Comments on: Measles week, part IV: Some of the answers

By: Neus Gator

Neus Gator — Fri, 04 Jun 2010 05:51:00 +0000

Very interesting post, please write more about this themes. Its very informative.

By: iayork

iayork — Sun, 21 Mar 2010 04:10:20 +0000

I came across several references to oxygen therapy ("Oxygen tents") in the 1940s literature, but didn't find a clear reference to when it started.

Doctors in the 1940s clearly considered oxygen treatment to be a major factor, but not the most critical one. From the 1945 round-table discussion I mentioned in Part III:

Improved nutrition was first and foremost, he thought, the cause of the lowered mortality, not the shift in the attack-age, though doubtless it played a part. There was no detectable difference between the character of the measles of 20 years ago and now, but there was a great difference in the nutrition of the children. Moreover, our therapeutic armamentarium was considerably enhanced by the oxygen tent, sulphonamides and penicillin, and by earlier operation for mastoiditis; even suppurative meningitis was not a great menace nowadays, whereas twenty years ago practically every child with meningitis died.

--Butler, W. (1945). The Fatality Rate of Measles: A Study of its Trend in Time. Journal of the Royal Statistical Society 108, 259-285.

(This discussion, as I said, is a completely fascinating one. They didn't reach a clear conclusion, and the points they raise are more in the thinking-aloud category than definitive solutions; but it's really intriguing and useful to see the viewpoint at that time.)

By: iayork

iayork — Sun, 21 Mar 2010 00:10:20 +0000

Improved nutrition was first and foremost, he thought, the cause of the lowered mortality, not the shift in the attack-age, though doubtless it played a part. There was no detectable difference between the character of the measles of 20 years ago and now, but there was a great difference in the nutrition of the children. Moreover, our therapeutic armamentarium was considerably enhanced by the oxygen tent, sulphonamides and penicillin, and by earlier operation for mastoiditis; even suppurative meningitis was not a great menace nowadays, whereas twenty years ago practically every child with meningitis died.

By: Measles week, part I: Introduction | Mystery Rays from Outer Space

Measles week, part I: Introduction | Mystery Rays from Outer Space — Fri, 19 Mar 2010 11:20:00 +0000

[...] Measles week, part IV: Some of the answers [...]

By: Measles week, Part V: What about the vaccine? | Mystery Rays from Outer Space

Fri, 19 Mar 2010 11:16:33 +0000

[...] Measles week, part IV: Some of the answers [...]

By: Tsu Dho Nimh

Tsu Dho Nimh — Fri, 19 Mar 2010 02:54:03 +0000

I think you are “multiple minor changes” territory where each change in demographic, social services, nutrition (when were the pure food laws passed?), and therapy each shoved the mortality down a bit.

By: iayork

iayork — Thu, 18 Mar 2010 17:04:57 +0000

chezjake: Interesting thought, but I don’t see a lot of evidence for it. Doctors in the 1910s and 1920s used aspirin for measles, as with other diseases, but didn’t seem particularly impressed by aspirin’s efficacy. I refer you to the rather disparaging comments about aspirin in measles in “Forchheimer’s therapeusis of internal diseases, Volume 2″ (Frank Billings, 1919), “An Account of an Epidemic of Measles” (E.W. Gardner, Am J Clin Med 23:925-929 (1916)), and “Infectious Diseases” (Julius L. Salinger, transl. by J.C. Wilson, 1911) among other commentaries of the time.

By: chezjake

chezjake — Thu, 18 Mar 2010 16:42:33 +0000

Another element in the “better treatment” group of factors may be the increasing use (and increasing affordability) of aspirin to reduce fever in the early 20th century. I don’t have handy stats, but I’m fairly sure that there was a direct correlation between duration of high fever in measles cases and subsequent complications, including pneumonia and encephalitis.

Bayer began worldwide distribution of aspirin in 1899, and Bayer’s patents in the US expired in 1917, making generic aspirin widely available.

Of course, there’s a secondary mystery of why Reyes Syndrome was not identified as a side effect of aspirin treatment of viral infections in children until 1963.

By: kierra

kierra — Thu, 18 Mar 2010 13:15:52 +0000

How well does the measles decrease coincide with child labor practices? I know that the Fair Labor Standard’s Act wasn’t passed until 1938, but child labor may have been decreasing before then. It may not have been that 1920s children were as malnourished as those in third world countries today, but they would have been crammed together inside poorly ventilated factories.

By: iayork

iayork — Thu, 18 Mar 2010 13:10:45 +0000

I came across several references to oxygen therapy (“Oxygen tents”) in the 1940s literature, but didn’t find a clear reference to when it started.

Doctors in the 1940s clearly considered oxygen treatment to be a major factor, but not the most critical one. From the 1945 round-table discussion I mentioned in Part III:

Improved nutrition was first and foremost, he thought, the cause of the lowered mortality, not the shift in the attack-age, though doubtless it played a part. There was no detectable difference between the character of the measles of 20 years ago and now, but there was a great difference in the nutrition of the children. Moreover, our therapeutic armamentarium was considerably enhanced by the oxygen tent, sulphonamides and penicillin, and by earlier operation for mastoiditis; even suppurative meningitis was not a great menace nowadays, whereas twenty years ago practically every child with meningitis died.

–Butler, W. (1945). The Fatality Rate of Measles: A Study of its Trend in Time. Journal of the Royal Statistical Society 108, 259-285.

(This discussion, as I said, is a completely fascinating one. They didn’t reach a clear conclusion, and the points they raise are more in the thinking-aloud category than definitive solutions; but it’s really intriguing and useful to see the viewpoint at that time.)