O936 - Complications and Sequelæ of Measles

In 1904, smallpox and diphtheria were fairly under control, so fever-causing diseases and malnutrition were the most important destroyers of human lives. This review by J. Mayer discussed measles, the complications it caused, and ways to treat it back then.

The article doesn't discuss much the frequency of each of these complications; some of them are probably quite rare. But it does demonstrate the wide variety of things that could possibly go wrong in certain (unknown) circumstances when infected with measles.

Mayer claims that measles generally is not dangerous unless complications arise, but these can arise in almost any type of tissue and can cause permanent, serious problems.

"It is hard to combat the old notion that measles is something akin to a common cold with a rash, and that there is nothing to be done but keep the patient warm. It is also difficult, as you know, to have people accept a new medical idea, which is not to be wondered at. The truth is that we, ourselves, too often encourage indifference by some such remark as 'It is only measles.'"

The most common, and thus most dangerous, is pneumonia, often caused by secondary bacterial infection. This happened in at least 5% and up to more than 20% of cases, sometimes with no clear way to prevent it from happening. Even today, in recent outbreaks in the US, 11-25% of cases needed hospitalization.

Next is laryngitis, which can also be caused by secondary bacterial infections. And otitis media, or ear infection, caused a great amount of suffering; if it led to infection, it could result in permanent hearing impairment or even death. And conjunctivitis is fairly common, sometimes leading to eye damage.

Mayer also claimed measles could cause gut problems—diarrhea, hemorrhage, colitis—but seemed like these might've been a result of mistreatment of the disease; the article wasn't clear.

These were the relatively common complications. Others were more rare but serious: meningitis, kidney problems, heart problems, etc. Skin problems such as eczema could occur.

Finally, Mayer quoted from a pamphlet distributed in Glasgow:

"Measles is a dangerous disease—one of the most dangerous with which a child under five yerars of age can be attacked. It is especially apt to be fatal to teething children. It tends to kill by producing inflammation of the lungs...It tends to maim by producing inflammations of the ears and eyes. Measles has carried off more than four times as many persons as enteric fever. It is therefore a great mistake to look upon measles as a trifling disease...It is therefore a great mistake—because as a rule children sooner or later have measles—to say, 'The sooner the better,' and to take no measures to protect them, or even deliberately to expose them to infection."

Seems like good advice.

Reference:

Mayer, J. Complications and Sequelæ of Measles. Cal State J Med 2, 221–224 (1904).