A STUDY IN SCARLET

NellThe Pox, Consumption, Dropsy, Scurvy, Scarlet Fever – anyone who has read the canon of classic English literature penned in the eighteenth and nineteenth centuries will be familiar with references to diseases that at the most could kill or at the very least leave a lifelong physical effect on the health of those exposed to them. In the absence of modern medical science, ancient herbal remedies were applied across the social divide until the aristocracy were introduced to the benefits of inoculation against Smallpox in the 1720s. Prominent lady of letters Lady Mary Wortley Montagu advocated inoculation after witnessing its success on her travels through the Ottoman Empire and convinced Caroline, Princess of Wales that something previously untested in the West could serve as a cure. Princess Caroline famously had her two daughters successfully inoculated, and less celebrated guinea pigs received the same treatment at Newgate Gaol. Offered a choice of execution or inoculation, seven condemned prisoners unsurprisingly chose the latter, survived the experiment, and were all granted their freedom as a consequence.

However, in an age of limited healthcare for those unable to pay for it – an age not noted for its excellent sanitation – sicknesses now viewed as completely curable claimed lives on a scale that we would today associate with the Third World. A society rigid in the primitive belief that diseases travelled on the air was ignorant of causes we now accept as a given, and it wasn’t until the widespread adoption of penicillin as a medical treatment from the 1940s onwards that many of the old illnesses ceased to be potential death sentences. Within living memory, a simple cut could lead to infection and then to death very quickly; penicillin and the drugs that were developed from it changed that forever. Or so we imagined.

Despite the publicised global eradication of Smallpox in 1980 – the only time in history an infectious disease had ever been eradicated until the animal disease Rinderpest was also wiped out five years ago – the belief that antibiotics ensure immunity from the majority of sicknesses has taken a knock in recent years due to the gradual evolution of various viruses to combat the ability of medicine to neutralise their impact. A battle medical science appeared to have won is now seeing battle lines being redrawn.

Whether this state of affairs can be held responsible for the resurgence of certain diseases that remain associated with the past is debatable, though the sudden rise in cases of Syphilis since the turn of the millennium was something few saw coming (if you’ll pardon the uncomfortable pun). A couple of hundred years ago, Syphilis was common among men who regularly frequented prostitutes, and a painful game of pass-the-parcel between punter and prostitute could then be handed on to babies born to an infected parent, causing appalling facial deformities. More prevalent as the cause of misery for small children, however, was a bacterial disease such as Scarlet Fever.

I first became aware of Scarlet Fever when watching one of those superb period dramas BBC1 used to produce as part of their children’s programming in the 1970s. I can’t remember the name of the particular serial in which one of the main characters was struck down by the sickness, but the name Scarlet Fever stuck in my head due to its evocative and lyrical moniker. It sounded like the title of a horror film or even a prog rock band. But the disease was not quite as attractive as its name, being one of the major contributors to the high infant mortality rate for centuries. Even if a child survived, the chances of heart and kidney disease in later life could be the lethal legacy of Scarlet Fever.

Both internally and externally painful, Scarlet Fever symptoms include headaches, hallucinations, a sore throat, swollen glands and the rash that gives the sickness its name, a bright red sandpaper-like varnish visible on both the skin and the tongue. The old Central Office of Information catchphrase, ‘Coughs and sneezes spread diseases’, could have been coined with Scarlet Fever in mind, as that was how it was usually passed from one person to another. Considering the cramped and insanitary conditions the poorer working-class dwelled in up until at least the halfway point of the twentieth century, it was no surprise that children were extremely vulnerable to a disease that could be caught quickly and could be fatal.

In 1900, a serum was developed in Vienna that was drawn from the blood of horses. The impact of the serum was considerable upon the patients it was tested on, reducing the mortality of Scarlet Fever by as much as 40%, an impressive success rate for something that had traditionally been resistant to treatment. But the serum was never widely available, and scientists continued to develop other vaccines they hoped would work up until the mass introduction of penicillin in the immediate post-war era. Antibiotics served to diminish the curse of this long-term plague upon children and Scarlet Fever became one of those archaic diseases that successive generations would mostly associate with ‘the olden days’.

This week’s news, that there have been more than 6,000 cases of Scarlet Fever in Britain over the last six months – the highest amount for several decades – has served as a sober reminder that medical science cannot afford to rest on its laurels when it comes to age-old diseases we imagined had been banished to the distant periphery of modern life. We may have a far greater awareness of diseases and their causes today, but Bacterium remains a wily adversary we ignore at our sophisticated peril.

© The Editor

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10 thoughts on “A STUDY IN SCARLET

  1. Time was when such communicable diseases were often very localised and burnt themselves out, or ran out of new folk to infect. The old ‘plagues’ took a long time to progress at walking-pace through the land. Trouble is, with modern travel, a new outbreak can be spread around the globe in 24 hours and run free at a pace which even the best medicine will struggle to contain.
    So the disease managers face two challenges, first finding a cure (and tweaking it to respond to variants in the strain), then getting that treatment to the affected population before the plague gets to everyone else – ebola was an example of this challenge. It was only the fear of ebola spreading to the wealthy West that caused all the panic mega-spend in West Africa a couple of years ago.

    The other challenge is commercial – faced with a choice whether to investigate and develop a new cure for third-world Scarlet Fever or a wizard cream to stop ladies’ tits from sagging with age, the Big Pharma Finance Director will very quickly focus all their in-house research scientists on the latter, as there’s far more money to be made from that tasty potion than from saving the lives of a few million penniless dusky folk in the arsehole of nowhere.

    So if Big Pharma won’t do it, should the UK government spend its own billions trying to find a cure for some disease somewhere in Asia a decade from now, or should it provide PIP benefits today to disabled voting folk in Britain ? You decide: but I’m pretty sure how any government will think.

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  2. Mudplugger makes a very valid point re travel and infection in the modern world. Another point is the large numbers of people flocking to this country from countries where diseases which we have been largely free of for years remain endemic: TB being one example. As for syphilis, I have no firm ideas on the current resurgence, but it always makes me think of one name: Elizabeth Mitchell. She died alone and penniless in a London hospital sometime in the early or middle 1800s. She had gone there to beg for mercury treatment for her tertiary syphilis. She was a short, rather plain girl, as we know because her skeleton was exhumed from the famous – or infamous – Cross Bones paupers’ graveyard in London the forensic archaeologists recreated her face using the modern techniques of facial reconstruction the police use. She had been ravaged by the disease. her medical records (brief) and death certificate survive. She was about 24, from memory, poor child. Tertiary syphilis suggests that she had been infected by the age of 13. It was a belief at the time that sex with a virgin would cure a man of the disease. I wrote about her in the Old Place under the title Girl in a Box. her story broke my heart. Sometimes I say a prayer for Elizabeth Mitchell. Tonight I shall.

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      1. Not much chance of an AIDS sufferer finding his salvation in Essex then – virgins are a bit thin on the ground there, so I’m told.

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      2. Would the same “cure” work for females with AIDS? Strange how we never hear about women with AIDS popping the cherries of young boys.

        Speaking from experience, I know many people infected with HIV, while grateful for their medication and improved life prospects (despite horrendous side effects from said medications) are cynical about them. Why bother to develop a cure when a lifetime of drugs dependency ensures a healthy income for Big Pharma?

        I have to admit, I am one of those cynics.

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  3. I happen to live in the tropics and these first world diseases are rarely mentioned I imagine everybody is immunized I think the government for all its failings has widespread free programs in place, but there is still a worrying affluent sector that is starting to embrace dangerous quack medicine (homeopathy and such) .
    There has always been herbalist and for more serious stuff obeah and even the catholic church can sometimes get involved.
    Anyway what I wanted to say is there are many diseases here that have no vaccine no cure and can kill you. There seems to have been an increase in the number of mosquito infections in the last 5 years.
    We have always, it seems, had dengue which can be very nasty, but recently we have had chikungunya and zika. I cannot say I’ve had any of them, but its worrying. I have ha leptospirosis which also kills a few people and I have to admit when I had it I thought I was going to die.

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    1. A friend who lives and works in China reports that the local approach to healthcare is a mixture of traditional herbal mythology (some of which may actually work, but no-one knows which or why), accompanied by the unregulated, over-the-counter, purchase of modern antibiotics, which the locals take for pretty much everything from a hangover to a broken leg. But with a population over a billion and counting, maybe it works ……… for now.

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  4. At last, I have to pick you up on something! “but Bacterium remains a wily adversary we ignore at our sophisticated peril.” OK, no problem, but dear editor, you may know of my near obsession with the causes of the phenomenon known as “The Black Death”, which wiped out anywhere between 30 and more likely 50% or even more of Europe’s population between 1348 and the early 1350’s. Exact figures are impossible, for obvious reasons, but estimates of 75 to 200 million deaths are put forward. It is the mystery which consumes me. Since the late 19th century it has been attributed to bubonic plague. But, there are many problems with this. One of the most important is this. Bubonic plague is a bacteria. bacteria do not spread quickly. They are, in the scheme of things, relatively large organisms. In the case of Bubonic Plague the rate of transmission is slow and the process cumbersome. Contrast a virus (eg flu) which everyone gets. Ultra tiny pieces of non biological computer code style single strand – not double strand – information, they spread easily with a cough or a sneeze. The spread of the Black Death is only consistent with a viral pandemic. Had you punched a hole in my theory? I wondered. A cursory search of Google will tell you that Scarlet Fever is a product of a bacteria. And so it is. but, there is a big but. If you look more closely into it, it is actually the product of a bacteria that we commonly carry with no harmful effects, but the bacteria itself has been infected by – (you guessed it) a virus. It is a virus called T!2, and it is a “bacteriophage” – a vires that infects the bacteria. And that isn’t difficult. In terms of scale, let me put it this way: if a bacteria is the size of a double decker bus, a virus is the size of a thimble. It is truly microscopic. So, the cough, the sneeze, spreads the virus, and the virus changes the previously harmless bacteria which excludes the toxin. Phew. Job done.

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