Scarlet fever

Scarlet fever, caused by Group A streptococcal bacteria, was a common diseaseat one time, especially in children. Named for the flushing of the face thatit causes, it is characterized by a sore throat, chills, fever, headache, vomiting, rapid pulse, red rash, and an inflamed or "strawberry" tongue. Scarlet fever (sometimes called scarlatina) was named by Thomas Sydenham, anEnglish physician who was known as the "English Hippocrates." From the timehe began his medical career in 1656, Sydenham kept thorough records of patients. Astute observations led him to conclude that there were differences between measles and scarlet fever which up until that time were thought to be thesame disease. He named scarlet fever for its most distinguishing characteristics.

In the early twentieth century, Alphonse Dochez, a pioneer in the field of respiratory diseases, studied many cases of scarlet fever as a doctor during World War I. When he returned to his professorship at Johns Hopkins Medical School, and later at Columbia University, he worked on the relationship betweenstreptococcus bacteria and scarlet fever. Many doctors of the time did not believe that scarlet fever was caused by streptococci, but Dochez was convinced. Definitive proof was obtained when he inoculated a pig with the streptococcus bacteria. Late one night Dochez called an associate of his and asked him to come over to see "his little pig, as rosy as a boiled lobster," thus showing that the bacteria did cause scarlet fever symptoms. He also used an antitoxininjection (called antiserum at the time) that whitened the rash of scarlet fever and had a therapeutic effect.

At the same time that Dochez was developing his scarlet fever antitoxin, another group of American researchers, George and Gladys Dick, were developing their diagnostic test for scarlet fever (the Dick test) and their antitoxin treatment. Although Dochez had obtained a British patent for his antitoxin in 1924 (earlier than the Dicks), his U.S. patent was dated 1926--later than those obtained by the Dicks. Thus, a court ruling forced Dochez to give uphis work on the antitoxin in favor of the Dicks. From the mid 1920s, the Dicktest was administered to thousands of children. For those without immunity to the disease, the antitoxin was prescribed.

In 1924, Anna Wessels Williams, an American doctor who isolated the diphtheria bacteria and developed lab procedures for detecting typhoid fever and rabies, also began working with scarlet fever. She published papers detailing theuse of the Dick test to diagnose scarlet fever with more than 21,000 school children. Like Dochez, Williams performed laboratory experiments with the streptococci which cause scarlet fever. She helped discover that toxin-producinghemolytic (capable of destroying red blood cells) streptococci could be isolated not only from infected wounds but even from the throats of healthypeople. She found that not all scarlet fever toxins were identical, which led to her explanation of why the disease could recur even after immunization.

During the 1930s and 1940s, the world was forever changed with the development of antibiotic drugs. Because scarlet fever is caused by streptococcus bacteria, it was a good candidate for treatment with antibiotics. Penicillin worked especially well, wiping out the streptococcus infection in individuals and,on a larger scale, preventing the kinds of epidemics which had been common in the past.

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