1769 — Throat Distemper (diphtheria), especially children, New York City, NY — >10

— >10  Blanchard minimum estimate based on descriptions in sources below.[1]

—     3  Deaths of children in one family early in the epidemic. (Duffy. 1953 and 1979, p. 128.)

 

Narrative Information

 

Duffy on diphtheria in New York City: “New York was attacked in 1769 and suffered heavily. Dr. Samuel Bard, a professor of medicine at King’s College, wrote an article in 1769 entitled ‘An Enquiry into the nature, cause and cure of the Angina Suffocation, or Sore Throat Distemper, as it is commonly called by the inhabitants of the city and colony of New-York.’[2] His introduction indicates the motive for his work: ‘I have determined,’ he wrote, ‘to attempt the history of a disease which has lately appeared among the children of this city, and which, both as an uncommon and highly dangerous distemper, well deserves an attentive consideration. The work is largely technical, but Bard indicates the high fatality rate by citing the case of one of the first families to experience the disorder. All seven children in the family were infected and only four survived the attack. This high mortality ration probably indicates diphtheria.” (Duffy. 128.)

 

Smith: “…The literary history of diphtheritic angina, in the State of New York, has its epoch anterior to the American Revolution. The first accounts of the disease were from the pens of Dr. Jacob Ogden, of Long Island, and Dr. Samuel Bard, of the city of New York. The former gentleman describes the disease in two letters addressed to Mr. Hugh Gaine, of New York, one dated in October, 1769, and the other, in September 1774, and which are preserved in the New York Medical Repository; and the latter, in an essay entitled ‘An Inquiry into the Nature and Cause of the Angina Suffocativa, or Sore Throat Distemper, as it is commonly called by the inhabitants of the City and Colony of New York.’ This essay is published in the first volume of the Transactions of the American Philosophical Society, and has attracted great attention on both sides of the Atlantic….

 

“Dr. B’s essay, can scarcely fail, we think, to produce the conviction that the disease he describes is the diphtherite of Bretonneau.[3] A few passages from his paper will show some of the more striking features which indicate the identity of the two diseases.

 

“‘In general, says Dr. Bard, ‘this disease was confined to children under ten years old, though some few grown persons, particularly women (while it prevailed), had symptoms very similar to it. Most of those who had it were observed to droop for several days before they were confined. And the first symptoms, in almost every case, were a slightly inflamed and watery eye, a bloated and livid countenance, with a few red eruptions here and there upon the face, and in one case a small ulcer in the nose, whence oozed an ichor so sharp as to inflame and erode the upper lip. At the same time, or very soon after, such as could speak complained of an uneasy sensation in the throat, but without any great soreness or pain. Upon examining it, the tonsils appeared swelled and slightly inflamed, with a few white specks upon them, which, in some, increased so as to cover them all over with one general slough; but this, although a frequent symptom, did not invariably attend the disease; and some had all the other symptoms without it. The breath was either so ways offensive, or had only that kind of smell which is occasioned by worms; and the swallowing was very little if at all impaired.’ With these symptoms was a slight fever which sometimes continued five or six days, and also in some, a difficulty of breathing which occasionally suddenly increase, threatening suffocation.

 

“‘This stage of the disease was attended with a very great and sudden prostration of strength; a very remarkable hollow dry cough, and a peculiar change in the tone of the voice; not easily described, but so singular, that a person who had once heard it, could almost certainly know the disease again by hearing the patient cough or speak. In some the voice was almost entirely lost, and would continue very weak and low for several weeks after recovery.’ In some the pulse was quick, soft, and fluttering, and there was a tendency to coma, and towards the close of the disease great restlessness, languor, and dejection expressed in the countenance, subsidence of the swelling of the face, sometimes a purging, and the patient died apparently of suffocation at the end of the third or fourth day, and occasionally within thirty-six hours. Cases occurred which ‘had not the difficulty of breathing, but in its stead very troublesome ulcers behind their ears. These began with a [end of p. 174] few red pimples, which soon ran together, itched violently, and discharged a great deal of very sharp ichor, so as to erode the neighboring parts, and in a few days spread all over the back part of the ear, and down upon the neck.’ In some, however, in which there were ulcers behind the ears, there was a slight difficulty of breathing. ‘These ulcers would continue for several weeks and appeared covered in some places with sloughs, resembling those on the tonsils.’

 

“Dr. Bard met with but two cases in adults. One resembled an inflammatory angina, but on the third day the tonsils were covered with thick sloughs; he had a low and feeble pulse, a moist skin, dejection of spirits, but no great difficulty of breathing. In the other case the tonsils were swelled and covered with sloughs, similar to those in children, the breath was more offensive but the breathing not suffocative.

 

“In three instances Dr. Bard had an opportunity of studying the pathological anatomy of the disease by dissection [an autopsy]. ‘One was a child of three years old. Her first complaint was an uneasiness in her throat. Upon examining it the tonsils appeared swelled and inflamed, with large white sloughs upon them, the edges of which were remarkably more red than the other parts of the throat. She had no great soreness in her throat, and could swallow with [end of p. 175] little or no difficulty.’ Subsequently the pulse was quick and soft, heat of the body moderate, face swelled, strength prostrated and breathing difficult. These symptoms increased and with some others continued till the third night, when, after several loose stools, she died early in the morning.

 

“‘Upon examining the body, which was done on the afternoon of the day she died, I found the fauces, uvula, tonsils, and root of the tongue interspersed with sloughs, which still retained their whitish color….The whole trachea, from the larynx down to its division in the lungs, was lined with an inspissated mucus, in form of a membrane, remarkably tough and firm; which, when it came to the first subdivisions of the trachea, seemed to grow thin an disappear. It was so tough as to require no inconsiderable force to tear it, an came out whole from the trachea, which it left with much ease; and resembled more than anything, both in thickness and appearance, a sheath of thin chamois leather. The inner membrane of the trachea was slightly inflamed; the lungs too appeared inflamed as in per-pneumonic cases; particularly the right lobe, on which there were many large livid spots, though neither rotten or offensive; and the left lobe had small black spots on it, resembling those marks left under the skin by gunpowder.’” [p.176]

 

 

Sources

 

Duffy, John. Epidemics in Colonial America. Baton Rouge, LA: Louisiana State University Press, 1953, reprinted 1979.

 

Smith, Joseph M. MD. Report on the Medical Topography and Epidemics of the State of New York. Philadelphia: Collins, Printer, 1860. Google preview accessed 3-31-2018 at: https://books.google.com/books?id=wtHmfz7Z4RwC&printsec=frontcover#v=onepage&q&f=false

 

 

 

 

[1] Duffy notes high fatality rate.

[2] New York, 1771, reprinted in the Transactions of the American Philosophical Society, 1769-71 (Philadelphia, 1789), I, 388-404.

[3] Pierre Bretonneau was a French medical doctor (1778-1862).