Lessons from a Kansas graveyard: What a 1903 outbreak of diphtheria can teach us today


In a shady corner of St. Mary’s Cemetery, a curious collection of little headstones, all of the same size and age, surround a large hooded monument. Unassuming and unadorned, the large family headstone does not prepare you for what you will read. This little cemetery just south of Hartford, Kansas is the final resting place for the “Children of James & Anna O’Marra,” eight of whom died in 1903.

James and Anna O’Marra and their nine children, ranging in age from six months to 21 years, lived seven miles south of Hartford. Their family was in mourning for James’ brother John, who had died of pneumonia on March 30, 1903. The newspapers are not clear as to exactly what happened next, but John O’Marra’s funeral may be a clue, as family members from outside the area came to Lyon County to pay their respects.

According to the Neosho Valley Times, a cousin visiting from Anderson County might have been the unwitting carrier for the tragedy that would devastate the O’Marra family.

“What’s diphtheria?” my colleague asked me as I told her this story.

“We’re so lucky we don’t know first hand,” I told her.

On April 10, nine-year-old Julia O’Marra was taken down with respiratory “black” diphtheria. As the bacteria grew thick dark membranes around her tonsils and throat, she grew weak, gasping for air, until the membrane completely blocked her airway. On the morning of Tuesday, April 14, Julia suffocated to death. She was buried the same afternoon.

The tiny marker for Julia O'Marra, age 9, the first to die of diphtheria.

Before the last of the earth was shoveled onto her grave, all eight of the remaining O’Marra children were extremely ill. Rumors were circulating that the O’Marras had already infected members of other large families. Though unfounded, the stories prevented many neighbors from offering assistance. Beyond the help of “the old priest,” Father J.W. “Paul” O’Connor and the undertaker, Mr. Holloway, the O’Marra family was on their own.

Thirteen-year-old Anastasia, called Annie, died Saturday morning, April 18, and was buried the same day. Her four-year-old brother James died at 11 o’clock Saturday night, followed by his seventeen-year-old sister Ellen, called Nellie, who died early Sunday morning.

Anastasia "Annie" O'Marra was the second sibling to die.

James and Nellie were buried in the same coffin Sunday afternoon.

James and Ellen "Nellie " O'Marra died within hours of each other, and were buried in the same grave.

How serious is diphtheria?

Diphtheria is a serious disease: 5%-10% of all people with diphtheria die. Up to 20% of cases lead to death in certain age groups of individuals (e.g., children younger than age 5 years and adults older than age 40 years).

Immunization Action Coalition

On Monday, April 20, 21-year-0ld William and his six-year-old sister, Hanora, called Nora, also passed away. They were buried in the same casket later that afternoon.

William and Hanora "Nora" O'Marra also share a grave after dying the same morning.

James and Anna were beside themselves with grief and worry. Anna grew physically ill herself, and it was feared that she, too, had contracted diphtheria from her children. While the parents looked on, the local doctor, S.P. Reser, administered anti-toxin, a therapy that had only been in use since the late 1890s, to the three remaining children. He was too late. Maggie, the six-month-old baby, died Monday night.

Six-month old Margaret "Maggie" O'Marra was the seventh sibling to die, despite anti-toxin treament.

A nurse from Kansas City arrived to help care for the two remaining children and the heart-sick, exhausted parents. The two surviving children, eighteen-year-old Mary and eleven-year-old Lizzie, appeared to respond to the anti-toxin treatment. Neighbors stepped in to help as they could. It was thought the two girls would recover.

On the morning of May 5, Mary’s heart gave out, most likely from myocarditis.

Thought to be recovering, Mary, the eldest daughter, died on May 5.

Lizzie, the middle child in a family of 11, was now the only surviving daughter to two of the most grief-stricken parents in Lyon County’s history. She would outlive her siblings by nearly six decades.

A confirmed case has not been reported in the U.S. since 2003. Approximately 0.001 cases per 100,000 population in the U.S. since 1980; before the introduction of vaccine in the 1920s incidence was 100-200 cases per 100,000 population. Diphtheria remains endemic in developing countries with low vaccination coverage. During the 1990s, the countries of the former Soviet Union reported >150,000 cases in a large epidemic.

Centers for Disease Control and Prevention: Diphtheria

Cemeteries are rich with the history of the people who live in a particular area. They indicate wealth, social status, social and religious affiliations, and ethnicity. They are also a strong indicator of the hard existence our not-so-distant ancestors endured.  For me, the graves of children are both the most heartbreaking and the most honest, because it is our nature as humans to do all we can to protect our young. The headstones and markers of the young tell the stories of those we couldn’t protect from stillbirth, disease, or tragic accident.

Cemeteries that date back a century or more often protect the remains of far more infants and children than most of us are comfortable seeing. The late 1800s and early 1900s brought death to children, death from diseases most of us have never even seen in another living being: tetanus, small pox, diphtheria, typhoid, and polio, as well as others that are beginning to reappear as more and more Americans lose the immunity acquired through vaccination or choose not to vaccinate their children (measles, mumps, pertussis). These families lost children — sometimes many or all of their children — in a matter of days or weeks.

I acknowledge that some of the most important decisions we ever face are those concerning our own health and the health of our loved ones. As thousands of children died all over the world from highly communicable and extremely dangerous diseases, doctors and scientists and other public health officials sought ways to protect the entire population by protecting the most vulnerable: the very young.

In some ways, those scientists and doctors and public health officials were almost too successful. We have forgotten how severe, painful, dangerous, and heartbreaking many of these diseases really are.

Vaccines have always generated dissenters as well as supporters. As the concept of vaccination spread through New England, many argued that to “sicken oneself as a way of preventing God from sickening you…[was] an act of supreme arrogance,” and considered a sin.  (See Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver by Arthur Allen.) Today, many believe that vaccines are physically dangerous, that there is no need to to vaccinate children from diseases that are sometimes mistakenly believed to have been eradicated. Yet we know that unvaccinated children are only as safe as the people around them, completely dependent on the immunity of others to protect them from harm.

As many news stories have demonstrated, in a world where people travel freely from city to city, state to state, country to country, it is very difficult to prevent exposure to some of these extremely deadly diseases. What’s more, there is a tremendous cost, physical and financial, to minimizing the impact these diseases have once they are reintroduced to populated areas.

My reaction is more visceral. When I hear of someone arguing against the benefits of vaccinations, I want to say, “Before you make up your mind, let me show you something.” Then I want to take them out to a local cemetery. “This,” I want to say, “This is why we have vaccines. Because I believe in my heart the O’Marras would have given anything to have protected their children from this. They would have given anything to have had children who lived full lives.”

I believe the O’Marras would have given anything for their children to have more than the occasional stranger standing over their graves, wondering what awful tragedy befell them in 1903.

The O'Marra family plot at St. Mary's Cemetery, south of Hartford, Kansas.

Author’s note: Two newspapers covered the O’Marra family tragedy: the Emporia Gazette and the Neosho Valley Times. The exact times of death vary slightly between the two papers; I opted to go with the times listed in the Neosho Valley Times, which was the more local paper for Hartford. O’Marra is occasionally spelled O’Mara, though all of the family markers at St. Mary’s Cemetery spell it “O’Marra.” All photos by Diana Staresinic-Deane.

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64 thoughts on “Lessons from a Kansas graveyard: What a 1903 outbreak of diphtheria can teach us today

  1. Diana

    AWESOME post, DIana! I had no idea until I read your Twitter bio that we are both interested in this type of things. My husband and I love all things cemetery, genealogical, historical… you understand, I’m sure. I used to have a lot of my work online… until a handful of people tried to steal my work and call it their own. Sad that has to happen. Anyway….

    Isn’t it amazing the stories we can learn just by “reading” the stones in cemeteries. Fascinating lives of our ancestors and their friends and neighbors… especially here in Kansas on the prairies.

    Reply
    1. Diana Staresinic-Deane Post author

      Great Dianas think alike! My husband and I are photo volunteers for findagrave.com. I think I’ve learned more about Lyon County history puttering through the cemeteries than anywhere else. And you’re right, there’s something about those old homesteading cemeteries that are especially endearing.

      Reply
  2. Angela

    I’ve seen some of those cemeteries with dozens upon dozens of tiny graves. It is wrenching, to say the least. Thank you for this post; it is excellent.

    Reply
  3. Valerie Custer

    I wish I was still doing Ped’s just so that I can hand them this article, and ask them– Is death worse fear or religious belief? Worse than a possible unfounded side effect from a bias study preformed by an unethical phyisican who has lost his medical licence? So many outbreaks of very preventable diseases are beginning to surface. Thanks for wonderful article, Bravo! You need to write a book. When it’s published I’ll be mailing it to you for an autograph.

    Reply
  4. Jim Gilligan

    From the mid 1880′s onward my great grandfather John Gilligan, grandfather William Gilligan, and father Bernard Gilligan were all friends, neighbors, fellow Irish immigrants, and fellow Catholic parishoners of this same O’Marra family. They sometimes traded or shared mutual planting and harvesting work among the two families. All attended the same St.Mary’s Catholic Church in Harfford, KS. and all are buried in the same cemetery as the O’Marra’s. I recall as a child in the late 1940′s and 50′s that many local people seemed to treat the O’Marra family with a quiet sense of tragedy and reserve. I never quite understood why this was until I came across this very sad story of infectious diseases which struck so close to home.

    Reply
    1. Diana Staresinic-Deane Post author

      Wow, your post is an amazing reminder of what a small world we live in. The O’Marra family’s story is truly tragic. It sounds like the community felt their grief many decades down the line. I still feel heartsick when I think of their family’s losses, and my only contact with the family was in visiting their graves one day.

      Thank you for sharing your story, Jim.

      Reply
  5. Jim

    Diana – I had passed your story about the O’Marra children on to my oldest sister asking her if she remembered hearing anything about this tragedy in the O’Marra family when she was growing up at Hartford. As a footnote to this story here is her reply:
    “Yes, I remember our Mom and Anna Marie O’Marra talking about it and looking at the stones in the Hartford Cemetery. It WAS a tragedy before these vaccinations were possible. Helen (my classmate) always complained that when they had O’Marra family reunions there were never many present ! I grew up and played with the O’Marra kids; Helen, Ann, and Margaret. Two of these siblings attend Mass most Sundays, at Holy Name Catholic church in Topeka to this day (Sept 2012). I see and sit by Ann and her sister, Margaret, with their little grandkids many Sundays! It is a small world, isn’t it? Your Sister, Jeannie”

    Reply
  6. Dale Free

    I am a findagrave.com volunteer as well, and I do frequently find cases of multiple young children in the same family who died the same year, leading me to believe it was an outbreak of some disease or another. It’s heartbreaking that so many now have lost our cultural memory of the devastation of these terrible yet preventable diseases.

    Reply
  7. G. Wilson

    Just wanted to thank those of you who are find a grave volunteers. We discovered my husband’s birth father’s hand made grave stone in GA in 2012 thanks to a find a grave volunteer.

    Reply
    1. Diana Staresinic-Deane Post author

      G – thanks so much for the kind words and for sharing a nice story. One of my favorite things about the internet is the fact that we can connect in such amazing ways, even if that connection is locating the grave of a family member.

      Reply
      1. G. Wilson

        I agree. I remember when i first found out about Find a Grave volunteers, I was amazed that someone would be generous enough to do that for strangers. I had a similar feeling when i found out about people who read and decipher old census records.

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  9. Nancy Carabio Belanger

    I stumbled onto your blog from Facebook and after reading this, feel terrible for complaining about miniscule things and petty annoyances. It is a good reminder to all of us in this comfy age of modern medicine, iPhones and instant everything to remember the harsh reality of day-to-day living back then, and the tragedies that were so frequent.Thank you for sharing this heartbreaking story, Diana. May the O’Marra family rest in peace with Our Heavenly Father.

    Reply
  10. Carleen Straub Dekat

    I am thinking you might like to go to see a cemetery in a farm community about 25 miles west and north of St. Marys where some of the earliest settlers in Kansas chose to live. The community is known by the name of “Flush.” One of the settlers by the name of Floersch applied for a post office–the name came back “Flush.” It has been that way since that time.

    Reply
  11. Carleen Straub Dekat

    And here is a P.S. to my earlier post–I have two children buried in the St. Joseph Cemetery at Flush–along with parents, grandparents and great grandparents.

    Reply
  12. Carleen Straub Dekat

    Yes, that is the cemetery I was talking about. It is beautiful country there. The Catholic Church across the road from the cemetery is known as “The Pearl of the Prairies.” The early German settlers built that church from native stone. Gorgeous inside and out. My husband and I both grew up in this community. No, I am not a Flush Floersch–and there are no Floersch families living there now. However, there are Floersches at Manhattan. My great grandfather Louis Lintz (1837-1913) was one of the early settlers there. He donated one of the church windows. My mother’s name was Gros–a descendant of Louis. My father’s name was Straub. My married name is Dekat–one of the original settlers there. I believe this cemetery may be online. There has been a lot of history recorded about it, done by a person who lived there in his childhood–does a lot for the Riley County Genealogical Society. I guess you can tell I am into genealogy also….

    Reply
    1. Diana Staresinic-Deane Post author

      That area between St. Marys and Manhattan is on our list of places to explore more thoroughly. We visited St. Marys a few months ago and were surprised by its loveliness. Just when I start to think I know most of Kansas, I realize I don’t!

      Reply
    2. Tim R. Ekart

      The Ekart’s have a long history in Flush as well. My Great Grandfather Antone Ekart (among others) is buried there. My Grandmother, Genevieve Ekart passed away in 2012 at age 105. She was an Umschied married to Clarence Ekart. They lived in Flush until 1942 when they moved to Manhattan.
      Flush has a rich history indeed and St. Joseph’s is indeed a pearl. We still attend mass there on occasion.
      Thanks for listening… Tim R. Ekart, Wamego, KS

      Reply
      1. Carleen Straub Dekat

        Tim, if you get back to this post–Sy Ekart must be your uncle. He is the person I was referring to who does genealogy work. I have worked with him on a few projects. He is a distant cousin of mine. In 1942 when your grandparents moved to Manhattan my family moved into the house at Flush that they left.
        Carleen Straub Dekat

      2. Tim Ekart

        You are correct. Sy, Sylvester, my Uncle, has done quite bit of genealogy work for The Ekart’s, Umschied’s, and Dekats. He’s published several genealogies for those families.

      3. Tim Ekart

        I know of the house to which you refer! It used to be two stories, but the top floor is now gone. I always wondered who moved into that house. I’m sure I was told by my Uncle.
        Thanks for the communication!
        Tim

      4. Carleen Straub Dekat

        Diana, we used to say if you blink when you go through it you will miss Flush. It is actually not a town, but a farm community. Years ago there was a country store there, but now all that is there is the church, cemetery, rectory, a parish hall….the school has been torn down. The country store that used to be at Flush is now a part of the historical museum at Wamego.

  13. Keon

    Diana, thanks so much. Touching story. Do you know of the Cholera cemetery? Western Shawnee Co.. Between Willard and Rossville and on a dirt road.

    Reply
  14. lukebunker

    Excellent post! I, too, live in Kansas (southwest Kansas – a friend who is expecting shared your article with me) and this makes me want to read up more on our history and culture. Thanks for writing this, and for clarifying the debate!

    Reply
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  16. ilovejay

    My Grandfather lost 4 of his siblings to childhood illnesses as well. I have two young daughters and I do vaccinate them, but I am careful not to do so when they have a fever or any sign of being sick. In 1971 my six month old brother was vaccinated with the Dpt shot while he had a low grade fever and within 48 hours he had died of sepsis. Many children have died from the Dpt shot, my daughters’ pediatrician gave me the data and said it wasn’t as safe 40 years ago as it is today. I think we need to remember the children who have died from the Dpt shot as well. There are many victims beyond this debate, on both sides, and I think in the end we should recognize all of them. Although I still believe that vaccines have saved many lives, let us not forget those who have died because of them. Vaccines are much safer now than they were 40 years ago, although my brother died from the Dpt vaccine, I still believe in them, but I think being educated on the facts are important for all parents. Rest in peace O’Marra’s and rest in peace Baby Burt.

    Reply
    1. Diana Staresinic-Deane Post author

      Thanks so much for your thoughtful comment, and please accept my condolences on your family’s losses.

      You’re absolutely right–especially in the earliest years, when our scientists and doctors and general public were just starting to wrap their minds around the idea of vaccines–there were many complications, particularly when so many of the vaccines used live forms of the viruses and bacteria. I’ve seen stories of parents trying to vaccinate their own children with live small pox viruses only to fatally infect their children with the disease, and similar stories exist in the early days of other vaccines, too. It has only been in recent years (when teens and adults started getting measles and whooping cough) that we’ve come to realize that some of the vaccines ultimately lose their effectiveness over time and require a booster.

      Fortunately, as our understanding of medicine grows, our ability to reduce the risks also grows. (Unfortunately, some of that knowledge came through the trial and error, sometimes at the expense of the earliest people to be vaccinated.) Like any medication, there is always a risk of side effects. Currently, the possibility of severe complications/death for the DTaP shot is less than 1 in one million. The CDC includes that information at their website: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

      Reply
  17. Lindsay

    I was on the fence about vaccinations throughout my entire pregnancy and even shortly after my daughter was born. But then, I realized that the benefits – prevention of deadly diseases – far outweighs the risks. At least in my mind.
    I love history, especially personal stories. This is a heartbreaking one. Thank you for sharing.

    Reply
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  19. timsarmywifey

    A tragedy … yet there are also thousands of survivors of diphtheria as well. Cemeteries never tell the whole story.

    Reply
  20. heepsprow

    I often talked to my grandmother about the devastation that outbreaks like this caused. She very nearly died of diphtheria. It was only the vigilance of the doctor caring for her that saved her life. My grandfather lost two younger siblings in the same outbreak, and a family on a nearby farm lost all five of their children. Whenever I hear arguments against vaccinations, I remember my grandmother’s words.

    Reply
  21. Carleen Straub Dekat

    Diana, if you decide to go to the cemetery at Flush and would like to talk to someone about the history of that area I suggest you might contact the St. Bernard’s parish office in Wamego for names of someone at Flush who would be willing to meet with you and possibly open the church so you can see the beautiful interior. The parish office in Wamego is also the office for St. Joseph’s at Flush. I have a lot of history about the area and would love to meet with you, but it is a long way from my home in Oklahoma City. I have a brother there who might be able to do it, if your schedules would coincide.

    Reply
  22. Erin

    My daughter got her first round of immunizations yesterday, and this article was what was running through my head while she cried. I cannot even imagine the alternative, and am so, so grateful I will be raising my children in a time and place where I can protect them from a tiny bit of what life will throw at them.
    I’ve shared your post with family and friends and social media. Thank you so much. Your post gave me comfort when I chose to immunize my daughter, and I pray it will help other people, too.

    Reply
    1. Diana Staresinic-Deane Post author

      Very good question! I am waiting to hear back from her niece. It turns out that long after all of Lizzie’s siblings died, a baby brother was born, and he would go on to grow up, get married, and have children. If I am able, I will share more of the story.

      Reply
  23. Lisa Beam

    Diana, Lizzie’s baby brother born 3 years later was John O’Marra. This was my grandfather. He married and had three daughters (Helen, Ann and Margaret). Margaret is my mother. Lizzie was born in 1891 and died Feb 1962. She died of cancer. John was 93 when he passed away.

    Reply
  24. denisejhoward

    Your blog post was shared by a friend on Facebook a few weeks ago, and I’ve been reflecting on it ever since. I cannot imagine the devastation, anger and grief the O’Marras must’ve gone through, to watch helplessly as 8 of their 9 children died over such a short span of time. What moved me most, though, was the photo at the end, of all the little headstones together in the cemetery, still there today as a collective symbol of the story. When I was younger, I didn’t think anything of cemeteries. Now I see every stone as representing not just a life, but a thousand stories. Thank you for sharing this one.

    Reply
    1. Diana Staresinic-Deane Post author

      Denise, thanks for such a moving comment. My husband and I have been visiting and photographing cemeteries for a few years now for the very reason you say–each headstone represents a real person with a real story. Thanks again.

      Reply
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  26. Mandal Haas MD

    Very intriguing and provocative, well written story…I too am a history buff and being a rural family doctor for 17 years I use stories like yours to educate and reinforce the benefits of vaccination and to provide perspective– yes, Government is invading health care more and more, ObamaCare, etc but at least we don’t face devastation such as diptheria and enjoy the benefits of “modern” medicine (antibiotics for last 70 years)…..here is a haunting, incredibly detailed and remarkably sculptured life-like monument here in Ohio of 3 children who died in 1890′s (death certificate of one states “membranous croup” which almost certainly was diptheria)- there was controversy among doctors of time whether membranous croup was diptheria or a distinct disease- today most physicians believe they were the same (croup is viral illness, does not produce pseudomembrane that defines diptheria)….here is the link, page 33 in the PDF document….http://www.carrollcountyohio.com/history/townships/Monroe/MonroeTownship.PDF..best wishes

    Reply
    1. Diana Staresinic-Deane Post author

      Thanks so much for your thoughts. Although as a nation we’re struggling with finding the best way to provide healthcare, I’m really glad we’ve at least made it possible for all children to have access to vaccinations. I know that not all forms of diphtheria create the suffocating membrane, which probably complicated the diagnostic process even more. I will take a look at the pdf when I’m on my computer and not my phone.

      I also want to say thank you for serving people in rural communities. Medical options are sometimes limited by geography, even in the United States. No doubt your community is lucky to have you.

      Reply
  27. Mandal Haas MD

    Thanks for the kind words. Yes not all forms of diptheria caused the suffocating membrane- largyngeal involvement was the most dangerous but from what I’ve learned most deaths were caused by the toxin produced by the bacteria which caused damage to the heart (myocarditis or malignant arrhythmias) and paralysis (damaged lining of nerves, in a sense similar to multiple sclerosis) and these deaths came days to weeks after the initial throat or larynx involvement. This would have been even more devastating because family/parents would have thought they made it through the worst with apparent recovery of the upper respiratory/throat involvement only to have their child die later from complications and effects of the toxin. Incidentally, not all strains of the bacteria Coreynebacterium diptheriae produce the deadly toxin– bacteria has to be infected by a virus called a bacteriophage in order to become deadly toxin-producing strain. Actually, production of the anti-toxin, which neutralized new “floating” toxin but did not stop damage already done by existing toxin, preceded vaccine and was obtained from horse serum– this was in the very late 1890′s, early 1900′s. This made it possible to stop the deadly effect of the toxin (no good treatment at time for airway obstruction by the pseudomembrane, they were doing tracheostomy and inserting small tube but this was preantibiotic era so increased risk of pneumonia and creating a secondary bacterial infection that would be rampant due to reduced effectiveness of immune system due to full engagement combatting diptheria infection). The development of anti-toxin toxoid was the beginning of the end of the diptheria scourge– yes there still deaths due to toxoid in the beginning as doctors found the right dose, impurities of toxoid production, obtaining from ill or inappropriate horse, reactions to horse serum, etc. but overall it would save thousands of lives. The first vaccine would follow a short time later. Death rate didn’t really begin to decline until 1920′s on but certainly the worst, an example of which you have told in this story, was over. I hope this information was helpful.

    Reply
  28. Mandal Haas MD

    PS….ditptheria and deadly toxin can also be produced from skin infection/ulceration with diptheria and diptheria is still a deadly disease even today so the importance of vaccination and revaccination (every 10 years for adults, “D” in DT (“tetanus shot”) is booster dose of diptheria vaccine so when you get tetanus shot/booster you are getting both diptheria and tetanus vaccine) cannot be overemphasized. No recent cases in USA that I am aware of but there have been several cases and deaths in former states of Soviet Union, India, and other countries. Good day!

    Reply
  29. Andrea

    Reblogged this on Parental Confessions and commented:
    There is a huge debate in our country about vaccinations. I don’t think we would if we saw first-hand what devastations these diseases cause. I just hope and pray that it doesn’t take an outbreak and large casualties before people wake up.

    Reply
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