Mistaken Infection 'On The Prairie'?02/04/13
MONDAY, Feb. 4 (HealthDay News) -- Fans of the pioneer tales
known as "Little House on the Prairie" are familiar with the
ravages of scarlet fever.
That's because Mary Ingalls -- sister of the autobiographical
series' author, Laura Ingalls Wilder -- went blind, supposedly
because of complications from the illness.
But medical experts today think it's time that explanation went
the way of the wagon wheel.
"Scarlet fever is unlikely because there isn't eye involvement with that disease," said Sarah Allexan, coauthor of a new article detailing Mary's illness.
The results of Allexan's detective work were released online
Feb. 4 in the journal
In a book from the
Little Houseseries called
By the Shores of Silver Lake, Ingalls Wilder wrote: "Mary
and Carrie and baby Grace and Ma had all had scarlet fever. Far
worst of all, the fever had settled in Mary's eyes and Mary was
Scarlet fever, caused by
Streptococcus pyogenes, caused many deaths of U.S. children
between 1840 and 1883, according to the historical review. Up to 30
percent of children who had scarlet fever died during that time
period. In the early 1900s, scarlet fever, measles, meningitis and
other "diseases of the head" were believed to be the top four
causes of blindness in the United States.
Without a known explanation, deaths from scarlet fever began to
drop in the early 1900s, even before antibiotics were introduced,
according to the review.
What also remains largely unexplained is how scarlet fever could
have caused blindness. Allexan, who was studying at the University
of Michigan in Ann Arbor when she started the review and is now a
student at the University of Colorado School of Medicine in Aurora,
suspects that many cases of blindness that were attributed to
scarlet fever might have been caused by meningitis instead.
According to historical records, Mary went blind in 1879 at age
14. But, in Laura Ingalls Wilder's memoirs, she only talks about
scarlet fever during the winter of 1872. Yet she later describes
Mary being sick in the winter of 1879, and then in April 1879, she
wrote that Mary was, "taken suddenly sick with a pain in her head
and grew worse quickly. She was delirious with an awful fever. We
feared for several days that she would not get well."
Ingalls Wilder goes on to describe her sister as having one side
of her face "drawn out of shape." Her mother told her that Mary had
had a stroke. As Mary recovered from the stroke, her eyesight grew
The local doctor wasn't sure what caused Mary's blindness and
consulted another physician. "They had a long name for her sickness
and said it was the result of the measles [sic] from which she had
never wholly recovered," Ingalls Wilder wrote.
In 1937, in a letter to her daughter, Ingalls Wilder wrote that
her sister had gone blind from spinal meningitis, and then crossed
that out and wrote "some sort of spinal sickness."
A historical register from 1889 lists the cause of Mary's
blindness as "brain fever," which at the time was the term for
meningoencephalitis, the swelling of the brain and the membranes
covering the brain.
The review authors suspect that during revisions of the novels,
"brain fever" was changed to "scarlet fever" because it was a more
recognizable illness at the time.
They suspect that meningoencephalitis caused by a virus is the
most likely cause of Mary's blindness. An actual stroke is unlikely
because she had no other areas of paralysis. A bacterial form of
meningoencephalitis, caused by a disease like scarlet fever, is
also unlikely, they said, because Mary likely would have had other
brain damage as a result of a bacterial infection. She would have
had learning problems, whereas from all accounts she remained as
bright as ever.
Dr. Bruce Hirsch, an infectious disease specialist at North
Shore University Hospital in Manhasset, N.Y., agreed that scarlet
fever probably didn't cause Mary's blindness.
"I don't think scarlet fever causes blindness directly, though it is possible that there was some febrile illness that could have been mislabeled as scarlet fever," he said. A febrile illness is sickness that includes a fever.
Hirsch is also skeptical that meningoencephalitis caused her
blindness because this usually causes damage to more than one area.
"If meningoencephalitis caused enough nerve damage to blind you, it
would be unusual for it to just hit that part of the brain without
causing a more general injury," he said.
He suspects that it's more likely that she had a viral illness
with a high fever and became dehydrated, which resulted in a
blocked vein in a blood vessel that supplies the eyes with blood
(retinal vein occlusion).
Whatever the actual cause was, Allexan said the message for
doctors is that it's "important what labels we use to talk about
disease. People still think scarlet fever is a serious, deadly
disease that can cause blindness."
Learn more about scarlet fever from the
U.S. Centers for Disease Control and Prevention.
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