As with scarlet fever, diphtheria (Corynebacterium diphtheriae) only becomes the dread disease that was quarantined and feared after it becomes infected with a toxin-producing bacteriophage (bacteria-infecting virus). You can be infected with an uninfected strain of C. diphtheriae and not develop any illness - the disease itself requires both the virus AND bacteria (well, one inside the other, of course).

When C. diphtheriae starts exuding toxins, it’s not surprising that the disease was so frightening. Those toxins enter the cells of the nasopharynx and inhibit protein synthesis, which eventually causes apoptosis (cell death), localized necrosis, and inflammation from the body’s response to the dead and dying cells.

The Strangling Death

The combination of those exotoxins, and the body’s response to the bacteria and affected epithelial cells, creates diphtheria’s strangling effects. Bluish skin, cough, difficult and painful swallowing, and rapid difficult breathing are all a result of the swelling and pseudomembrane formation in the throat.

Despite antitoxins, antibiotics, and incredibly sophisticated intensive care units, this disease still kills nearly 10% of all patients, and 20% of those under five or over forty. Diphtheria can kill either by strangulation or overloading the organs of the body with toxins; when adults die of the disease, toxin overload is more common than strangulation. Even when patients survive, heart damage from myocarditis and lingering pain from peripheral neuropathy can continue to cause problems for months or years.

Textbook of Pediatrics.
Julius Parker Sedgwick and Carl Ahrendt Scherer, 1922.

Aconitum variegatum - Wolf’s Bane, Monkshood

Aconitum is thought to be from the Greek ἀκόνιτον - “without struggle”. And it is without struggle that this plant causes death.

This beautiful perennial flower can be seen through the autumn months in forests and taigas in Europe, and is popular as an ornamental in gardens, lending color long after summer blooms have faded.

It can also be found in the traditional bikh poison, nepaline, in the writings of Ovid and Dioscorides, and in the bodies of murdered Borgia family members.

Flora Conspicua; a selection of the most ornamental flowering, hardy, exotic and indigenous trees, shrubs, and herbaceous plants. Richard Morris, 1826.

Toxins and Antidotes.

This is an exercise that everyone is welcome to try.

Imagine a patient coming into the emergency department having suffered an overdose or severe exposure to a toxin listed on the left. How would you treat them?

On the right is a list of antidotes. Match each toxin to its correct treatment. More than one antidote could be used for each toxin or it may not be used at all. Submit your answers below.