Diphtheria arrived in Victoria and Tasmania late in 1858 as a ‘new, brutal mystery’, probably being introduced via migrants who had left England in the middle of the same year (Smith, 1999). The first Australian death ascribed to ‘diphtheria’ occurred in Melbourne on 20 October 1858, and deaths were also registered in Tasmania early in the following year. The disease soon spread to other colonies; South Australia in 1859, and Queensland and Western Australia in 1860. Records in New South Wales are unclear, but Sydney’s Health Officer Henry Graham, reported that the disease was present (SMH, 27 Sep. 1859, p.3). At first, diagnosis was often confused with croup, scarlatina, quinsy or even measles.
The initial outbreak in Victoria was virulent, with the crude death rate rising from 55 per 100,000 population in 1859 to 120 in 1860. This was the highest rate recorded in Australia, apart from a late 1860s outbreak among the small Western Australian population. Diphtheria was epidemic in Victoria during the years 1859–70 and again in 1889–90, as well as in Queensland in 1873, Western Australia in 1864–69, 1874 and 1883, South Australia in 1859–72 and 1888–91, and Tasmania in 1875–80 (Figure 6.1).
Diphtheria assumed an endemic form following its explosive introduction. The total death rate for Australia fluctuated, but declined overall from 1860 to 1886 (Figure 6.2). Between 1887 and 1890, all colonies experienced serious epidemics, but after 1890 rates declined rapidly.
In most years, female mortality rates were higher than male. Diphtheria averaged around two per cent of total Australian mortality over the entire period, although in epidemic years it approached five per cent. Children under five were most affected, with diminishing incidence to age 15 (Figure 6.3). Case notifications assume a different profile, with 20-30 per cent under five years of
age, 40-50 per cent between five and 15, and the remainder among older age groups (Cumpston, 1989, p.296). In the 1860s and 1870s, the case-fatality rate was around one-in-three or -four, although in epidemic years, Victorian case- fatality reached as high as 50-60 per cent (Smith, 1999). Deaths usually peaked in early winter.
Figure 6.1: Diphtheria mortality rates, by colony, 1853–1906
Note: Mortality rates are age-standardised to the 1881 total Australian census population.
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 New South Wales
CDR ASR Deaths per 100,000 population
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 Victoria CDR ASR Deaths per 100,000 population
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 Queensland CDR ASR Deaths per 100,000 population
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 Western Australia CDR ASR Deaths per 100,000 population
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 South Australia CDR ASR Deaths per 100,000 population
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 Tasmania CDR ASR Deaths per 100,000 population
Dr. J. A. Moore was first to report the disease in Australian medical literature, with his account of the January 1859 New Norfolk, Tasmania outbreak (AMJ, Jul. 1859, p.166–169). Victorian Registrar-General Archer’s weekly abstracts also documented the unfolding epidemic in Melbourne,
‘Catarrhal afflictions have been greatly on the increase both in and around the metropolis. At Brunswick several cases of quinsy of a severe form occurred this week…A child under 3 at Collingwood died of “diphtheria and exhaustion”. In the Flemington district malignant sore throat has attacked young and old …At Richmond two cases of death occurred in one family within a few minutes of each other; the sufferers being children of the respective ages of 2 and 4 years old, and the disease in both instances, ulcerated sore throat’ (VicGG, 11 Mar., 19 May, 23 Sep. 1859).
Figure 6.2: Diphtheria mortality rate, Australia, 1856–1906
Note: Mortality rates are age-standardised to the 1881 total Australian census population.
0 25 50 75 100 125 150 1850 1860 1870 1880 1890 1900 1910 CDR ASR
Deaths per 100,000 population
0.0 0.5 1.0 1.5 2.0 2.5 1850 1870 1890 1910
Male:Female rate ratio
0 5 10 15 20 25 1850 1870 1890 1910
A Royal Commission into diphtheria was launched in Victoria in 1871. The findings shed much light on early thinking about the disease—it concluded (erroneously) that the disease had spread to Victoria from Tasmania; that unsanitary conditions did not cause the disease (and hence that it was not miasmatic) but that filth could make attacks more severe; that it was a distinct disease, although often co-morbid with scarlet fever, rubella or measles; and that it was contagious (Smith, 1999). Dr William Thomson used the opportunity to downplay the effect of climate and to promote germ theory, arguing for house quarantine and fumigation (AMJ, Jul. 1872, pp.193–211).
Figure 6.3: Age-specific mortality rates for diphtheria, Australia, 1875–79 and 1900–04
In 1877, Blair published a resume of papers on diphtheria and included a table of deaths in Victoria by age and sex for the years 1858–1876, supplied by Victorian statist H. H. Hayter (AMJ, Oct. 1877, pp.298–301).
The Klebs-Loeffler bacillus (Corynebacterium diphtheria) was isolated in Germany in 1884 and identified as the cause of the disease. In the 1890s, Emil von Behring developed an antitoxin that did not kill the bacterium, but neutralized its toxic poisons. Antitoxin was first used in Australia by Springthorpe in 1895, and by 1906 most cases were treated by this method. The death rate fell to less than 10 per 100,000 population, although it would rise again during the early decades of the twentieth century (Turner, 1899a, b; Cumpston, 1989, p.293).
0 25 50 75 100 125 150 0 1- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- Age group (years)
1875-79 1900-04 Deaths per 100,000 population
Diphtheria was made notifiable in New South Wales, South Australia and Western Australia in 1898 and in the other colonies shortly thereafter. It was one of the first diseases to become closely identified with the new science of bacteriology and laboratory-based public health (Hooker & Bashford, 2002).
Figure 6.4: Injecting the serum (Australian Town & Country Journal, 19 Jan. 1895)