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.

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“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.

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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.

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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

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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.

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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

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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.

02/22/2015 Update: I’ve often wondered what happened to the surviving O’Marra family members who were left to pick up the pieces of their lives. Margaret O’Marra Miller, a descendant, reached out to me to share their story. Read more about Lizzie, James, and Anna here.