When Measles Was Endemic – The Atlantic

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Many people who contract measles don’t know right away that they have it. Days after infection, the symptoms can feel like the flu, until the tell-tale blotchy red rash emerges—usually near the hairline at first, later traveling down the biceps, abdomen, thighs, feet, hands. So far this year, 712 people in America are known to have been infected with the highly contagious disease. This number is already higher than last year’s, which totalled 285. The virus has been particularly widespread in West Texas, where two young girls have died—the first measles deaths America has seen in a decade. And the official cause of death of a New Mexico resident who contracted measles remains under investigation.

Each of the three people who died were unvaccinated, renewing the controversy over vaccine hesitancy. It is a stance that has been around for as long as vaccines have. But a time before the measles vaccine—before 1963, when the virus was so widespread that virtually every child was expected to fall ill from it—is beyond the memory of most generations today.

“My will I made last week, while I was in bed with the measles,” the 18-year-old Frances Anne Kemble, who later published her letters in The Atlantic, wrote in 1828. “I lay parched and full of pain and fever in my illness!”

Then Kemble’s account took an optimistic turn: “I have been very ill for the last fortnight, but am well again now. I am pressed for time to-day, but will soon write to you in earnest.” Even though measles infected millions of people each year in the 19th century, killing more than 12,000 people in 1900, it was seen as less worrisome than other diseases. Scarlet fever and smallpox had higher mortality rates, and the ubiquity of measles meant that contracting it was almost a rite of passage. (The word measly is derived from the virus, Adam Ratner noted in Booster Shots.) Consider the way in which the disease was written about in this magazine: A book review from 1859 mentions “a complaint as common to a certain period of life as measles.” And in 1871, a passion for collecting items was described as something that “befalls most boys, like measles or whooping-cough.”

Measles’ reputation as a common childhood illness also meant that health officials didn’t usually take mitigation efforts as seriously as they did for other diseases. In How the Other Half Lives, Jacob Riis described the virus’s devastating effects in New York City’s tenement housing in the 1880s, where impoverished and starving people gathered in close quarters with little access to hygiene: “Listen! That short hacking cough, that tiny, helpless wail—what do they mean? … The child is dying with measles. With half a chance it might have lived; but it had none.” He reported on records showing that respiratory diseases, including the flu and measles, were the most common cause of death in these housing conditions. But diphtheria and scarlet fever were “considered more dangerous to the public health,” so health officials moved those cases to hospitals, resulting in “a low death-rate.”

Recovery from measles is not always linear; contracting the virus can make people more vulnerable to other diseases. In 1925, one mother recalled pulling from the family’s savings to settle the bills for her children’s treatment. Those who were unable or unwilling to pay relied on homemade remedies that largely lacked scientific backing. Tansy and pennyroyal leaves could be steeped to make tea, and sometimes catnip would be used as well, according to a 1933 Atlantic article. Anybody bold (or desperate) enough could try “sheep tea,” which got its name from the main ingredient of dried sheep manure.

Though drinking rehydrated animal waste might seem outlandish today, the prospect of using unconventional methods to treat measles hasn’t faded from popularity. Take Health Secretary Robert F. Kennedy Jr.: Throughout the current outbreak, he has promoted unproven treatments such as cod-liver oil and steroids. Experts widely agree that these are no substitutes for the measles vaccination. No antivirals will cure a patient once they’re infected—doctors can only manage the symptoms. Depending on certain factors (age, vaccination status, underlying conditions), in many cases these symptoms will abate; in others, possible complications (pneumonia, brain swelling) can lead to long-term issues or death.

“Measles is not a forgiving virus,” my colleague Katherine J. Wu wrote last month. And it’s currently spreading in an environment very different from that of the prevaccine era, when primarily kids were infected and people lived in a world less connected by air, rail, and car. The most recent example of a measles epidemic took place in the late 1980s and early ’90s. It “infected 55,000 people, put 11,260 in the hospital, and killed more than 150,” the policy researcher Mary Graham wrote in The Atlantic in 1993. Doctors scrambled to treat a disease they hadn’t come across for years; crowded hospitals set aside beds for feverish patients. “Epidemics are no longer local events,” Graham explained. “The rapid spread of measles to forty-nine states was a destructive reminder that from the perspective of a virus we have become one community.”