LITTLE HOUSE SLEUTH

by Kaye Bennett

Just two years after graduating from Kalamazoo College, Sarah Allexan ’11 has already co-authored a paper that not only caught the attention of the news media, but has also clarified a long-standing question embedded in a classic children’s book.  Not a bad start to her medical career.

Allexan, a native of Englewood, Colorado, majored in biology at K, captained the cross-country and lacrosse teams, and sang with the women’s a capella group.  Her study abroad program was in Ecuador, and she did an externship at Vanderbilt Children’s Hospital and an internship at the Seattle Aquarium.  Her Senior Individualized Project was based on research she did at the University of California San Diego in the area of anti-inflammatory hormones used to treat sepsis. An impressive “more in four!”

After graduating from K, Allexan worked for a few months in the emergency department of a Littleton, Colorado, hospital, before getting a job as a research assistant in the Department of Pediatrics at the University of Michigan Hospitals in Ann Arbor.

That was when Allexan met Beth Tarini, M.D., a pediatrician, professor, and researcher at the University, and started (though she didn’t suspect it at the time) on the road to the media spotlight.

In Ann Arbor, Allexan’s primary job was to interview parents of newly diagnosed cystic fibrosis patients, with the goal of helping medical providers communicate better, helping parents understand the devastating disease they and their child were facing.  But, says Allexan, her workload was slow at times, so she asked Tarini if there were additional tasks she could be doing.

Tarini saw Allexan’s offer as a way to help her finish a project she had started ten years earlier.  “Beth brought in an old dilapidated brown box,” remembers Allexan.  “She said, ‘I have job for you to do.’”

While she was a medical student at the Albert Einstein Medical Center, Tarini told Allexan, she had asked an instructor, “Can scarlet fever cause blindness?”  Without hesitating, the professor told Tarini that no, scarlet fever does not cause blindness.


“But,” Tarini had persisted, “It happened in Little House on the Prairie.”  Like all fans of the classic series, written by Laura Ingalls Wilder and detailing her childhood in mid-West America in the last third of the nineteenth century, Tarini knew full well that Laura’s sister Mary had become blind following a bout of scarlet fever.

No, the instructor insisted, that’s not real; scarlet fever does not cause blindness.  But Tarini was not convinced, and now, ten years hence, as a pediatrician, she had seen the real fear on parents’ faces after their child was diagnosed with scarlet fever (or scarletina, a friendlier-sounding term, which is more commonly used today).  If the parents were familiar with the Little House books—and many of them were—they feared their child might become blind as a result.

So Tarini still had it in the back of her mind that she wanted to explore the disease and the books; what she didn’t have was the time to do it.  Allexan’s offer was her answer.

“I really got into it,” says Allexan, who had also read the Little House books as a child.  “It was my job to gather all the information I could.”

Despite a lack of encouragement from colleagues, who told them that no one really cared what the answer to the old question was, they kept working on it.  “We kept it up because we liked it,” says Allexan.

Allexan tried to track down all the writings of Laura Ingalls Wilder.  She worked with the Laura Ingalls Wilder Association in Minnesota, finally locating Wilder’s diary.  Allexan learned that, by the late 1920s, Wilder feared that people were forgetting the stories of the American pioneers, so she and her daughter, Rose, wrote Wilder’s memories down and sent them to a publisher.  The publisher wanted the memoir re-written, in the form of children’s stories.  That’s when the Little House on the Prairie series was born and, says Allexan, that’s when the particular statement she was researching, attributing Mary’s blindness to scarlet fever, came into being.

Earlier references in Wilder’s diary, she found, referred to Mary’s disease as “brain fever” or as a “spinal sickness,” but along the way, editors apparently wanted to give the disease a name that readers would be more familiar with.  Allexan says the change to scarlet fever appears to have been an “editing artifact.”

Along with co-authors ophthalmologist Jerome Finkelstein, M.D., and infectious disease specialist Carrie Byington, M.D., Tarini and Allexan compiled their work and their conclusions and submitted it as an historical perspective to Pediatrics, the journal of the American Academy of Pediatrics, where it was published in February 2013.  By this time Allexan had started medical school at the University of Colorado.

To the authors’ surprise, the study caught the eye of both news media
"She said, 'I have job for you to do.'"
and the medical community.  Both the American Academy of Pediatrics and the University of Michigan issued press releases about the study, and the media frenzy began.

In early February 2013, Allexan recalls, she was studying in the university library in the morning and being interviewed by USA Today, The Associated Press, and Health Day (a syndicator of medical news) in the afternoon.  Tarini was also interviewed on NPR’s All Things Considered, and the story was ultimately covered in news media around the world.

Physicians, says Allexan, agree with the study’s conclusions, despite records from the late 1800s indicating that scarlet fever was the fourth leading cause of blindness.  Physicians now believe that Mary Ingalls’s blindness was most likely due to viral meningitis, which can cause damage to the optic nerve.  That would explain why the memoirs say that, after Mary became blind, her eyes did not look any different. Other causes of blindness might have left external evidence, which could be seen on the patient’s eyes by others. 

Despite its esoteric nature, both Allexan and Tarini see a real value to their labor of love.  As Tarini said in the New York Times (Feb. 4, 2013), “If I say ‘scarlet fever’ and a mother is thinking ‘Mary Ingalls,’ then, if I don’t pull that out, I’m not doing my job.”  Allexan agrees, but she has also found personal value in the work.  Tarini, she says, “taught me clinical reasoning skills. It’s helped me out in medical school already.”

Little House fans, colleagues, friends and family are urging Tarini and Allexan to keep up the detective work.  They’ve been invited to speak at the next LauraPalooza, a conference for Laura Ingalls Wilder fans, educators and academics, in 2015, and people are asking them to figure out what health issues dogged Almanzo, Laura Ingalls Wilder’s husband, throughout his life. But Allexan is busy with her medical studies now, just as Tarini had been ten years ago, so questions like that may take awhile--and possibly a new K graduate with time on her hands--to answer.

Photo 1 - The preparation of a medical detective is quite liberal arts-ish. It includes canoeing (with the Kalamazoo Outing Club and first-year roommate Tova Berg ’11).
Photo 2 - Study abroad in Ecuador.
Photo 3 - Running for the K cross-country team (Sarah is second from left).
Photo 4 - Sarah and boyfriend Caleb Kline ’13 on campus.


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3 RESPONSES TO LITTLE HOUSE SLEUTH
SALLEXAN@GMAIL.COM on May 13, 2013 at 12:39 pm
ANAZING STORY
catherine mckenna on May 16, 2013 at 5:09 pm
Loved it all.
Paul Asbury '60 on October 28, 2013 at 2:02 pm
What a great smile!
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