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.