Long Ago Against Diphtheria, the Heroes Were Horses
From the Archive of Dr. Howard Markel
An illustration that originally appeared in the Nov. 17, 1894, issue of the journal Scientific American showed doctors drawing blood from a horse to produce antitoxin for diphtheria.
By HOWARD MARKEL, M.D.
Published: July 10, 2007
The Claremont Riding Academy, on the Upper West Side of Manhattan, shut its doors for good a few months ago. As the oldest continuously operated stable in New York City, it reached back to an era when horses were as common as taxis are today, and it prompted thoughts of some of New York's most heroic horses: the 13 beasts of burden used in 1894 to produce the miracle drug of their day, diphtheria antitoxin.
The horses and their successors were stabled for nearly two decades at the New York College of Veterinary Surgeons, on East 57th Street and Third Avenue. Initially joined by a few sheep, goats and dogs, the horses prevailed because they were larger and better antitoxin factories: when systematically injected with diphtheria toxin, their immune systems were prompted to develop neutralizing antibodies against the germ's poison. (Most survived the injections with nothing more than a fever and loss of appetite, but over the years quite a few horses succumbed to even tiny doses of toxin.)
At the time, diphtheria was one of the most common killers of children ages 2 to 14. Its name comes from the Greek for "leather" because the organism that causes it, Corynebacterium diphtheriae, induces a thick, tenacious membrane at the back of the throat that blocks the airway. Even when doctors insert a tube to prevent suffocation, the microbe remains a deadly threat by secreting a toxin that can cause paralysis and heart and kidney damage within weeks.
From 1890 to 1893, the physicians Emil von Behring of Berlin and Émile Roux of Paris independently developed effective diphtheria antitoxin to counteract the disease. During the summer of 1894, when Dr. Hermann Biggs, the chief bacteriologist of the New York City Health Department, made a scientific tour of Europe, Dr. Behring and Dr. Roux were using horses to produce antitoxin on a grand scale with stunning results; it staved off death in as many as half of all cases, especially if administered within 24 hours of infection.
So impressed by what was essentially human history's first effective treatment against a devastating infectious disease, Dr. Biggs ran to the nearest telegraph office to wire his colleagues to obtain some horses immediately. There was one hitch. Dr. Biggs needed $27,000 for this life-saving effort, but the city did not apportion the budget until Jan. 1, 1895. Dr. Biggs wanted to start immediately because the process of "ripening" a horse to produce antitoxin required three to six months; consequently, he and a colleague, Dr. T. Mitchell Prudden, paid for the horses themselves.
The animals were injected with toxin starting in October. By December, they were subjected to regular blood draws, in which one to four pints were removed and refrigerated for a few days. The antitoxin serum was then separated from the clotted blood and purified using chemical techniques developed by health department bacteriologists.
The first doses of what became a steady supply of diphtheria antitoxin were available on Jan. 1, 1895. The results were striking. In 1894, there were 2,870 diphtheria deaths in New York City; by 1900, the number was down to 1,400, and it declined steadily in the following decades.
Diphtheria antitoxin was one of the first of a long line of medical media sensations that have come to characterize our culture. The New York Herald organized a public fund-raising drive to support the antitoxin stable. Magazines and newspapers around the globe clamored to report on the "antitoxin horses."
Ever conscious of the importance of public relations when it came to public health, Dr. Biggs took great pains to explain how the horses were treated like hospital patients, how the healthiest of horses were selected for this vital task, and that the animals were fed wholesome food and lived in pristine stables.
In 1906, 59 antitoxin horses (some retired from the police force, others purchased from farmers) were moved to Otisville, in upstate New York, where the city health department maintained a 175-acre animal farm and
tuberculosis sanitarium. That year, the city operated 318 stations in all five boroughs where physicians could get immediate access to fresh antitoxin, including $104,000 in free antitoxin for the poor. In addition, at least that much was sold to health departments around the nation. The health department continued to mass-produce antitoxin until well after World War II.
From the 1950s to the 1980s, commercial companies assumed control of manufacturing vaccines and blood-based products, and municipal and state health departments around the nation phased out such activities. The Otisville facility was sold to a biotech company in 1987 with the stipulation that the retired horses living there would be cared for until they died.
Safe, effective diphtheria vaccines have been administered to American children since the 1940s, transforming the killer into a forgotten malady, at least in this country. In 1990, a major epidemic erupted in the former Soviet Union, Eastern Europe and parts of Asia where large numbers of people had not been immunized.
For those stricken, antitoxin remained the treatment of choice. That epidemic appears to be tamed thanks to vigorous
vaccination practices, but it serves a potent warning that even preventable illnesses inevitably re-emerge when we let down our guard.
Howard Markel is a professor of pediatrics, psychiatry and the history of medicine at the University of Michigan.