Increasing mortality from Measles at the end of the 18th century.
There were epidemics of measles with high mortality in the 17th and 18th centuries, occurring in special circumstances of time and place, of which instances have been given. But in general the position of measles was not then so high among the causes of death in infancy and childhood as it afterwards became. It is not easy to demonstrate the exact proportions by figures, even for London; the bills of the Parish Clerks are less trustworthy for measles than for smallpox, for the reason that deaths from scarlatina were probably included among the former (see under Scarlatina). For example, the ratio of 1·10 per cent. measles deaths for the ten years 1781-90 in the following table should be only 0·70 if the 793 deaths in 1786, supposed scarlatinal, be left out. But, taking the bills as they stand, they show an increasing ratio of measles (as well as of whooping-cough) among the deaths from all causes towards the end of the 18th century.
Percentage of Measles and Whooping-cough in all London deaths, 1731-1830.
| Ten-year periods | Share of measles | Share of whooping-cough | ||
| 1731-40 | 0·70 | 0·41 | ||
| 1741-50 | 0·68 | 0·40 | ||
| 1751-60 | 1·15 | 1·03 | ||
| 1761-70 | 1·11 | 1·12 | ||
| 1771-80 | 0·93 | 1·66 | ||
| 1781-90 | 1·10 | 1·32 | ||
| 1791-1800 | 1·34 | 1·97 | ||
| 1801-10 | 3·11 | 3·14 | ||
| 1811-20 | 3·52 | 3·49 | ||
| 1821-30 | 3·17 | 3·13 |
During the same period, the ratio of deaths from all causes under two years of age had decreased, while the ratio of deaths from two to five, and at all ages above five, had increased as in the following table, also compiled from the London bills beginning with the year 1728 when the ages at death were first published.
Ratios of Deaths from all causes under two years, from two to five, and above five, London, 1728-1830.
| Period | Total deaths | Ratio under Two years | Ratio from Two to Five | Ratio of all ages above Five | ||||
| 1728-30 (3 yrs.) | 84,293 | 36·7 | 8·7 | 54·6 | ||||
| 1731-40 | 246,925 | 38·6 | 8·9 | 52·5 | ||||
| 1741-50 | 254,717 | 33·6 | 7·9 | 58·5 | ||||
| 1751-60 | 204,617 | 30·9 | 9·3 | 59·8 | ||||
| 1761-70 | 234,412 | 34·1 | 9·1 | 56·8 | ||||
| 1771-80 | 214,605 | 34·4 | 9·6 | 56·0 | ||||
| 1781-90 | 192,690 | 32·5 | 9·5 | 58·0 | ||||
| 1791-1800 | 196,801 | 31·8 | 10·9 | 57·3 | ||||
| 1801-10 | 185,823 | 29·3 | 11·5 | 59·2 | ||||
| 1811-20 | 190,768 | 27·7 | 9·8 | 62·5 | ||||
| 1821-30 | 209,094 | 28·0 | 9·7 | 62·3 |
Thus, while measles (with whooping-cough) was usurping, so to speak, a larger share of all the deaths, the two first years of life were claiming a smaller share of the deaths from all causes as the probability of life was improving. The saving of infant life was due to various things, but especially due to the decline of smallpox, as described in another chapter. We may now turn to consider, by a less abstract method, the increase of measles mortality from the last years of the 18th century.
In Willan’s periodical reports of the prevailing diseases of London[1208], scarlatina declined in 1795 and became sporadic, after having been extremely fatal for a long period, while measles and smallpox began to extend about the end of that year, the former being for the most part mild in its symptoms and favourable in its termination, the latter often confluent, and fatal to children. The report for March and April, 1796, is that measles had become more severe, and had been followed by obstinate coughs; for May, that “smallpox and measles have prevailed more during this spring than has been known for many years past.” However, it was smallpox that occasioned the larger share of the deaths among infants and children. The next general view that Willan gives us of the relative importance of measles among the infectious diseases is under Oct.-Nov. 1799: “The measles, though extensively diffused, have continued mild and moderate. The scarlet fever has increased, since the last report, both in extent and in the violence of its symptoms; but the contagious malignant fever [typhus] has been the most frequent, as well as the most fatal, of all acute diseases.” There is little sign of fatal measles in the London bills during the years of distress, 1799-1801; but we hear of it in Scotland and Ireland, where there was probably less scarlatina. An Edinburgh observer of the prevailing diseases says that “several hundreds” died of measles there in the winter of 1799[1209]. In the Irish emigration to America, which took one of its periodic starts owing to the repressive measures following the rebellion of 1798 and the union with England, measles appears to have been the fatal form of infection among the children on board ship. A medical letter from Philadelphia, 10 December, 1801, says that measles had been imported to Newcastle and Wilmington in the summer of 1801 by some vessels from Ireland, on board which a great many children died during the voyage; the epidemic at length reached Philadelphia and had become general throughout the city[1210]. At Whitehaven large numbers of infants were attended in measles from the Dispensary in 1796 and 1799, but the deaths (2 in 202 cases, and 2 in 266 cases) are probably only a few that came to the knowledge of the visiting physician. An epidemic at Uxbridge, Middlesex, in the winter of 1801-2 was certainly malignant or fatal more than ordinary, whatever its anomalous type may have meant.
The epidemic began in September, and was at first of so mild a type as to need no medical assistance. Towards November the cases increased in number and severity, but still, says the narrator, “I believe every case terminated favourably, not in my practice only, but in that of other gentlemen also.” Towards the middle of November, the attacks were more sudden and more violent while they lasted, and were soon over either in death or recovery. In some the eyes became all at once as red as blood, the pulse full, quick and hard, the cough incessant, with a rattling noise in the throat and quick laboured breathing, the skin hot and parched. “Another peculiarity in this epidemic was that the cuticle in many children did not separate after the disappearance of the eruption, and in several others that I particularly noticed, it came off in large flakes instead of branny scales; and the appearance of the rash in others assumed so striking a resemblance to the scarlet fever that, had it not been for the violent cough and other measly symptoms, many such cases occurring singly might, upon a superficial view, have been considered and treated as that disorder.” The various forms occurred in the same family; thus, of four children, one had typical measles, ending in a branny scurf, two others had the sneezing and the watery inflamed eyes, but the eruption in the form of an universal red fiery rash, after which the skin peeled in large flakes, while the fourth had the disease of a low typhoid type and recovered with difficulty. The epidemic “continued its destructive career” through December and January, after which the type became as mild as it had been at first. If the author had not discussed the diagnosis as between measles and scarlatina, deciding in favour of the former, one might have suspected that there were cases of both. But even the sphacelation that followed the application of blisters, the pemphigus-like eruption turning gangrenous, and the petechiae, were signs of malignancy in more than one of the exanthematous fevers. The sequelae of this epidemic of measles were as anomalous as the symptoms themselves; instead of the inflamed eyes, and the distressing cough (sometimes ending in consumption) there were aphthous fever and dysenteric purging[1211].
The deaths in the London bills for the first twelve years of the century will be found in the table on p. 655. We find the measles deaths for the first time equalling the smallpox deaths in 1804, and in 1808 surpassing them, and we may take it that the deaths so entered were almost wholly of measles proper. The epidemic of measles in 1807-8 was, in fact, a great and clearly defined event in British epidemiology, the first of a series of epidemics in which that disease established not only its equality with smallpox as a cause of infantile deaths but even its supremacy over the latter. It would appear, also, to have been more malignant than the scarlatina that coexisted with it. Thus, Bateman, of London, at the outset of the great measles epidemic of 1807-8, says: “The most prominent acute disorders have been eruptive fevers and particularly the measles, which during October and November have been very prevalent, and, when occurring in young children, have proved very fatal by terminating in violent inflammation of the organs of respiration.... The scarlatina was generally mild, presenting the eruption with a slight sore-throat[1212].”
Other accounts of the epidemic in London show it to have been of the type which Sydenham, in 1674, called anomalous or malignant.
The epidemic began in October-November, 1807, and was remarked as unusually fatal[1213].
Several children in the same family had fallen victims to it. Some cases were fatal in a few days, either from the intensity of the fever or from pneumonic complication. “But when these symptoms have been less violent, and the patient has passed without much alarm through the different stages of the disorder, and even after all apprehension of danger in the mind of parents or friends has been dismissed, a continuance or recurrence of pneumonic symptoms has laid a foundation for phthisis pulmonalis.” In some cases attended from the Westminster Dispensary, death followed from effusion into the chest or from membranous inflammation of the trachea. Numbers who recovered from the measles were afterwards affected with debility, cough, emaciation and oedematous swellings of the face and extremities which proved very difficult to remove. These particulars are given mostly for the end of 1807, but it is under the year 1808 that the great rise in the measles deaths appears in the London bills of mortality.
Besides these accounts for London, we have some details of the same epidemic at Edinburgh and Aberdeen and exact figures for Glasgow. It began at Edinburgh in the winter of 1807, and at Aberdeen (as at Glasgow) in the spring of 1808. At both places it was remarked as unusually fatal, chiefly from a complication of bowel complaint in children and from pulmonary affections in adults.
The Aberdeen observer says that in town (the disease being milder in the country) there were troublesome symptoms in almost every case—a violent pain in the belly, frequently accompanied with diarrhoea (and even with vomiting), and with the dysenteric symptoms of tenesmus and mucus in the stools. This bowel complaint usually lasted three or four days, and wasted the patients remarkably. There was also the usual catarrh with violent tickling cough, and, after the acute attack, a tendency to sudden dyspnoea and “fatal coughs.” In some the convalescence was lingering and very distressing to the patient: “it consists in a slow kind of fever, with evening exacerbations[1214].”
The observers at Edinburgh and Aberdeen agree that the epidemic was the worst that had been seen for many years. Says the former[1215]: “I believe that the present epidemic has been more general in this place and its vicinity than ever happened within the remembrance of any medical man at present living, and I am sorry to say it has been very fatal.” The Aberdeen chronicler says the mortality was “greater than we have witnessed for a long period,” and that the epidemic was general throughout the whole of England and Scotland. But, besides this direct testimony, there is a not less indirectly significant fact of the epidemic. It affected many adults—“persons of all ages, who had never had them,” says the Aberdeen writer: few persons escaped, says the Edinburgh observer, “who had been previously unaffected by this disease.” The deaths from pulmonic complaints did not often happen among children, but among people somewhat advanced in life. Significant also was the outbreak in the Invernessshire Militia, which marched into Edinburgh in March while the epidemic was raging. Fifty men, all young recruits newly joined, were attacked in the course of a few days, the others escaping the disease though equally exposed to it; in some of those who died in the regiment there were found, on opening the thorax, fibrinous pleurisy and pericarditis, with effusion of fluid, as well as evidences of bronchial catarrh[1216]. The Aberdeen writer says: “I always observed that in full-grown persons the eruptions were more numerous, quicker in appearing, and longer in going off than in young subjects.... Many full-grown persons were very ill, yet the measles were more fatal to the young.” The implication of so many adults in the severe epidemic of 1808 would of itself show that measles had not been for some time before a steady and universal affection of infancy and childhood[1217].