November 9, 2015
Today when we talk of measles, we talk of a killer disease that could potentially wipe out mankind. Those who choose not to get the MMR vaccine are, in essence, putting the world’s survival at risk. In February of 2015, the CDC classified 125 measles cases at Orange County, California’s Disney Theme Park as an “outbreak.”
But what was the actual end result of the “outbreak?” The CDC connected 125 total measles cases from Disney Theme Park, 100 of them were considered “patients.” But these “patients,” all survived. And by “survived,” I mean they weren’t injured and there were no deaths. Sound familiar? This isn’t much different than the way we experience colds, sans the “outbreak” and “patient” statistics.
But what if we started vaccinating for colds? Many people might think that to be strange, I mean, because colds just aren’t a big deal. And if you are one of those people who would find a cold vaccine absurd, how do you think the people of 1959 would have found a measles vaccine?
When we think of the measles today, we think of a killer disease. The media paints a doom and gloom scenario every time the illness is mentioned. But in 1959, measles epidemics of 4000 times more intensity were seen as a “mild infection.”
Measles epidemic [page 354]
Br Med J 1959;1:351.2 (Published 07 February 1959)
In the first three weeks of this year about 41,000 cases of measles were recorded in England and Wales. This is well above the corresponding figures of the last two years – namely, about 9,000 in 1958 and 28,000 in 1957 – though it is below the highest levels reached in the last nine years. To give some idea of the main features of the disease as it appears today and of how it is best treated, we invited some general practitioners to write short reports on the cases they have seen in their practices recently.
These appear at p.380 (extracts from this page follow this article). It is interesting to note, first, that the distribution of the disease is rather patchy at present. It has not yet reached the areas where two of these doctors practise (in South Scotland and Cornwall), and other areas are known to be free of the disease so far. On the other hand, in Kent it is reported to have arrived in time to put the children to bed over Christmas. These writers agree that measles is nowadays normally a mild infection, and they rarely have occasion to give prophylactic gamma globulin.As to the treatment of the disease and its complications, the emphasis naturally varies from one practice to another. Amount of bed-rest, when to administer a sulphonamide or antibiotic, the use of analgesics and linctuses – all these may still be debatable problems in the treatment of what is said to be the commonest disease in the world. But there is probably much in the opinion which one of the writers expresses: “It is the frequent visiting by the interested clinician and not the therapy which produces the good results.”
REPORTS FROM GENERAL PRACTITIONERS
REPORTS FROM GENERAL PRACTITIONERS
Br Med J 1959;1:380 (Published 07 February 1959)
EXTRACTS [pages 380-381]
We are much indebted to the general practitioners whose names appear below for the following notes on the present outbreak of measles.
Dr G. I. WATSON (Peaslake, Surrey) writes:
Measles was introduced just before Christmas by a child from Petworth …….
Treatment of Attack. – No drugs are given for either the fever or the cough; if pressed, I dispense mist. salin. B.N.F. as a placebo. Glutethimide 125 mg. may be given in the afternoon if the child is restless when the rash develops; 250 mg. in single or divided doses at bedtime ensures a good night’s sleep in spite of coughing. I encourage a warm humid atmosphere in the room by various methods: some electric fires and most electric toasters allow an open pan of water to rest on top; an electric kettle blows off too much steam to be kept on for more than short periods. Parents, conscious of the need to darken the room and to forbid reading, may carry this to an unnecessary extreme, starting even before the rash appears. To save a mother some demands, the wireless is a boon to children in darkened rooms. They are allowed up when the rash fades from the abdomen-usually the fourth or fifth day-and may go outside on the next fine day. Apart from fruit to eat, solid food is avoided on the day the rash is appearing; fruit drinks or soups are all they appear to want.
Complications. – So far few complications have arisen. Four cases of otitis media occurred in the first 25 children, but only one had pain. No case of pneumonia has occurred, but one child had grossly abnormal signs in the chest for a few days after the fever subsided, uninfluenced by oral penicillin. One girl had a tear-duct infection and another an undue blepharitis. Of three adult males with the disease, two have been more severely affected than any of the children.
Dr. R. E. HOPE SIMPSON (Cirencester, Glos) writes:
We make no attempt to prevent the spread of measles, and would only use gamma globulin to mitigate the severity of the disease in the case of the exposure of a susceptible adult or child who is already severely debilitated. Bed rest, for seven davs for moderate and severe cases and of five to six days in mild cases, seems to cut down the incidence of such complications as secondary bacterial otitis media and bronchopneumonia. We have not been impressed by the prophylactic or therapeutic use of antibiotics and sulphonamides in the first week of the disease. As soon as the patient is out of bed we allow him out of doors almost regardless of the weather. Otitis Media and Bronchopneumonia.-These conditions often appear so early, sometimes even before the rash, that in such cases one can only conclude that the responsible agent is the virus itself.Despite their initial alarming severity, they tend to resolve spontaneously, and treatment apart from first principles seems useless. When, on the other hand, otitis media or bronchopneumonia comes on after the subsidence of the initial symptoms of measles, it is probably due to a secondary bacterial invader, and we find antibiotics or sulphonamides useful…..
Dr. JOHN FRY (Beckenham, Kent) writes:
The expected biennial epidemic of measles appeared in this region in early December, 1958, just in time to put many youngsters to bed over Christmas. To date there have been close on 150 cases in the practice, and the numbers are now steadily decreasing. Like previous epidemics, the primary cases have been chiefly in the 5- and 6-year-olds, with secondary cases in their younger siblings. No special features have been noted in this relatively mild epidemic. It has been mild because complications have occurred in only four children. One little girl aged 2 suffered from a lobular pneumonia, and three others developed acute otitis media following their measles. In the majority of children the whole episode has been well and truly over in a week, from the prodromal phase to the disappearance of the rash, and many mothers have remarked ”how much good the attack has done their children,” as they seem so much better after the measles.
A family doctor’s approach to the management of measles is essentially a personal and individual matter, based on the personal experiences of the doctor and the individual character and background of the child and the family. In this practice measles is considered as a relatively mild and inevitable childhood ailment that is best encountered any time from 3 to 7 years of age. Over the past 10 years there have been few serious complications at any age, and all children have made complete recoveries. As a result of this reasoning no special attempts have been made at prevention even in young infants in whom the disease has not been found to be especially serious.