In the film — based on Louisa May Alcott’s debut novel — the third March daughter Beth catches scarlet fever when she goes to care for the impoverished Hummel family, whose baby is sick from the disease (also called scarlatina). Beth, who came into contact with the infant, falls ill too, and later passes away from the infection's complications. Her charitable heart ends up leading to her tragic demise.
But the movie leaves a few lingering questions about what scarlet fever is, and why Beth has it for so long before finally succumbing. Here are the answers to your burning fever questions.
What is the scarlet fever?
It’s an illness that comes from the bacteria Group A strep, the same strain of bacteria that causes strep throat. The infection tends to breed in the nose and throat, and easily can be spread from person to person through coughing. It's called scarlet fever because it's characterized by a red, sore throat; a strawberry-colored, bumpy tongue; a sandpapery skin rash; and, of course, a fever, the Centers for Disease Control and Prevention outlines.
The illness was a common when Alcott published her book, which was based roughly off of her own experiences growing up. Beth's character is reminiscent of Alcott’s second-youngest sister, Lizzie, who also ultimately died due to the effects of scarlet fever.
“She died tragically young, though not quite as young as her literary counterpart,” The Paris Review notes. "By the end, the fight had gone out of her body. The final words her family could understand were, 'Well now, mother, I go, I go. How beautiful everything is tonight.'"
Is scarlet fever still a thing?
Yes. While it's not the major killer it was in the 19th and 20th century, it is still around today. In fact, in the last decade, it’s had a bit of a resurgence. The rate of scarlet fever cases tripled between 2013 to 2014 in England and Wales, according to a 2017 paper published in the Lancet Journal of Infectious Diseases. The paper's authors say the incident rate spiked higher than it had in the last 50 years, ultimately affecting one in 500 children under age 10.
Experts still don't know why the disease is becoming more common. Luckily, the condition can now be quickly and effectively treated using antibiotics such as penicillin or amoxicillin, the CDC notes.
Why was Beth sick for so long?
After her first tango with scarlatina, Beth recovers — thanks in part to the astonishing rotation of patchwork quilts her sisters wrap her in. (I swear, in every scene she has a new blanket.) One morning, Jo (Saoirse Ronan) wakes up to find Beth not in her bed. You can tell she’s imagining the worst, but when Jo rushes downstairs to the kitchen, she finds Beth cheerfully eating breakfast off of blue China plates with Marmee (Laura Dern).
But we ultimately find out find out Beth's system has been weakened for good.
Years go by, the sisters grow up — Meg gets married and has children, Jo is living and working in New York, the youngest sibling Amy (Florence Pugh) is in Paris working on her art — and Beth gets really sick again. This time, she's suffering from the fever’s complications.
As I learned from my deep dive into the CDC's website, complications are uncommon these days, but they can happen if the group A strep bacteria spreads to parts of the body other than the throat and nose. That can lead to long-term health problems, including: tonsil infections, chronic problems in the sinuses and ears, vulnerability to pneumonia, rheumatic fever (a type of heart disease), and a kidney disease called post-streptococcal glomerulonephritis.
The movie doesn’t specify which of these happen to Beth, but the book (and Alcott's history) points to severe rheumatic heart disease.
In the film, when Jo wakes up in a panic to find Beth not in her bed once again, she hurries back to the kitchen. But this time, she finds a tearful Marmee. The blue plates are on the wall behind her. No amount of blankets could save Beth this time.