Sydenham’s description of Measles in London, 1670 and 1674.
Sydenham’s account of the epidemic of 1670 is full enough to leave no doubt that it was measles of the ordinary kind; the details, indeed, are as minute for all essential points as they would be in a modern text-book[1188]:
Measles, he says, is a disease mainly of young children (infantes), and is apt to run through all that are under one roof. It begins with a rigor, followed by heats and chills during the first day. On the second day there is fever, with intense malaise, thirst, loss of appetite, white tongue (not actually dry), slight cough, heaviness of the head and eyes, and constant drowsiness. In most cases a humour distils from the nose and eyes, the effusion or suffusion of tears being the most certain sign of sickening for measles, more certain indeed than the exanthem. The child sneezes as if it had taken cold, the eyelids swell, there may be vomiting, more usually there are loose green stools (especially during dentition), and there is excessive fretfulness. On the fourth or fifth day small red maculae, like fleabites, begin to appear on the forehead and the rest of the face, which coalesce, as they continue to come out in increasing numbers, so as to form racemose clusters. These maculae will be found by the touch to be slightly elevated, although they seem level to the eye. On the trunk and limbs, to which they gradually extend, they are not elevated. About the sixth day the maculae begin to roughen and scale, from the face downwards, and by the eighth day are scarcely discernible anywhere. On the ninth day the whole body is as if dusted with bran. The common people say that the spots had “turned inwards,” by which they mean that, if it had been smallpox, they would have remained out longer, and have proceeded to suppuration or maturation. The rash having thus “gone in,” there is an access of fever, attended with laboured breathing and cough, the latter being so incessant as to keep the children from sleep day or night. If they had been treated by the heating regimen, they are apt to have the chest troubles pass into peripneumonia, by which complication measles becomes more destructive than smallpox itself, although there is no danger in it if it be rightly treated. When peripneumonia threatens, the patient should be bled, even if it be a tender infant. Diarrhoea, which sometimes continues for weeks after an attack of measles, may be cut short by blood-letting, and so also may whooping-cough.
This epidemic, says Sydenham, began in January, and was almost ended in July, which agrees exactly with the rise and decline of measles deaths in the weekly bills of the Parish Clerks.
His account of the epidemic of 1674 is still more important to be set beside the figures in the bills; for the type, according to Sydenham, was anomalous, and the total of deaths entered by the Parish Clerks (795) is exceptionally large. Like the epidemic four years before, it began in January, came to a height about the vernal equinox, and was nearly over at the summer solstice[1189].
Weekly Deaths in London in the first six months of 1674. (Epidemic of Measles.)
1674
| Week ending | Fever | Smallpox | Griping in the guts | Measles | Convulsions | Teeth | Consumption | All causes | |||||||||
| Jan. | 6 | 35 | 13 | 35 | 0 | 37 | 15 | 78 | 332 | ||||||||
| 13 | 35 | 19 | 32 | 1 | 32 | 22 | 65 | 369 | |||||||||
| 20 | 37 | 12 | 29 | 0 | 39 | 18 | 65 | 327 | |||||||||
| 27 | 34 | 15 | 38 | 0 | 38 | 17 | 68 | 354 | |||||||||
| Feb. | 3 | 32 | 23 | 39 | 7 | 45 | 26 | 75 | 418 | ||||||||
| 10 | 47 | 18 | 35 | 4 | 48 | 35 | 86 | 430 | |||||||||
| 17 | 55 | 21 | 46 | 15 | 70 | 38 | 98 | 537 | |||||||||
| 24 | 62 | 17 | 45 | 28 | 54 | 44 | 97 | 510 | |||||||||
| March | 3 | 58 | 31 | 28 | 59 | 48 | 49 | 87 | 547 | ||||||||
| 10 | 55 | 22 | 31 | 87 | 85 | 58 | 122 | 688 | |||||||||
| 17 | 63 | 15 | 46 | 95 | 79 | 57 | 113 | 695 | |||||||||
| 24 | 59 | 23 | 44 | 65 | 57 | 39 | 96 | 568 | |||||||||
| 31 | 51 | 19 | 49 | 60 | 77 | 51 | 105 | 622 | |||||||||
| April | 7 | 44 | 13 | 40 | 43 | 65 | 48 | 118 | 547 | ||||||||
| 14 | 53 | 20 | 32 | 31 | 60 | 50 | 98 | 535 | |||||||||
| 21 | 40 | 17 | 43 | 38 | 55 | 42 | 106 | 517 | |||||||||
| 28 | 50 | 17 | 44 | 53 | 67 | 34 | 87 | 520 | |||||||||
| May | 5 | 51 | 31 | 28 | 30 | 56 | 24 | 75 | 452 | ||||||||
| 12 | 38 | 26 | 47 | 30 | 54 | 37 | 79 | 479 | |||||||||
| 19 | 50 | 35 | 33 | 26 | 47 | 28 | 82 | 461 | |||||||||
| 26 | 67 | 27 | 33 | 13 | 45 | 28 | 63 | 415 | |||||||||
| June | 2 | 48 | 24 | 28 | 14 | 41 | 26 | 77 | 365 | ||||||||
| 9 | 35 | 26 | 38 | 15 | 48 | 27 | 66 | 369 | |||||||||
| 16 | 64 | 34 | 38 | 19 | 38 | 22 | 70 | 419 | |||||||||
| 23 | 34 | 33 | 34 | 9 | 52 | 15 | 71 | 368 | |||||||||
| 30 | 37 | 39 | 30 | 9 | 30 | 21 | 59 | 343 | |||||||||
It will be seen that the highest weekly mortality from measles is only 95, in the week ending 17th May. But in that week the deaths from all causes reached the enormous total of 695, which was nearly three hundred above the weekly average of the time. This appears to have been the epidemic of measles which Morton declares to have destroyed three hundred in a week, a mode of reckoning which would claim for measles, directly or indirectly, the excess of mortality from all causes during the height of the epidemic[1190].
These high weekly mortalities in February, March, April and May are remarkable for the season of the year. Usually when the weekly figures reach six or seven hundred, it is in a hot autumn, and the cause is infantile diarrhoea, represented in the bills by the excessive number of deaths from “griping in the guts” and “convulsions;” more rarely, and then only for three or four weeks, correspondingly high figures are reached in a season of influenza. But in this case the epidemic measles is the only relevant thing. The measles deaths by themselves do by no means account for the enormous weekly totals; but two of the three columns of figures which help them, and indeed keep pace with the rise of the measles deaths, namely, “convulsions” and “teeth,” are infantile deaths obviously related to the prevailing epidemic; while the third column, “consumption,” which contributes most of all, did not in the London bills mean pulmonary consumption exclusively, but also the wasting or marasmus which followed or attended acute fevers in general, and was specially apt to follow or attend measles[1191].
Sydenham gives no indication that the spring of 1674 was unusually productive of pneumonia or pleurisy among adults; the winter, he says, was unusually warm, the weather in spring turning colder. But, as to the measles, he does say that the epidemic was anomalous or irregular; while both he and Morton refer the fatalities more especially to the sequelae of measles,—to the “suffocation” of infants and children by the bronchitis or peripneumonia, or to “angina,” as Morton says, meaning perhaps the same as in Scotland was understood by “closing” in infants. Measles itself was a milder disease than smallpox, according to the experience of all times; and yet, by its sequelae (bronchitis, capillary bronchitis and pneumonia, including what Morton calls “angina,” and excluding, for the present, whooping-cough), it raised the weekly mortalities of February, March, April and May, 1674, to far above the average. Sydenham said, with reference to the much milder epidemic of 1670, that these after-effects of measles “destroyed more than even smallpox itself” (quae [peripneumonia] plures jugulat quam aut variolae ipsae). We shall not correctly understand the part played by measles among the infective maladies of children unless we keep that grand character of it in mind—that its effects upon the mortality of infancy and childhood are only in part expressed by the deaths actually appearing under its name.
The London bills for 1674 afford us the opportunity of testing Sydenham’s paradox that measles, by its after-effects, destroyed more than smallpox itself. The epidemic of measles was nearly over in June; and immediately thereafter an epidemic of smallpox began (not of course from zero but from the usual level of the disease), which reached a maximum of 122 deaths in the week ending 20th October. The second half of the year was thus marked by a sharp outburst of smallpox, as the first half was marked by a sharp outburst of measles; and those two diseases were the only epidemic maladies that gave character to the respective seasons, each being in its proper season, according to Sydenham—measles in the spring, smallpox in the autumn. Although the measles deaths were only 795 for the whole year, the smallpox deaths being 2507, yet the former epidemic was attended by so great an excess of deaths under various other heads that the half of the year in which it fell was far more unhealthy than the succeeding half in which the smallpox mainly fell, the weekly average of the first six months having been 468 deaths, and of the second six months 349 deaths. The following table shows the weekly mortalities for the second half of the year; it will be observed that no column of figures keeps pace with the rise of the smallpox deaths, as three columns had kept pace with the rise of the measles deaths in the first six months of the year.
Weekly Deaths in London in the last six months of 1674. (Epidemic of Smallpox.)
1674
| Week ending | Fever | Smallpox | Griping in the guts | Measles | Convulsions | Teeth | Consumption | All causes | |||||||||
| July | 7 | 31 | 44 | 35 | 9 | 44 | 24 | 69 | 351 | ||||||||
| 14 | 38 | 55 | 34 | 5 | 37 | 17 | 54 | 353 | |||||||||
| 21 | 40 | 71 | 47 | 6 | 42 | 25 | 56 | 395 | |||||||||
| 28 | 43 | 71 | 37 | 3 | 49 | 18 | 48 | 367 | |||||||||
| Aug. | 4 | 38 | 68 | 39 | 6 | 31 | 23 | 47 | 347 | ||||||||
| 11 | 33 | 66 | 48 | — | 18 | 8 | 45 | 324 | |||||||||
| 18 | 49 | 86 | 41 | 1 | 26 | 20 | 48 | 374 | |||||||||
| 25 | 35 | 85 | 23 | 3 | 32 | 10 | 46 | 328 | |||||||||
| Sept. | 1 | 60 | 96 | 41 | — | 32 | 18 | 57 | 414 | ||||||||
| 8 | 32 | 99 | 48 | 3 | 22 | 16 | 32 | 374 | |||||||||
| 15 | 28 | 102 | 38 | 2 | 30 | 19 | 55 | 362 | |||||||||
| 22 | 27 | 72 | 32 | 3 | 29 | 11 | 57 | 327 | |||||||||
| 29 | 39 | 81 | 34 | 2 | 41 | 9 | 53 | 358 | |||||||||
| Oct. | 6 | 37 | 98 | 29 | — | 34 | 10 | 63 | 391 | ||||||||
| 13 | 36 | 75 | 25 | — | 35 | 17 | 49 | 311 | |||||||||
| 20 | 42 | 122 | 35 | 1 | 34 | 10 | 68 | 402 | |||||||||
| 27 | 24 | 75 | 36 | — | 38 | 15 | 45 | 294 | |||||||||
| Nov. | 3 | 34 | 83 | 21 | — | 30 | 11 | 41 | 322 | ||||||||
| 10 | 30 | 81 | 15 | — | 31 | 12 | 49 | 321 | |||||||||
| 17 | 31 | 70 | 16 | — | 24 | 10 | 58 | 304 | |||||||||
| 24 | 35 | 70 | 28 | — | 38 | 14 | 57 | 344 | |||||||||
| Dec. | 1 | 33 | 85 | 29 | — | 32 | 14 | 68 | 378 | ||||||||
| 8 | 33 | 66 | 28 | — | 36 | 11 | 53 | 327 | |||||||||
| 15 | 29 | 61 | 26 | — | 39 | 16 | 49 | 339 | |||||||||
| 22 | 34 | 68 | 21 | — | 32 | 11 | 52 | 335 | |||||||||
| 29 | 41 | 41 | 19 | — | 33 | 7 | 74 | 337 | |||||||||
The total of deaths by smallpox for the year, 2507 was the highest since the bills began, and remained the highest until 1681. It is open to us to suppose that it would not have been so high but for the epidemic of measles preceding. The measles not only made the first half of the year far more deadly than the second, within which most of the smallpox fell, but its effects may have aided the high mortality of smallpox itself, according to the experience of later times that infants and young children recovering from measles in a greatly weakened condition fell an easier prey to smallpox coming after[1192].
Morton passes from the fatal epidemic of 1674 (or, as he says, 1672), with the remark that the malady had not been epidemic again in London from that time until the date of his writing, 1692-94, a period of nearly twenty years; and that is on the whole borne out by the London bills and by Sydenham’s records so far as they extend. From 1687 to 1700, inclusive, the London bills grouped the measles deaths along with the deaths from smallpox, under the heading, “Flox, Smallpox and Measles”; in 1701 the total of measles, 4 deaths, is given as a separate item in the same bracket with smallpox; and in 1702 the heading of “Measles,” is restored to the place in the alphabetical list which it had held, except for that unaccountable break, from the beginning of the published bills in 1629. The following are the annual totals from and including the great epidemic of 1674:
| Year | Death from measles | |
| 1674 | 795 | |
| 1675 | 1 | |
| 1676 | 83 | |
| 1677 | 87 | |
| 1678 | 93 | |
| 1679 | 117 | |
| 1680 | 49 | |
| 1681 | 121 | |
| 1682 | 50 | |
| 1683 | 39 | |
| 1684 | 6 | |
| 1685 | 197 | |
| 1686 | 25 |
Thus for a good many years after the general prevalence of measles in 1674 the deaths from it in London averaged only about one and a half in the week, while in no year until 1705-6 is there an epidemic comparable to that of 1674. It is clear that the severe epidemics of measles came at first at very long intervals, and that the years between had a very moderate mortality from that disease.