sicilian liars

Diphtheria

by Hilary Butler

HISTORY OF DIPHTHERIA INFECTIONS AND DIAGNOSIS.
DECLINE OF DIPHTHERIA IN DEVELOPED COUNTRIES
DISEASE PROCESS:
TREATMENT OF DIPHTHERIA – NOW AND IN HISTORY
ALTERNATIVE TREATMENTS:
HOMOEOPATHY
HERBS

Diphtheria, like whooping cough and tetanus, is classed as a toxin-mediated disease. But diphtheria is better paired with scarlet fever, because both clinical syndromes are determined not by the bacteria, but by a class of virus called a B phage. This virus holds the genetic 'key' to the production of the toxin that causes the classical membrane and neurological damage. Without this B phage, the diphtheroid family causes only minor, nuisance-value problems.

There are many different forms of non-toxin-producing, interrelated, relatively harmless 'diphtheroids' that live with lots of other so-called disease-causing bacteria in our throats, on our skin, or in the environment. Most people would be horrified if they were told what could be cultured off a normal throat swab. Diphtheroids do not normally appear on most throat cultures because the normal culture medium for throat swabs is hostile to diphtheroids. If there is suspicion that diphtheria is a problem, then a special medium, which restricts the growth of all other bacteria, is prepared.

Many different species of Corynebacterium are widely distributed in nature and are commonly found in soil and water as well as on the skin and mucous membranes of humans and animals. Diptheroids are relatively resistant to adverse environmental influences such as dryness. They may survive for many weeks in dust and on dry fomites (books, toys, pencils, etc). The dust in hospitals and institutions may become heavily infected with dried pulverised secretions. Sources of infection are most commonly nose carriers, children with diseased tonsils, discharging ears or skin lesions. The infection is probably spread by airborne infected dust, contact with fingers, eating utensils or fomites and, possibly, by secretion droplets or droplet-nuclei.

Common environmental factors throughout history which have greatly increased the incidence and severity of diphtheria are shown in the following quotes:

'There is no doubt that exposure to sewage emanation is a fruitful source of diphtheria...the statistics of the association between the two are very positive.' (Quain 1894, in Beddow-Bayly, 1939, p.105).

'…shows in interesting and conclusive fashion the definitive effect of school buildings, their construction and sanitation, on the spread of diphtheria. The highest incidence was observed in those schools where sanitation is most deficient and ventilation and lighting the least satisfactory. The brightest and airiest school showed the lowest incidence, and the incidence throughout all the schools placed them in exact order of sanitary virtue. Moreover, the incidence indicated the schools where malnutrition in the children is most conspicuous.' (Medical World, 1931, p. 627.)

Even in America, there were those who recognised the lessons of the decrease of diphtheria prior to the use of a vaccine by saying:

'The eradication of diphtheria will not come through the serum treatment of patients, by the immunization of the well, or through the accurate clinical and laboratory diagnosis of the case and the carrier followed by quarantine; rather it will be attained through the mass sanitary protection of the populace subconsciously practised by the people at all times.' (JAMA, 1922, p. 682.)

With regard to diphtheria in New Zealand, it is interesting in the light of the recent Auckland case, to note that during the period 1879 – 85, diphtheria in the Christchurch area was particularly severe. The majority of cases occurred in areas where there were either no sewers, or where the sewerage systems had grave sanitary defects. The water supplies were heavily contaminated, and the living conditions were beyond description. (Maclean, 1964).

Why is the issue of sewage important? There are many historical instances of sewage being relevant to the spread of disease, but even today very few textbooks mention this. A few days before the recent Auckland case, storm water had flooded the sewer system, resulting in raw sewage flowing onto the property of the family concerned. The Public Health Authority refused to investigate this potential causal factor. It could well be that the case had nothing to do with the parents' holiday in Bali, and everything to do with the presence of diphtheria from North Shore carriers in the sewage. Two years ago the Americans discovered that toxicogenic diphtheria has had continual undetected circulation for decades throughout areas in the United States and Canada. It remained undetected because they never looked for it, assuming it was eradicated. The same situation could quite likely exist here.

The recent Russian epidemic was caused, we were told, by low levels of childhood immunity (WHO, July 1993). But the majority of cases were in adults who had gone through a compulsory vaccination system that mandated 5 injections of diphtheria vaccine. According to the old philosophy, these people should have been immune for life. They now realise that immunity to disease requires 2 things: repeat exposure to antigen, and a healthy, stress-free body.

Why do they say the epidemic was caused by inadequate childhood vaccination? By 1993, the situation was quite different and diphtheria is only now significantly reduced.

'Reported nationwide coverage among children aged 12-23 months increased from 72.6% in 1992 to 79.2% in 1993. During 1992-1993 at least 90% of children