Volume 2 — AN ACCOUNT OF THE MEASLES, AS THEY APPEARED IN PHILADELPHIA, IN THE SPRING OF 1789.

The weather in December, 1788, and in January, 1789, was variable, but seldom very cold. On the first of February, 1789, at six o'clock in the morning, the mercury in Fahrenheit's thermometer fell 5° below 0, in the city of Philadelphia. At twenty miles from the city, on the Schuylkill, it fell 12° below 0, at the same hour. On the 19th and 20th of this month, there fell a quantity of snow, the depth of which, upon an average, was supposed to be about eight or ten inches. On the 23d, 24th, 25th, and 27th, the weather was very cold. The mercury fluctuated during these days between 4° and 10° above 0.

In the intervals between these cold days, the weather frequently moderated, so that the Delaware was frozen and thawed not less than four times. It was not navigable till the 8th of March. There were in all, during the winter and month of March, sixteen distinct falls of snow.

In April and May there were a few warm days; but upon the whole, it was a very cold and backward spring. The peaches failed almost universally. There were no strawberries or cherries on the 24th of May, and every other vegetable product was equally backward. A country woman of 84 years of age informed me, that it was the coldest spring she had ever known. It was uncomfortable to sit without fire till the first of June.

The measles appeared first in the Northern Liberties, in December. They spread slowly in January, and were not universal in the city till February and March.

This disease, like many others, had its precursor. It was either a gum-boil, or a sore on the tongue. They were both very common, but not universal. They occurred, in some instances, several days before the fever, but in general they made their appearance during the eruptive fever, and were a sure mark of the approaching eruption of the measles. I was first led to observe this fact, from having read Dr. Quin's accurate account of the measles in Jamaica. I shall now proceed to mention the symptoms of the measles as they appeared in the different parts of the body.

1. In the head, they produced great pain, swelling of the eye-lids, so as to obstruct the eye-sight, tooth-ach, bleeding at the nose, tinnitus aurium, and deafness; also coma for two days, and convulsions. I saw the last symptom only in one instance. It was brought on by a stoppage of a running from the ear.

2. In the throat and lungs, they produced a soreness and hoarseness, acute or dull pains in the breast and sides, and a painful or distressing cough. In one case, this cough continued for two hours without any intermission, attended by copious expectoration. In two cases, I saw a constant involuntary discharge of phlegm and mucus from the mouth, without any cough. One of them terminated fatally. Spitting of blood occurred in several instances. The symptoms of pneumonia vera notha and typhoides were very common. I saw two fatal cases from pneumonia notha, in both of which the patients died with the trunk of the body in an erect posture. I met with two cases in which there was no cough till the eruption made its appearance on the fourth day, and one which was accompanied by all the usual symptoms of the cynanche trachealis.

3. In the stomach the measles produced, in many instances, sickness and vomiting. And

4. In the bowels, griping, diarrhœa, and, in some instances, bloody stools. The diarrhœa occurred in every stage of the disease, but it was bloody and most painful in its decline. I attended a black girl who discharged a great many worms, but without the least relief of any of her symptoms.

There was a great variety in this disease. 1. In the time of the attack of the fever, from the time of the reception of the contagion. In general the interval was fourteen days, but it frequently appeared before, and sometimes later than that period.

2. In the time of the eruption, from the beginning of the fever. It generally appeared on the third and fourth days. In one case, Dr. Waters informed me, it did not appear till the eighth day.

3. In the abatement or continuance of the fever after the eruption.

4. In the colour and figure of the eruption. In some it put on a pale red, in others a deep, and in a few a livid colour, resembling an incipient mortification. In some there appeared red blotches, in others an equally diffused redness, and in a few, eruptions like the small-pox, called by Dr. Cullen, rubiola varioloides.

5. In the duration of the eruption on the skin. It remained in most cases only three or four days; but in one, which came under my care, it remained nine days.

6. In the manner of its retrocession. I saw very few cases of its leaving the branny appearance so generally spoken of by authors on the skin.

7. In not affecting many persons, and even families who were exposed to it.

The symptoms which continued in many after the retrocession of the measles, were cough, hoarseness, or complete aphonia, which continued in two cases for two weeks; also diarrhœa, opthalmy, a bad taste in the mouth, a defect or excess of appetite, and a fever, which in some instances was of the intermitting kind, but which in more assumed the more dangerous form of the typhus mitior. Two cases of internal dropsy of the brain followed them. One was evidently excited by a fall. They both ended fatally.

During the prevalence of the disease I observed several persons (who had had the measles, and who were closely confined to the rooms of persons ill with them) to be affected with a slight cough, sore throat, and even sores in the mouth. I find a similar fact taken notice of by Dr. Quier.

But I observed further, many children to be affected by a fever, cough, and all the other symptoms of the measles which have been mentioned, except a general eruption, for in some there was a trifling efflorescence about the neck and breast. I observed the same thing in 1773 and 1783. In my note book I find the following account of the appearance of this disease in children in the year 1773. “The measles appeared in March; a catarrh (for by that name I then called it) appeared at the same time, and was often mistaken for them, the symptoms being nearly the same in both. In the catarrh there was in some instances a trifling eruption. A lax often attended it, and some who had it had an extremely sore mouth.”

I was the more struck with this disease, from finding it was taken notice of by Dr. Sydenham. He calls it a morbillous fever. I likewise find an account of it in the 2d article of the 5th volume of the Edinburgh Medical Essays. The words of the author, who is anonymous, are as follow. “During this measly season, several persons, who never had the measles, had all the symptoms of measles, which went off in a few days without any eruptions. The same persons had the measles months or years afterwards.” Is this disease a common fever, marked by the reigning epidemic, and produced in the same manner, and by the same causes, as the variolous fever described by Dr. Sydenham, which he says prevailed at the same time with the small-pox? I think it is not. My reasons for this opinion are as follow.

1. I never saw it affect any but children, in the degree that has been mentioned, and such only as had never had the measles.

2. It affected whole families at the same time. It proved fatal to one of three children whom it affected on the same day.

3. It terminated in a pulmonary consumption in a boy of ten years old, with all the symptoms which attend that disease when it follows the regular measles.

4. It affected a child in one family, on the same day that two other members of the same family were affected by the genuine measles.

5. It appeared on the usual days of the genuine measles, from the time the persons affected by it were exposed to its contagion. And,

6. It communicated the disease in one family, in the usual time in which the disease is taken from the genuine measles.

The measles, then, appear to follow the analogy of the small-pox, which affects so superficially as to be taken a second time, and which produce on persons who have had them what are called the nurse pock. They follow likewise the analogy of another disease, viz. the scarlatina anginosa. In the account of the epidemic for 1773, published in the third volume of the Edinburgh Medical Essays, we are told, that such patients as had previously had the scarlet fever without sore throats, took the sore throat, and had no eruption, while those who had previously had the sore throat had a scarlet eruption, but the throat remained free from the distemper. All other persons who were affected had both.

From these facts, I have taken the liberty of calling it the internal measles, to distinguish it from those which are external. I think the discovery of this new state of this disease of some application to practice.

1. It will lead us to be cautious in declaring any disease to be the external measles, in which there is not a general eruption. From my ignorance of this, I have been led to commit several mistakes, which were dishonourable to the profession. I was called, during the prevalence of the measles in the above-named season, to visit a girl of twelve years old, with an eruption on the skin. I called it the measles. The mother told me it was impossible, for that I had in 1783 attended her for the same disease. I suspect the anonymous author before-mentioned has fallen into the same error. He adds to the account before quoted the following words. “Others, who had undergone the measles formerly, had at this time a fever of the erysipelatous kind, with eruptions like to which nettles cause, and all the previous and concomitant symptoms of the measles, from the beginning to the end of the disease.”

2. If inoculation, or any other mode of lessening the violence of the disease, should be adopted, it will be of consequence to know what persons are secure from the attacks of it, and who are still exposed to it.

I shall now add a short account of my method of treating this disease.

Many hundred families came through the disease without the help of a physician. But in many cases it was attended with peculiar danger, and in some with death. I think it was much more fatal than in the years 1773 and 1783, probably owing to the variable weather in the winter, and the coldness and dampness of the succeeding spring. Dr. Huxham says, he once saw the measles attended with peculiar mortality, during a late cold and damp spring in England. It was much more fatal (cæteris paribus) to adults than to young people.

The remedies I used were,

1. Bleeding, in all cases where great pain and cough with a hard pulse attended. In some I found it necessary to repeat this remedy. But I met with many cases in which it was forbidden by the weakness of the pulse, and by other marks of a feeble action in the blood-vessels.

2. Vomits. These were very useful in removing a nausea; they likewise favoured the eruption of the measles.

3. Demulcent and diluting drinks. These were barley water, bran, and flaxseed tea, dried cherry and raw apple water, also beverage, and cyder and water. The last drink I found to be the most agreeable to my patients of any that have been mentioned.

4. Blisters to the neck, sides, and extremities, according to the symptoms. They were useful in every stage of the disease.

5. Opiates. These were given not only at night, but in small doses during the day, when a troublesome cough or diarrhœa attended.

6. Where a catarrhal fever ensued, I used bleeding and blisters. In those cases in which this fever terminated in an intermittent, or in a mild typhus fever, I gave the bark with evident advantage. In that case of measles, formerly mentioned, which was accompanied by symptoms of cynanche trachealis, I gave calomel with the happiest effects. In the admission of fresh air I observed a medium as to its temperature, and accommodated it to the degrees of action in the system. In different parts of the country, in Pennsylvania and New-Jersey, I heard with great pleasure of the cold air being used as freely and as successfully in this disease, as in the inflammatory small-pox. The same people who were so much benefited by cool air, I was informed, drank plentifully of cold water during every stage of the fever. One thing in favour of this country practice deserves to be mentioned, and that is, evident advantage arose in all the cases which I attended, from patients leaving their beds in the febrile state of this disease. But this was practised only by those in whom inflammatory diathesis prevailed, for these alone had strength enough to bear it.

The convalescent state of this disease required particular attention.

1. A diarrhœa often continued to be troublesome after other symptoms had abated. I relieved it by opiates and demulcent drinks. Bleeding has been recommended for it, but I did not find it necessary in a single case.

2. An opthalmia which sometimes attended, yielded to astringent collyria and blisters.

3. Where a cough or fever followed so slight as not to require bleeding, I advised a milk and vegetable diet, country air, and moderate warmth; for whatever might have been the relation of the lungs in the beginning of the disease to cold air, they were now evidently too much debilitated to bear it.

4. It is a common practice to prescribe purges after the measles. After the asthenic state of this disease they certainly do harm. In all cases, the effects of them may be better obviated by diet, full or low, suitable clothing, and gentle exercise, or country air. I omitted them in several cases, and no eruption or disease of any kind followed their disuse.

I shall only add to this account of the measles, that in several families, I saw evident advantages from preparing the body for the reception of the contagion, by means of a vegetable diet.