HHH Column: Ghosts of the past? The dangers of measles by Mayra Murkens

The HHH column is a monthly blog in which History, Health & Healing members share their thoughts on research, current affairs, or anything to do with medical history. Each edition is written by a different member – in due time, we hope to offer everybody a chance to publish a contribution. This month, the floor is for Mayra Murkens, post-doctoral researcher within the research project ‘Lifting the burden of disease’ at Radboud University. In this column Mayra discusses historical and present day perceptions and threats of the measles as an epidemic disease.

Ghosts of the past? The dangers of measles 

Mayra Murkens

On November 26^th, 1889, seven-month-old Albert died in his home on one of Amsterdam’s Eastern Islands called Wittenburg. The cause of his death was recorded as measles, one of the numerous rampant infectious childhood diseases. The grim reaper was, however, not yet finished with this family. He returned a couple of days later, on December 2^nd, to take the life of Albert’s three-year-old sister Elizabeth Jacoba, who had also been infected with measles. According to the local health committee, measles had started reaching epidemic proportions in December of the previous year. Its death toll had been especially high in the first half of 1889: out of the total 326 deaths due to measles that year, no less than 249 had passed away before the start of July, mostly young children. By July, local authorities declared the epidemic to be over. Albert and Elizabeth had been able to survive the peak of the outbreak, but that did not mean the threat of this disease had suddenly disappeared. Their neighbourhood, the Eastern Islands, had been hit the hardest during the epidemic. While there were over 50 neighbourhoods in the city, as much as 17 per cent of the deaths had occurred in this neighbourhood alone. While the neighbourhood harboured a large share of the Amsterdam population, 7 per cent of the total population lived in this neighbourhood T in 1889, the percentage of measles mortality was still disproportionate. Indeed, for Albert and Elizabeth the disease proved to be fatal, even when the epidemic had been officially over.

With today’s reoccurring outbreaks of a disease, we thought we had left behind in the previous century, the importance of awareness of its dangers cannot be understated. Measles has often been regarded as a mild childhood disease, both in the nineteenth and early twentieth century. Before the vaccine became part of the Dutch national vaccination programme in 1976, it was considered normal for each child to endure the annoying red dots and the accompanying fever and cough. Generally speaking, measles usually did not cause high levels of distress. The fact that the disease could lead to various deadly complications was, and still is, not generally well-known. 

As researchers in the Lifting the burden of disease. The modernisation of health in the Netherlands: Amsterdam 1854-1940, we are well aware of the death toll of measles throughout the late nineteenth- and early twentieth century. As such, I would never characterise measles as an innocent disease. Before vaccination, a new epidemic outbreak came along every few years, wreaking havoc among the new virgin population of children that had been born and had not yet been exposed to an outbreak. And every few years the disease would cull a considerable portion of children. As living standards, sanitation, and public health improved throughout the late nineteenth and early twentieth centuries,the chances of dying from many of the typical childhood diseases decreased. However, measles continued to cause many lethal spikes well into the twentieth century. Eventually, measles mortality did also decline, although the disease did not disappear. Children’s overall disease burden due to infectious diseases decreased which led to lower mortality of measles as well. However, this did not make the disease innocent. Complications could and can still occur, with lethal consequences. In the nineteenth century, pneumonia and meningitis, for example, were already well-known complications that could occur a couple of weeks after the infection had started. Modern day medicine has, however, discovered that measles can cause lethal meningitis up to seven years after infection. 

Moreover, recent research has shown that measles was not an equally distributed disease. Mid-nineteenth century children belonging to the lower classes had higher chances of dying of measles compared to their more well-to-do counterparts. Apparently, the higher social classes were already able to shield their children, probably either because their children were less exposed, or better fed, which could improve their resistance. Children like Albert and Elizabeth were less fortunate. Their father was a stonecutter, which required some skill, and the family was therefore not amongst the most destitute in the city. However, the family lived in one of the poorest neighbourhoods of Amsterdam, which rendered their position more precarious. Perhaps if we learned more about the lives of Albert and Elizabeth, we would be more vigorous in our battle against such a dangerous and ultimately unfair disease. 

For more information about the project and the research, please have a look at this website.