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Rheumatic fever is a common disease in military operations. Streptococcus pyogenese, known as Strep A, or beta hemolyic Streptococcus or GAS, has the capability to be non-symptomatically carried and can even exist "intracellularly"within cells of the pharynx (it is known) in a semi-dormant state, and in the current population in America, probably 5 -15 percent of people are carriers (Rheumatic Fever and Streptococcal Infections, Benedict Massell, MD, Harvard Press, 1997). The microorganism can be carried on the skin, in tonsillar crypts, in the sinuses, pharynx, adenoids, recesses near the vocal cords, and in the lungs. It can be carried in the vagina, around the anus, and one source found it within the gastrointestinal tract, and on fomites, that are inanimate objects humans touch. It is the microorganism that has killed millions of women and new borns due to child bed fever that Semmelweiss decreased by simply washing hands and being clean with women in childbirth. He was "run out of Vienna" for being different! Pasteur found it on the teats of cows. In general, in early America, before pasteurizaion, when farm families drank "cows milk", many of them became infected. Certain Russian information indicates that all domestic animals are carriers of Streptococcus pyogens.

Rheumatic fever has decreased since the civil war time when a so many men experienced it. The ones who had it probably had high-grade cases so it was identified, but probably a much greater percentage had lower grade cases and it was thought to be the "flu" diarrhea, headaches, back pain, or a pneumonia like disease. It is a great chameleon! Information indicates that 160,000 soldiers in the civil war had acute rheumatism (which is an old name for rheumatic fever), rheumatic fever, infectious arthritis, or gout. There is a question about, infectious arthritis, but people with rheumatic fever have an infectous fever and if it is severe they have arthritis, so it may be another name for rheumatic fever. 12,000 troops were discharged for chronic pheuistic fever and reactive arthritis. That is not a current word, but it seems to be a pulmonary disease with reactive arthritis and that kind of a presentation could be a rheumatic fever-like disease also, but chronic and held on for some time. Sir William Osler, in his famous text, "Principles and Practices of Medicine, indicates that scarlet fever (similar to rheumatic fever) could be high-grade, subacute or less than subacute and chronic. Rheumatic fever can also present highly variably. Rheumatic and Scarlet fever are the same disease except the Streptococcus pyogenes that causes scarlet fever can excrete erythrotoxin A B or C and so a more or less, specific rash can be developed.

Rheumatic fever/scarlet fever is a crowd disease. That is why it appears so commonly in military organizations! When a group of people are assembled for three to six weeks, live close together in a semi-stable group, Streptococcus pyogenes can be spread from person to person and become more pathological. This process is termed, passage. The microorganism has such a complex genetic make up, it can evolve virulence by passing from one individual to the next.

Naturally, lack of great hygeine that often exists when a group of men "camp out" is important. Lack of changes of clothes, chilliness, living in close proximity with people moving in and out, with some of them being carriers of virulent strains made the perfect situation for Streptoccus pyogenes to spread amonst the troops.

Now, the crux: No one gets immune to Streptococcus pyogenes and we all contract it many times in our lives. Get on a bus, a train or an airplane and three people sneeze: watch out. Usually we have decent sized houses and small families and so, normally, Streptococcus is not distributed as rapidly between people so it generates great virulence. Schools are great places for Streptococcus pyogenes to spread between children and for them to bring the more virulent types home: good reason to home school children. Every time an individual contracts a Streptococcus pyogenes infection it causes an immune response, however, with Streptococcus pyogenes it also causes an autoimmune response. The orgamism has at least 12 complex molecules in its wall that mimic human tissue! That permits the microorganism to invade its hosts (people, dogs, cats, horses, pigs, goats (information from Russian literature, V. Navonova, Russian Academy of Sciences)), and it is spread between all vertebrates: it is a zooinosis, that is a microorganism that can exist in a subset of hosts, and be transfered to humans.

Some of the antibodies humans make to contest the many antigens on Streptococcus pyogenes are autoantigens, they attack the microorganism, which is good, but they also attack ourselves. This is termed an autoimmune response. It causes arthritis, various types of Heart disease, including valve disease, but also pericarditis and others. It can affect the kidneys and the brain and cause various mental changes such as Tourette's syndrome, St. Vitus' Dance, and other mental problems. Acutely, it can cause seizures, stupor, epilepsy, acute carditis and congestive heart failue and cardiac arrhythmia and death. If people have high-grade rheumatic fever: they experience a great amount of pain.

So, to get back to the question, rheumatic fever affected the civil war troops, because all the elements of its epidemiology were present: large groups of people living semi-continuously together, poor personal hygeine, new people coming into the area frequently, and carriers of the microorganism. Probably, I think, also, was the commonality of using cows milk without pasteurization, at least "on the farm" whereat many troops had lived before they went into the army.

The microorganism is very complex and, for instance, one of the virulent factors, M protein, has over one-hundred known variatiations and there are many other virulence factors on, or secreted by, the microorganism.

In the above text by Massell, it indicates that many epidemics and pandemics of rheumatic fever/scarlet fever have taken place. Newsholme, an English epidemiologist, probably in the late 1800's, indicated that the disease was endemic in Europe and North America and from time to time would be in epidemic proportions. That happened in the American Civil War.

Rheumatic fever declined in frequency from the 1920's and kept declining, but in WW II there were 1,000,000 of Strep infection and something like 60,000 cases of rheumatic fever in the Navy alone. I read somewhere that in 1965 more Americans, under 30 yrs., died of rheumatic fever, than any other infectious disease! It kept becoming less frequent until about 1985, and then it started coming back. Veasey, in Salt Lake City wrote a paper about it. Many papers have followed. It has showed up in military camps again, a number of times: Great Lakes Training Station, for one.

One thing though, 99% of physicians do not know anything about it. Most doctors are this and that specialist and do not even deal with "people being sick" at home or on the street. If a person has a medical problem nowadays, and has this or that polyp, blocked artery, stroke, rash, colitis, lung problem and see "the appropriate specialist" and no one figures out rheumatic fever: because it is a systemic, autoimmune disease and it can affect all tissues and therefore organs in its own way. So, if you go to the doc with rheumaic fever nowadays, you will usually get a wrong diagnosis: fibromyalgia, chronic fatigue syndrome, pneumonia with complications, viral meningitis, death because of opiates, sudden ischemic cardiac death, and the list goes on and on.

I usually do not know too much about any disease because I was a general practitioner for thirty years. I learned, the hard way, however, that I practiced in a nidus of rheumatic fever. It took me two years of 10 to 14 hour days to figure it out.

Another reason I can write the above "out of my brain" is that I am nearly finished with a book, Rheumatism, Enigma Unraveled" and it tells the true, full story, about rheumatic fever and all the things that it does to a person. It will be on the market in about 5 months, I suppose. Hint: what do you think the Vietnam War, Gulf War, and Desert Storm syndromes are: yup, the manifestations of rheumatic fever. In the book: 400 pages nearly. It is well researched and well documented.

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Q: What caused rheumatic fever in the civil war?
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