Scarlet fever historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

This disease was also once known as Scarlatina (from the Italian scarlattina). Many novels depicting life before the 19th century (see Scarlet fever in literature below) describe scarlet fever as an acute disease being followed by many months spent in convalescence. The convalescence was probably due to complications with rheumatic fever. Prior to an understanding of how streptococcus was spread, it was also not uncommon to destroy or burn the personal effects of a person afflicted with scarlet fever to prevent transmission to other people.

The first description of this disease is uncertain.[1] It is possible that Hippocrates in c. 400 BC described this in a case with a sore throat and skin ulcers, but the diagnosis is not entirely clear from the description. In the 10th/11th century, the physicians Rhazes, Ali Abbas and Avicenna described a measles-like illness that had a more vivid colour and was more dangerous. Again it is not certain that these descriptions refer to scarlet fever.

The disease appears to have been first described in the medical literature in the 1553 book De Tumoribus praeter Naturam by the Sicilian anatomist and physician Giovanni Filippo Ingrassia, where he referred to it as rossalia or rosania. It was redescribed by Johann Weyer during an epidemic in lower Germany between 1564 and 1565 who referred to it as scalatina anginosa. The first unequivocal description of scarlet fever was published by Jean Cottyar of Poieters in his book De febre purpura epidemiale et contagiosa libri duo published in 1578 in Paris. Daniel Sennert of Wittenberg described the classical 'scarlatinal desquamation' in 1572 and was also the first to describe the early arthritis, scarlatinal dropsy and ascites associated with the disease.

Bright in 1827 first recognised the involvement of the renal system in scarlet fever.

The association of streptococci and disease was first described in 1874 by Billroth in patients with wound infections. Billroth also coined the genus name Streptococcus. The organism was first cultured in 1883 by the German surgeon Friedrich Fehleisen who cultured it from perierysipelas lesions. It received its current name (Streptococcus pyogenes) in 1884 from Rosenbach.

The German physician Friedrich Loeffler was the first in 1884 to show the presence of streptococci in the throats of patients with scarlet fever. Because not all patients with pharyngeal streptococci developed scarlet fever, these findings remained controversial for some time. The association between streptocci and scarlet fever was confirmed by Dochez, George, and Dick in the early 1900s.

Dick Test and Vaccine

The Dick Test was invented in 1924 and was used to identify those susceptible to scarlet fever.[2] A broth culture filtrate from an erythrogenic toxin producing group A streptococci was injected intracutaneously into susceptible persons. In those susceptible erythematous and oedematous skin reactions developed by 24 hours after injection. A second injection of antitoxin into the site neutralized the reactions. Non-reactors were considered to have sufficient antibodies to the toxin and thus were not susceptible to scarlet fever. The antitoxin was made by injecting horses with the broth filtrates and later collecting the serum from the horse.

Gladys Henry Dick and George Frederick Dick developed a vaccine in 1924 that was later eclipsed by penicillin in the 1940s. Broth filtrates were used as the basis for the patent the Dicks took out on their vaccine in 1924 in the United Kingdom and in 1925 in the United States.

Neither the vaccine nor the Dick Test are in use currently.

Fictional Cases

Scarlet fever has been used as a plot device in a variety of fictional settings.


In Act II, Scene V of Rossini's opera, The Barber of Seville, Don Basilio is terrified and sent away to bed at a very crucial point in the plot under the false persuasion that he has contracted the dreaded "febbre scarlattina" (despite the fact that he is told he has turned yellow, rather than red).


In Mary Shelley's Frankenstein, Catherine Beaufort, Victor Frankenstein's mother, contracts scarlet fever from Elizabeth. The disease results in her death.

Beth, the third sister in Little Women, suffered from the effects of scarlet fever before dying.

Mary Ingalls from the Little House on the Prairie book and TV series lost her sight from the effects of scarlet fever.

In the children's book The Velveteen Rabbit, a toy rabbit's owner contracts scarlet fever and all his toys, including the rabbit, are taken to be burned.

Scarlet fever was a major plot point in American Girl's Kit Kittredge short story Kit Uses Her Head, when Kit, along with her best friends Ruthie Smithens and Stirling Howard, were diagnosed with the disease.


Gene Wilder's character in See No Evil, Hear No Evil went deaf due to scarlet fever.

In Osmosis Jones, the main antagonist, Thrax, is a Scarlet Fever virus intent on getting himself in the medical records by overheating Frank's body in record time.

In Love's Everlasting Courage, Ellen Davis dies of scarlet fever.

In the movie Anne of Green Gables: The Continuing Story, Gilbert Blythe (Anne's love interest) contracts scarlet fever from the hospital while studying medicine. During this time, Anne promises to marry him, which is said to be what helped him survive.

Scarlet fever serum from horses was used in the treatment of children beginning in 1900 and reduced mortality rates significantly.

In 1906 the Austrian pediatrician Clemens von Pirquet postulated that disease-causing immune complexes were responsible for the nephritis that followed scarlet fever.[3]

Bacteriophages were discovered in 1915 by Frederick Twort. His work was overlooked and phages were later rediscovered by Felix d'Herelle in 1917. The specific association of scarlet fever with the Group A streptococcus had to await the development of Lancefield's streptococcal grouping scheme in the 1920s. The Dicks showed that cell-free filtrates could induce the erythematous reaction characteristic of scarlet fever, proving that this reaction was due to a toxin. Karelitz and Stempien discovered that extracts from human serum globulin and placental globulin can be used as lightening agents for scarlet fever and this was used later as the basis for the Dick test. The association of scarlet fever and bacteriophages was described in 1926 by Cantucuzene and Boncieu.[4]

The discovery of penicillin and its subsequent widespread use has significantly reduced the mortality of this once feared disease.

The first toxin that causes this disease was cloned and sequenced in 1986 by Weeks and Ferretti.

Famous Cases

Lope de Vega, the famous Spanish writer and poet died because of scarlet fever in 1635.

Johann Strauss I, composer of waltzes and other light classics, died in Vienna in 1849 from scarlet fever contracted from one of his illegitimate children.[5]

Myron Florin, the accordionist on The Lawrence Welk Show had scarlet fever as a child. His accordion playing saved his life, as the exertion strengthened his heart back to pre-fever performance.

Maria Franziska von Trapp, the second daughter of Captain Georg von Trapp, suffered from scarlet fever and infected her mother Agathe Whitehead, who died from the disease. Maria von Trapp then entered the family, giving rise to the story behind The Sound of Music.

Liu Tianhua,刘天华(1895-1932, a Chinese musicologist died of scarlet fever in 1932 in Beijing.


  1. Rolleston, J. D. (1928). "The History of Scarlet Fever". BMJ. 2 (3542): 926–929. doi:10.1136/bmj.2.3542.926. PMC 2456687. PMID 20774279.
  2. Dick, G. F.; Dick, G. H. (1924). "A skin test for susceptibility to scarlet fever". J Am Med Assoc. 82 (4): 265–266. doi:10.1001/jama.1924.02650300011003.
  3. Huber, B. (2006). "100 years of allergy: Clemens von Pirquet - his idea of allergy and its immanent concept of disease". Wien. Klin. Wochenschr. 118 (19–20): 573–579. doi:10.1007/s00508-006-0701-3. PMID 17136331.
  4. Cantacuzène, J.; Bonciu, O. (1926). "Modifications subies par des streptocoques d'origine non scarlatineuse au contact de produits scarlatineux filtrès". CR Acad Sci Paris. 182: 1185–1187.
  5. "Johann Strauss I on Grove Music Online". Grove Music Online. Retrieved 5 October 2008.

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