By Barry C. Fox, M.D., University of Wisconsin
In the 1950s, aside from poliomyelitis, there were few other infectious diseases that were a nuisance to the American public. These included strep tonsillitis, childhood ear infections, and the common cold. Diseases such as mumps and measles were defeated, and the introduction of polio vaccines helped in controlling poliomyelitis to a great extent. Infectious diseases such as tuberculosis, influenza, and pneumonia had also reduced, and some scientists believed that the worst was over.
Tonsillitis
One of the seemingly benign bacterial infections of the 1950s was Tonsilitis. Children suffering from this disease have a sore throat and have trouble swallowing due to pain. A patient would also have swollen and tender lymph nodes in the neck. In children, the most common cause of tonsillitis is Group A streptococcus.
Since strep is a bacterium, it responds to antibiotics. Surprisingly, almost all tonsillitis gets better on its own. Antibiotics do shorten the duration of sore throat symptoms, but only by about 24 hours.
The main reason antibiotics are used for streptococcal tonsillitis is because, if left untreated, there is a small chance of developing rheumatic fever. This is an autoimmune disorder, where the body attacks itself, and this is more serious than tonsillitis.
Rheumatic fever was a leading cause of heart problems in the United States and is still the leading cause of heart disease in children from developing countries, affecting over 6 million children in India alone.
The M Protein
The strep germ that causes tonsillitis has a special component on its outer surface known as the M protein. In some cases, an individual’s body may resent the M protein, leading to the creation of immune proteins called antibodies, which attack the body. The attack may include the large joints of the knees or the shoulders, but especially concerning are the valves of the heart.
This rare autoimmune event usually occurs about 2 to 6 weeks after a person has been suffering from rheumatic fever. Symptoms of antibodies’ attack include a fever with aching joints and sometimes a rash. If the heart is involved, there might be symptoms of heart failure such as sluggishness and fluid in the lungs. Rheumatic heart disease is still a common cause for the need for artificial heart valves.
Due to a change in the biology of the M protein over the last several decades, the incidence of rheumatic fever has dramatically fallen in the United States, to less than 1 case per 100,000 population. In adults, the risk of developing rheumatic fever after streptococcal pharyngitis is significantly lower, estimated at a chance of 1 in 5000.
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The Frequency of Tonsillectomy in the US
A circumstance that has changed over the past fifty years is the frequency of tonsillectomy in children for recurrent sore throats. In older days, most children had their tonsils removed. However, at present times, it is quite unusual unless a child is facing consistent problems.
In fact, the official position for tonsillectomies suggests performing this procedure only if there are recurrent throat infections for more than 12 months, or the patient has a sleep-disordered breathing problem. Even with these guidelines, there are more than half a million tonsillectomies in the United States each year.
Viral Illness, a Cause for Pharyngitis
Another important fact about pharyngitis in adults is that only 5 percent is due to Group A streptococcus. Hence, over 90 percent are due to viral illnesses.
The percentage may be a little higher for streptococcus if there is a household contact diagnosed with strep. This means that adults will rarely need antibiotics and they are usually not at risk of developing rheumatic fever.
Thus, the question that arises is how does a doctor determine if a patient is suffering from a simple sore throat or something more serious? The answer lies in rapid office tests for streptococcus that are very reliable and give accurate results.
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Group A Strep Scarlet Fever
One of the common illness of the mid-20th century was the Group A strep scarlet fever. Several days after a sore throat, children broke out with a lacy, almost imperceptible, rash on their entire body. In the 1950s, with penicillin available, children were usually kept at home from school for a few days. In contrast, before the antibiotic era, this disease had almost a 25 percent mortality.
In present times, 24 hours of penicillin or similar antibiotics is considered enough time to render a child non-contagious to others. This is due to the rapid bactericidal killing by penicillin, so the number of surviving germs is so low in 24 hours as to be considered non-contagious.
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Childhood Ear Infections
Childhood ear infections are mostly the result of a viral illness, and it is seen that antibiotics are usually unnecessary. Children under two are more prone to secondary, late bacterial ear infections.
This relates to anatomical differences in the ear among the angle of the inner ear, the Eustachian tube, and the back of the throat. Under the age of two, the angle formed is more than 90 degrees, making it more difficult for accumulating fluid in the ear to drain into the throat, and this increases the risk of bacterial infection.
As children age, the ear angle becomes more obtuse, closer to 135 degrees, allowing for easier drainage. The best thing to be done is to have the child checked out by a doctor, provide pain relief for the symptoms. Antibiotics should be prescribed only if the doctor thinks they are necessary.
Common Questions about Bacterial Infections of the 1950s
Children suffering from tonsillitis have a sore throat and have trouble swallowing due to pain. They also have swollen and tender lymph nodes in the neck.
The main reason antibiotics are used for streptococcal tonsillitis is because, if left untreated, there is a small chance of developing rheumatic fever.
When an individual’s body resents the M protein, it leads to the creation of immune proteins called antibodies that attack the body.
