Mortality Before the Diphtheria Vaccine

Laura Warning

Although rarely spoken about in today’s modern age, diphtheria was a large contributor to child and immune-compromised individual mortality up until the early 20th century. When epidemics occurred the mortality rate could rise to 30 or 50 percent of young children affected (Carmichael). Death by diphtheria was sudden as it happens from the airway becoming blocked and the children suffocating. The numbers of diphtheria cases varied among regions and cities as cases and mortality would be much higher if an epidemic occurred.

Average Diphtheria Death Rates (1855-80) from the book Diphtheria: its natural history and prevention. Obtained from Flickr

Medical Officer of Health Reports are a way of understanding past levels of mortality and infection that diphtheria once had. Often reports were made that document the same town over multiple years so that trends in its rate of diphtheria and other illnesses can be observed. For this reason, I focused on three areas of London to see how these areas reacted to diphtheria cases and if there were improvements in mortality rates over the years.

The first area is Bethnal Green, an area in east London, which in the report from 1862 had no deaths from diphtheria despite having 18 cases for every 10,000 people (Bethnal Green 1862). This is much better than the overall London rate for mortality that year which was 6 out of every 14 cases per 10,000 people. In the following years including 1870, 1872, and 1873 there were 2, 6, and 6 respectively showing a small increase over the years (Bethnal Green 1870, 72, 73). The reason for this rise in mortality could be that Bethnal Green was growing increasingly poorer, while the birth and death rates were also rising.

The next area is Lewisham, in the south east of London, which before 1873 had an average from the last 10 years of 9.1 deaths from diphtheria (Lewisham 1873). In the following years, these numbers stayed around normal with 4 deaths in 1874, 8 in 1875, and 11 in 1876 (Lewisham 1875 and 1876). Compared to Bethnal Green, these numbers of death make sense since the area of Lewisham is about three times larger.

St George (Southwark) in central London kept records of mortality from viral diseases including diphtheria. Their records were also kept up until the early 20th century so it was interesting to see the diphtheria mortality rates directly before the vaccination was discovered. Also, an interesting discovery was how many patients, some suffering from diphtheria or other viral ailments, refused hospital aid despite possible mortality (St George (Southwark) 1895, 28). One report showed that the number of cases of diphtheria for this area was 209 persons, of which 85 of those cases were children under 5 years old. Luckily, the mortality rate was a bit lower as only five actually died that year as only severe cases caused death (St George (Southwark) 1896, 13). The rates seemed to climb a bit the following year however with 10 children under 5 dying, and 13 total dying (St George (Southwark) 1897, 14). Across all the MOH reports younger children were seen at an increased rate for mortality. These more recent reports also show that diphtheria remained a consistent childhood illness up until the vaccination was discovered.

Throat swab used to diagnose diphtheria, England, 1901-1930
Credit: Science Museum, London. Obtained from Wellcome Images

To understand the broad effects that diphtheria had in the late 19th-century and observe the differences of effects among different countries, mortality rates were also looked at for different countries such as the United States, Sweden, and France.

A study of Philadelphia in the late 19th century showed the death rates from diphtheria going as high as 150 deaths per 100,000 people in 1885 (Condran). A graph also shows that rates in mortality from diphtheria seemed to go up and down depending on if an epidemic occurs. This trend was very similar to those observed in London. After 1900, around the time the vaccination was introduced, there is a sharp decline in mortality.

In Sweden, the number of diphtheria deaths followed a slightly different trend than that of Philadelphia or London. The deaths slowly declined throughout the 19th century, with the peak mortality being around 1870 (Nelson). This could be due to a difference in immigration patterns which may have caused the epidemics to happen earlier in Sweden or later in the other cities.

France was another country that had high mortality rates from diphtheria during the late 19th century. It is reported that a child with pure laryngeal diphtheria had a mortality rate of 41% in 1892 (Opinel). Before vaccination, the disease had unpredictable trends and decreased virulence. This made it in issue to prove the effectiveness of vaccination which the French were in the process of helping to develop (Opinel).

Exploring diphtheria’s effect across different countries and regions of London has lead to some interesting findings. It was very surprising to find just how contagious and dangerous this disease once was that now is barely a threat. While different countries had different rates of mortality from diphtheria it was true across all countries that children were those most affected. Another finding is that diphtheria would come through in epidemic waves which would then lead to a period of declined virulence.

MOH Reports

  1. “Bethnal Green 1862” Wellcome Library.
  2. “Bethnal Green 1870.” Wellcome Library.
  3. “Bethnal Green 1872.” Wellcome Library.
  4. “Bethnal Green 1873.” Wellcome Library.
  5. “Lewisham 1873.” Wellcome Library.
  6. “Lewisham 1876.” Wellcome Library.
  7. “Lewisham 1875.” Wellcome Library.
  8. “St George (Southwark) 1895.” Wellcome Library.
  9. “St George (Southwark) 1896.” Wellcome Library.
  10. “St George (Southwark) 1897.” Wellcome Library.

Secondary Sources

“Bethnal Green: Building and Social Conditions from 1876 to 1914.” A History of the County of Middlesex 11 (1998): 126–32.

Carmichael, Ann. “Diphtheria.” Chapter. In The Cambridge World History of Human Disease, edited by Kenneth F. Kiple, 680–83. Cambridge: Cambridge University Press, 1993.

Condran, Gretchen A. “The Elusive Role of Scientific Medicine in Mortality Decline: Diphtheria in Nineteenth- and Early Twentieth-Century Philadelphia.” Journal of the History of Medicine and Allied Sciences 63, no. 4 (October 2008): 484–522.

Nelson, Marie C. “Diphtheria in Late-Nineteenth-Century Sweden: Policy and Practice.” Continuity and Change 9, no. 2 (1994): 213–42.

Opinel, Annick, and Gabriel Gachelin. “French 19th Century Contributions to the Development of Treatments for Diphtheria.” Journal of the Royal Society of Medicine, April 2011, 173–78.