1 - Aetiology of Diphtheria in Pre-independence Ireland

Summary

The old public health was concerned with the environment; the new is concerned with the individual. The old sought the sources of infectious disease in the surroundings of man; the new finds them in man himself. The old public health sought these sources in the air, the water, in the earth, in the climate and the topography of localities, in the temperature of the soils at four and six feet deep, in the rise and fall of ground-waters; it failed because it sought them, very painstakingly and exhaustively it is true, in every place and in everything where they were not.

Hibbert Winslow Hill, 1916.

The history of diphtheria is traceable to a period ‘almost contemporary with Homer’. References to ‘malignant sore throat’ among young children can be identified in the writings of the Greek physician Aretaeus who, in the first century C.E., described a condition, which he termed ‘Egyptian’ or ‘Syrian’ ulcer, as it was most prevalent in those countries. Aretaeus traced the spread of these ulcers to the thorax near the windpipe – which occasioned ‘death by suffocation within the space of a day’ – and lamented that ‘children, until puberty, especially suffer’. Macrobius Aurelius recorded an epidemic that swept through Rome in 380 C.E., when sacrifice to the gods failed to liberate the city from the ravages of the suffocating disease ‘angina maligna’. Macrobius's account of this visitation was contemporaneous with the Goth invasion of the Roman Empire, and in the period spanning the fall of Rome to the fall of Constantinople, references to ‘malignant sore throat’ and ‘angina maligna’ remain largely absent from the historical record.

In January 1517, an epidemic disease ‘wholly unknown to medical men’ appeared in Holland. While displaying similar characteristics to ‘angina maligna’, an attendant infectious inflammation of the throat was said to be ‘so rapid in its course’ that unless assistance was procured within the first eight hours ‘the patient was past all hope of recovery […] the threatened suffocation, at length actually produced it’. Outbreaks of disease displaying similar epidemiological characteristics occurred in Paris in 1576 and in Naples in 1618–19, where 5,000 victims perished.