In my previous blog I speculated about the illness that made Anne de Bourgh sickly and cross. Anne features prominently in my novel Cousin Anne, where the seventeen-year-old heiress can be found in London with her parents. While there she falls in love with Mr. Wickham and later becomes seriously ill. (Presumably there is no connection between these two events!) In my other novel about Anne, Rosings Park, she submits to leeching, fomentations and plasters of pitch to relieve the pain of a rheumatic affection. Were her symptoms due to rheumatism? Or were they a complication of some other condition? Could there be a link between the illness she had as a teenager and the rheumatic affection she endured as an adult? Why, yes, there might be: scarlet fever.

Dr. Buchan’s Description of Scarlet Fever

Dr. William Buchan (Source: Wikimedia Commons [PD=1923])

Dr. William Buchan (Source: Wikimedia Commons [PD=1923])

Dr. William Buchan features prominently in my blog posts on Regency medicine. His book Domestic Medicine was very popular during Jane Austen’s day and was consulted by every class of people looking for relief from whatever ailed them.1 (I tend to use the edition published in 1811, but numerous other editions exist.) Buchan wrote a tidy summary of the symptoms and treatment for scarlet fever.

Scarlet fever began with shivering and a feeling of being cold. Soon after, the skin became covered with red spots, the rash lasting perhaps two or three days. After the rash disappeared the cuticle (the epidermis or the outermost layer of the skin) or “scarf-skin” sloughed off. Dr. Buchan considered these symptoms to be mild, seldom requiring any medicine.

The "strawberry" tongue associated with scarlet fever (Source: Wikimedia Commons. Author: Afag Azizova)

The “strawberry” tongue associated with scarlet fever (Source: Wikimedia Commons. Author: Afag Azizova)

But there was a more serious form of scarlet fever, he pointed out, one that was attended with “putrid or malignant symptoms,” which were always dangerous. The symptoms of the malignant scarlet fever included:

  • coldness and shivering
  • sluggishness and great oppression
  • excessive heat (fever), nausea, and vomiting
  • a quick pulse
  • the skin hot, but not quite dry
  • the tongue moist and covered with a whitish mucus, giving a “strawberry” look
  • the tonsils inflamed and ulcerated

When the skin rash appeared in this malignant form of scarlet fever, it brought no relief. “On the contrary,” Dr. Buchan wrote, “the symptoms generally grow worse, and fresh ones come on, as purging, delirium, etc.”

Dr. Buchan’s Treatment for Scarlet Fever

“When this disease is mistaken for a simple inflammation,” he wrote, “and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal.” But when the physician was certain his patient had scarlet fever, Dr. Buchan advised depending upon cordials and antiseptics, such as the Peruvian bark, wine, snake-root, and the like. In general, treating the serious form of scarlet fever was similar to treating the putrid fever or the malignant, ulcerous sore throat—both considered dangerous and often fatal.

Dr. Buchan’s Simple Summary Belies the Controversy that Raged about Scarlet Fever

Dr. Buchan’s thinking would fit easily within today’s online medical community. His book was the Regency equivalent of the disease summaries posted by the Centers for Disease Control and Prevention, the Mayo ClinicWebMDWikipedia, and other such sites that provide general information on scarlet fever and many other diseases.

Like today’s blogger, Dr. Buchan strove to keep his summaries simple. For this reason, his brief and informative description of scarlet fever belies the controversy and confusion that reigned within the Regency medical community: Was scarlet fever one disease or two … or three? What caused it? How could it be prevented? These questions will be explored in my upcoming posts.


1Buchan, William. Domestic Medicine (Boston, 1811), p. 189.
2Ibid., p. 8.