I don’t know about the rest of you, but strep throat was the bane of my existence in middle school. I think I caught it 4 times in sixth grade, and there was talk of having my tonsils removed.
But what is strep? What causes it and how dangerous is it if untreated?
The Disease
Strep is a throat infection caused by group A streptococcus, a common enough bacteria that is spread through airborne droplets, or hard surfaces that have come into contact with these droplets. It causes pain and inflammation in the back of the throat and tonsils, fever, enlarged lymph nodes, and in some cases vomiting or nausea and headaches.
Today we have rapid tests that can be done in the doctor’s office and return a result in a matter of minutes, pain killers to relieve symptoms, and antibiotics that can clear up the infection in 3-5 days or so. But what about a hundred years ago?
Left untreated, strep can develop into two infections readers of historical fiction are likely familiar with: rheumatic fever and scarlet fever. Another potential complication is abscesses. In most cases, however, strep will run it’s course in about a week; antibiotics can shorten the length of time patients deal with symptoms, and prevent them from passing it on to others.
The Complications
So while strep itself isn’t lethal, the complications it can lead to most definitely are. Scarlet fever (remember, this is what started Beth going downhill in Little Women?) is typically a childhood disease that hits the 6-12 age category hardest, though other age groups are also impacted. In the Victorian era, entire schools would shut down to prevent the spread of the disease once discovered. Today it is easily treated with the same antibiotics used for strep, but it is far more dangerous if left untreated and will not resolve on it’s own.
Scarlet fever symptoms start out just like strep, however within a few days the body develops a red, rough rash that begins peeling soon after. Fevers can jump to 103F, and secondary infections of the ears, ear bones, kidneys, bones, and blood can occur, though blood and bone infections are relatively rare. More common are severe middle ear infections, which can cause deafness (scarlet fever is one of the 2 front runners medical historians suspect led to Hellen Keller’s deafness and loss of sight as an infant. The other contender is meningitis). Scarlet fever can also lean to pneumonia, which was frequently lethal (and today is still lethal, but at a much lower rate, mostly posing a threat to the elderly and those with weakened immune systems.
More rare but more serious is rheumatic fever, which causes inflammation in the heart, joints, skin, and even the brain.
History
We have reports of strep-like diseases dating back to the ancient Greeks, but no records of scarlet fever until the mid 1500s. Did the disease mutate around this time? Or was there another reason we don’t have ancient records of scarlet fever? We may never know. Perhaps it was confused with measles, another rash-producing fever accompanied by a sore throat. Both are highly contagious and had much higher mortality rates 500 years ago.
While the streptococcus bacteria was identified in 1883*, it wasn’t until the 1920s that disease and bacteria were successfully linked, and that the bacteria could secrete a toxic causing the rash (i.e. George and Gladys Dick proved the streptococcus bacteria caused a sore throat, and that sore throat could become scarlet fever). Finally in the 1940s antibiotics became more widespread and scarlet fever found itself relegated mostly to the history books.
Conclusion
While the history of strep is not as colorful as some other historical diseases I’ve covered, it has certainly lurked in the back of the collective consciousness, a partially open door on one of history’s biggest bogeymen.
Remember, everyone: isolate if you’re sick, wash your hands, and wear a mask.
*While the streptococcus bacteria family was identified in 1874, it wasn’t until 1883 that scientists realized it came in different forms and that only one of them was responsible for strep throat. Streptococcus wasn’t officially subdivided until 1918.
Further Reading:
NCBI
Wiki (Warning: this one has some pretty gross pictures)
Britannica: Scarlet Fever
New World Encyclopedia
Minnesota Department of Health
MedScape
ResearchGate
Thanks to Tara for suggesting this month’s WTKM! If you would to suggest a disease for future entries, just leave a comment below.
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