The high ratio of measles and the low ratio of smallpox did not remain as Watt’s researches left them. When Cowan resumed the tabulation of figures from 1835 to 1839 he found the ratios of those two infantile infections almost equal, and the two together contributing to the whole mortality of Glasgow only a little more than half their joint share in the end of the 18th century. The substitution which Watt saw during a few years was only the most dramatic part of a general movement forwards of measles among the causes of infantile mortality. He supposed, as everyone did at that time, that smallpox was forcibly repressed, and that another infectious disease had seized the opportunity to become exuberant. The most relevant thing in the whole situation was urged by those who thought, with Jenner, that the doctrine of substitution had an “evil tendency” as detracting from the absolute value of the inoculation principle. In order to discredit Dr Watt altogether, they pointed out that his ratios of smallpox and measles took no account of the diminished death-rate of Glasgow by all diseases in the earlier years of the 19th century.
Great changes were proceeding in the old city, the Glasgow of ‘Rob Roy.’ The population which was reckoned at 45,889 in the year 1785, had increased to 66,578 in the year 1791, and thereafter, at a slower rate, to 83,769 in 1801 and to 100,749 in 1811. The first great increase after the American War meant overcrowding; but in a short time new suburbs spread over such an extent that, in the year 1798, more than half the burials were in the graveyards attached to chapels-of-ease and meeting-houses outside the original parishes. The modern expansion of Glasgow, like that of London and of all other large cities, has been an increase of area still more than an increase of numbers. The public health improved steadily, at all events until 1817, the improvement being shown first in the increasing number of infants that survived their second year. That rise in the probability of life corresponded to the substitution of measles for smallpox, and in part depended upon the ascendancy of the milder infection. Still more remarkable was the rise of scarlatina, which Dr Watt did not live to see; so little was made of it at the date of his writing that he found “scarlatina, typhus, &c., all comprehended under the same head.” The seeds of measles and scarlatina had long existed beside the seeds of smallpox, but the ascendancy of each of the two former had to wait events. Said Banquo to the witches who hailed Macbeth as king and himself as the sire of later kings:
“If you can look into the seeds of time,
And say which grain will grow, and which will not—”
The succession of reigning infections is the same problem. All we can say is that each new predominant type is somehow suited to the changed conditions. In the long period covered by this history we have seen much coming and going among the epidemic infections, in some cases a dramatic and abrupt entrance or exit, in other cases a gradual and unperceived substitution. Some of the greatest of those changes have fallen within the two hundred years since Sydenham kept notes of the prevalent epidemics of London. We are that posterity, or a generation of it, which he expected would have its own proper experiences of epidemics and at the same time would know all that had passed meanwhile—“posteris quibus integrum epidemicorum curriculum venientibus annis sibi invicem succedentium intueri dabitur.”
CHAPTER V.
MEASLES.
In the earliest English writings on medicine, measles is the inseparable companion of smallpox; so closely are they joined in pathology and treatment that even the statements as to the pustules and scars of the eruption are in some compends made to apply to both without distinction. This singular conjunction of two diseases came originally from the Arabian teaching, which was everywhere authoritative in the medieval period, and especially authoritative in all that related to smallpox. In the Latin compends based upon Avicenna or other Arabic writers, the two names were variolae and morbilli, the former being as it were the morbus proper and the latter its diminutive. It can hardly be doubted that we owe the English name of measles as the equivalent of morbilli to John of Gaddesden. Originally the English word meant the leprous, first in the Latin form miselli and misellae (diminutive of miser), as in the histories of Matthew Paris, and later in the Norman-French form of mesles, as in the Acts of Parliament of Edward I. and in the ‘Vision of Piers the Ploughman.’ In the 15th century the leper-houses in the suburbs of London were called the “lazarcotes” or “meselcotes.”
Gaddesden, by some unaccountable stretch of similarity, coupled the sores or tubercular nodules on the legs of “pauperes vel consumptivi,” who were called “anglicé mesles,” with the spotted rash of the Arabian “morbilli”; and it was doubtless this haphazard bracketting of two unlike diseases that led in course of time to the name of mesles being disjoined from its original sense of the leprous and restricted to the second member of Gaddesden’s strangely assorted couple. In the time of Henry VIII. smallpox and mezils are familiarly named together just as variolae et morbilli are an inseparable pair in the treatises of the Arabistic writers. A still more singular usurpation by “mezils” or “maysilles” or “measles” is met with in the Elizabethan period. In the vocabulary of Levins, a schoolmaster who was also a medical graduate of Oxford, the word variolae is rendered by “ye maysilles,” while morbilli is omitted altogether among the Latin names and smallpox among the English; and in the English translation of Latin aphorisms appended to one of the works of William Clowes, surgeon to St Bartholomew’s Hospital, variolae is in like manner translated “measles” on every occasion. In the English dictionary by Baret, belonging to the same period, measles is defined as “a disease with many reddish spottes or speckles in the face and bodie, much like freckles in colour”—which seems to exclude the possibility of a pustular disease having been part of the Elizabethan notion of measles.