Welcome to Stuff You Missed in History Class, a production of I Heart Radio. Hello, and welcome to the podcast. I'm Tracy V. Wilson and I'm Holly Fry. So some of my friends kids got scarlet fever late last year, and their response to this was kind of like, what is this the nineteenth century? And I remember having a really similar feeling when I got scarlet fever as a kid back in the nineteen eighties, because I really associated scarlet fever with old timey children's books to me, like The Velveteen Rabbit and Little Women, and this sort of response to scarlet fever of like, what century is it that's not unique to me or my friends. When I started working on this episode, the very initial research just turned up a ton of news articles going back many years, all of them reporting on scarlet fever outbreaks, and all of this with a tone of like the return of an old disease. Um They all made it sound like this was like a unique thing, and it was really just year after year after year, a new headline of a new scarlet fever outbreak with a new like an old disease has returned. So scarlet fever is caused by Group A Streptococcus, and over the last few months there's been a big spike in Group A Strep infections in many parts of the world, sometimes causing relatively minor illnesses, but also sometimes much more dangerous and even deadly invasive infections, usually in places where people have prompt access to medical care. Scarlet fever specifically is pretty treatable with antibiotics, but in the middle of the nineteenth century it was the leading cause of death in children in some parts of the world. A lot of times antibiotic get the credit from turning that trend around, but it wasn't just because of antibiotics, which is one of several kind of mysteries about this disease. Scarlet fever usually starts with symptoms like a fever, sore throat, headache, and sometimes nausea or vomiting. A rash usually forms a day or two after the fever starts. The appearance and texture of this rash can vary based on a person's skin color. At least in the US and Europe, most descriptions and pictures of this are of white children and people with lighter skin. The rash is red and bumpy and often has this texture that's described as sand papery. In people with brown or black skin, the rash is often the same color as the skin or slightly darker, and while it's usually still raised in bumpy, it sometimes doesn't have quite the same texture. Scarlet fever can also cause something called strawberry tone that's a white coating that can progress to a red, bumpy appearance. If you google this, which I'm not necessarily recommending that you do, it's obvious why they call it that. If left untreated, scarlet fever and other strep infections can cause some really serious complications, including organ damage and an inflammatory disease called rheumatic fever. There's also a possible connection between strap infections and autoimmune disease and neurological disorders and children. And again, they're also invasive strep infections that themselves can be like really dangerous. Streptococcus bacteria can cause a wide range of diseases, and while strep is believed to have been one of the most frequent causes of infectious diseases in prehistoric times, it's not clear when exactly it started causing scarlet fever. This is because strep only causes scarlet fever when it's been infected with a bacteria phage. That's a virus that infects bacteria. The bacteria phage causes the bacteria to produce a toxin, and scarlet fever is the body's response to that toxin. It's likely that there were strains of Streptococcus present in much of the world prior to the fifteenth century, but that scarlet fever specifically was introduced to some places during colonization, including the America's, Australia and New Zealand. Scarlet fever is most common in children, and there are just a lot of childhood diseases that can cause similar symptoms, so a lot of the time it's not really possible to tell whether an early medical text or other writing is referencing scarlet fever or some other disease that causes some combination of like a fever, sore throat, rash, and other symptoms. There are references to various childhood fevers and rashes and medical texts from the Mediterranean, the Middle East, and Asia going all the way back to Hippocrates and the fourth century BC. We don't really have a way of knowing whether any of them were talking about scarlet fever, or even if scarlet fever really existed. Yet, accounts describing scarlet fever as a distinct illness started to develop in the sixteenth century. Jovanni Philippo Ingrassias was a physician born in Sicily, and in fifteen fifty three he described an illness that he called rosalia. He specified that this was not the same thing as chicken pox or measles, and that it involved quote numerous spots, large and small, fiery and red of universal distribution, so that the whole body appeared to be on fire. In fifteen sixty five, Dutch physician Johann Bayer described something similar and added another detail, which was a severe sore throat. Then, in fifteen seventy eight, Jehan Cottier of Foatier described an illness causing quote general weariness, headache, redness of the eyes, sore throat, and fever. Pepura appeared on the second or third day, accompanied by delirium and soreness of the throat. Purpura is a rash that's caused by the breaking of small blood vessels underneath the skin. In sixteen thirty five, German physician Daniel Center described an epidemic in Wittenberg in which the skin later desquamated or peeled, something that often happens in cases of scarlet fever. Center also described other complications that can follow scarlet fever, including a dem up fluid in the abdomen and arthritis. Scarlet fever was showing up in writings outside of the medical world as well. Samuel Peeps, who comes up so often on the show when we're talking about this period of history, wrote this in his diary on November tenth, sixteen sixty four. Quote my little girly Susan is falling sick of the measles we fear or at least of a scarlet fever. This seemed to pass pretty quickly. The next day he wrote, quote, our little girl is better than she was yesterday. Scarlet Fever as a term was in common use in English at this point, as was the name scarlett tina. The first use of the term scarlettina in medical literature is believed to be in sixteen seventy four. English physician Amas Sydenham wrote Medical Observations on the History and Treatment of Acute Diseases, which was published in Latin, and in it he described febro scarlatina. This way, quote, Scarlet fever may appear at any season. Nevertheless, it often breaks out towards the end of summer, when it attacks whole families at once, and more especially the infant part of them. The patient feel rigors and shivering, just as they do in other fevers. The symptoms, however, are moderate. Afterwards, however, the whole skin becomes covered with small red maculae thicker than those of measles, as well as broader and redder and less uniform. These last for two or three days and then disappear. The cuticle peels off and branny scales remain lying on the surface like meal. They appear and disappear two or three times. This was before the development of the germ theory of disease, and Sydenham believed that this was caused by quote a moderate effervescence of the blood, arising from the heat of the preceding summer or from some other exciting cause. This made him cautious of using blood letting or enemas to treat the patient, which is something that would have happened with other illnesses. He believed that the blood needed to be left to its own regulation in cases of scarlet fever, and that blood letting or animals could introduce particles into the blood that were harmful to it. Instead, he said it was quote sufficient for the patient to abstain wholly from animal food and from fermented liquors, to keep always indoors, and not to keep always in his bed. When the desclamation is complete, and when the symptoms are departing, I consider it proper to purge the patient with some mild laxative accommodated to his age and strength. So at the same time, he noted that if a child experienced seizures or a coma, then they needed to be treated immediately with a blister on the back of the neck and a dose of opium tincture. Sydenham recommended repeating this every night until the patient had recovered, and feeding them diluted milk, but again not animal food. So these descriptions of this illness don't sound really pleasant, and both Sydenham and Centered described complications and more serious cases. But like none of this sounds nearly as frightening as scarlet fever became in the nineteenth century. Samuel Peeps made it sound like scarlet fever was like a lesser illness than measles would have been. Became much worse later on, and we'll get to that after a sponsor break Through the seventeenth and eighteenth centuries, scarlet fever epidemics occurred regularly in Europe, with the disease often striking a particular place every four to six years. That same general pattern seems to have been pres than in other places. Also in the twenties and thirties, though, the number of scarlet fever cases really started to rise in a lot of places, and so did their severity. There are several possible explanations for why, and it's possible that all of them played some kind of role. Nineteenth Century urbanization led to more people living in closer quarters, often without sufficient facilities for hygiene, which made it easier for a contagious illness like scarlet fever to spread, but that can't account for everything, since scarlet fever cases started increasing before this trend really started to escalate. Some researchers have found a correlation between scarlet fever and wheat prices. When wheat prices rose, there was an increase in scarlet fever three years later, as though malnutrition during pregnancy might make children more susceptible to it. This is a correlation, though it's not necessarily a cause and effect situation, and it is also possible that a more virulent form of the disease evolved, which allowed it to spread more easily and cause wars illnesses. Scarlet fever was also introduced into parts of the world that had never encountered it before during the nineteenth century. The first case of scarlet fever and the Archipelago of Madeira, was reported in eighteen o six. They reached South America in eighteen twenty nine, Greenland in eighteen forty seven, and both Australia and New Zealand in eighteen forty eight. Although scarlet fever had been reported in the northeastern United States for centuries, the first case reported in California wasn't until eighteen forty nine. Some sources will describe the nineteenth century spread of scarlet fever as a pandemic, stretching from about eighteen twenty five to eighteen eighty five. Death rates could really vary from place to place and from one outbreak to the next. In places that had no experience with scarlet fever, The mortality rate was often particular really high. As we said a moment ago, the first cases reported in New Zealand were in eighty eight, and in Auckland that year, one out of every eight people who contracted scarlet fever died. The vast majority of cases and deaths were in children between the ages of two and ten, and no one over the age of forty seemed to catch it at all. The worst cases seemed to be encrowded or badly ventilated homes. There's not a ton of exact data, though, especially in the earlier decades of the eighteen hundreds, a lot of places didn't have formal departments of health or public health services. Widespread outbreaks of scarlet fever and other contagious diseases were part of the motivation for those to be established. In some places, there were laws in place to try to control the spread of infectious diseases, and a lot of those laws traced back to things like the Black Death of the fourteenth century. But a lot of the time there just wasn't a more systematic tracking of diseases and they're spread. However, it's generally agreed that by eighteen forty, scarlet fever was a leading cause of childhood death in the United States and parts of Europe, possibly the leading cause of death and children during widespread outbreaks throughout the nineteenth century, scarlet fever was terrifying. Communities often used isolation and quarantine to try to control the diseases spread, along with things like canceling school and public gatherings, recommending the deletion and disinfection procedures, and urging people to keep children at home and away from other people, especially other children. The increasing spread of scarlet fever also led to researchers learning more about it. English physician Richard Bright made the connection between streptococcus infections and kidney disease in eighteen thirty six. Bright was one of the first people to describe nephritis or kidney inflammation, which came to be known as Bright's disease, and he wrote of it, quote Scarlatina has apparently laid the foundation for the future mischief, so Scarlatina later causing nephritis, although his next sentence went on to say, quote exertion and childish plays has done the same. So some questions about don't let your kids play too hard? Yeah, they might have kidney disease. Later, although people didn't know exactly what caused scarlet fever yet, they did know that it spread easily from person to person, so much so that people thought that the disease could linger on things like clothing, bedding, and toys for a long period of time. And in eighteen sixty seven, Dr Michael Taylor, who was a local physician in northwestern England, connected a scarlet fever outbreak to milk. At this point, Louis Pester had done groundbreaking work on what would come to be known as pasteurization, but he was doing this work in the context of fermentation, the idea that milk should be pasteurized that was still decades away. Taylor knew about the work of Dr John Snow, who had identified a water pump as the source of a cholera outbreak in eighteen fifty four. Taylor had thought that if water could carry a disease, then surely milk could as well, and he had later traced a typhoid outbreak to contaminated milk. In eighteen sixty seven, people started reporting cases of scarlet fever in and around the town of Penrith, which had not seen a case of scarlet fever in more than a year. It turned out that the people who got sick had all bought milk from the same milk dealer whose child had gotten scarlet fever and died. In eighteen seventy four, Theodore bill Roth of Austria identified and named the Streptococcus bacterium, which he had found in infected wounds and in a case of a skin infection called arisipelas. He had observed quote small organisms as found in either isolated or arranged pairs, sometimes in chains, and he named them for the Greek terms strepto or chain, and caucus or berry. Five years later, Louis Pester isolated the same organism in the uterus and bloodstream of a number of patients with child bed fever. Then, in eighteen eighty four, microbiologists Friedrich Julius Rosenbach refined the organism's name to Streptococcus pyogenes, with pyogenes from Greek words meaning pus forming. It did not take long for the connection to be made between Streptococcus pyogenes and scarlet fever. In eighteen eighty seven, Dr Emmanuel Klan published a report in the Proceedings of the Royal Society of London, saying that he had identified the Streptococcus organism in both people with acute scarletina in London and cows at a milk farm in Hendon, so he believed that the milk from the Hendon farm had caused the scarlet fever outbreak in London. This report was the result of years of work. Klein was a bacteriologist who had been born in Hungary and studied in Austria before moving to England to work as a researcher at the Brown Institution of the University of London. His scarlet fever research had included post mortem examinations of children who had died of it, and he had spotted similar pathological changes in cows that he examined at the Hendon farm. This wasn't just a matter of observing the similarities in the sick cows and the sick children. He followed the criteria that at that point had been outlined by Robert Coke, now known as Coke's postulates, to show that the same bacteria were causing both the illness and the cows, and in the people who had drank their milk. He also had shown that the bacteria he cultured from the sick cows could grow and survive and basically thrive in milk. He called this organism Micrococcus scarlet tena. Although it was indistinguishable from the one previously named Streptococcus pogenes. This was an important discovery, although he was using a different name for it. Klein was the first person to connect Streptococcus pyogenes to scarlet fever, but his results were not widely accepted. Since Michael Taylor's discovery in eighteen sixty seven, there had been other scarlet fever outbreaks traced to milk, and most of the time milk from the affected dairy had been destroyed, but most people had thought these outbreaks had a human source, like a child who lived on the farm, or a dairy worker, or a delivery worker who had cared for a child with scarlet fever, or someone who had it themselves. Taylor had showed that the cows could carry the disease, which could mean that destroying the milk was not enough to stop an outbreak, that the cows themselves might have to be culled. Destroying potentially contaminated milk was a financial hardship for dairy farm but destroying their cows was far worse, and people resisted the idea that cows could be a source of infection. Although a few people had tried applying Louis Pasteur's heat treatment process to milk, almost twenty more years passed before German agricultural chemists Franz Vum Suckslet suggested that milk be routinely treated with pasteurization, and a big reason for that was that so many diseases were being transmitted through milk, not just scarlet fever, but also typhoid, diphtherory a, tuberculosis, and various gastro intestinal illnesses. It still took a while for pasteurization to catch on, though there were concerns that pasteurizing milk destroyed the nutrients in it, or affected the flavor, or made it harder to digest. But by that point, scarlet fever rates were on the decline, and we'll talk more about that after a sponsor break. Although the number of scarlet fever cases was declining at the end of the nineteenth century and the disease didn't seem to be as deadly as it had been in the early twentieth century, it was still seen as a major public health concern. In England. For example, isolation hospitals were established for people with contagious illnesses who could not effectively be isolated at home. During outbreaks of scarlet fever, there could be house to house visits to find sick people so they could be isolated in the hospital. Unfortunately, it is really not clear how much or whether this really helped slow the spread of the disease. And also people with different contagious diseases were all being housed in the same hospitals, and the sled people to say that the isolation hospital was where you went when you caught one disease, so that you could come out with all the rest. Welcome to Petri dish Arms. You'll get a bed at probably seven different things. It's no good. Other efforts to control the spread of scarlet fever also did not help. A nineteen fifteen article in the American Journal of Nursing described it this way quote, it seems to cling to whatever object it encounters. In no other disease has the infection been apparently conveyed with such frequency by objects which have come in contact with those ill as clothes, books, toys, and the like. This article recommended that quote all hangings, carpets, and upholstered furniture are to be taken from the room before the patient is brought in. The furniture left should be of a kind readily cleansed. There should be no such fancied attempts at purifying the air as by hanging up sheets wet with disinfectants. Such measures are not only useless but tend to give a false sense of security. Needless to say, the patients should be provided with bedclothing, nightgown towels, eating utensils, and drinking vessels for his ex elusive use. Yeah, that's it. Is no longer believed that scarlet fever is just transmitted readily and for a long period of time, and things like curtains. Uh. This article also recommended disinfecting anything that the sick person had used using either a five percent solution of carbolic acid or a two percent solution of creosol, and anything that had been used for coughing or sneezing into was to be burned. Also, the recommended treatment for patients themselves was at least three weeks in bed, even if they only had a mild case. Around this same time, people were making more discoveries about scarlet fever, something that really escalated during the nineteen teens and twenties. In nineteen fifteen, English bacteriologist Frederick William Twart and his brother were using colonies of bacteria as part of an effort to find a way to grow smallpox vaccine in a lab. Towart discovered areas where the bacteria couldn't grow and found that a substance from these areas was capable of passing through a porcelain filter that trapped most bacteria. He published an article in The Lancet about what he described as a filter passing virus that attacked bacteria. His work didn't get a lot of attention, but this was the first known description of a bacteria phage. French microbiologist Felix Derell made the same discovery independently of tort about two years later. In the nineteen twenties, husband and wife researchers George and Gladys Dick made a series of discoveries about scarlet fever and its cause. While working in Chicago. They confirmed the link between the disease and Streptococcus bacteria, and they identified a toxin produced by the bacteria that was the cause of scarlet fever. They also developed a skin test known as the Dick test to show whether a person was susceptible to scarlet fever or not. They were nominated for the Nobel Prize in Medicine for the sore in ninety five. In ninety six and ninety seven, two different pairs of researchers discovered a bacteria phage that could change a non toxogenic strain of Strep into a toxogenic one. In other words, to turn a variety of Strep. That did not cause scarlet fever into one that did. Various researchers started trying to develop an inoculation for scarlet fever using either the bacteria or various modifications of the toxin that it produced. In nine, American microbiologist Rebecca craig Hill Lancefield developed a system for classifying Strep. Bacteria into groups based on the antigens found on the bacteria. Initially, she proposed two groups, the group A and Group B. As we said earlier, scarlet fever is group A. Today there are many more groups. She was also one of the first people to demonstrate that Strep. Infections could lead to rheumatic fever. The first sulfa drugs were developed in the nineteen thirties, and we're used as a treatment for strep infections, including scarlet fever. But the big medical breakthrough was penicillin. We did a whole episode on penicillin's development back in September. Today, penicillin and amoxicillin are the antibiotics most often used to treat scarlet fever, with other antibiotics recommended for people who are allergic to those. Today, in most children, scarlet fever clears up quickly as long as antibiotic treatment begins promptly. Yeah, that made the myxicillen shortages that were happening at the end of last year in a lot of places particularly scary for folks. So penicillin is often credited with turning scarlet fever from a terrifying and deadly disease to one that's considered to be a relatively mild childhood illness most of the time. As we said earlier, though deaths from scarlet fever were becoming less and less common decades before penicillin was introduced. We don't totally know why. Starting in the nineteen eighties, though, the opposite started to happen, as invasive strep infections started to become more common in spite of the existence of antibiotics to treat them. Scarlet fever specifically started to become more prevalent in a lot of parts of the world starting in about two thousand and eight. Increased rates of scarlet fever were first reported in parts of Asia, and then in the UK and other parts of Europe, and then in the US. The UK, for example, saw a sudden spike in scarlet fever cases starting in twenty and soon the rate of scarlet fever was higher there than it had been in almost fifty years. At first, it seemed like this wasn't leading to a similar increase in fatalities, but a year later invasive strep infections started to increase there as well. Worldwide, there was a fivefold increase in the number of scarlet fever cases between twenty eleven and with a drop in twenty after the start of the COVID nineteen pandemic and a lot of places, the general trend of when scarlet fever cases are the highest was like sort of nearing its end when the COVID nineteen pandemic really started. Although health officials thought there might be some more dangerous strain of Strep bacteria that was causing this increase, some whole genome sequencing of samples from a lot of different sick children found that there was not one strain that was responsible for most of the illnesses. Some researchers have suggested that the bacteria may have started producing a more aggressive form of the toxin that causes the disease. It's also not clear what has caused this most recent spike in scarlet fever cases that started towards the end of in the northern hemisphere. Scarlet fever cases usually peak in the late winter or early spring, so this outbreak happened out of season. At this point, this is all really speculative, with some of those speculations being more based less than others, like the measures put in place to try to control the spread of the COVID nineteen pandemic lead to people not being exposed to other diseases. It's also possible that kids who might have gotten strip or scarlet fever over the last couple of years didn't and are instead just getting it now. But there have also been totally baseless claims pointing to either COVID nineteen vaccines or the flu vaccine is somehow causing a rise in strep infections. There is no credible evidence for either. They were not doctors, so we cannot possibly comment on every conceivable thing that has been postulated about the spike and scarlet fever cases. Like it does seem possible that it is an extension of the spike that was happening before the pandemic started, that kind of paused during the pandemic peak when so many places were taking a lot of mitigation measures. As we said at the top of the show, though a lot of folks experience with scarlet fever is not from their own illnes us or the illness of their children. It's literature. So we'll close out with just a few of the most famous examples. First, there is Little Women by L. M. Alcott, in which Beth gets scarlet fever and is extremely sick. She dies years later, and while the book doesn't give a specific cause, it's usually interpreted that she had developed rheumatic fever after that scarlet fever case. Alcott's real life sister, Elizabeth Sewell Alcott, died at the age of twenty two, two years after having had scarlet fever, and then Alcott published Little Women ten years later in eighteen sixty eight. Another past podcast subject with a scarlet fever connection is Laura Ingalls Wilder, whose real sister Mary became blind after what the family described as brain fever, probably some form of meningitis or encephalitis. In the book The Shores of Silver Lake, set in eighteen seventy nine, the fictional version of Mary becomes blind after she and the rest of the family contracts scarlet fever. And yet another example that incorporates both fiction and reality. Several of the von Trapp family contracted scarlet fever in the early nineteen twenties, and their mother, Agatha, contracted it while caring for them and died in nineteen twenty two. This led to a young woman named Maria being hired from a convent to work as a tutor with the convalescing children, and the family later became a performing group called the trap Family Singers, that, of course inspired the musical The Sound of Music. Lastly, of course, there's The Velveteen Rabbit or How Toys Become Real by Marjorie Williams, which was published in nineteen two, and in this book, a little boy gets a velveteen rabbit as a Christmas present, and then there's a whole story about how nursery magic can make a toy real through the strength of a child's love. This little boy then gets scarlet fever and it's very sick for a long time, and once he's better, there's a plan to take him to the seaside while his room is disinfected, and all of his toys and books and everything he has played with is going to be burned, which, as we talked about it is a real thing that people would do. So the doctor then describes the velveteen rabbit as quote, a mass of scarlet fever germs. Fortunately, the nursery magic fairy appears and makes the velveteen rabbit real, so he is not burned. But honestly, this story is kind of horrifying. It's the meanest thing ever. I remembered it being sad from like my own childhood, Like I remembered feeling sad about it. And I'm pretty sure I have like a copy of the book with its original illustrations and all that, like in the house somewhere, but I read it at my desk while working on this episode, and I mean maybe it was my emotional state that there was a lot of just weeping over this story, and I was like, why did they give this to children? I will tell you a velveteen rabbit story on Friday. Okay, that'll be great. We can talk more about our literature experiences with scarlet fever. So if anybody's kids have had scarlet fever, I hope everybody has recovered nicely and you were able to find some of moscilling, because I know that was tough for a while. Um, and now I have some listener mail. This listener mail is from Aaron, and Aaron wrote hello ladies while I typically and went to skip out before listener emails. I was at work the other day and happens to catch your correction about the Marx Brothers versus the Three Stooges. Imagine my surprise and delight at your defense of the Stooges as I was currently restocking the gift shop at the only Three Stooges museum in the country. The Stoogeum located just outside of Philadelphia, Pennsylvania. When people find out where I work, they are usually astonished that such a place exists and are intrigued to find out more. We house the largest collection of stooge Bilia or maybe stooge abilia in the world, where there were three floors, ten thousand square feet exhibit space and well over ten thousand items on display. This doesn't even include our research library, photo and document archives, film vault in additional storage spaces for objects not on display. I was so touched when Tracy talked about the students having intelligence and meaning behind all the slapstick. I'm gonna pause the conversation and say, I want to credit Holly for being part of that conversation too and bringing nuance I had and necessarily thought about. Uh so, And then the email goes on to say, because that is what my coworker and I try to express when educating the public about our collection. Not only were the three Stooges, in their various iterations, masters of comedic timing and among the hardest working entertainers of their day, They're over fifty year career can stand as a microcosm of the modern entertainment industry, from vaudeville through early films, the studio system in the dawn of television to the start of marketing to children and onward. The Stooges were never looked on with much respect, but I think that their lives and careers fast dating one and would be a great podcast subject. There's even a bit of scandal. Did Stooge founder Ted Healy get murdered? The jury is still out on that one. Just a quick plug in the museum and its founder Gary lassen Or in the process of publishing a book about the stooges lengthy touring career called A Tour de Farce, which is a great title. It chronicles forty years and thousands of three Stooges live appearances throughout the US and abroad, and contains never before seeing photos and stories. Thanks for granting me that little boost, and if you guys are ever interested in doing a podcast about the Stooges, feel free to reach out. We love to help with research. Thanks again for your defense of who we affectionately call the boys in Stooge. We trust Aaron ps. We get emails all the time of people mixing up the Marx Brothers and the Stooges. Someone even tried to donate a picture of the Marx Brothers to our collection once I found this email. Very delightful obviously, um, and I also will reiterate I feel like, based on my limited experience, that a lot of people, whether confusion or misremembering or whatever, uh, mix up the Marx Brothers and the Three Stooges, and that Three Stooges folks seem to have a lot more humor about this than Marx Brothers folks do. Um. That is just my impression based on emails and looking at stuff on the internet. So thank you so much. I did not know that museum existed. I've been to Philadelphia a couple of times. Not sure exactly how far outside of Philadelphia it is, but man, I'm glad to know that's a thing. Yeah. Same, It just went on my list of places I must visit. Yeah yeah. So, if you would like to send us a note about this or another podcast or history podcast that I heart radio dot com and we're all over social media. Missed in History That's Real? 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Welcome to Stuff You Missed in History Class, a production of I Heart Radio. Hello, and welcome to the podcast. I'm Tracy V. Wilson and I'm Holly Fry. So some of my friends kids got scarlet fever late last year, and their response to this was kind of like, what is this the nineteenth century? And I remember having a really similar feeling when I got scarlet fever as a kid back in the nineteen eighties, because I really associated scarlet fever with old timey children's books to me, like The Velveteen Rabbit and Little Women, and this sort of response to scarlet fever of like, what century is it that's not unique to me or my friends. When I started working on this episode, the very initial research just turned up a ton of news articles going back many years, all of them reporting on scarlet fever outbreaks, and all of this with a tone of like the return of an old disease. Um They all made it sound like this was like a unique thing, and it was really just year after year after year, a new headline of a new scarlet fever outbreak with a new like an old disease has returned. So scarlet fever is caused by Group A Streptococcus, and over the last few months there's been a big spike in Group A Strep infections in many parts of the world, sometimes causing relatively minor illnesses, but also sometimes much more dangerous and even deadly invasive infections, usually in places where people have prompt access to medical care. Scarlet fever specifically is pretty treatable with antibiotics, but in the middle of the nineteenth century it was the leading cause of death in children in some parts of the world. A lot of times antibiotic get the credit from turning that trend around, but it wasn't just because of antibiotics, which is one of several kind of mysteries about this disease. Scarlet fever usually starts with symptoms like a fever, sore throat, headache, and sometimes nausea or vomiting. A rash usually forms a day or two after the fever starts. The appearance and texture of this rash can vary based on a person's skin color. At least in the US and Europe, most descriptions and pictures of this are of white children and people with lighter skin. The rash is red and bumpy and often has this texture that's described as sand papery. In people with brown or black skin, the rash is often the same color as the skin or slightly darker, and while it's usually still raised in bumpy, it sometimes doesn't have quite the same texture. Scarlet fever can also cause something called strawberry tone that's a white coating that can progress to a red, bumpy appearance. If you google this, which I'm not necessarily recommending that you do, it's obvious why they call it that. If left untreated, scarlet fever and other strep infections can cause some really serious complications, including organ damage and an inflammatory disease called rheumatic fever. There's also a possible connection between strap infections and autoimmune disease and neurological disorders and children. And again, they're also invasive strep infections that themselves can be like really dangerous. Streptococcus bacteria can cause a wide range of diseases, and while strep is believed to have been one of the most frequent causes of infectious diseases in prehistoric times, it's not clear when exactly it started causing scarlet fever. This is because strep only causes scarlet fever when it's been infected with a bacteria phage. That's a virus that infects bacteria. The bacteria phage causes the bacteria to produce a toxin, and scarlet fever is the body's response to that toxin. It's likely that there were strains of Streptococcus present in much of the world prior to the fifteenth century, but that scarlet fever specifically was introduced to some places during colonization, including the America's, Australia and New Zealand. Scarlet fever is most common in children, and there are just a lot of childhood diseases that can cause similar symptoms, so a lot of the time it's not really possible to tell whether an early medical text or other writing is referencing scarlet fever or some other disease that causes some combination of like a fever, sore throat, rash, and other symptoms. There are references to various childhood fevers and rashes and medical texts from the Mediterranean, the Middle East, and Asia going all the way back to Hippocrates and the fourth century BC. We don't really have a way of knowing whether any of them were talking about scarlet fever, or even if scarlet fever really existed. Yet, accounts describing scarlet fever as a distinct illness started to develop in the sixteenth century. Jovanni Philippo Ingrassias was a physician born in Sicily, and in fifteen fifty three he described an illness that he called rosalia. He specified that this was not the same thing as chicken pox or measles, and that it involved quote numerous spots, large and small, fiery and red of universal distribution, so that the whole body appeared to be on fire. In fifteen sixty five, Dutch physician Johann Bayer described something similar and added another detail, which was a severe sore throat. Then, in fifteen seventy eight, Jehan Cottier of Foatier described an illness causing quote general weariness, headache, redness of the eyes, sore throat, and fever. Pepura appeared on the second or third day, accompanied by delirium and soreness of the throat. Purpura is a rash that's caused by the breaking of small blood vessels underneath the skin. In sixteen thirty five, German physician Daniel Center described an epidemic in Wittenberg in which the skin later desquamated or peeled, something that often happens in cases of scarlet fever. Center also described other complications that can follow scarlet fever, including a dem up fluid in the abdomen and arthritis. Scarlet fever was showing up in writings outside of the medical world as well. Samuel Peeps, who comes up so often on the show when we're talking about this period of history, wrote this in his diary on November tenth, sixteen sixty four. Quote my little girly Susan is falling sick of the measles we fear or at least of a scarlet fever. This seemed to pass pretty quickly. The next day he wrote, quote, our little girl is better than she was yesterday. Scarlet Fever as a term was in common use in English at this point, as was the name scarlett tina. The first use of the term scarlettina in medical literature is believed to be in sixteen seventy four. English physician Amas Sydenham wrote Medical Observations on the History and Treatment of Acute Diseases, which was published in Latin, and in it he described febro scarlatina. This way, quote, Scarlet fever may appear at any season. Nevertheless, it often breaks out towards the end of summer, when it attacks whole families at once, and more especially the infant part of them. The patient feel rigors and shivering, just as they do in other fevers. The symptoms, however, are moderate. Afterwards, however, the whole skin becomes covered with small red maculae thicker than those of measles, as well as broader and redder and less uniform. These last for two or three days and then disappear. The cuticle peels off and branny scales remain lying on the surface like meal. They appear and disappear two or three times. This was before the development of the germ theory of disease, and Sydenham believed that this was caused by quote a moderate effervescence of the blood, arising from the heat of the preceding summer or from some other exciting cause. This made him cautious of using blood letting or enemas to treat the patient, which is something that would have happened with other illnesses. He believed that the blood needed to be left to its own regulation in cases of scarlet fever, and that blood letting or animals could introduce particles into the blood that were harmful to it. Instead, he said it was quote sufficient for the patient to abstain wholly from animal food and from fermented liquors, to keep always indoors, and not to keep always in his bed. When the desclamation is complete, and when the symptoms are departing, I consider it proper to purge the patient with some mild laxative accommodated to his age and strength. So at the same time, he noted that if a child experienced seizures or a coma, then they needed to be treated immediately with a blister on the back of the neck and a dose of opium tincture. Sydenham recommended repeating this every night until the patient had recovered, and feeding them diluted milk, but again not animal food. So these descriptions of this illness don't sound really pleasant, and both Sydenham and Centered described complications and more serious cases. But like none of this sounds nearly as frightening as scarlet fever became in the nineteenth century. Samuel Peeps made it sound like scarlet fever was like a lesser illness than measles would have been. Became much worse later on, and we'll get to that after a sponsor break Through the seventeenth and eighteenth centuries, scarlet fever epidemics occurred regularly in Europe, with the disease often striking a particular place every four to six years. That same general pattern seems to have been pres than in other places. Also in the twenties and thirties, though, the number of scarlet fever cases really started to rise in a lot of places, and so did their severity. There are several possible explanations for why, and it's possible that all of them played some kind of role. Nineteenth Century urbanization led to more people living in closer quarters, often without sufficient facilities for hygiene, which made it easier for a contagious illness like scarlet fever to spread, but that can't account for everything, since scarlet fever cases started increasing before this trend really started to escalate. Some researchers have found a correlation between scarlet fever and wheat prices. When wheat prices rose, there was an increase in scarlet fever three years later, as though malnutrition during pregnancy might make children more susceptible to it. This is a correlation, though it's not necessarily a cause and effect situation, and it is also possible that a more virulent form of the disease evolved, which allowed it to spread more easily and cause wars illnesses. Scarlet fever was also introduced into parts of the world that had never encountered it before during the nineteenth century. The first case of scarlet fever and the Archipelago of Madeira, was reported in eighteen o six. They reached South America in eighteen twenty nine, Greenland in eighteen forty seven, and both Australia and New Zealand in eighteen forty eight. Although scarlet fever had been reported in the northeastern United States for centuries, the first case reported in California wasn't until eighteen forty nine. Some sources will describe the nineteenth century spread of scarlet fever as a pandemic, stretching from about eighteen twenty five to eighteen eighty five. Death rates could really vary from place to place and from one outbreak to the next. In places that had no experience with scarlet fever, The mortality rate was often particular really high. As we said a moment ago, the first cases reported in New Zealand were in eighty eight, and in Auckland that year, one out of every eight people who contracted scarlet fever died. The vast majority of cases and deaths were in children between the ages of two and ten, and no one over the age of forty seemed to catch it at all. The worst cases seemed to be encrowded or badly ventilated homes. There's not a ton of exact data, though, especially in the earlier decades of the eighteen hundreds, a lot of places didn't have formal departments of health or public health services. Widespread outbreaks of scarlet fever and other contagious diseases were part of the motivation for those to be established. In some places, there were laws in place to try to control the spread of infectious diseases, and a lot of those laws traced back to things like the Black Death of the fourteenth century. But a lot of the time there just wasn't a more systematic tracking of diseases and they're spread. However, it's generally agreed that by eighteen forty, scarlet fever was a leading cause of childhood death in the United States and parts of Europe, possibly the leading cause of death and children during widespread outbreaks throughout the nineteenth century, scarlet fever was terrifying. Communities often used isolation and quarantine to try to control the diseases spread, along with things like canceling school and public gatherings, recommending the deletion and disinfection procedures, and urging people to keep children at home and away from other people, especially other children. The increasing spread of scarlet fever also led to researchers learning more about it. English physician Richard Bright made the connection between streptococcus infections and kidney disease in eighteen thirty six. Bright was one of the first people to describe nephritis or kidney inflammation, which came to be known as Bright's disease, and he wrote of it, quote Scarlatina has apparently laid the foundation for the future mischief, so Scarlatina later causing nephritis, although his next sentence went on to say, quote exertion and childish plays has done the same. So some questions about don't let your kids play too hard? Yeah, they might have kidney disease. Later, although people didn't know exactly what caused scarlet fever yet, they did know that it spread easily from person to person, so much so that people thought that the disease could linger on things like clothing, bedding, and toys for a long period of time. And in eighteen sixty seven, Dr Michael Taylor, who was a local physician in northwestern England, connected a scarlet fever outbreak to milk. At this point, Louis Pester had done groundbreaking work on what would come to be known as pasteurization, but he was doing this work in the context of fermentation, the idea that milk should be pasteurized that was still decades away. Taylor knew about the work of Dr John Snow, who had identified a water pump as the source of a cholera outbreak in eighteen fifty four. Taylor had thought that if water could carry a disease, then surely milk could as well, and he had later traced a typhoid outbreak to contaminated milk. In eighteen sixty seven, people started reporting cases of scarlet fever in and around the town of Penrith, which had not seen a case of scarlet fever in more than a year. It turned out that the people who got sick had all bought milk from the same milk dealer whose child had gotten scarlet fever and died. In eighteen seventy four, Theodore bill Roth of Austria identified and named the Streptococcus bacterium, which he had found in infected wounds and in a case of a skin infection called arisipelas. He had observed quote small organisms as found in either isolated or arranged pairs, sometimes in chains, and he named them for the Greek terms strepto or chain, and caucus or berry. Five years later, Louis Pester isolated the same organism in the uterus and bloodstream of a number of patients with child bed fever. Then, in eighteen eighty four, microbiologists Friedrich Julius Rosenbach refined the organism's name to Streptococcus pyogenes, with pyogenes from Greek words meaning pus forming. It did not take long for the connection to be made between Streptococcus pyogenes and scarlet fever. In eighteen eighty seven, Dr Emmanuel Klan published a report in the Proceedings of the Royal Society of London, saying that he had identified the Streptococcus organism in both people with acute scarletina in London and cows at a milk farm in Hendon, so he believed that the milk from the Hendon farm had caused the scarlet fever outbreak in London. This report was the result of years of work. Klein was a bacteriologist who had been born in Hungary and studied in Austria before moving to England to work as a researcher at the Brown Institution of the University of London. His scarlet fever research had included post mortem examinations of children who had died of it, and he had spotted similar pathological changes in cows that he examined at the Hendon farm. This wasn't just a matter of observing the similarities in the sick cows and the sick children. He followed the criteria that at that point had been outlined by Robert Coke, now known as Coke's postulates, to show that the same bacteria were causing both the illness and the cows, and in the people who had drank their milk. He also had shown that the bacteria he cultured from the sick cows could grow and survive and basically thrive in milk. He called this organism Micrococcus scarlet tena. Although it was indistinguishable from the one previously named Streptococcus pogenes. This was an important discovery, although he was using a different name for it. Klein was the first person to connect Streptococcus pyogenes to scarlet fever, but his results were not widely accepted. Since Michael Taylor's discovery in eighteen sixty seven, there had been other scarlet fever outbreaks traced to milk, and most of the time milk from the affected dairy had been destroyed, but most people had thought these outbreaks had a human source, like a child who lived on the farm, or a dairy worker, or a delivery worker who had cared for a child with scarlet fever, or someone who had it themselves. Taylor had showed that the cows could carry the disease, which could mean that destroying the milk was not enough to stop an outbreak, that the cows themselves might have to be culled. Destroying potentially contaminated milk was a financial hardship for dairy farm but destroying their cows was far worse, and people resisted the idea that cows could be a source of infection. Although a few people had tried applying Louis Pasteur's heat treatment process to milk, almost twenty more years passed before German agricultural chemists Franz Vum Suckslet suggested that milk be routinely treated with pasteurization, and a big reason for that was that so many diseases were being transmitted through milk, not just scarlet fever, but also typhoid, diphtherory a, tuberculosis, and various gastro intestinal illnesses. It still took a while for pasteurization to catch on, though there were concerns that pasteurizing milk destroyed the nutrients in it, or affected the flavor, or made it harder to digest. But by that point, scarlet fever rates were on the decline, and we'll talk more about that after a sponsor break. Although the number of scarlet fever cases was declining at the end of the nineteenth century and the disease didn't seem to be as deadly as it had been in the early twentieth century, it was still seen as a major public health concern. In England. For example, isolation hospitals were established for people with contagious illnesses who could not effectively be isolated at home. During outbreaks of scarlet fever, there could be house to house visits to find sick people so they could be isolated in the hospital. Unfortunately, it is really not clear how much or whether this really helped slow the spread of the disease. And also people with different contagious diseases were all being housed in the same hospitals, and the sled people to say that the isolation hospital was where you went when you caught one disease, so that you could come out with all the rest. Welcome to Petri dish Arms. You'll get a bed at probably seven different things. It's no good. Other efforts to control the spread of scarlet fever also did not help. A nineteen fifteen article in the American Journal of Nursing described it this way quote, it seems to cling to whatever object it encounters. In no other disease has the infection been apparently conveyed with such frequency by objects which have come in contact with those ill as clothes, books, toys, and the like. This article recommended that quote all hangings, carpets, and upholstered furniture are to be taken from the room before the patient is brought in. The furniture left should be of a kind readily cleansed. There should be no such fancied attempts at purifying the air as by hanging up sheets wet with disinfectants. Such measures are not only useless but tend to give a false sense of security. Needless to say, the patients should be provided with bedclothing, nightgown towels, eating utensils, and drinking vessels for his ex elusive use. Yeah, that's it. Is no longer believed that scarlet fever is just transmitted readily and for a long period of time, and things like curtains. Uh. This article also recommended disinfecting anything that the sick person had used using either a five percent solution of carbolic acid or a two percent solution of creosol, and anything that had been used for coughing or sneezing into was to be burned. Also, the recommended treatment for patients themselves was at least three weeks in bed, even if they only had a mild case. Around this same time, people were making more discoveries about scarlet fever, something that really escalated during the nineteen teens and twenties. In nineteen fifteen, English bacteriologist Frederick William Twart and his brother were using colonies of bacteria as part of an effort to find a way to grow smallpox vaccine in a lab. Towart discovered areas where the bacteria couldn't grow and found that a substance from these areas was capable of passing through a porcelain filter that trapped most bacteria. He published an article in The Lancet about what he described as a filter passing virus that attacked bacteria. His work didn't get a lot of attention, but this was the first known description of a bacteria phage. French microbiologist Felix Derell made the same discovery independently of tort about two years later. In the nineteen twenties, husband and wife researchers George and Gladys Dick made a series of discoveries about scarlet fever and its cause. While working in Chicago. They confirmed the link between the disease and Streptococcus bacteria, and they identified a toxin produced by the bacteria that was the cause of scarlet fever. They also developed a skin test known as the Dick test to show whether a person was susceptible to scarlet fever or not. They were nominated for the Nobel Prize in Medicine for the sore in ninety five. In ninety six and ninety seven, two different pairs of researchers discovered a bacteria phage that could change a non toxogenic strain of Strep into a toxogenic one. In other words, to turn a variety of Strep. That did not cause scarlet fever into one that did. Various researchers started trying to develop an inoculation for scarlet fever using either the bacteria or various modifications of the toxin that it produced. In nine, American microbiologist Rebecca craig Hill Lancefield developed a system for classifying Strep. Bacteria into groups based on the antigens found on the bacteria. Initially, she proposed two groups, the group A and Group B. As we said earlier, scarlet fever is group A. Today there are many more groups. She was also one of the first people to demonstrate that Strep. Infections could lead to rheumatic fever. The first sulfa drugs were developed in the nineteen thirties, and we're used as a treatment for strep infections, including scarlet fever. But the big medical breakthrough was penicillin. We did a whole episode on penicillin's development back in September. Today, penicillin and amoxicillin are the antibiotics most often used to treat scarlet fever, with other antibiotics recommended for people who are allergic to those. Today, in most children, scarlet fever clears up quickly as long as antibiotic treatment begins promptly. Yeah, that made the myxicillen shortages that were happening at the end of last year in a lot of places particularly scary for folks. So penicillin is often credited with turning scarlet fever from a terrifying and deadly disease to one that's considered to be a relatively mild childhood illness most of the time. As we said earlier, though deaths from scarlet fever were becoming less and less common decades before penicillin was introduced. We don't totally know why. Starting in the nineteen eighties, though, the opposite started to happen, as invasive strep infections started to become more common in spite of the existence of antibiotics to treat them. Scarlet fever specifically started to become more prevalent in a lot of parts of the world starting in about two thousand and eight. Increased rates of scarlet fever were first reported in parts of Asia, and then in the UK and other parts of Europe, and then in the US. The UK, for example, saw a sudden spike in scarlet fever cases starting in twenty and soon the rate of scarlet fever was higher there than it had been in almost fifty years. At first, it seemed like this wasn't leading to a similar increase in fatalities, but a year later invasive strep infections started to increase there as well. Worldwide, there was a fivefold increase in the number of scarlet fever cases between twenty eleven and with a drop in twenty after the start of the COVID nineteen pandemic and a lot of places, the general trend of when scarlet fever cases are the highest was like sort of nearing its end when the COVID nineteen pandemic really started. Although health officials thought there might be some more dangerous strain of Strep bacteria that was causing this increase, some whole genome sequencing of samples from a lot of different sick children found that there was not one strain that was responsible for most of the illnesses. Some researchers have suggested that the bacteria may have started producing a more aggressive form of the toxin that causes the disease. It's also not clear what has caused this most recent spike in scarlet fever cases that started towards the end of in the northern hemisphere. Scarlet fever cases usually peak in the late winter or early spring, so this outbreak happened out of season. At this point, this is all really speculative, with some of those speculations being more based less than others, like the measures put in place to try to control the spread of the COVID nineteen pandemic lead to people not being exposed to other diseases. It's also possible that kids who might have gotten strip or scarlet fever over the last couple of years didn't and are instead just getting it now. But there have also been totally baseless claims pointing to either COVID nineteen vaccines or the flu vaccine is somehow causing a rise in strep infections. There is no credible evidence for either. They were not doctors, so we cannot possibly comment on every conceivable thing that has been postulated about the spike and scarlet fever cases. Like it does seem possible that it is an extension of the spike that was happening before the pandemic started, that kind of paused during the pandemic peak when so many places were taking a lot of mitigation measures. As we said at the top of the show, though a lot of folks experience with scarlet fever is not from their own illnes us or the illness of their children. It's literature. So we'll close out with just a few of the most famous examples. First, there is Little Women by L. M. Alcott, in which Beth gets scarlet fever and is extremely sick. She dies years later, and while the book doesn't give a specific cause, it's usually interpreted that she had developed rheumatic fever after that scarlet fever case. Alcott's real life sister, Elizabeth Sewell Alcott, died at the age of twenty two, two years after having had scarlet fever, and then Alcott published Little Women ten years later in eighteen sixty eight. Another past podcast subject with a scarlet fever connection is Laura Ingalls Wilder, whose real sister Mary became blind after what the family described as brain fever, probably some form of meningitis or encephalitis. In the book The Shores of Silver Lake, set in eighteen seventy nine, the fictional version of Mary becomes blind after she and the rest of the family contracts scarlet fever. And yet another example that incorporates both fiction and reality. Several of the von Trapp family contracted scarlet fever in the early nineteen twenties, and their mother, Agatha, contracted it while caring for them and died in nineteen twenty two. This led to a young woman named Maria being hired from a convent to work as a tutor with the convalescing children, and the family later became a performing group called the trap Family Singers, that, of course inspired the musical The Sound of Music. Lastly, of course, there's The Velveteen Rabbit or How Toys Become Real by Marjorie Williams, which was published in nineteen two, and in this book, a little boy gets a velveteen rabbit as a Christmas present, and then there's a whole story about how nursery magic can make a toy real through the strength of a child's love. This little boy then gets scarlet fever and it's very sick for a long time, and once he's better, there's a plan to take him to the seaside while his room is disinfected, and all of his toys and books and everything he has played with is going to be burned, which, as we talked about it is a real thing that people would do. So the doctor then describes the velveteen rabbit as quote, a mass of scarlet fever germs. Fortunately, the nursery magic fairy appears and makes the velveteen rabbit real, so he is not burned. But honestly, this story is kind of horrifying. It's the meanest thing ever. I remembered it being sad from like my own childhood, Like I remembered feeling sad about it. And I'm pretty sure I have like a copy of the book with its original illustrations and all that, like in the house somewhere, but I read it at my desk while working on this episode, and I mean maybe it was my emotional state that there was a lot of just weeping over this story, and I was like, why did they give this to children? I will tell you a velveteen rabbit story on Friday. Okay, that'll be great. We can talk more about our literature experiences with scarlet fever. So if anybody's kids have had scarlet fever, I hope everybody has recovered nicely and you were able to find some of moscilling, because I know that was tough for a while. Um, and now I have some listener mail. This listener mail is from Aaron, and Aaron wrote hello ladies while I typically and went to skip out before listener emails. I was at work the other day and happens to catch your correction about the Marx Brothers versus the Three Stooges. Imagine my surprise and delight at your defense of the Stooges as I was currently restocking the gift shop at the only Three Stooges museum in the country. The Stoogeum located just outside of Philadelphia, Pennsylvania. When people find out where I work, they are usually astonished that such a place exists and are intrigued to find out more. We house the largest collection of stooge Bilia or maybe stooge abilia in the world, where there were three floors, ten thousand square feet exhibit space and well over ten thousand items on display. This doesn't even include our research library, photo and document archives, film vault in additional storage spaces for objects not on display. I was so touched when Tracy talked about the students having intelligence and meaning behind all the slapstick. I'm gonna pause the conversation and say, I want to credit Holly for being part of that conversation too and bringing nuance I had and necessarily thought about. Uh so, And then the email goes on to say, because that is what my coworker and I try to express when educating the public about our collection. Not only were the three Stooges, in their various iterations, masters of comedic timing and among the hardest working entertainers of their day, They're over fifty year career can stand as a microcosm of the modern entertainment industry, from vaudeville through early films, the studio system in the dawn of television to the start of marketing to children and onward. The Stooges were never looked on with much respect, but I think that their lives and careers fast dating one and would be a great podcast subject. There's even a bit of scandal. Did Stooge founder Ted Healy get murdered? The jury is still out on that one. Just a quick plug in the museum and its founder Gary lassen Or in the process of publishing a book about the stooges lengthy touring career called A Tour de Farce, which is a great title. It chronicles forty years and thousands of three Stooges live appearances throughout the US and abroad, and contains never before seeing photos and stories. Thanks for granting me that little boost, and if you guys are ever interested in doing a podcast about the Stooges, feel free to reach out. We love to help with research. Thanks again for your defense of who we affectionately call the boys in Stooge. We trust Aaron ps. We get emails all the time of people mixing up the Marx Brothers and the Stooges. Someone even tried to donate a picture of the Marx Brothers to our collection once I found this email. Very delightful obviously, um, and I also will reiterate I feel like, based on my limited experience, that a lot of people, whether confusion or misremembering or whatever, uh, mix up the Marx Brothers and the Three Stooges, and that Three Stooges folks seem to have a lot more humor about this than Marx Brothers folks do. Um. That is just my impression based on emails and looking at stuff on the internet. So thank you so much. I did not know that museum existed. I've been to Philadelphia a couple of times. Not sure exactly how far outside of Philadelphia it is, but man, I'm glad to know that's a thing. Yeah. Same, It just went on my list of places I must visit. Yeah yeah. So, if you would like to send us a note about this or another podcast or history podcast that I heart radio dot com and we're all over social media. Missed in History That's Real? 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