respiratory obstruction.
The patient may recover at this point; or if enough toxin is absorbed, develop severe prostration, striking pallor, rapid pulse, stupor, and coma, and may even die within 6 to 10 days. Fever is usually not high, even though the patient may appear quite toxic. Patients with severe disease may develop marked edema of the submandibular areas and the anterior neck along with lymphadenopathy, giving a characteristic “bullneck” appearance."http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf
Here is what that means:

Thanks to the vaccine, we are lucky enough not to see it very often. Since the vaccine, it is in the single digits. But it's still here - there are a handful of cases in the U.S. almost every year, and several thousand world wide (happily no more than that) http://www.who.int/immunization_monitoring/diseases/diphteria/en/ and it can come back, without the vaccine.

A King battles Smallpox; Smallpox wins.

In April 27, 1774, Louis XV of France, then aged 64, felt a little unwell. His head hurt and he felt stiff.  Nonetheless, an avid hunter, he decided to go out hunting. Still unwell in the evening he skipped his supper; since he was still ill the next day his doctor ordered that he be transferred from his little palace in Trianon, where he was relaxing with his mistress and some friends, to his bedchamber in Versailles.

The King, still feeling bad, was bled. His doctors surrounded him – and finally, he was diagnosed. “While giving him a drink, red spots were observed on his face. “Bring the candle closer, the King does not see his glass,” said a doctor, standing near by with his colleagues. Everyone recognized the symptoms of smallpox.”

Th

The royal family was kept away, to protect the non-immune heirs against infection. In spite of not being inoculated and not having had the disease, his middle-aged daughters tended him during the day and his youthful mistress, Madame Du Barry, tended him during the night (not at the same time, since the Princesses refused to share the space with the mistress, and she tactfully avoided their presence).

The fever and headaches continued and intensified, and the King’s body was covered in pustules. His head appeared “fort grosse et rouge” – very fat and red. On May 3, the King looked at his hands and realized what he had – smallpox. Frightened for his soul, he asked his mistress, in tears, to leave him the next day.

On May 7, the King called his confessor. In addition to the private confession, the Cardinal de La Roche-Aymon announced in his name that the King “asks forgiveness from God  for offending him and for scandalizing his people” and promises to reform if he heals. 

The crisis point came on May 8, and after that, the King’s fever rose dramatically. He became delirious and suppuration (discharge of pus) slowed down. On May 9 the pustules were dry and turned black. Pustules and scabs in his throat prevented him from swallowing. His face looked like “a bronze mask with a gaping mouth,” his head black and swollen. The smell was unbearable. His final agony lasted from 11am to 3:15 PM.

That was how Louis XV fell victim to the small pox, a disease that had a 30% mortality rate https://docsimmunize.org/immunize/cdcmanual/original/smallpox.pdf. Soon after his death, his three grandson, led by the new King, Louis XVI, followed the example of the British royal family and inoculated themselves,  a process in which the patient was scratched and material from a smallpox lesion put on the wound.  Not the safest process. Luckily, in 1796 Edward Jenner invented the first vaccine, the vaccine against smallpox, a much safer procedure (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/). And the rest, as they say, is history.

http://en.chateauversailles.fr/history/the-great-days/most-important-dates/1774-the-death-of-louis-xv

Simone Bertierre, Marie-Antoinette L’insoumise (2002).