Instrumental to Survival

Victoria M. Indivero

In 1925 dog sleds raced across frozen tundra to deliver diphtheria antitoxin to disease-riddled Nome, Alaska. In the heart of winter only dogs could traverse the Iditarod Trail, then an important mail and supply route. Today the Iditarod Trail Sled Dog Race is held every year, in part to commemorate the heroism of the dog-sled teams that carried the diphtheria serum between Anchorage and Nome.

At the turn of the 20th century diphtheria was still a feared childhood illness. This bacterial infection affects the mucous membranes of the nose and throat; a thick membrane eventually forms and covers the larynx, which can in turn suffocate the patient. Before 1880 diphtheria patients underwent a tracheotomy to open up their airways, with the hope that they would live long enough to fight off the infection. Yet the operation itself was risky: the New York Foundling Asylum performed this procedure on children in its care, but from 1873 through 1880 recorded no recoveries following the surgery.

A pediatrician and obstetrician named Joseph O’Dwyer joined the Foundling Asylum staff in 1872. While working there, O’Dwyer developed a far less invasive treatment for diphtheria patients: intubation. Unlike a tracheotomy, intubation does not involve surgery. Instead, a tube is pushed down a patient’s throat until it comes to rest on the larynx. Membrane would grow around the tube, allowing patients to breathe more easily. Others had tried and failed to create an instrument for intubation. O’Dwyer succeeded because by 1887 he had figured out how to keep tubes in patients’ throats and had also devised instruments for safely inserting and extracting the tubes.

By 1891 intubation was the preferred treatment for diphtheria because it enabled more patients to survive. However, that same decade an antitoxin remedy developed by German scientist Emil Adolf von Behring was introduced to fight diphtheria. In 1896 the antitoxin serum was tested in public trials in New York City. The first Nobel Prize in Physiology or Medicine was awarded in 1901 to von Behring “for his work on serum therapy, especially its application against diphtheria, by which he has opened a new road in the domain of medical science and thereby placed in the hands of the physician a victorious weapon against illness and deaths.”

While intubation sets, such as the one pictured here, are no longer used to help children survive diphtheria, antitoxin serum is still administered. Most children are vaccinated against diphtheria. But if someone contracts the disease, antitoxin may be used in conjunction with antibiotics. No intubation—or dog sleds—required.