Past Pandemics: Diphtheria and Baby Ruth Cleveland
Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Symptoms often come on fairly gradually, beginning with a sore throat and fever, and in severe cases, a grey or white patch develops in the throat. This can block the airway and create a barking cough. The neck may swell in part due to enlarged lymph nodes. Complications may include myocarditis, inflammation of nerves, kidney problems, and bleeding problems due to low levels of platelets. Diphtheria is usually spread between people by direct contact or through the air, or by contaminated objects. People can carry the bacterium without having symptoms, but can still spread the disease to others. Today it is rare in the developed world due to widespread vaccination. In the United States, 57 cases were reported between 1980 and 2004. Death occurs in 5% to 10% of those affected.
Before 1826, diphtheria was known by different names across the world. In England, it was called Boulogne sore throat. In 1826, Pierre Bretonneau gave the disease the name diphthérite (from the Greek word diphthera, meaning "leather") describing the appearance of pseudomembrane in the throat. One of the first epidemics was reported in California in 1878. In 1878, Queen Victoria's daughter Princess Alice and her family became infected with diphtheria, leading to the deaths of Princess Marie of Hesse and by Rhine and Princess Alice herself.
It wasn't until 1883, that Edwin Klebs identified the bacterium causing diphtheria. He named it Klebs-Loeffler bacterium. Friedrich Loeffler was the first person to cultivate the bacteria. Joseph P. O’Dwyer introduced the O'Dwyer tube, used for laryngeal intubation in patients with an obstructed larynx in 1885. It soon replaced tracheostomy as the emergency diphtheric intubation method. Progress on a vaccine began in 1890, when Shibasaburo Kitasato and Emil von Behring immunized guinea pigs with heat-treated diphtheria toxin. They also immunized goats and horses in the same way and showed that an "antitoxin" made from serum of immunized animals could cure the disease in non-immunized animals. Behring used this antitoxin for human trials in 1891, but they were unsuccessful. Successful treatment of human patients with horse-derived antitoxin began in 1894, after production and quantification of antitoxin had been optimized. Von Behring won the first Nobel Prize in medicine in 1901 for his work on diphtheria.
There were problems in the introduction of the vaccine. In 1901, 10 of 11 inoculated St. Louis children died from contaminated diphtheria antitoxin. The horse from which the antitoxin was derived died of tetanus. This incident led to federal regulation of biologic products. Just after the turn of the century, there was an outbreak of the disease reported in New Jersey. On January 7, 1904, Ruth Cleveland, the daughter of former President Grover Cleveland and his wife Frances, died of diphtheria at the age of 12 years in Princeton, New Jersey. Ruth was the couple's oldest daughter.
Known as "Baby Ruth", Ruth Cleveland was born on October 3, 1891. She was the oldest of five children born to the Clevelands. She was born between Cleveland's two terms of office, and her birth caused a national sensation. Interest in her continued even after her father's second presidential term was over. Ruth had been in poor health for most of her short life. She contracted diphtheria on January 2, 1904. At first, doctors thought her case was mild, but they were wrong. Ruth died five days after her diagnosis. She is buried in Princeton Cemetery.
There is a popular misconception that the "Baby Ruth" candy bar (formerly known as Kandy Kake from 1900–1920) was named in honor of Ruth Cleveland. In fact, the name of the candy bar was changed in 1921, seventeen years after her death, and in the same year that legendary baseball player George Herman Ruth, better known by the nickname Babe Ruth, was having one of his best years, having just broken the single-season home run record. But the chocolate bar's creator, the Curtiss Candy Company, never admitted that because if it had done so, it would have had to compensate Babe Ruth. Instead, it was the company that claimed the inspiration was "Baby Ruth" Cleveland, the daughter of President Grover Cleveland, as a means of not having to pay the ball player, while taking advantage of his name and his fame.
Cleveland wasn't the only President to lose a child to diphtheria. Over four decades earlier, Eliza Arabella Garfield, the first child of Congressman and future President James Garfield and his wife Lucretia, died from the disease on December 3, 1863, just as her father was beginning his first term in Congress . Nicknamed "Trot", she had been born on July 3, 1860, and was only 3 years and 5 months old when she died of diphtheria.
In 1905, Franklin Royer of Philadelphia's Municipal Hospital, published a paper calling for the timely treatment for diphtheria and production of adequate doses of antitoxin. Between 1910 and 1911, Béla Schick developed the Schick test to detect pre-existing immunity to diphtheria in an exposed person. A massive, five-year campaign was coordinated by Dr. Schick in which 85 million pieces of literature were distributed by the Metropolitan Life Insurance Company with an appeal to parents to "Save your child from diphtheria." A vaccine was developed in the next decade, and deaths began declining significantly by 1924.
In the 1920s, an estimated 100,000 to 200,000 cases of diphtheria occurred in the United States, causing 13,000 to 15,000 deaths per year. Children represented a large majority of these cases and fatalities. One of the most infamous outbreaks of diphtheria was in Nome, Alaska. In 1926, Alexander Thomas Glenny increased the effectiveness of diphtheria toxoid (a modified version of the toxin used for vaccination) by treating it with aluminum salts.
Between 2004 and 2017, state health departments have reported only 2 cases of diphtheria in the United States.
Before 1826, diphtheria was known by different names across the world. In England, it was called Boulogne sore throat. In 1826, Pierre Bretonneau gave the disease the name diphthérite (from the Greek word diphthera, meaning "leather") describing the appearance of pseudomembrane in the throat. One of the first epidemics was reported in California in 1878. In 1878, Queen Victoria's daughter Princess Alice and her family became infected with diphtheria, leading to the deaths of Princess Marie of Hesse and by Rhine and Princess Alice herself.
It wasn't until 1883, that Edwin Klebs identified the bacterium causing diphtheria. He named it Klebs-Loeffler bacterium. Friedrich Loeffler was the first person to cultivate the bacteria. Joseph P. O’Dwyer introduced the O'Dwyer tube, used for laryngeal intubation in patients with an obstructed larynx in 1885. It soon replaced tracheostomy as the emergency diphtheric intubation method. Progress on a vaccine began in 1890, when Shibasaburo Kitasato and Emil von Behring immunized guinea pigs with heat-treated diphtheria toxin. They also immunized goats and horses in the same way and showed that an "antitoxin" made from serum of immunized animals could cure the disease in non-immunized animals. Behring used this antitoxin for human trials in 1891, but they were unsuccessful. Successful treatment of human patients with horse-derived antitoxin began in 1894, after production and quantification of antitoxin had been optimized. Von Behring won the first Nobel Prize in medicine in 1901 for his work on diphtheria.
There were problems in the introduction of the vaccine. In 1901, 10 of 11 inoculated St. Louis children died from contaminated diphtheria antitoxin. The horse from which the antitoxin was derived died of tetanus. This incident led to federal regulation of biologic products. Just after the turn of the century, there was an outbreak of the disease reported in New Jersey. On January 7, 1904, Ruth Cleveland, the daughter of former President Grover Cleveland and his wife Frances, died of diphtheria at the age of 12 years in Princeton, New Jersey. Ruth was the couple's oldest daughter.
Known as "Baby Ruth", Ruth Cleveland was born on October 3, 1891. She was the oldest of five children born to the Clevelands. She was born between Cleveland's two terms of office, and her birth caused a national sensation. Interest in her continued even after her father's second presidential term was over. Ruth had been in poor health for most of her short life. She contracted diphtheria on January 2, 1904. At first, doctors thought her case was mild, but they were wrong. Ruth died five days after her diagnosis. She is buried in Princeton Cemetery.
There is a popular misconception that the "Baby Ruth" candy bar (formerly known as Kandy Kake from 1900–1920) was named in honor of Ruth Cleveland. In fact, the name of the candy bar was changed in 1921, seventeen years after her death, and in the same year that legendary baseball player George Herman Ruth, better known by the nickname Babe Ruth, was having one of his best years, having just broken the single-season home run record. But the chocolate bar's creator, the Curtiss Candy Company, never admitted that because if it had done so, it would have had to compensate Babe Ruth. Instead, it was the company that claimed the inspiration was "Baby Ruth" Cleveland, the daughter of President Grover Cleveland, as a means of not having to pay the ball player, while taking advantage of his name and his fame.
Cleveland wasn't the only President to lose a child to diphtheria. Over four decades earlier, Eliza Arabella Garfield, the first child of Congressman and future President James Garfield and his wife Lucretia, died from the disease on December 3, 1863, just as her father was beginning his first term in Congress . Nicknamed "Trot", she had been born on July 3, 1860, and was only 3 years and 5 months old when she died of diphtheria.
In 1905, Franklin Royer of Philadelphia's Municipal Hospital, published a paper calling for the timely treatment for diphtheria and production of adequate doses of antitoxin. Between 1910 and 1911, Béla Schick developed the Schick test to detect pre-existing immunity to diphtheria in an exposed person. A massive, five-year campaign was coordinated by Dr. Schick in which 85 million pieces of literature were distributed by the Metropolitan Life Insurance Company with an appeal to parents to "Save your child from diphtheria." A vaccine was developed in the next decade, and deaths began declining significantly by 1924.
In the 1920s, an estimated 100,000 to 200,000 cases of diphtheria occurred in the United States, causing 13,000 to 15,000 deaths per year. Children represented a large majority of these cases and fatalities. One of the most infamous outbreaks of diphtheria was in Nome, Alaska. In 1926, Alexander Thomas Glenny increased the effectiveness of diphtheria toxoid (a modified version of the toxin used for vaccination) by treating it with aluminum salts.
Between 2004 and 2017, state health departments have reported only 2 cases of diphtheria in the United States.