Diphtheria

George Washington died in his bed at his Mount Vernon plantation on December 15, 1799 because his throat was so swollen he could not breathe. It was a ghastly end for the Virginia gentleman, perhaps the result of infection Corynebacterium diphtheriae. (The genus is so named because all its members are club-shaped , from the Greek koryne, meaning club.) Though physicians still debate whether George was done in by diphtheria, the disease's status in litery history is ensured by William Carlos William's 1993 story, " The Use of Force".

Although outbreaks of such deadly sore throats had been noted sporadically since the time of Hippocrates, epidemics seem to have become common beginning in the sixteenth century. To prevent suffocation, tracheotomies were first used widely during an epidemic in Naples in 1610. In 1659, Cotton Mather described " Malady of Bladders in the Windpipe " in Massachusetts that was especially vicious in children. Another New England epidemic started in New Hampshire in 1735, taking about a thousand lives, of which nine hundred were children. In 1826, during a period whrn the disease was prevalent in France, the physician Pierre- Fidele Bretonneau aptly named it after the Greek word for a piece of leather, dipthera, referring to the tough, gray, mucousy membrance of dead cells thjat may block the victim's throat. The Spanish had once used an even more graphic term, calling it garrotillo after the executioner's implement, a string around the neck tightened by twisting a stick.

In the mid-nineteenth century, the microbe responsible for diptheria apparently became even more potent because severe cases began to multiply sharply worldwide. In New York, where annual deaths averaged about 325 in 1872, fatalities jumped to more than 2,300 in 1875. Corynebacterium diphtheriae was identified in 1883, and by 1890, it was known that the bacterium produced a poison, called an exotoxin which could be used in weakened form to prod the human immune system into producing a defensive material , called antitoxin. In this regard, it was sililiar to tetanus whose mysteries were being unraveled at about the same time. Routine immunizations began in the 1920s, leading to near eradication of the disease wherever such programs are maintained. Not until 1951, however, was perhaps the most curious microbiological fact about diphtheria discovered : C.diphtheriae microbes that produce disease are themselves infected with viral parasites called bacteriophages. Actually, the gene necessary for producing diphtheria toxin comes from the bacteriophage, not from C.diphtheria. Without it, C.diphtheriae would not be virulent.

Today, the tetanus-pertusiss ( whooping cough ) - diphtheria shot (DPT) is among the first that children receive after birth. In 1993, not a single case of diphtheria was registered in united States. In Russia, by contrast, with a public-health system under severe stress, recorded cases jumped from 3900 in 1992 to 15.210 in 1993 to nearly 50,000 in 1994. The epidemic is most severe in cities on the Sea of Japan north of North Korea where authorities launched a vaccination campaign at train stations and hotels.

C.diphtheriae bacteria thrive in dark, wet places like our upper respirary tracts. Contagion usually occurs through close-up coughing or hand-to-mouth contact. Crowded, unhygenic living conditions help the microbes spread from person to person. Once established in a victim's tonsil's, say, C.diphtheriae microbes are among the fastest microorganisms in producing symtons of illness ----- not by racing throughout the body but by the formation of powerful exotoxin. The poison may spread to damage tissues in the heart, kidneys or nervous system. Death often comes from inflammation of the heart. Unimmunized sufferers must be given a quick jolt of antitoxin plus abtibiotics and must be isolated under intensive care.

One of Corynebacterium diphtheriae's cousins, C.glutamicum, has a much friendlier relationship with human race. It is used to manufacture the all-purpose flavor enhancer monosodium glutamate or MSG