Measles in the 18th century.

There is hardly a reference to be found to measles in medical or other writings until the annual accounts of the public health at Ripon, York, Plymouth, etc. in the third decade of the 18th century. The annual deaths from it in London, according to the bills, were as follows, from 1701, when the disease was restored to its separate place in the classification:

Year Measles
deaths
1701 4
1702 27
1703 51
1704 12
1705 319
1706 361
1707 37
1708 126
1709 89
1710 181
1711 97
1712 77
1713 61
1714 139
1715 30
1716 270
1717 35
1718 492
1719 243
1720 213
1721 238
1722 114
1723 231
1724 118
1725 70
1726 256
1727 72
1728 82
1729 41
1730 311
1731 102
1732 30
1733 605
1734 20
1735 10
1736 169
1737 127
1738 216
1739 326
1740 46

The high mortalities of 1705 and 1706 belonged to one continuous epidemic from October, 1705, to April, 1706 (Sir David Hamilton says that smallpox was common in London in July, 1705, but the deaths in the bills are not excessive). The epidemic followed a great prevalence of the autumnal diarrhoea of infants, so that it is probable the high mortality was due as much to a greater fatality of cases from the antecedent weakening, as to an unusual number of cases[1193]. The following were the weekly deaths in a population about one-sixth that of London now:

1705-1706

Week
ending		 Measles
deaths
Oct.16 9
23 9
30 12
Nov.6 10
13 30
20 34
27 29
Dec.4 37
11 46
18 44
25 22
Jan.1 35
8 33
15 28
22 20
29 18
Feb.5 27
12 11
19 26
26 28
Mar.5 10
12 10
19 9
26 13
Apr.2 9
9 9

The unusually large mortalities from measles in 1718-19 and in 1733 were again associated with a “constitution” otherwise sickly. The epidemic in the latter year, from the middle of March to the end of July, which had a maximum of 47 deaths in each of the two middle weeks of May, followed close upon a severe influenza. Like the epidemic of 1674, it was attended by a high mortality from other causes, especially “convulsions” and “consumption”; and, as the bills had now begun to give the ages at death, it is no longer doubtful, or merely conjectural, that the great excess of deaths under these and other heads was really among infants, or that a rise in “consumption” at that time of the year meant an increase in the wasting diseases of infancy. This was a period when any epidemic malady among London children was sure to go hard with many of them, the period, namely, when spirit drinking, besides ruining the health of the parents, rendered them, in the opinion of the College of Physicians, “too often the cause of weak, feeble and distempered children[1194].”

The intervals between epidemics of measles in London having been so considerable as the table shows, it is not surprising to find but casual mention of the disease in the chronicles of Wintringham, Hillary, and Huxham for England, of Rogers, O’Connell and Rutty for Ireland, and of the Edinburgh annalists. Wintringham, of York, whose annals extend from 1715 to 1730, records an epidemic of measles in 1721, which began in April and lasted all the summer, being for the most part of a bad type, attended with continual cough and inflammation of the lungs. Hillary, of Ripon, enters measles in 1726, “very common but mild,” autumn and winter being the season of it. Wintringham briefly mentions the same epidemic. Huxham of Plymouth has an entry of measles in the first year of his annals, 1727, in the month of July, followed by whooping-cough in December. Wintringham again enters measles at York in 1730 in the company of smallpox. In the annual accounts of the disease at Edinburgh, for a series of years beginning with 1731, measles is first mentioned in 1735[1195]. The epidemic began in June and became universal in December: “The progress of these measles along the west road of England towards Edinburgh was very remarkable, for they could be traced from village to village; and it was singular that the first person in Edinburgh who was seized with them was a lady in childbed, who saw nobody but her nurse and a friend who lived in the house with her”—an argument, apparently, for the doctrine of an epidemic “morbillous” constitution of the air. Five years after, we obtain the mortality statistics of Edinburgh, in the two great years of scarcity, typhus fever and sicknesses of all kinds, the years 1740 and 1741: in those two years measles must have been as general as smallpox if it were half as mortal, for the deaths set down to it in each year are 110 and 112, as compared with 274 and 206 from the more usual infantile infection. In like manner the second year of the disastrous epidemic of typhus in 1741-42, had the highest total of measles deaths in London until the great epidemic of 1808. While the high mortality of that year was due to special causes, it is at the same time clear from the following table that measles had not yet become a steady or perennial cause of death to the infancy of the capital:

Year Measles
deaths
1741 42
1742 981
1743 17
1744 5
1745 14
1746 250
1747 81
1748 10
1749 106
1750 321
1751 21
1752 111
1753 253
1754 12
1755 423
1756 156
1757 24
1758 696
1759 316
1760 175
1761 394
1762 122
1763 610
1764 65
1765 54
1766 482
1767 80
1768 409
1769 90
1770 325
1771 115
1772 211
1773 199
1774 121
1775 283
1776 153
1777 145
1778 388
1779 99
1780 272
1781 201
1782 170
1783 185
1784 29
1785 20
1786 793[1196]
1787 84
1788 55
1789 534
1790 119
1791 156
1792 450
1793 248
1794 172
1795 328
1796 307
1797 222
1798 196
1799 223
1800 395

The considerable epidemic of 1755 is thus referred to by Fothergill in his monthly notes:

May: the measles more common than for some years, adults, who had not before had it, rarely escaping. June: measles common, smallpox rare. September and October: no epidemic disease but measles; few perished in proportion to all who took it[1197]. The epidemic of 1758 was more fatal, but Fothergill’s notes are not continued to that year. The elder Heberden says that measles was remarkably epidemical (in London) in 1753, which year has only 253 deaths in the bills, whereas the year 1755 has 423 deaths and the year 1758 has 696; but, as he implies that the type was mild, there would have been a multitude of cases to produce that number of deaths. It was a peculiarity of that epidemic, he says, that the cough preceded the outbreak of measles by seven or eight days, whereas it was usually but two or three days in advance of the eruption[1198].

At that period there would have been an epidemic of measles in London every other year, or once in three years, with a fatality from the direct effects seldom more than a sixth part that of an epidemic of smallpox. A London writer some twenty years after said that few escaped measles in infancy or childhood, while the deaths put down to it were only a tenth part of those due to smallpox on an average of years[1199]. The proportion of measles deaths to smallpox deaths was nearly the same in Manchester for twenty years from 1754 to 1774, according to Percival’s table of the burials in the register of the Collegiate Church where most of the poorer class were buried[1200]:

Annual averages of Burials from Measles etc. at the Collegiate Church, Manchester.

Period Measles Smallpox All deaths
under two		 Deaths at
all ages		 Baptisms
1754-58 21 64 209 651 678
1759-63[1201] 10·6 95 213 639 731
1764-69 9·6 98 229 659 827
1770-74 21·6 102 242 651 1062

The ages of those who died of measles “in six years from 1768 to 1774,” to the number of 91, were as follows:

Total 3 mo. -6 mo. -12 mo. -2 years -3 -4 -5 -10 -20 -30
91 2 3 10 31 25 7 9 2 1 1

Fifty were males, forty-one females—a preponderance of males which is according to rule. Of the whole ninety-one, no fewer than fifty-one died in June of the several years.

In the smaller and more healthy towns, such as Northampton, the epidemics of measles came at long intervals and caused but few deaths:

Infantile Causes of Death, All Saints, Northampton[1202].

Year Measles Whooping-cough Convulsions Teething
1742 3 1 10 8
1743 — — 21 2
1744 — 3 14 4
1745 — — 22 7
1746 — 3 19 3
1747 7 — 29 —
1748 — — 24 4
1749 — 6 15 4
1750 1 — 17 1
1751 — — 14 6
1752 — 1 13 6
1753}not published
1754
1755 — 1 8 1
1756 — 2 10 2
1757 1 1 28 4

In the parish of Holy Cross, a suburb of Shrewsbury, there were 4 deaths from measles in the ten years 1750-60, and 15 in the ten years 1760-70, the smallpox deaths having been respectively 33 and 46. Ackworth, in Yorkshire, may represent the country parishes. It had no deaths from measles from 1747 to 1757, two deaths from 1757 to 1767. At Kilmarnock during thirty-six years from 1728 to 1764, there were 93 deaths from measles, 52 of them in the period 1747-52, and only 11 in the next twelve years. Sims, of Tyrone, having described an epidemic of smallpox which desolated the close of 1766 and spring of 1767 with unheard of havoc (it had been out of the country for some years), mentions farther that an epidemic of measles followed immediately: “Before the close of the summer solstice the measles sprang up with a most luxuriant growth,” and was followed in harvest by whooping-cough.

Wherever we have the means of comparison by figures, it appears that measles caused by its direct fatality not more than a sixth part of the deaths by smallpox in Britain generally. But in the colonies, where an epidemic of smallpox was a rare event of the great seaports, and as much an affair of adults as of children, measles seems to have been more fatal, dividing with diphtheria or scarlatina the great bulk of the infectious mortality of childhood. Thus Webster enters under 1772: “In this year the measles appeared in all parts of America with unusual mortality. In Charleston died 800 or 900 children”; and under 1773: “In America the measles finished its course and was followed by disorders in the throat”—especially in 1775[1203]. It is only among the children of public institutions in England that we find in the corresponding period a similar predominance of measles and scarlatina over smallpox. In the Infirmary Books of the Foundling Hospital the more general outbreaks of smallpox cease after 1765, while epidemics of measles, extending to perhaps a third or more of the inmates, as well as great epidemics of scarlatina, begin after that date to be common[1204].

In the Infirmary Book from which the following extracts are taken, the number of deaths is not stated. The number of children in the Hospital was 312 in 1763, 368 in 1766 and 438 in 1768.

1763. Before the date of the Infirmary Book, Watson records an epidemic of putrid measles from 21 April to 9 June, 1763, which attacked 180 and caused 19 immediate deaths.

Nov. 19. Nine in the infirmary with “morbillous fever”; many cases of “fever” until the 17th December.

1766. May to July. Many entries in the book; Watson says: “Seventy-four had benign measles, and all recovered.”

1768. Great epidemic, May to July; one hundred and twelve in the infirmary with measles on June 4th; Watson gives the total cases at 139, of which 6 were fatal.

1773. Nov. and Dec. Great epidemic: maximum of 130 cases of measles in the infirmary on 27th November. Next week there were 40 with measles, and 90 convalescing therefrom.

1774. May. A slight outbreak (8 cases at one time).

(Records from 1776-1782 not seen.)

1783. March and April. Great epidemic: maximum number of cases in the infirmary with measles 94, on March 22nd.

1784. June. Eleven cases of measles at once.

1786. March and April. Maximum on April 5th—measles 47, recovering from measles 19.

The records from 1789 to 1805 have not been seen, but Willan gives the following dates and numbers, on the information of Dr Stanger, physician to the charity[1205].

1794. 28 had measles, all recovered.

1798. 69 had measles, 6 girls died.

1800. 66 had measles, 4 boys died.

1802. 8 had measles, one died.

The general testimony in the last quarter of the 18th century is that measles, if a common affection, was not usually a severe one. Heysham, of Carlisle, says that measles came thither in 1786 from the south-west of Northumberland, “where, I am informed, they proved very fatal”; the epidemic began at Carlisle in August, and continued very general until January, 1787, but extremely mild and favourable, only 28 having died (26 under five years, 2 from five to ten), out of “some six or seven hundred, I suppose.” The previous epidemic of measles at Carlisle in 1780 (mortality not stated), had followed a most fatal epidemic of smallpox in 1779; and although the epidemic of mild measles in 1786 did not follow a great epidemic of smallpox, it followed a high and steady annual average of deaths of infants and young children from that cause year after year[1206]. In both years of the measles at Carlisle, there were no deaths from smallpox. In like manner at Leeds, in 1790, measles followed smallpox, and was extremely mild; Lucas wrote of it, “I have not seen one instance of a fatal termination[1207].” This was the time (1785) when Heberden said of the disease in London, just as Willis, Harris and others had said of it and of smallpox together a century before: “The measles being usually attended with very little danger, it is not often that a physician is employed in this distemper.”