• Robert J Karp and Bobby Gearing.
• Children's Hospital at Downstate, SUNY-Downstate Medical Center. Electronic address: rjkarp@downstate.edu.
• J Natl Med Assoc. 2015 Feb 1; 107 (1): 68-74.

AcknowledgementsLaura Dattner, John Krai and Linda Oppenheim provided assistance in obtaining archival material and manuscript review. Edwin Rosenthal's decedents, Robert, Eleanore Jane and Edwin Rosenthal II, provided information about their distinguished grandfather's life and commitments. Linda Oppenheim, Michael Angelo, Jessica Lydon, and Sofie Serada, archivists at Princeton University, Thomas Jefferson University, Temple University, and the College of Physicians of Philadelphia provided access to material on Edwin Rosenthal and medical care in Philadelphia at the turn of the 20th century. We thanks Laura Dattner, John Krai and Linda Oppenheim for their manuscript review.BackgroundThe Souls of Black Folks, W. E. B. Du Bois' compelling narrative from 1903, includes a description of the death of his only son, Burghardt. His death was caused by diphtheria and occurred in Atlanta, GA in the year 1899. Mortality from diphtheria had fallen precipitously in the mid-1890s, but neither city of Atlanta nor Philadelphia, from which the family had recently moved, had made the diphtheria antitoxin available for general use.ObjectivesTo identify factors affecting availability diphtheria treatment in the two cities the Du Bois family lived in and to address implications for immunization policies today.MethodsWe reviewed data and observations from medical texts and articles from the turn of the 20th century, health department records, archives of newspapers and Du Bois' writings.ResultsMortality from diphtheria dropped precipitously at the end of the 19th century with the introduction of laryngecostomy and a diphtheria antitoxin. However these measures required action by health departments and was dependent on the availability of physicians and medical facilities. Lack of Public Health Departments put all southerners at risk for infectious illnesses. With respect to diphtheria, there was neither an available supply of antitoxin nor physician care available. Philadelphia may have been too mired in corruption to provide antitoxin. Burghardt lived in close proximity to a facility where antitoxin was available, data suggests he would have received appropriate treatment there and was likely to have survived. Similar phenomena-disinterest and dysfunction-affect provision of immunization for children today. Currently, availability of immunization is affected by ethnicity, income levels and immigration status.© 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

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