If you have ever seen a case of diphtheria, then you know how life-threatening and horrible the disease can be. Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae. After a 2-to-5-day incubation period from being infected by respiratory droplets, the patient begins to feel ill and starts developing a mild fever and sore throat. Diphtheria comes in two varieties: respiratory or cutaneous. The one we more strongly associate with childhood illness is respiratory. This is because the infection causes a pseudomembrane (a layer of mucus and cells) to form over the tonsils, the throat, and the larynx. Death can come from that membrane obstructing the airway or from the toxin that the bacteria release into the bloodstream, causing myocarditis and neuritis. According to the Centers for Disease Control and Prevention (CDC): “The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age.”
The era of antibiotics changed things in countries where antibiotics were easy to obtain. A simple course of antibiotics clears up the infection in a matter of days. But the momentous change in how the disease affected children came in the form of the diphtheria vaccine. As part of the childhood immunization schedule, the vaccine has reduced the number of cases and deaths all over the world. In the United States, rare cases are reported now and then, with several years going by without a reported case. For comparison, in 1921, before the vaccine, over 15,000 children were reported to have died from the disease in the United States.
According to the Abraham Lincoln Bicentennial Foundation, Edward Baker Lincoln died shortly before his fourth birthday from diphtheria:
“In December 1849 Eddie became quite ill with what was thought to be diphtheria. Most likely the disease was pulmonary tuberculosis. After 52 days of acute illness, Eddie died on February 1, 1850, a month short of his fourth birthday.
On the following Sunday, services were conducted by Reverend James Smith of the First Presbyterian Church. The little boy was buried in nearby Hutchinson’s Cemetery a few blocks west of the Lincoln home.
In 1865 Eddie’s remains were moved to a temporary tomb at Oak Ridge Cemetery. The remains of Abraham and his sons, Eddie and Willie, remained in the temporary tomb before being moved to the permanent tomb on September 19, 1871.
Eddie was an affectionate and deeply loved little boy. His loss left permanent scars in the hearts of his loving parents. A week after Eddie’s death, Mary (possibly assisted by Abraham) wrote a poem entitled “Little Eddie” which was printed “by request” in the Illinois State Journal.”
You may have noticed in the passage quoted above that the disease was likely to be “pulmonary tuberculosis.” The speculation comes from the fact that Edward showed signs and symptoms of more of a chronic condition than an acute one like diphtheria. However, the physicians who treated him diagnosed him with diphtheria.
In 1863, the daughter of James A. Garfield (who would be the 20th US President for less than one year in 1881) died from diphtheria. Little Eliza Arabella “Little Trot” Garfield died at the age of three right before Christmas. According to the National Park Service:
“Trot was a bright, dark-eyed little girl, who looked very much like her mother. According to her cousin Adelaide Rudolph, she was “not…a model of good behavior.” On October 11, 1863, Trot got a baby brother and a visit from her father, who was about to leave the army to begin his first term as a US Congressman. While he was at home, James Garfield’s “precious little darling” got a sore throat – the first symptom of the diphtheria that claimed her life on December 1st. She was only 3-1/2 years old. Adelaide would be the only child of her generation that would remember “Trottie.””
Later, in 1904, Ruth Cleveland, the daughter of Grover Cleveland (the 24th US President), also died from diphtheria at the age of 12. Ruth was born in 1891, in the era of antitoxin treatment for diphtheria. An antitoxin is derived from the serum of animals exposed to toxins. In the case of diphtheria, large mammals — usually horses — were given the diphtheria toxin. After some time, the horses would develop an immune response against the toxin. The horses’ serum (the liquid portion of the blood) would be collected and purified. That antitoxin would then be given to children with diphtheria to aid their immune system in fighting off the disease.
Ruth Cleveland didn’t benefit from the antitoxin treatment because there had been an incident in 1901 that scared people away from using it. That year, several children in St. Louis, Missouri, died after receiving the antitoxin. After an investigation, it was found that the horse used to create the antitoxin suffered from botulism. As a result, the antitoxin also included botulinum toxin, a paralyzing agent. The result of that accident was the first legislative attempt at regulating the biologics industry: The 1902 Biologics Control Act.
Lincoln, Garfield, and Cleveland were not the only US Presidents who came face-to-face with infectious diseases now conquered by vaccines. Abraham Lincoln and Andrew Jackson both contracted smallpox and survived. John Adams was variolated — given smallpox in a controlled manner — to prevent getting full-blown smallpox, a procedure that was replaced by vaccination. Franklin Delano Roosevelt contracted polio as a young man and became a powerful advocate and fundraiser for the efforts to develop a polio vaccine. Most recently, Donald Trump contracted COVID-19 while in the White House.
The history of vaccines is full of people who were powerful and influential in their time and still had to deal with the diseases we no longer see or fear today thanks to vaccines. Sadly, throughout the same history, it is the disadvantaged and marginalized who take the brunt of the impact of those diseases. As we get closer to July 4th, when Americans celebrate Independence from the British, we hope these last few blog entries on the impact of vaccines on American history help the reader understand how vaccines and the people who developed them are as big a part of American history as the people who fought wars or gave inspiring speeches.