Monday, 21 April 2014

Dear Measles, Please Don't Come Back

I still remember getting my second dose of the measles, mumps, and rubella vaccine.  I was 10 years old, and convinced myself that a distraction, any distraction, would make the process of vaccination go faster.  So, with childhood logic I started reciting times tables in my head…while out loud saying “oww, owww, owwww” even though the needle wasn’t even close to my arm.

Needless to say, the distraction didn’t actually help.  I still remember how horrified I felt at the vision of the needle sticking out of/hanging from my arm as the startled (I don’t know why he was startled, actually) physician let go of the needle.  Ah well, I was vaccinated and managed to leave the office with a lot more candy than I was probably allowed to eat on a single day.[1]

Yeah.  How I ended up as an historian of medicine is, sometimes, a mystery even to me.

Anyway, childhood reminisces aside, did you know that measles is making something of a comeback?  Canada officially eradicated measles as a domestically spread disease in 1998. Yet, a recent notice by the Canadian Public Health Agency listed 5 provinces that had recent measles cases.  In British Columbia alone the number infected is nearing 400.  News media informs me that the outbreaks across Canada were sparked by unvaccinated and infected overseas travelers.

The Lancet MMR vaccination article debacle – that claimed the vaccine led to autism – certainly helped matters.[2]  More recently, due to recent measles outbreaks,  Canadian media has identified a few fringe religious groups that refuse vaccination.  And, of course, we have the ever-vociferous celebrity voice – Jenny McCarthy (of Playboy fame) being the most outspoken – discouraging parents from vaccinating their children.  There are, of course, also those who did not vaccinate because they did not feel it necessary with such low domestic infection numbers.

Measles before vaccinations, proper hygiene, and a solid understanding of infection was a terrifying thing indeed.  So terrifying, in fact, that the early modern people saw measles and smallpox as closely related, differentiating between the two diseases only by degree.[3]  James Cooke, a 17th century surgeon, wrote that the two ailments were: “contagious and killing many, are fitly referr’d to maligned and pestilential Feavers.  The first are pustules, coming to ripenesse.  The seconded are small tubercles with intense rednesse, like an erysipelas…both these are accompanied with a continual Feaver.”[4]

Beginning with a cough, runny nose, and itchy or red eyes, measles masquerades briefly as a common cold or allergy.  Then, fever sets in, followed by the infamous itchy red rash that covers the whole body.  Complications lead to pneumonia, encephalitis, and even death.

“The duke has been thought past all hopes of recovery from a fever that preceded his measles: and I am told, that, whilst the danger lasted, the king sat crying upon his bed the whole day; and that he came three or four times in a night to see him.” - Seymour, Frances Thynne, Duchess of Somerset from Countess of Pomfret (1723)
This woman has measles.
Little was known about the manner of infection or how to prevent it.  Indeed, the measles vaccine was created only 51 years ago in 1963.

There were a couple competing theories about how one contracted the disease:

Blame Your Mom

One popular 17th century belief lay the blame for measles squarely at one’s mother’s feet.  Anthony Westwood’s De Variolis & Morbillis (1656) argued that infected mother’s blood led to measles in children.  This was, of course, logically deducted as “among many thousands of men it is hard to find one, who once in his life hath not had these diseases.  But a disease common to all men, must needs depend upon some common cause; such as are the principles of Generation, viz. the Seed and Mothers Blood.”[5]

He continued, “from the Mothers Blood, with which the child is nourished in the womb; for therein be it never so pure, some impurities are found, which communicate their pollution to the parts of the child; and that pollution of the parts doth defile the masse of blood.”[6]  The foetus, however, did not contract measles in the womb or even upon birth.  Rather, these impurities stayed in the body, further corrupting and then putrefying, finally culminating in the disease.

Okay, Maybe Not Mom’s Fault?

James Cooke restated the mother’s blood theory above.  He also, however, acknowledged that it was possible to contract the disease through what he termed “external” means.  By this, Cooke meant infection in a sense we can almost recognize today. 

As he wrote: “External causes are either contagion, as when a body so diseased, communicates the disease to another, call’d infection, or the aire from the influx of the planets or other causes, corrupting or disturbing the humours.”[7]

Gideon Harvey, in his A Treatise of the Small-Pox and Measles (1696), leaned toward Cooke’s infection theory.  Displaying logic a bit superior to Westwood, he questioned how a mother who had never had smallpox could infect their child with the disease.[8]  This idea simply did not make sense to Harvey who concluded that rather, “all are, or have been imbued with those impure, contagious Effluvia after their Birth, that have the power to produce the Small-pox or Measles.”[9]

So What?

The airborne infection theory did not immediately revolutionize how one thought about the measles.  While some thought that certain scents could help treat or prevent smallpox, the sheer infectious nature of the disease was not fully grasped.

Thomas Cocke, for example, recommended inhaling special vapours as “a great Antidote against the Plague, malignant Feavers, Small Pox, Measles, and all contagious Diseases, and of absolute use, not onely for sick People, but such also as live in the House, and tend them; or are necessiated to take their diseased Reekes, and dying Breaths.”[10]

Over 100 years later in 1767, Lady Coke, Mary Campbell noted that the Duchess of Northumberland felt little compunction in visiting her brother, one Mr. Howard, who was severely stricken with measles.  Indeed, Lady Coke ridiculed a Mrs. Pennant for fearing to come into contact with “anybody that came from a House where there was the measles.”  Coke wrote, “I laugh'd at her unreasonable fears, & assured her the measles cou'd not be carried.”[11]

From 1915. 4 kids in 1 bed, 2 with measles. The mother tells the district nurse that there is no risk of infection.
Howard, it seems, was told to keep to his bed and the prognosis was positive – he was strong enough to be bled for a third time.  Six days later, Lady Coke heard news that Mr. Howard was still doing better, then had a turn for the worse, then was bled and felt better again.

“I said to the Servant, ‘I hope there is no danger!’ he assured me none was apprehended.”

Mr. Howard died, due to the measles, at 8am the next morning.


From Lady Coke’s memoirs, we can see that bloodletting was a tried and trusted treatment for measles – even when inefficacious!

Practitioners used generally a combination of dietetics and medicines to treat the ailment as well.  Westwood, for example, recommended eating things that were easy to digest to counteract the phlegmatic humours that caused the disease.  He suggested especially wheat and barley bread, lamb, partridge, larks, and pheasant while “moistening” the meat with the juice of sorrels.  While poultry seems to be the meat of the day, Westwood did, however, note that water-fowls were to be avoided.[12]

I leave you with a receipt to treat measles used in 17th and 18th century England.  Lady Allen's water made it into many early modern receipt books!
Lady Allen's water for small pox, fevers, and measles contains sage, rosemary, rue, wormwood, bettony, centaury, gentian root etc.  All easy to access herbal ingredients. Wellcome MS 160/63.

Let me know what you think here or on Twitter – I’m @medhistorian.

[1] The receptionist was very amused by my audible “owwws” and said that I managed to terrify the few children in the waiting room into begging their parents to not be vaccinated.  I was double their age and vaguely remembered feeling mortified (until there was chocolate in hand and we were in the car).
[2] The article by Andrew Wakefield was subsequently retracted. Lancet apologized and Wakefield was banned from practicing medicine.
[3] Likely due to al Rhazi’s A Treatise on the Small-pox and Measles (9-10th century).
[4] James Cooke, Supplementum Chirurgiae (1655), 260-261.
[5] Anthony Westwood, De Variolis & Morbillis (1656), 7-8.
[6] Ibid., 9.
[7] Cooke, 262.
[8] Gideon Harvey, A Treatise of the Small-pox and Measles (1696), 15.
[9] Ibid., 16-17.
[10] Thomas Cocke, Miscelanea Medica (1675).
[11] Coke, Lady Mary Campbell, 1726-1811, Diary of Lady Mary Campbell Coke, February, 1767, in The Letters and Journals of Lady Mary Coke, vol. 1. Edinburgh, Scotland: David Douglas, 1889, pp. 247.
[12] Westwood, 49.

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