#rheumatic fever

Rheumatic Fever (Lev’s Notes)

“She had had difficulties of every sort to contend with, and in addition to these distresses, had been afflicted with a severe rheumatic fever, which finally settling in her legs, had made her for the present a cripple. She had come to Bath on that account, and was now in lodgings near the hot-baths, living in a very humble way, unable even to afford herself the comfort of a servant, and of course almost excluded from society.”

Persuasion, Chapter 17

Diagnosis: Rheumatic Fever

Harriet Smith (from Persuasion, not Emma) is stated to suffer from severe rheumatic fever, which led her to seek treatment in Bath. I always thought that “rheumatic fever” was this sweeping old-time diagnosis given for any issue involving the joints, but it’s actually a real thing that people from developing countries can still suffer from. So why don’t we ever hear about it?

Remember being a little kid with a sore throat and getting “strep-tested” at the pediatrician’s office? It was always great news to be “strep positive” because then you could take antibiotics that would make your strep throat go away a whole lot faster. However, in a world without antibiotics (Jane Austen’s world) having a sore throat caused by Streptococcus pyogenes bacteria (pictured) could lead to some serious consequences, such as rheumatic fever. In some individuals with streptococcal pharyngitis, their body’s immune system non-specifically attacks not only the bacteria but also the individual’s own tissues, particularly the heart and joints. This can lead to diseased valves and later congestive heart failure in the heart, and can lead to arthritis in the joints. Unfortunately for Harriet, I’m not sure that Bath would really make much of a difference in her symptoms. (Patients today would be treated with steroids and pain medications). I would guess though that physicians at that time suggested Bath for her joint pains because the hot baths were known to lessen the symptoms of another common cause of joint pain (stay tuned!)

Rheumatic fever is a dangerous condition that primarily affects children and adolescents, resulting in inflammation and damage to the heart, joints, skin, and brain. It is the result of an untreated or undertreated Streptococcus bacterial infection. Certain risk factors, such as genetic predisposition, overcrowded living conditions, inadequate healthcare access, and a family history of rheumatic fever, enhance the likelihood of contracting the disease. In order to avoid rheumatic fever, streptococcal infections must be treated promptly and appropriately.

Rheumatic fever is difficult to diagnose because of its wide range of symptoms, which include fever, joint stiffness, rash, shortness of breath, and heart inflammation. Diagnostic methods often include a medical history evaluation, a physical examination, and specialized testing such as blood tests, electrocardiograms (ECGs), and echocardiography.