Haunted by the Strangling Angel (of History)

Cross-posted from History Compass Exchanges

I’m a historian because I’m haunted. The words and names from the archives surface in my thoughts and dreams…as I immerse myself in their world, their stories become mine. Am I like a clan storyteller, curating and re-telling the memories from long ago? Or am I merely that eccentric cat lady with no life of her own, her piles of papers and a worn laptop offering ample space for escape from the real world? Though I now sit in an overstuffed chair in my suburban living room with the ambient sound of a lawnmower outside, I am not really here. I am at the sickbed. Hearing a young child’s chest heave and rise, reminding me of my son.

The cough brought our pediatrician running down the hallway. It was the third time I’d brought in my newborn baby out of concern for his stuffy nose and congestion. He had stopped nursing. There was the faintest tinge of blue at the corners of his lips. Dr. Yu speedily unzipped my son’s pajamas, and placing a stethoscope over his tiny chest and heart. Then stepped back for a moment, watching the labored rise and fall of our son’s breathing, his ribcage dipping down nearly to spine each time he coughed. We all watched. Each intake of air a deep gasp from within his belly. What happened next is a blur of memory, my fear eclipsing exact recall. A rush to the nearest Children’s Hospital and an exam by an infectious disease specialist. Isolation due to the risk of contagion. Learning that our son was infected with a disease that was often fatal, with a name that only faintly registered in my memory: pertussis. As we were to learn later, it’s the “P” part of the DTP immunization that most babies receive at their two month checkup. Our baby was only four weeks old.

The specter in my research today is not pertussis, but a different letter of the vaccination alphabet. The “D” for diphtheria is hovering around my living room as I shuffle through the account of physicians’ failed attempts at treatment. The disease called the “strangling angel” caused leathery membranous wings to grow in the throat, eventually coating the mouth, nasal passages, and windpipe. Its sounds are much like those that I remember from pertussis: the forced breathing that is dreadful, but not as dreadful as the silence. Those long moments when all sound stops.

Now reading from The Lancet, an 1859 account of diphtheria: “When the surgeon is summoned, he finds the throat and mouth covered with yellow or brownish leathery exudation. Within a few hours a hoarse, barking cough, and a change in the tone of the voice are marked; oppression of the breathing supervenes; then paroxysms of suffocation, more and more frequent; the cough is stifled, and the voice also dies out. As…suffocation is felt, the poor child turns from side to side, throws its arms into the air, clutches its mother violently, and struggles furiously to gain breath, then falls exhausted in the bed, and gaining strength from momentary repose, renews the hopeless struggle to the end. Perhaps, in a violent fit of coughing, it expels a false membrane from the air-tubes, which has extended down to the fifth division of the bronchi; then it breathes easily, smiles again, and sleeps, but soon wakes to resume its struggle with death-it may be again to expel the membrane, and finally to triumph. But such a happy victory is wholly exceptional, and when once the grip of the disease has closed upon the air-tubes, death claims its prey.”[1]

My son survived. Our pediatrician later explained to us that he had only heard a pertussis cough once before, while practicing overseas. Our infectious disease doctor told us that if Dr. Yu hadn’t heard the distinctive cough and recognized it for what it was, we would have lost our son. A few weeks spent in an isolation ward with a steady flow of oxygen and feeding tube restored his vigor–his slight propensity to asthma is the only legacy of that time. I’m not the only person haunted by children dying of infectious diseases. “Of all the horrors…that of a child struggling under [diphtheritic] strangulation, is, perhaps, the most painful,” wrote one California physician in 1863.[2] Back then, many doctors had simply given up trying to find an effective treatment for the disease, the proscriptive advice in medical texts varying so widely so as to make any practitioner’s head spin.[3] From various texts, the remedies were:

Take spirits of turpentine, 1 ounce…[4]

nitrate of silver, if used at all, is employed in a weak solution…[5]

Many of the German physicians…advise gargling the throat with the brine of Holland herring…[6]

the disease vanishes under the influence of Cimicifuga…[7]

Carbolic or phenic acid is the best remedy…[8]

Dr. Edward Adamson states that he has treated fifty-five cases of diphtheria by the internal administration of the officinal tincture of iodine…[9]

per sulphate of iron as a topical application…[10]

Ice is applied in a bag, or by means of a lump cut to fit, and placed saddle-wise across the throat…a piece as large as a hen’s egg, secured in contact with the neck by a strip of oiled silk, and covered afterwards in front with flannel. It is not to be removed till relief is established, and it may be necessary to prevent reaction after its removal by the application of cold water…[11]

As time went on, more invasive options–tracheotomy surgery or intubation–held some promise for success. But these procedures were risky, because “diphtheria was the only disease in which the practitioner of internal medicine was likely to find himself called upon to wield the knife.[12]” Success rates for tracheotomy tended to be contingent on the skill of the physician as well as whether it was too late for any effective treatment. Despite an understanding of the appropriate procedure for a tracheotomy, it was relied on only when strangulation was imminent. Thus, this was not a procedure that doctors had time to prepare for. A physician wrote that the need for the surgery was so urgent, after cutting the hole in his patients’ neck, he risked his own health by laying “a handkerchief over the wound made in the trachea and, with the lips, suck[ed] the secretions from the larynx.”[13] Another doctor admitted to similarly aspirating the throat of a patient with his own mouth, adding that afterwards he chewed on a plug of tobacco and “indulged freely in spiritus frumenti [whisky] as an antidote” to the germs he received from his patient.[14] One can only imagine the desperation of a physician cutting through a baby’s throat and putting his own mouth on the baby’s neck, trying to force air from his lungs through the baby’s membrane-coated passageways. Blood on hands, blood on his lips, blood pooling around the body of the strangling child.

The editor of the San Francisco Medical Press explained how he performed the tracheotomy with marked success. Before the surgery his young patient’s skin had a bluish tinge due to lack of oxygen, and afterwards she breathed freely. However, due to the strain of the illness on her body, she died of secondary complications within a week of the surgery. The editor continues to advocate for tracheotomy, however, and explains the success of the surgery in this case because it spared the patient from death by asphyxiation. He writes, “Now from the result of this case, (though fatal,)…we have much to vindicate it from the odium which strongly in its favor, if this were not sufficient, is the relief which it instantly affords the patient struggling with all the throes of death by asphyxia;–for, of all the horrors which are presented to[the] eyes of the Physician, in his pathological experience, that of a child struggling under croupal strangulation, is, perhaps, the most painful, and invokes from the heart the keenest feeling of sympathy.”[15]

Diseases like diphtheria tended to afflict urban communities more than sparsely-settled areas. Like many other infectious diseases, it spread via contaminated water or milk supplies as well as by human contact. In the more sparsely settled regions of nineteenth-century America, diphtheria was still feared, even though the threat was more remote than in densely populated areas. The nearly-exponential growth of nineteenth century California communities experienced numerous waves of diphtheria outbreaks, triggering a response from the local medical community as well as from regional public health organizations. And it wasn’t until the 1890s that an antitoxin for diphtheria became widely available. Within another two decades a successful vaccination for the disease meant that the number of cases on the United States dropped to an almost negligible amount. The strangling angel no longer haunted American children, or at least that’s how it seemed.

The young nurse taking my health history shook his head. He’d asked questions for over an hour, detailed queries that included a thorough recounting of my sexual history, my overseas travel, and of my extended family’s medical issues. My own coughing spells frequently disrupted our conversation. The nurse was the first to connect the dots between me, my mother who had recently visited her firstborn grandchild, and my father who was dying of cancer in a San Diego hospital. A pattern emerged: although we were all immunized as children, those shots wear off over time and leave us vulnerable (my husband, alone, immune due to recent boosters received before living in Asia). The hospital in an international border town was a likely vector for a disease that had all-but-disappeared in the United States. Like with diphtheria, adults carried a mild form of the disease, which was rarely life-threatening. Pertussis infected my son through me, through my mother, though my father, but mostly through forgetting. A decade ago, before a worldwide flu epidemic and drug-resistant TB, who knew that such diseases were still mingling amongst us? Or that they would continue to return, like that strangling angel…

“an angel looking as though he is about to move away from something he is fixedly contemplating. His eyes are staring, his mouth is open, his wings are spread…Where we perceive a chain of events, he sees one single catastrophe which keeps piling wreckage and hurls it in front of his feet. The angel would like to stay, awaken the dead, and make whole what has been smashed. But a storm is blowing in from Paradise; it has got caught in his wings with such a violence that the angel can no longer close them. The storm irresistibly propels him into the future to which his back is turned, while the pile of debris before him grows skyward. This storm is what we call progress.”[16]

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[1] “Report of the Lancet Sanitary Commission on Diphtheria: Its History, Progress, Symptoms, and Treatment.,” The Lancet 73, no. 1850 (February 12, 1859): 169-170, http://www.sciencedirect.com/science/article/B6T1B-49HF759-4GB/2/07561f0d20eec18ff9b1ab19c39e8524.

[2] Wm. H Sherwood, “of Croup following Diphtheria: Tracheotomy—Successful Termination,” The San Francisco Medical Press 5, no. 1 (April 1863): 24-26.

[3] Physicians were “apathetic and hopeless in regard to the treatment of diphtheria to a degree not experienced in any other disease,” said Evelynn Maxine Hammonds, Childhood’s Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930, (The Johns Hopkins University Press, 2002), 36.

[4] “Diphtheria,” Farmer’s Cabinet, February 14, 1867, http://infoweb.newsbank.com/iw-search/we/HistArchive/?p_product=EANX&p_theme=ahnp&p_nbid=K58H51UFMTI1ODU1NTU5MS40MjEyNToxOjE0OjE2OS4yMzQuMTIxLjg5&p_action=doc&s_lastnonissuequeryname=2&d_viewref=search&p_queryname=2&p_docnum=27&p_docref=v2:108BD1FCD7E9FA90@EANX-108D96155CA30E00@2403012-108D96184C9ACA98@0-108D961970141EE8@Diphtheria.

[5] “Editor’s Tools: Treatment of Diphtheria,” The San Francisco Medical Press 6, no. 1 (April 1864): 31.

[6] “Diphtheria: History of the Fell Disease–Some Suggestions as to Treatment that May be Valuable,” Daily Evening Bulletin (San Francisco, CA), February 2, 1887, http://infotrac.galegroup.com/itw/infomark/885/414/81067853w16/purl=rc1_NCNP_0_GT3000872395&dyn=16!xrn_35_0_GT3000872395&hst_1?sw_aep=univca20.

[7] Cimicifuga, commonly known as Black Cohosh, was a medicament popular with eclectic practitioners in the mid-19th century. “Editor’s Tools: Treatment of Diphtheria.”

[8] Ibid.

[9] “Tincture of Iodine in Diphtheria,” St. Louis Courier of Medicine 14: 256, http://books.google.com/books?id=E6QRAAAAYAAJ&printsec=frontcover#PPA256,M1.

[10] “Editor’s Tools: Treatment of Diphtheria.”

[11] Ibid.

[12] Anne Hardy, “Tracheotomy Versus Intubation: Surgical Intervention in Diphtheria in Europe and the United States, 1825-1930.,” Bulletin of the History of Medicine 66, no. 4 (1992): 538, http://search.ebscohost.com/login.aspx?direct=true&db=ahl&AN=A000376044.01&site=ehost-live.

[13] Francis Long, A Prairie Doctor of the Eighties Some Personal Recollections and Some Early Medical and Social History of a Prairie State (Norfolk Neb.: House Pub. Co., 1937), 60.

[14] Ibid.

[15] Wm. H Sherwood, “of Croup following Diphtheria: Tracheotomy—Successful Termination.”

[16] “On the Concept of History / Theses on the Philosophy of History – Wikipedia, the free encyclopedia,” http://en.wikipedia.org/wiki/On_the_Concept_of_History_/_Theses_on_the_Philosophy_of_History.

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