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Master of Arts




McKellar, Shelley

2nd Supervisor

May, Allyson


The diphtheria outbreaks among children in nineteenth-century London required surgical intervention by means of tracheotomy to prevent death by suffocation. Tracheotomy was not universally accepted, and was contested by many circles as a high-risk procedure that offered no guarantee of success. Employing a detailed primary source analysis of contemporary medical records, case notes, textbooks, and journals, as well as newspapers accessed through the British Newspaper Archive and other databases, I analyze the various ways stakeholders (physicians, parents, public health officials) contended with risk to accept or reject tracheotomy as a procedure which could save the lives of diphtheritic children. Various understandings of risk and success greatly influenced the use of tracheotomy, and this prevented its universal acceptance despite the recorded benefits of this procedure.

Summary for Lay Audience

The spread of diphtheria in the child population of London in the nineteenth century was of epidemic proportions. In a time of medical uncertainty, one surgical procedure – the tracheotomy – was employed to provide immediate relief and a temporary artificial passage for breathing in cases of asphyxiation by diphtheritic membrane. Tracheotomy was extremely controversial. Opening the windpipe of a child was, in many cases, treated as a last resort in the treatment of diphtheria. However, tracheotomy served as the only effective treatment to alleviate this symptom of diphtheria. It was not until the late 1880s and 1890s that alternative treatments began to show promising numbers in recovery from diphtheritic suffocation. Given its continued use, why was tracheotomy so controversial? The first chapter examines the medical community and discourse surrounding tracheotomy as medical stakeholders assess the validity, dangers, and effectiveness of this procedure when performed on diphtheritic children. The second chapter examines public perceptions of diphtheria and tracheotomy as communicated through the Victorian newspaper press. In addressing diphtheria outbreaks, the lay narrative emphasizes preventative measures, rather than medical treatments, to combat this disease and improve public health overall. Ultimately, this thesis analyzes the risks involved in allowing for the operation of tracheotomy to be performed on diphtheritic children and how various stakeholders contended with risk and success to accept or reject tracheotomy as a solution to the diphtheria problem.