Copyright © 2020 by Wendy Waszut-Barrett
In 1918, Thomas G. Moses wrote, “In March we did a lot of work for the production of “Cinderella,” to be put on in Oak Park at the High School.” Unfortunately, an outbreak of the measles closed down the school production that month. On May 12, 1918, the “Chicago Tribune” reported, “The opera ‘Cinderella,’ which was to have been given by students from the Oak Park High School has been indefinitely postponed because of an epidemic of measles among the cast. Three members of the cast are ill” (page 3).
There is no indication that the show was ever rescheduled. However, I did encounter an informative article about measles and the recommendation to wear facemasks. In light of our recent situation with COVID-19, this seems like a timely article to share. After all, the Spanish Flu would follow on the heels of the measles epidemic.
The “Chicago Tribune” included a medical section entitled, “How to Keep Well by Dr. W. A. Evans.” On Nov. 18, 1918, Dr. Evans addressed “The Measles Question” (page 8).
He wrote to following advice:
“Ask the average man on the street about measles and he will say, ‘Oh, fiddlesticks – don’t amount to a row of pins!’ Ask and health officer the same question and he will say, ‘Very important health department question.’ More children die from measles than from any other form of contagion. It kills more children than diphtheria or scarlet fever. Ask any school principal and he will reply: ‘I don’t know about the severity of the disease, but I know that it upsets the schools more than any other disease.’ Now here are three options, no two which are the same and two almost directly contradictory. All the answers are honest. Why the difference? Measles starts like an ordinary cold. Within a few hours this particular cold differs from an ordinary cold in that the eyes get red. It also differs in degree in that there is more dry cough. In an ordinary cold the cough does not come on until a few days after the nose cold. In the family is accustomed to using a thermometer it will find that the measles cold causes the higher fever of the two. After about three days the measles eruption begins to appear, starting first on the face. The disease is most contagious in the period before the eruption.
As to all those points there is no disagreement In fact, most parents and some school officials say measles is so contagious in this early stage that there is not use trying to stop an epidemic once the disease starts. In this Col. Raymond of the army replies by telling of a time when measles broke out in a command of which he had medical charge. At once he locked all the cases on one house and all the contacts in another barracks and marched the bulk of the command away. The epidemic stopped short.
The mother who has had fortunate experiences with measles in her family tells of a few days of fever and hollow cough, then fading of the eruption, disappearance of fever, and stopping of the hollow cough in about ten days. In this the health officer agrees, but he adds so many children get what are known as complications that the number of deaths form measles in half the United Sates in 1916 was 7,946 and other deaths, really from measles but entered on the record as bronchitis, pleurisy, lung abscess, empyema, but really due in the first instance to measles would bring the total up to at least 16,000.
And right there is where the disagreement comes in. The average man on the street does not know about these cases that went wrong. The health officer knows about them because the death certificates go through his hands and he has been studying them. In olden days we said that the ‘measles struck in’ or that the patient ‘caught cold.’ Recent work indicates that what happens is that the patient gets an infection with a pus coccus called streptococcus hemolyticus.
One great advantage of the discovery is that along with it comes another one having to do with prevention. Not only must the other members of the family be protected against the measles patient, but the measles patient must be protected against them. When measles has him down streptococci from the throats of well members of the family are prone to jump on him and convert a mild disease to a severe one.
To prevent this the patient should wear a face mask. The members of the family in contact with the patient – the mother and those nursing and helping – should wear face masks. Cultures of the throats of the well should be made. Those having no streptococci in their throats and having had measles can take off their masks and stay at home. Those negative as to streptococci and with a history of having had measles can come home if they have been sent away. Those with streptococci in their throats should be sent away. If it is absolutely necessary that any such should stay at home they must wear face masks with care as to minute details.”
In regard to the measles and streptococcal co-infections of 1917-1918, David M. Morens and Jeffrey K. Taubenberger published a paper in 2015 – “A forgotten epidemic that changed medicine: measles in the US Army, 1917-18.”
Here is the abstract in case you want to read it: A US army-wide measles outbreak in 1917-18 resulted in more than 95,000 cases and more than 3000 deaths. An outbreak investigation implicated measles and streptococcal co-infections in most deaths, and also characterized a parallel epidemic of primary streptococcal pneumonia in soldiers without measles. For the first time, the natural history and pathogenesis of these diseases was able to be well characterized by a broad-interdisciplinary research effort with hundreds of military and civilian physicians and scientists representing disciplines such as internal medicine, pathology, microbiology, radiology, surgery, preventive medicine, and rehabilitation medicine. A clear conceptualization of bronchopneumonia resulting from viral-bacterial interactions between pathogens was developed, and prevention and treatment approaches were developed and optimized in real time. These approaches were used in the 1918 influenza pandemic, which began as the measles epidemic waned. The outbreak findings remain relevant to the understanding and medical management of severe pneumonia. Here is a link to the paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617519/
To be continued…
