SYMHC Classics: Scarlet fever

This 2023 episode covers scarlet fever, which is treatable with antibiotics. But in the middle of the 19th century, it was the leading cause of death in children in parts of the world, and today, there are several ongoing mysteries about the disease. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:42Holly Frey?

  We've all tumbled down an internet rabbit hole trying to self-diagnose, and it leaves us more anxious than informed. Our feeds are full of wellness trends, but how do we know what's real, what's exaggerated, and what's just wrong? Health vs. Hype from the American Medical Association breaks it all down. Emmy-nominated science communicator Trace Dominguez talks to doctors, influencers, and real people trying these trends, not to cancel them, but to understand them. Because when it comes to your health, who you listen to matters. So listen to Health vs. Hype wherever you get your podcasts.

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• 2:27Tracy V. Wilson?

  Happy Saturday. Since one of the updates we talked about in this week's installment of Unearthed was about scarlet fever, we thought we would replay our episode on it as the day's Saturday classic.

• 2:39Holly Frey?

  This originally came out on February 8, 2023. Enjoy.

• 2:46Holly Frey?

  Welcome to Stuff You Missed in History Class, a production of iHeartRadio.

• 2:57Tracy V. Wilson?

  Hello and welcome to the podcast. I'm Tracy V. Wilson.

• 3:00Holly Frey?

  And I'm Holly Frey.

• 3:02Tracy V. Wilson?

  So some of my friends' kids got scarlet fever late last year. And their response to this was kind of like, what is this, the 19th century? And I remember having a really similar feeling when I got scarlet fever as a kid back in the 1980s because I really associated scarlet fever with old-timey children's books to me, like The Velveteen Rabbit and Little Women. And this sort of response to scarlet fever of like, what century is it? That's not unique to me or my friends. When I started working on this episode, the very initial research just turned up a ton of news articles going back many years,

• 3:45Tracy V. Wilson?

  all of them reporting on scarlet fever outbreaks, and all of this with a tone of like, the return of an old disease. They all made it sound like this was like a unique thing, and it was really just year after year after year, a new headline of a new scarlet fever outbreak with a new, like, an old disease has returned. So scarlet fever is caused by Group A streptococcus. And over the last few months, there's been a big spike in Group A strep infections in many parts of the world, sometimes causing relatively minor illnesses, but also sometimes much more dangerous and even deadly invasive infections.

• 4:26Tracy V. Wilson?

  Usually, in places where people have prompt access to medical care, scarlet fever specifically is pretty treatable with antibiotics. But in the middle of the 19th century, it was the leading cause of death in children in some parts of the world. A lot of times, antibiotics get the credit for turning that trend around, but it wasn't just because of antibiotics, which is one of several kind of mysteries about this disease.

• 4:54Holly Frey?

  Scarlet fever usually starts with symptoms like a fever, sore throat, headache, and sometimes nausea or vomiting. A rash usually forms a day or two after the fever starts. The appearance and texture of this rash can vary based on a person's skin color. At least in the US and Europe, most descriptions and pictures of this are of white children. And in people with lighter skin, the rash is red and bumpy and often has this texture that's described as sandpapery. In people with brown or black skin, the rash is often the same color as the skin or slightly darker. And while it's usually still raised and bumpy, it sometimes doesn't have quite the same texture. Scarlet fever can also cause something called strawberry tone.

• 5:39Holly Frey?

  That's a white coating that can progress to a red, bumpy appearance.

• 5:44Tracy V. Wilson?

  If you Google this, which I'm not necessarily recommending that you do, it's obvious why they call it that. If left untreated, scarlet fever and other strep infections can cause some really serious complications, including organ damage and an inflammatory disease called rheumatic fever. There's also a possible connection between strep infections and autoimmune disease and neurological disorders in children. And again, there are also invasive strep infections that themselves can be like really dangerous.

• 6:14Holly Frey?

  Streptococcus bacteria can cause a wide range of diseases. And while strep is believed to have been one of the most frequent causes of infectious diseases in prehistoric times, it's not clear when exactly it started causing scarlet fever. This is because strep only causes scarlet fever when it's been infected with a bacteriophage. That's a virus that infects bacteria. The bacteriophage causes the bacteria to produce a toxin, and scarlet fever is the body's response to that toxin. It's likely that there were strains of streptococcus present in much of the world prior to the 15th century, but that scarlet fever specifically was introduced to some places during colonization, including the Americas, Australia, and New Zealand.

• 7:00Tracy V. Wilson?

  Scarlet fever is most common in children, and there are just a lot of childhood diseases that can cause similar symptoms. So a lot of the time, it's not really possible to tell whether an early medical text or other writing is referencing scarlet fever or some other disease that causes some combination of like a fever, sore throat, rash, and other symptoms. There are references to various childhood fevers and rashes in medical texts from the Mediterranean, the Middle East, and Asia, going all the way back to Hippocrates in the 4th century BCE. We don't really have a way of knowing whether any of them were talking about scarlet fever or even if scarlet fever really existed yet.

• 7:41Holly Frey?

  Accounts describing scarlet fever as a distinct illness started to develop in the 16th century. Giovanni Filippo Ingracius was a physician born in Sicily, and in 1553, he described an illness that he called rosacea. He specified that this was not the same thing as chicken pox or measles, and that it involved, quote, "numerous spots, large and small, fiery and red, of universal distribution, so that the whole body appeared to be on fire."

• 8:11Tracy V. Wilson?

  In 1565, Dutch physician Johan Beyer described something similar and added another detail, which was a severe sore throat. Then in 1578, Jean Cotier of Huatier described an illness causing, quote, "general weariness, headache, redness of the eyes, sore throat, and fever. Purpura appeared on the second or third day, accompanied by delirium and soreness of the throat." Purpura is a rash that's caused by the breaking of small blood vessels underneath the skin.

• 8:42Holly Frey?

  In 1635, German physician Daniel Sennert described an epidemic in Wittenberg in which the skin later desquimated or peeled, something that often happens in cases of scarlet fever. Sennert also described other complications that can follow scarlet fever, including edema, fluid in the abdomen, and arthritis.

• 9:04Tracy V. Wilson?

  Scarlet fever was showing up in writings outside of the medical world as well. Samuel Peeps, who comes up so often on the show when we're talking about this period of history, wrote this in his diary on November 10th, 1664, quote, "My little girly Susan is fallen sick of the measles we fear, or at least of a scarlet fever." This seemed to pass pretty quickly. The next day, he wrote, quote, "Our little girl is better than she was yesterday."

• 9:31Holly Frey?

  Scarlet fever as a term was in common use in English at this point, as was the name scarletina. The first use of the term scarletina in medical literature is believed to be in 1674. English physician Thomas Siddeham wrote Medical Observations on the History and Treatment of Acute Diseases, which was published in Latin. And in it, he described februs scarletina this way, quote, "Scarlet fever may appear at any season. Nevertheless, it often breaks out toward the end of summer when it attacks whole families at once, and more especially the infant part of them. The patient feel rigors and shivering just as they do in other fevers. The symptoms, however, are moderate.

• 10:16Holly Frey?

  Afterwards, however, the whole skin becomes covered with small red maculae, thicker than those of measles, as well as broader and redder and less uniform. These last for two or three days and then disappear. The cuticle peels off and branny scales remain lying on the surface like meal. They appear and disappear two or three times."

• 10:39Tracy V. Wilson?

  So this was before the development of the germ theory of disease. And Siddeham believed that this was caused by, quote, "A moderate effervescence of the blood arising from the heat of the preceding summer or from some other exciting cause." This made him cautious of using bloodletting or enemas to treat the patient, which is something that would have happened with other illnesses. He believed that the blood needed to be left to its own regulation in cases of scarlet fever and that bloodletting or enemas could introduce particles into the blood that were harmful to it.

• 11:14Holly Frey?

  Instead, he said it was, quote, "Sufficient for the patient to abstain wholly from animal food and from fermented liquors, to keep always indoors and not to keep always in his bed. When the desquamation is complete and when the symptoms are departing, I consider it proper to purge the patient with some mild laxative, accommodated to his age and strength." So at the same time, he noted that if a child experienced seizures or a coma, then they needed to be treated immediately with a blister on the back of the neck and a dose of opium tincture. Siddeham recommended repeating this every night until the patient had recovered and feeding them diluted milk, but again, not animal food.

• 11:56Tracy V. Wilson?

  So these descriptions of this illness don't sound really pleasant. And both Siddeham and Sennert described complications and more serious cases, but like, none of this sounds nearly as frightening as scarlet fever became in the 19th century. Samuel Peeps made it sound like scarlet fever was like a lesser illness than measles would have been, became much worse later on. And we'll get to that after a sponsor break.

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  Samantha, you know, I watch a lot of YouTube. I watch a lot of it for fun, but I also watch a lot of it for research for this show. And I also put on a lot of stuff in the background, videos in background to set a mood. I find it very relaxing or sometimes kind of hype, you know? If you're looking to get ready to go out.

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• 13:34Tracy V. Wilson?

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• 14:02Tracy V. Wilson?

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• 14:15Tracy V. Wilson?

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• 14:26Tracy V. Wilson?

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• 14:32Holly Frey?

  We've all done it, tumble down an internet rabbit hole trying to self diagnose. And sometimes doing our own research can leave us more anxious than informed. Your feed is packed with wellness trends telling you to cold plunge, protein max, detox, track your sleep. But what's actually real? What's exaggerated? What's just wrong? That's exactly what Health vs. Hype from the American Medical Association and iHeart Media's Ruby Studio is here to find out. Each episode, Emmy nominated science communicator Trace Dominguez, who's racked up billions of views across PBS, Discovery Channel, and YouTube, talks to doctors, influencers, and real people trying these trends.

• 15:14Holly Frey?

  Not to cancel them, not to hype them more, but to actually understand them. Because when it comes to your health, who you listen to matters. Start asking better questions and listen to Health vs. Hype on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 15:35Tracy V. Wilson?

  Guess who's back in the house? The old gays return for season two of Silver Linings, their hit podcast from iHeart's Ruby Studio in partnership with ViiV Healthcare. Just wait until you hear what hosts Robert McMillan and Jess A. have in store this time around. They strut back down memory lane, navigating life, love, loss, and everything that shaped them along the way. And as usual, someone just might break into song. From leather bars to bathhouses, dance floors to drag brunch, nothing stays off limits. These are the kinds of insights that can only come from experience. So listen to your elders, honey, and discover the silver linings you can take with you. All sass, zero filter, and decades of perspective from four friends

• 16:19Tracy V. Wilson?

  proving that queer joy only gets better with age on the podcast that never gets old. Listen to Silver Linings, available on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 16:40Tracy V. Wilson?

  Through the 17th and 18th centuries, scarlet fever epidemics occurred regularly in Europe, with the disease often striking a particular place every four to six years. That same general pattern seems to have been present in other places also. In the 1820s and 30s, though, the number of scarlet fever cases really started to rise in a lot of places, and so did their severity. There are several possible explanations for why, and it's possible that all of them played some kind of role.

• 17:13Holly Frey?

  19th century urbanization led to more people living in closer quarters, often without sufficient facilities for hygiene, which made it easier for a contagious illness like scarlet fever to spread. But that can't account for everything, since scarlet fever cases started increasing before this trend really started to escalate. Some researchers have found a correlation between scarlet fever and wheat prices. When wheat prices rose, there was an increase in scarlet fever three years later, as though malnutrition during pregnancy might make children more susceptible to it. This is a correlation, though. It's not necessarily a cause and effect situation. And it is also possible that a more virulent form of the disease evolved,

• 17:58Holly Frey?

  which allowed it to spread more easily and cause worse illnesses.

• 18:02Tracy V. Wilson?

  Scarlet fever was also introduced into parts of the world that had never encountered it before during the 19th century. The first case of scarlet fever in the archipelago of Madeira was reported in 1806. They reached South America in 1829, Greenland in 1847, and both Australia and New Zealand in 1848. Although scarlet fever had been reported in the northeastern United States for centuries, the first case reported in California wasn't until 1849.

• 18:35Holly Frey?

  Some sources will describe the 19th century spread of scarlet fever as a pandemic stretching from about 1825 to 1885. Death rates could really vary from place to place and from one outbreak to the next. In places that had no experience with scarlet fever, the mortality rate was often particularly high. As we said a moment ago, the first cases reported in New Zealand were in 1848. And in Auckland that year, one out of every eight people who contracted scarlet fever died. The vast majority of cases and deaths were in children between the ages of two and 10, and no one over the age of 40 seemed to catch it at all. The worst cases seemed to be in crowded or badly ventilated homes.

• 19:20Tracy V. Wilson?

  There's not a ton of exact data, though, especially in the earlier decades of the 1800s. A lot of places didn't have formal Departments of Health or Public Health Services. Widespread outbreaks of scarlet fever and other contagious diseases were part of the motivation for those to be established. In some places, there were laws in place to try to control the spread of infectious diseases. And a lot of those laws traced back to things like the Black Death of the 14th century. But a lot of the time, there just wasn't a more systematic tracking of diseases and their spread. However, it's generally agreed that by 1840, scarlet fever was a leading cause of childhood

• 20:03Tracy V. Wilson?

  death in the United States and parts of Europe, possibly the leading cause of death in children during widespread outbreaks.

• 20:11Holly Frey?

  Throughout the 19th century, scarlet fever was terrifying. Communities often used isolation and quarantine to try to control the disease's spread, along with things like canceling school and public gatherings, recommending ventilation and disinfection procedures, and urging people to keep children at home and away from other people, especially other children.

• 20:34Tracy V. Wilson?

  The increasing spread of scarlet fever also led to researchers learning more about it. English physician Richard Bright made the connection between streptococcus infections and kidney disease in 1836. Bright was one of the first people to describe nephritis or kidney inflammation, which came to be known as Bright's disease. And he wrote of it, quote, "Scarletina has apparently laid the foundation for the future mischief." So scarletina later causing nephritis. Although, his next sentence went on to say, quote, "exertion in childish plays has done the same." So just some questions about that.

• 21:13Holly Frey?

  Don't let your kids play too hard.

• 21:15Tracy V. Wilson?

  Yeah, they might have kidney disease later.

• 21:18Holly Frey?

  Although people didn't know exactly what caused scarlet fever yet, they did know that it spread easily from person to person, so much so that people thought that the disease could linger on things like clothing, bedding, and toys for a long period of time. And in 1867, Dr. Michael Taylor, who was a local physician in northwestern England, connected a scarlet fever outbreak to milk. At this point, Louis Pester had done groundbreaking work on what would come to be known as pasteurization, but he was doing this work in the context of fermentation. The idea that milk should be pasteurized, that was still decades away.

• 21:56Tracy V. Wilson?

  Taylor knew about the work of Dr. John Snow, who had identified a water pump as the source of a cholera outbreak in 1854. Taylor had thought that if water could carry a disease, then surely milk could as well. And he had later traced a typhoid outbreak to contaminated milk. In 1867, people started reporting cases of scarlet fever in and around the town of Penrith, which had not seen a case of scarlet fever in more than a year. It turned out that the people who got sick had all bought milk from the same milk dealer whose child had gotten scarlet fever and died.

• 22:36Holly Frey?

  In 1874, Theodore Bilroth of Austria identified and named the Streptococcus bacterium, which he had found in infected wounds and in a case of a skin infection called Erisipellus. He had observed, quote, "small organisms as found in either isolated or arranged in pairs, sometimes in chains." And he named them for the Greek terms strepto or chain and coccus or berry. Five years later, Louis Pester isolated the same organism in the uterus and bloodstream of a number of patients with childbed fever. Then, in 1884, microbiologist Friedrich Julius Rosenberg refined the organism's name to Streptococcus pyogenes,

• 23:21Holly Frey?

  with pyogenes from Greek words meaning pus-forming.

• 23:25Tracy V. Wilson?

  It did not take long for the connection to be made between Streptococcus pyogenes and scarlet fever. In 1887, Dr. Emanuel Klein published a report in the Proceedings of the Royal Society of London saying that he had identified the Streptococcus organism in both people with acute scarletina in London and cows at a milk farm in Hendon. So he believed that the milk from the Hendon farm had caused the scarlet fever outbreak in London.

• 23:56Holly Frey?

  This report was the result of years of work. Klein was a bacteriologist who had been born in Hungary and studied in Austria before moving to England to work as a researcher at the Brown Institution of the University of London. His scarlet fever research had included postmortem examinations of children who had died of it, and he had spotted similar pathological changes in cows that he examined at the Hendon farm.

• 24:22Tracy V. Wilson?

  This wasn't just a matter of observing the similarities in the sick cows and the sick children. He followed the criteria that at that point had been outlined by Robert Koch, now known as Koch's postulates, to show that the same bacteria were causing both the illness in the cows and in the people who had drank their milk. He also had shown that the bacteria he cultured from the sick cows could grow and survive and basically thrive in milk. He called this organism Micrococcus scarletine, although it was indistinguishable from the one previously named as Streptococcus pyogenes.

• 25:01Holly Frey?

  This was an important discovery. Although he was using a different name for it, Klein was the first person to connect Streptococcus pyogenes to scarlet fever. But his results were not widely accepted. Since Michael Taylor's discovery in 1867, there had been other scarlet fever outbreaks traced to milk, and most of the time, milk from the affected dairy had been destroyed. But most people had thought these outbreaks had a human source, like a child who lived on the farm or a dairy worker or a delivery worker who had cared for a child with scarlet fever or someone who had it themselves. Taylor had showed that the cows could carry the disease, which could mean that destroying the milk was not enough to stop an outbreak,

• 25:46Holly Frey?

  that the cows themselves might have to be culled. Destroying potentially contaminated milk was a financial hardship for dairy farms, but destroying their cows was far worse. And people resisted the idea that cows could be a source of infection.

• 26:02Tracy V. Wilson?

  Although a few people had tried applying Louis Pasteur's heat treatment process to milk, almost 20 more years passed before German agricultural chemist Franz von Sochslitz suggested that milk be routinely treated with pasteurization. And a big reason for that was that so many diseases were being transmitted through milk, not just scarlet fever, but also typhoid, diphtheria, tuberculosis, and various gastrointestinal illnesses. It still took a while for pasteurization to catch on, though. There were concerns that pasteurizing milk destroyed the nutrients in it or affected the flavor or made it harder to digest.

• 26:42Holly Frey?

  But by that point, scarlet fever rates were on the decline. And we'll talk more about that after a sponsor break.

• 26:52Speaker 02

  This episode is brought to you by YouTube Premium.

• 26:55Speaker 01

  Samantha, you know I watch a lot of YouTube. I watch a lot of it for fun, but I also watch a lot of it for research for this show. And I also put on a lot of stuff in the background, videos in the background to set a mood. I find it very relaxing or sometimes kind of hype, you know, if you're looking to get ready to go out.

• 27:15Speaker 02

  I use it too. And YouTube Premium takes something you already love, YouTube, and makes it even better. The content, the creators, the feeling of finding exactly what you're into for every mood and moment of your day. Premium transforms that experience into a more supercharged, enhanced way to enjoy YouTube.

• 27:34Speaker 01

  Yes, a YouTube Premium subscription gives you access to exclusive YouTube features and benefits, including but not limited to being ad-free, so uninterrupted videos, background play, so that lets you keep listening with your screen locked, and offline downloads, so you can download your videos to watch anywhere.

• 27:52Speaker 02

  So if you like YouTube, you'll love Premium. Sign up now for your free trial. Terms and conditions apply.

• 27:59Holly Frey?

  We've all done it, tumble down an internet rabbit hole trying to self-diagnose. And sometimes doing our own research can leave us more anxious than informed. Your feed is packed with wellness trends telling you to cold plunge, protein max, detox, track your sleep. But what's actually real? What's exaggerated? What's just wrong? That's exactly what Health vs. Hype from the American Medical Association and iHeartMedia's Ruby Studio is here to find out. Each episode, Emmy-nominated science communicator Trace Dominguez, who's racked up billions of views across PBS Discovery Channel and YouTube, talks to doctors, influencers, and real people trying these trends, not to cancel them,

• 28:42Holly Frey?

  not to hype them more, but to actually understand them. Because when it comes to your health, who you listen to matters. Start asking better questions and listen to Health vs. Hype on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 29:02Tracy V. Wilson?

  Guess who's back in the house? The old gays return for season two of Silver Linings, their hit podcast from iHeart's Ruby Studio in partnership with ViiV Healthcare. Just wait until you hear what hosts Robert McMillan and Jess A. have in store this time around. They strut back down memory lane navigating life, love, loss, and everything that shaped them along the way. And as usual, someone just might break into song. From leather bars to bathhouses, dance floors to drag brunch, nothing stays off limits. These are the kinds of insights that can only come from experience. So, listen to your elders, honey, and discover the silver linings you can take with you. All sass, zero filter, and decades of perspective from four friends proving that queer joy

• 29:47Tracy V. Wilson?

  only gets better with age on the podcast that never gets old. Listen to Silver Linings, available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 30:01Speaker 07

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• 31:02Tracy V. Wilson?

  Although the number of scarlet fever cases was declining at the end of the 19th century, and the disease didn't seem to be as deadly as it had been, in the early 20th century, it was still seen as a major public health concern. In England, for example, isolation hospitals were established for people with contagious illnesses who could not effectively be isolated at home. During outbreaks of scarlet fever, there could be house-to-house visits to find sick people so they could be isolated in the hospital. Unfortunately, it is really not clear how much or whether this really helped to slow the spread of the disease. And also, people with different contagious diseases were all being housed in the same

• 31:45Tracy V. Wilson?

  hospitals, and this led people to say that the isolation hospital was where you went when you caught one disease so that you could come out with all the rest.

• 31:53Holly Frey?

  Welcome to Petri Dish Arms. You'll get a bed and probably seven different things.

• 32:01Tracy V. Wilson?

  This is not great.

• 32:02Holly Frey?

  No good. Other efforts to control the spread of scarlet fever also did not help. A 1915 article in the American Journal of Nursing described it this way, quote, "It seems to cling to whatever object it encounters. In no other disease has the infection been apparently conveyed with such frequency by objects which have come in contact with those ill, as clothes, books, toys, and the like." This article recommended that, quote, "All hanging carpets and upholstered furniture are to be taken from the room before the patient is brought in. The furniture left should be of a kind readily cleansed. There should be no such fancied attempts at purifying the air as by hanging up sheets wet with disinfectants.

• 32:46Holly Frey?

  Such measures are not only useless, but tend to give a false sense of security." Needless to say, the patient should be provided with bed clothing, nightgown, towels, eating utensils, and drinking vessels for his exclusive use.

• 33:00Tracy V. Wilson?

  Yeah, that's, it is no longer believed that scarlet fever is just transmitted readily and for a long period of time in things like curtains. Uh, this article also recommended disinfecting anything that the sick person had used, using either a 5% solution of carbolic acid or a 2% solution of Creosol, and anything that had been used for coughing or sneezing into was to be burned. Also, the recommended treatment for patients themselves was at least three weeks in bed, even if they only had a mild case.

• 33:35Holly Frey?

  Around this same time, people were making more discoveries about scarlet fever, something that really escalated during the 19 teens and twenties. In 1915, English bacteriologist Frederick William Tort and his brother were using colonies of bacteria as part of an effort to find a way to grow smallpox vaccine in a lab. Tort discovered areas where the bacteria couldn't grow and found that a substance from these areas was capable of passing through a porcelain filter that trapped most bacteria. He published an article in The Lancet about what he described as a filter-passing virus that attacked bacteria. His work didn't get a lot of attention, but this was the first known description of a bacteriophage.

• 34:19Holly Frey?

  French microbiologist Felix Derelle made the same discovery independently of Tort about two years later.

• 34:26Tracy V. Wilson?

  In the 1920s, husband and wife researchers George and Gladys Dick made a series of discoveries about scarlet fever and its cause while working in Chicago. They confirmed the link between the disease and streptococcus bacteria, and they identified a toxin produced by the bacteria that was the cause of scarlet fever. They also developed a skin test, known as the Dick Test, to show whether a person was susceptible to scarlet fever or not. They were nominated for the Nobel Prize in Medicine for the Sork in 1925.

• 35:01Holly Frey?

  In 1926 and 1927, two different pairs of researchers discovered a bacteriophage that could change a non-toxogenic strain of strep into a toxogenic one. In other words, to turn a variety of strep that did not cause scarlet fever into one that did. Various researchers started trying to develop an inoculation for scarlet fever, using either the bacteria or various modifications of the toxin that it produced.

• 35:29Tracy V. Wilson?

  In 1928, American microbiologist Rebecca Craig Hill Lancefield developed a system for classifying strep bacteria into groups based on the antigens found on the bacteria. Initially, she proposed two groups, Group A and Group B. As we said earlier, scarlet fever is Group A. Today, there are many more groups. She was also one of the first people to demonstrate that strep infections could lead to rheumatic fever.

• 35:58Holly Frey?

  The first sulfa drugs were developed in the 1930s and were used as a treatment for strep infections, including scarlet fever. But the big medical breakthrough was penicillin. We did a whole episode on penicillin's development back in September. Today, penicillin and amoxicillin are the antibiotics most often used to treat scarlet fever, with other antibiotics recommended for people who are allergic to those. Today, in most children, scarlet fever clears up quickly as long as antibiotic treatment begins promptly.

• 36:30Tracy V. Wilson?

  Yeah, that made the amoxicillin shortages that were happening the end of last year in a lot of places particularly scary for folks. So, penicillin is often credited with turning scarlet fever from a terrifying and deadly disease to one that's considered to be a relatively mild childhood illness most of the time. As we said earlier, though, deaths from scarlet fever were becoming less and less common decades before penicillin was introduced. We don't totally know why. Starting in the 1980s, though, the opposite started to happen as invasive strep infections started to become more common in spite of the existence of antibiotics to treat them.

• 37:12Tracy V. Wilson?

  Scarlet fever specifically started to become more prevalent in a lot of parts of the world starting in about 2008. Increased rates of scarlet fever were first reported in parts of Asia, and then in the UK, and other parts of Europe, and then in the US.

• 37:27Holly Frey?

  The UK, for example, saw a sudden spike in scarlet fever cases starting in 2015, and soon the rate of scarlet fever was higher there than it had been in almost 50 years. At first, it seemed like this wasn't leading to a similar increase in fatalities, but a year later, invasive strep infections started to increase there as well. Worldwide, there was a five-fold increase in the number of scarlet fever cases between 2011 and 2020, with a drop in 2020 after the start of the COVID-19 pandemic.

• 38:00Tracy V. Wilson?

  Yeah, and a lot of places, the general trend of when scarlet fever cases are the highest was like sort of nearing its end when the COVID-19 pandemic really started.

• 38:13Tracy V. Wilson?

  Although health officials thought there might be some more dangerous strain of strep bacteria that was causing this increase, some whole genome sequencing of samples from a lot of different sick children found that there was not one strain that was responsible for most of the illnesses. Some researchers have suggested that the bacteria may have started producing a more aggressive form of the toxin that causes the disease.

• 38:36Holly Frey?

  It's also not clear what has caused this most recent spike in scarlet fever cases that started toward the end of 2022. In the northern hemisphere, scarlet fever cases usually peak in the late winter or early spring, so this outbreak happened out of season. At this point, this is all really speculative, with some of those speculations being more baseless than others. Like, the measures put in place to try to control the spread of the COVID-19 pandemic led to people not being exposed to other diseases. It's also possible that kids who might have gotten strep or scarlet fever over the last couple of years didn't and are instead just getting it now.

• 39:17Holly Frey?

  But there have also been totally baseless claims pointing to either COVID-19 vaccines or the flu vaccine as somehow causing a rise in strep infections. There is no credible evidence for either.

• 39:29Tracy V. Wilson?

  Yeah, we're not doctors, so we cannot possibly comment on every conceivable thing that has been postulated about the spike in scarlet fever cases. Like, it does seem possible that it is an extension of the spike that was happening before the pandemic started that kind of paused during the pandemic peak, when so many places were taking a lot of mitigation measures. As we said at the top of the show, though, a lot of folks' experience with scarlet fever is not from their own illness or the illness of their children. It's literature, so we'll close out with just a few of the most famous examples. First, there is Little Women by L.M. Alcott, in which Beth gets scarlet fever and is extremely sick.

• 40:12Tracy V. Wilson?

  She dies years later, and while the book doesn't give a specific cause, it's usually interpreted that she had developed rheumatic fever after that scarlet fever case. Alcott's real-life sister, Elizabeth Sewell Alcott, died at the age of 22, two years after having had scarlet fever. And then Alcott published Little Women 10 years later in 1868.

• 40:34Holly Frey?

  Another past podcast subject with a scarlet fever connection is Laura Ingalls Wilder, whose real sister Mary became blind after what the family described as "brain fever," probably some form of meningitis or encephalitis. In the book, The Shores of Silver Lake, set in 1879, the fictional version of Mary becomes blind after she and the rest of the family contract scarlet fever.

• 41:00Tracy V. Wilson?

  And yet another example that incorporates both fiction and reality. Several of the Von Trapp family contracted scarlet fever in the early 1920s, and their mother, Agatha, contracted it while caring for them and died in 1922. This led to a young woman named Maria being hired from a convent to work as a tutor with the convalescing children, and the family later became a performing group called the Trapp Family Singers. That, of course, inspired the musical The Sound of Music. Lastly, of course, there's The Velveteen Rabbit, or How Toys Become Real by Marjorie Williams, which was published in 1922. And in this book, a little boy gets a velveteen rabbit as a Christmas present, and then there's

• 41:42Tracy V. Wilson?

  a whole story about how nursery magic can make a toy real through the strength of a child's love. This little boy then gets scarlet fever and is very sick for a long time. And once he's better, there's a plan to take him to the seaside while his room is disinfected, and all of his toys and books and everything he has played with is going to be burned, which, as we talked about, is a real thing that people would do. So the doctor then describes the velveteen rabbit as, quote, "a mass of scarlet fever germs." Fortunately, the nursery magic fairy appears and makes the velveteen rabbit real, so he is not burned. But honestly, this story is kind of horrifying.

• 42:21Holly Frey?

  It's the meanest thing ever.

• 42:23Tracy V. Wilson?

  I remembered it being sad from, like, my own childhood. Like, I remembered feeling sad about it, and I'm pretty sure I have, like, a copy of the book with its original illustrations and all that, like, in the house somewhere. But I read it at my desk while working on this episode, and, I mean, maybe it was my emotional state. There was a lot of just weeping over this story, and I was like, why did they give this to children?

• 42:51Holly Frey?

  I will, I will tell you a velveteen rabbit story on Friday.

• 42:56Tracy V. Wilson?

  Okay, that'll be great. We can talk more about our literature experiences with scarlet fever. Thanks so much for joining us on this Saturday. If you'd like to send us a note, our email address is [email protected]. And you can subscribe to the show on the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 43:29Holly Frey?

  A rare disease diagnosis can change your life, but it doesn't have to define your future. In season seven of Untold Stories: Life with a Severe Autoimmune Condition, host Martine Hackett continues the conversation with people living with MG, CIDP, and the broader rare disease community, exploring what comes after diagnosis through stories of hope, progress, and connection. Produced by Ruby Studio in partnership with Argenx. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 43:59Tracy V. Wilson?

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• 46:05Speaker 00

  Hola a todos. Soy Jamie Lynn Sigler. Cuando me diagnosticaron tenía veintitantos años y todo mi mundo cambió por completo. Pero con el tiempo decidí que no iba a permitir que eso frenara mi vida. Quise tomar las riendas, y después de hablar con mi médico sobre mis opciones, la elección para mí fue obvia. Boom, eso es Kisimtah. Obtenga más información sobre Kisimtah o fotumab en kisimtah.com. This is an iHeart Podcast. Guaranteed Human.