As I continue to work on my next book, I found I wanted to know a little more about the history of scarlet fever. You see, I needed to use a disease that would keep Elizabeth away from Longbourn so she would be forced to interact with Darcy at Netherfield, but I didn’t want a sickness that would cause permanent scarring like smallpox. I also wanted the sick to have a strong chance to survive and was looking for something common for the period.
The ancient Greeks described a disease that was believed to be scarlet fever, so it has been around for a very long time. By 1675, the disease was called scarlatina. As you may know, it is a bacterial infection that can now be easily treated, but before society had antibiotics, the illness had a mortality rate between 15 and 20 percent. They isolated and quarantined those who caught the disease to control the spread. Sometimes, damp sheets were hung over the doorways of the rooms containing the sick to contain the illness. There were, of course, several ineffective and potentially dangerous “treatments,” but an ounce of prevention was the only true defense.
Historically, the disease affects more children than adults, since children have less built-up immunity. It could, however, impact adults as well. Though having survived scarlet fever in the past did not guarantee immunity, it certainly helped. By age 10, up to 80% of children would have developed lifelong immunity because of repeated exposure.
Yes, in my story, older teens and adults become ill. I also leave poor Kitty behind to nurse the group, reasoning that she has had the illness and therefore has immunity. While the scenario I am creating is possible, I am a little disappointed with it. I imagine some readers will question my choice of disease, reasoning that these adults should already have built-up immunity. If you’d like to suggest a different illness that required a quarantine, was around during that era, and was more common in adults, I am open to suggestions.
There were many outbreaks between 1770 and 1800, and between 1820 and 1880, there was a world pandemic of scarlet fever. One thing I found interesting was that researchers found a correlation between the wheat prices and outbreaks but with a three-year lag. In years with dry spring and summer seasons, wheat productions would fall and prices would go up. This led to more malnutrition among pregnant women. Babies get antibodies for pathogens from their mothers, but by age two, most of these antibodies have cleared their systems. Three years after periods of high wheat prices, data showed a rise in the number of scarlet fever patients, suggesting that malnourishment during pregnancy resulted in the subsequent children having greater susceptibility to the bacteria that leads to this illness.