This PhD thesis analyzes and interprets prevailing patterns of diphtheria incidences and their spread over space and time. In Europe, diphtheria was thought to be almost eradicated by the end of the 1970s, but recent epidemics starting from the states of the former Soviet Union once more attached importance to this disease. The project aims to reveal, on various scales, geographic, socio-cultural and economic determinants contributing to disparities in disease incidences within a population. The underlying hypothesis of this project regards the decline of infectious diseases as the result of more than merely medical and technical advances. The topic thus fits into research activities in medical geography. Medical geographical research in Germany was once concentrated in Heidelberg and is today coordinated and continued by the Working Group on Medical Geography of the German Association of Geography.
In a first step major incidents of diphtheria are reconstructed dating from the Ancient Greeks to the beginnings of the bacteriological era in late 19th century. It was not until the diphtheria bacteria was discovered and its toxin identified that diphtheria could be treated effectively. Research focuses on a first-time analysis of clinical records (time span 1901 – 1910) collected by the Luisenheilanstalt in Heidelberg. Personal details taken from these records allow to explore the patients’ spatial, socio-demographic and socio-economic background while further examination of published mortality tables puts the Heidelberg cases in a national and international context.
In addition, analyses of anonymous case studies taken from various countries are intended to draw a picture of the “modern” diphtheria patient. Resulting disparities concerning the patients’ socio-demographic characteristics, their social and geographical environment as well as the distribution of diphtheria is subject to further interpretation. Of particular interest is the ambiguous impact of vaccination. On the one hand vaccination counts for the sharp decline of diphtheria incidents in industrialized countries after World War II, on the other hand it might have contributed to the re-emergence of diphtheria in the former Soviet Union. This PhD project examines these contrary opinions by analyzing current patterns and rates of coverage aiming at optimizing them.