SYMHC Classics: Scarlet fever

Summary

Stuff You Missed in History Class: "SYMHC Classics: Scarlet Fever"

Podcast by iHeartPodcasts | Hosts: Tracy V. Wilson & Holly Frey
Episode originally aired: February 8, 2023; re-broadcast: July 25, 2026

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Episode Overview

This classic episode dives deep into the history of scarlet fever—a disease that evokes images of 19th-century childhood illness but which continues to circulate today. Tracy and Holly trace the origins and the historical waves of scarlet fever, explore medical and social responses, highlight advances in research and treatment, and examine the disease’s notable appearances in literature and popular culture.

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Main Discussion Points & Insights

1. Personal and Cultural Perceptions of Scarlet Fever

• Introduction: Tracy shares personal anecdotes and notes how scarlet fever feels “old-timey”—linked to books like The Velveteen Rabbit and Little Women.
  • Quote (03:09):

    “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.” — Tracy V. Wilson

• Society often perceives new scarlet fever outbreaks as the “return of an old disease,” though such headlines recur almost every year.

2. Medical Overview: What Scarlet Fever Is

• Caused by Group A Streptococcus; treatable with antibiotics today.
• Symptoms: fever, sore throat, headache, rash (appears 1-2 days after fever onset), and "strawberry tongue."
  • Rash is sandpapery and red in lighter skin, but may differ with darker skin.
  • Quote (05:49):

    “If you google this... it's obvious why they call it that.” — Tracy V. Wilson

• Complications if untreated include organ damage, rheumatic fever, autoimmune and neurological disorders.

3. Historical Emergence and Recognition

• Difficult to identify scarlet fever in ancient texts due to symptom overlap with other diseases.
• First distinct medical descriptions in 16th-century Europe:
  • Giovanni Filippo Ingratias (1553) describes "Rosalia"—an illness not measles or chickenpox, “spots... fiery and red… the whole body appeared to be on fire.” (07:45)
  • Others (Bayer, Couture, Senner) add details like sore throat and skin peeling (“desquamation”).
• Term “scarlatina” first used in 1674 by Thomas Sydenham:
  • Quote (09:36):

    “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…”

4. Public Health and Epidemics: 17th-19th Centuries

• Epidemics recurred every 4-6 years; frequency and severity escalated in the 1820s-30s.
• Possible causes:
  • Urbanization and crowded living conditions.
  • Correlation between wheat prices (malnutrition) and outbreaks.
  • Potential evolution of more virulent strains.
• Disease introduced to new regions through colonization.
• High mortality, especially in children ages 2–10 (in New Zealand in 1848, 1 in 8 died).

5. Medical Understanding and Early Control Efforts

• Early theories (pre-germ theory) ascribed scarlet fever to blood “effervescence” or “bad air.”
• Efforts included isolation, quarantines, public gathering bans, and hygiene campaigns.
• Early links made between streptococcus and severe complications (e.g., nephritis/Bright's disease).

6. Milk as a Vehicle and the Rise of Germ Theory

• Outbreaks traced to contaminated milk (Dr. Michael Taylor, 1867).
  • Inspired control measures, but people resisted culling cows/flushing milk.
• Identification and naming of Streptococcus pyogenes (Bilroth, Pasteur, Rosenbach).
• Emanuel Klein connects this bacterium to scarlet fever (1887), using Koch’s postulates.
• Pasteurization suggested, delayed by concerns about milk quality/flavor.

7. Declining Mortality Before Antibiotics

• Scarlet fever death rates declined before penicillin’s introduction—a mystery to historians.

8. 20th-Century Scientific Breakthroughs

• Isolation hospitals established, though effectiveness varied.
• Frederick Twort (1915) and Felix d’Herelle independently discover bacteriophages.
• George & Gladys Dick (1920s): confirm toxin as disease cause; develop the “Dick test” to assess susceptibility.
• Rebecca Lancefield (1928): develops Streptococcus grouping; connects strep and rheumatic fever.
• Sulfa drugs (1930s), then penicillin—major breakthroughs in treatment.

9. Contemporary Scarlet Fever Resurgence

• Despite antibiotics, invasive strep infections have become more common since the 1980s.
• Notable surge in scarlet fever cases 2011–2020, peaking in the UK in 2015.
• COVID-19 pandemic saw a temporary drop in cases, but recent spikes are unexplained.
• Disinformation debunked: No evidence links spike to COVID-19 or flu vaccines.
  • Quote (35:51):

    “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.” — Narrator/Researcher

10. Literary and Cultural Legacy

• The fear of scarlet fever persists in literature:
  • Little Women: Beth dies years after scarlet fever (rheumatic fever).
  • Laura Ingalls Wilder’s Little House books: Mary goes blind after family contracts scarlet fever (possibly meningitis).
  • The Sound of Music: The real von Trapp family’s mother dies after catching scarlet fever from her children.
  • The Velveteen Rabbit: Child’s illness leads to threat of all his toys being burned—a common, terrifying public health measure at the time.
    • Quote (39:36):

      “I remembered it being sad from, like, my own childhood. Like, I remembered feeling sad about it... There was a lot of just weeping over this story and I was like, why did they give this to children?” — Tracy V. Wilson

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Notable Moments & Quotes

• On historical treatments:
  “Sydenham believed that this was caused by, quote, a moderate effervescence of the blood… This made him cautious of using bloodletting or enemas... the blood needed to be left to its own regulation...” — Tracy V. Wilson (10:44)
• On isolation hospital risks:
  “...the isolation hospital was where you went when you caught one disease so that you could come out with all the rest.” — Tracy V. Wilson (29:16)
  • Narrator: “Welcome to Petri Dish Arms, where you'll get a bed and probably seven different things.” (29:07)
• On literature’s role:
  "A lot of folks' experience with scarlet fever is not from their own illness or the illness of their children. It's literature." — Tracy V. Wilson (36:44)
• On The Velveteen Rabbit's impact:
  "Honestly, this story is kind of horrifying." — Tracy V. Wilson (39:24)

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Key Timestamps for Important Segments

• 03:02–04:59: Introduction, personal anecdotes, public perception
• 04:59–06:19: Medical overview, symptoms, complications
• 07:05–10:44: Early historical documentation and terminology
• 15:20–18:52: Epidemics in 18th–19th centuries; new regions
• 19:13–24:41: Spread via milk; breakthroughs in bacteriology
• 28:16–30:49: Public health responses (isolation hospitals, cleaning, disinfecting)
• 31:41–33:44: Interwar discoveries: toxins, skin test, and breakthroughs
• 33:44–36:44: Modern resurgence, debate over causes, COVID-19 period
• 36:44–39:37: Cultural legacy in literature

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Conclusion

The episode weaves together the medical, historical, and cultural threads of scarlet fever, challenging the notion that it is a disease of the past. Listeners are left with an appreciation for the ongoing mysteries of infectious disease, as well as the ways that scarlet fever shaped public health, literature, and everyday life.

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Transcript

[Tracy V. Wilson]

This is an iHeart podcast.

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[Tracy 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 today's Saturday classic.

[Narrator/Researcher]

This originally came out on February 8th, 2023. Enjoy. Welcome to Stuff youf Missed in History Class, a production of iHeartradio.

[Tracy V. Wilson]

Hello and welcome to the podcast. I'm Tracy V. Wilson. And I'm Holly Fry. 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 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, 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, 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.

[Narrator/Researcher]

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.

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[Narrator/Researcher]

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

[Tracy 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.

[Narrator/Researcher]

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.

[Tracy 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 and 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.

[Narrator/Researcher]

Yet accounts describing scarlet fever as a distinct illness started to develop in the 16th century. Giovanni Filippo Ingratias was a physician born in sicily, and in 1553, he described an illness that he called Rosalia. He specified that this was not the same thing as chickenpox 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.

[Tracy V. Wilson]

In 1565, Dutch physician Johann Bayer described something similar and added another detail, which was a severe sore throat. Throat. Then in 1578, Jean Couture of Poitiers 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.

[Narrator/Researcher]

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

[Tracy V. Wilson]

Scarlet fever was showing up in writings outside of the medical world as well. Samuel Pepys, who comes up so often on the show when we're talking about this period of history, wrote this in his diary on November 10, 1664, quote, My little girly Susan has 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.

[Narrator/Researcher]

Scarlet fever as a term was in common use in English at this point, as was the name scarlatina. The first use of the term scarlatina in medical literature is believed to be in 1674. English physician Thomas Sydenham wrote Medical Observations on the History and Treatment of Acute Diseases, which was published in Latin, and in it he described febra scarlatina. This 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. 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.

[Tracy V. Wilson]

So this was before the development of the germ theory of disease, and Sydenham 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.

[Narrator/Researcher]

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. Sydenham recommended repeating this every night until the patient had recovered and feeding them diluted milk, but again, not animal food.

[Tracy V. Wilson]

So these descriptions of this illness don't sound really pleasant, and both Sydenham and Senart described complications and more serious cases. But like none of this sounds nearly as frightening as scarlet fever became in the 19th century. Samuel Pepys 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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[Tracy 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.

[Narrator/Researcher]

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

[Tracy 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.

[Narrator/Researcher]

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 2 and 10, and no one over the age of 40 seemed to catch it at all. The worst cases seem to be in crowded or badly ventilated homes.

[Tracy 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 death in the United States and parts of Europe, possibly the leading cause of death in children. During widespread outbreaks throughout the 19th century,

[Narrator/Researcher]

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.

[Tracy 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, scarlatina has apparently laid the foundation for the future mischiefs. So Scarlettino later causing nephritis, although his next sentence went on to say, quote, exertion and childish plays has done the same. So just some questions about that.

[Narrator/Researcher]

Don't let your kids play too hard.

[Tracy V. Wilson]

Yeah, they might have kidney disease later.

[Narrator/Researcher]

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.

[Tracy 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 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.

[Narrator/Researcher]

In 1874, Theodor 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 erysipelas, 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 Pasteur isolated the same organism in the uterus and bloodstream of a number of patients with childbed fever. Then in 1884, microbiologist Friedrich Julius Rosenbach refined the organism's name to Streptococcus pyogenes, with pyogenes from Greek words meaning pus forming.

[Tracy 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 scarlatina 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.

[Narrator/Researcher]

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 post mortem examinations of children who had died of it, and he had spotted similar pathological changes in cows that he examined at the Hendon farm.

[Tracy 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 scarlatinae, although it was indistinguishable from the one previously named Streptococcus pyogenes.

[Narrator/Researcher]

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, 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.

[Tracy 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 Soxlitzsch 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.

[Narrator/Researcher]

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

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Oh yeah.

[Sam's Club Host]

Come join us Sam's Club.

[Tracy 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 in the same 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.

[Narrator/Researcher]

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

[Tracy V. Wilson]

It's not great. No good.

[Narrator/Researcher]

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 hangings, 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. 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.

[Tracy 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. 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.

[Narrator/Researcher]

Around this same time, people were making more discoveries about scarlet fever, something that really escalated during the nineteen teens and twenties. In 1915, English bacteriologist Frederick William Torte and his brother were using colonies of bacteria as part of an effort to find a way to grow smallpox vaccine. In a lab, Torte discovered areas where the bacteria couldn't grow and found that a substance from these areas was capable of 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. French microbiologist Felix d' Harrelle made the same discovery independently of Torte about two years later.

[Tracy 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 SORC in 1925.

[Narrator/Researcher]

In 1926 and 1927, two different pairs of researchers discovered a bacteriophage that could change a non toxigenic strain of strep into a toxigenic 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.

[Tracy V. Wilson]

In 1928, American microbiologist Rebecca Craighill 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.

[Narrator/Researcher]

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.

[Tracy V. Wilson]

That made the amoxicillin shortages that were happening at 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, 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 the uk, for example,

[Narrator/Researcher]

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.

[Tracy V. Wilson]

Yeah, in 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. 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 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.

[Narrator/Researcher]

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. 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.

[Tracy 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. She dies years later. And while the book doesn't give a specific cause, it's usually interpreted that she had developed rheumatic fe 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 ten years later in 1868.

[Narrator/Researcher]

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.

[Tracy 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 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 it, 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.

[Narrator/Researcher]

It's the meanest thing ever.

[Tracy 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?

[Narrator/Researcher]

I will tell you a Velveteen Rabbit story on Friday.

[Tracy 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 history podcastheartradio.com and you can subscribe to the show on the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

[Sam's Club Host]

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[Tracy V. Wilson]

This is an iHeart podcast. Guaranteed Human.