A STUDY IN SCARLET

The 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