Speaker 1: Welcome to Stuff You Missed in History Class, a production
Speaker 1: of iHeartRadio. Hello, and welcome to the podcast.
Speaker 2: I'm Tracy V.
Speaker 1: Wilson and I'm Holly Frye.
Speaker 2: Right after I got back from that trip to Philadelphia
Speaker 2: to see that Marine Laura sign exhibit, there were some
Speaker 2: headlines about a measles outbreak happening there, and then right
Speaker 2: at the same time also warnings about a potential measles
Speaker 2: exposure for travelers who had passed through Dulles or Reagan
Speaker 2: Airports in Washington, d C. So measles was declared eliminated
Speaker 2: in the United States more than twenty years ago, meaning
Speaker 2: that there is no longer sustained transmission of the disease
Speaker 2: happening here. But outbreaks do obviously still happen. They're usually
Speaker 2: related to travel to and from places where it's a
Speaker 2: lot more common. Outbreaks can spread really quickly if they
Speaker 2: reach an area where a lot of people are unvaccinated. So,
Speaker 2: of course I do not like that there are measles
Speaker 2: outbreaks happening anywhere. It's a highly contagious virus. It can
Speaker 2: put people in the hospital. An estimated one hundred and
Speaker 2: thirty six thousand people died of it worldwide in twenty
Speaker 2: twenty three, and in the years just before vaccines for
Speaker 2: it became widely available, measles killed an estimated two point
Speaker 2: six million people around the world every year. Uh but
Speaker 2: as a vaccinated person living in a highly vaccinated area,
Speaker 2: I am not at a lot of risk for measles myself.
Speaker 2: So these headlines for me, they sparked more curiosity than fear,
Speaker 2: and they also reminded me a little bit of the
Speaker 2: things that led me to write an episode on scarlet
Speaker 2: fever last year. People seem to really like the scarlet
Speaker 2: Fever episode, so I thought I would take a look
Speaker 2: at the history of measles heads up. They we will
Speaker 2: have just a little bit of questionable slash unethical research
Speaker 2: stuff happening this episode, and a tiny bit about ways
Speaker 2: that we used to inoculate people that's potentially gross. Neither
Speaker 2: of these are very long discussions, but they are there.
Speaker 1: In the US, there are two different diseases that are
Speaker 1: commonly called measles. One caused by the measles morbilivirus also
Speaker 1: called rubiola, is usually just called measles. The other is
Speaker 1: caused by the rubella virus, and it is sometimes called
Speaker 1: German measles. These diseases have some similar symptoms, and they're
Speaker 1: both targeted by the measles mumps rubella or MMR vaccine,
Speaker 1: which is used in much of the world. But measles
Speaker 1: and German measles are different illnesses caused by different viruses.
Speaker 1: This episode is primarily about the one caused by measles morbilivirus,
Speaker 1: although German measles will come up occasionally as we're talking
Speaker 1: this through. The virus that causes measles is highly contagious.
Speaker 1: Between eighty five and ninety percent of people who are
Speaker 1: exposed to it and are not already immune will contract it.
Speaker 1: It's also something that can spread really easily before people
Speaker 1: realize they have it. Measles causes a characteristic rash, but
Speaker 1: it is also contagious for up to four days before
Speaker 1: that rash actually appears, and before that happens, people might
Speaker 1: just think they have something like a cold. In most cases,
Speaker 1: it takes about two weeks between exposure to measles and
Speaker 1: the development of that rash, and the virus can linger
Speaker 1: in the air and on surfaces for a couple of hours.
Speaker 1: This can make outbreaks really challenging to track, since health
Speaker 1: officials have to try to piece together who a person
Speaker 1: had contact with about two weeks before, or who may
Speaker 1: have moved through a space that person had even briefly
Speaker 1: been in day.
Speaker 2: That's why these warnings about Dulles and Reagan Airports were
Speaker 2: on specific days for like a six sish hour window
Speaker 2: when a person might have been exposed had they gone
Speaker 2: through there. If you are Hollies in my age or younger,
Speaker 2: and you're from the United States or Europe, which is
Speaker 2: most of our listeners, you probably have not seen a
Speaker 2: case of the measles in person, even though it has
Speaker 2: become more common in these places over the last several years.
Speaker 2: And as is the case with a lot of illnesses,
Speaker 2: there is some variation and exactly what symptoms people experience,
Speaker 2: but most of the time, measles starts with a fever
Speaker 2: and cold like symptoms like a running nose and a cough,
Speaker 2: possibly accompanied by pink eye. Most people, but not all,
Speaker 2: then develop white spots in their mouth, known as Coplic spots.
Speaker 2: These are named after American physician Henry Koplick, who first
Speaker 2: described them in eighteen ninety six. Then that's followed by
Speaker 2: the rash, which usually starts on the face and the neck,
Speaker 2: and then progresses to the rest of the body. On
Speaker 2: people with light skin, this rash is usually red and flat,
Speaker 2: although there may also be raised bumps. The rash can
Speaker 2: be harder to see on people who have darker skins.
Speaker 2: Sometimes it appears as a darker shade of that person's
Speaker 2: regular skin color. Usually the person's fever spikes after the
Speaker 2: rash develops, and the rash usually peels as it goes away.
Speaker 1: There's no treatment for measles. It's just rest, supportive care
Speaker 1: and treatment of specific symptoms if needed, like oatmeal bass
Speaker 1: if a person's rash is itchy, which it may or
Speaker 1: may not be.
Speaker 2: Obviously, this is not medical advice. If you think you
Speaker 2: have measles.
Speaker 1: See darker.
Speaker 2: Most people recover from measles without any apparent issues, but
Speaker 2: there's increasing evidence that the virus causes immune system damage
Speaker 2: that can last for at least two years. This is
Speaker 2: described as immune amnesia, meaning the body kind of forgets
Speaker 2: how to fight pathogens that it previously knew how to handle,
Speaker 2: and between five percent and fifteen percent of people who
Speaker 2: contract measles also develop some kind of more immediate complication.
Speaker 2: Some of these are relatively mild like, since measles can
Speaker 2: lower a person's resistance to other pathogens. Ear infections and
Speaker 2: sinus infections are common, but others are more acutely serious,
Speaker 2: like pneumonia and inflammation of the internal organs, including the heart.
Speaker 2: One of the most serious complications of measles is encephalitis,
Speaker 2: or inflammation of the brain, which can develop weeks after
Speaker 2: a person seems to have recovered. This is fatal in
Speaker 2: ten to fifteen percent of people who develop it, and
Speaker 2: it can also cause long term issues like seizures and
Speaker 2: cognitive disabilities. There is also a very rare fatal complication
Speaker 2: of the central nervous system called subacute sclerosing panacephalitis, which
Speaker 2: can develop seven to ten year years after recovering from measles.
Speaker 2: Measles can also be particularly dangerous during pregnancy, and that
Speaker 2: includes carrying a risk of low birth weight, pregnancy loss,
Speaker 2: and stillbirth. German measles or rebella, is also particularly dangerous
Speaker 2: during pregnancy, and congenital rebella syndrome is associated with heart problems,
Speaker 2: hearing loss, developmental delays, and other issues. Today, measles outbreaks
Speaker 2: in wealthy countries make a lot of headlines but that
Speaker 2: isn't where measles is most common. There's a very effective
Speaker 2: vaccine for measles, one that's about ninety six percent effective
Speaker 2: with two doses, with that immunity lasting for a person's
Speaker 2: whole life. So places that have a robust healthcare system
Speaker 2: with broad vaccine coverage aren't likely to see huge outbreaks
Speaker 2: of measles, and even if there are outbreaks in communities
Speaker 2: that have religious or cultural or philosophical objections to vaccines,
Speaker 2: health officials are more likely to be able to respond
Speaker 2: to them effectively. But places without that infrastructure, without the
Speaker 2: resources to coordinate widespread vaccination campaigns, and places that are
Speaker 2: experiencing some kind of civic unrest or war are a
Speaker 2: lot more likely to see large outbreaks of measles and
Speaker 2: also less likely to be able to respond to them effectively.
Speaker 2: People who are already malnourished or sick, or aren't able
Speaker 2: to get enough food or water or rest while they're
Speaker 2: recovering are just more likely to develop measles complications. This
Speaker 2: means mortality rates from measles can really vary from country
Speaker 2: to country, with the countries that are facing the most
Speaker 2: poverty and unrest seeing the worst outcomes from measles, so globally,
Speaker 2: measles is still a leading cause of childhood death. So
Speaker 2: that is the basics of measles, and we're going to
Speaker 2: get into more about its history after we pause for
Speaker 2: a sponsor break. Measles more bili viruses than the pyramics.
Speaker 2: The virus family of viruses, and that also includes the
Speaker 2: viruses that cause para influenza, mumps and rsv rsv I
Speaker 2: feel like has been in the headlines so much over
Speaker 2: the last few years. That stands for respiratory sensicial virus.
Speaker 2: This family also includes a number of viruses that primarily
Speaker 2: affect animals, including the viruses that cause canine distemper and
Speaker 2: render pest. Two prevailing theories about the origin of measles
Speaker 2: have been that it evolved from canine distemper as people
Speaker 2: started domesticating dogs, or that it diverged from render pest
Speaker 2: as people started domesticating cattle. Measles morbilivirus is most closely
Speaker 2: related to render pest, and most of the recent research
Speaker 2: into this has focused on render pest. Render pest was
Speaker 2: declared eradicated in twenty eleven, and we are going to
Speaker 2: have our episode on that as an upcoming Saturday Classic.
Speaker 2: A lot of this research into the question of exactly
Speaker 2: where measles came from and when has involved molecular clock analysis.
Speaker 2: That's basically looking at mutations over time to try to
Speaker 2: pinpoint when two organisms diverged from one another. Studies conducted
Speaker 2: in the twenty teens concluded that measles diverged from render
Speaker 2: past quite recently, it's just the eleventh or twelfth century CE,
Speaker 2: but then research published in twenty twenty suggests that it
Speaker 2: was centuries earlier than that, possibly as early as the
Speaker 2: sixth century BCE. A lot of papers written in the
Speaker 2: twenty teens framed the idea of like the eleventh or
Speaker 2: twelfth century divergence of measles is basically settled knowledge, but
Speaker 2: then that twenty twenty research called that timeline into question.
Speaker 1: This, of course, makes it tricky to pin down some
Speaker 1: of the early history of measles. There are a lot
Speaker 1: of illnesses that cause fever and a rash, and a
Speaker 1: lot of historical accounts just aren't specific enough to say
Speaker 1: for sure whether they're describing smallpox, scarlet fever, measles, or
Speaker 1: something else. Measles is one of the diseases that has
Speaker 1: been proposed as the cause of the Antonine plague, also
Speaker 1: called the plague of Galen, which took place between the
Speaker 1: years one sixty five to one eighty CE. If measles
Speaker 1: didn't diverge from render pest until the eleventh century, it
Speaker 1: couldn't have been the cause. But if that divergence really
Speaker 1: took place around the sixth century BCE, it could have been.
Speaker 1: There are also clinical descriptions of measles that date back
Speaker 1: to before the eleventh or twelfth centuries. The most well
Speaker 1: known is by Abu Baker Mohammad ibn Zakaria. Al Razi,
Speaker 1: known in some Western accounts as Ross Alrazi, was a
Speaker 1: physician during the Islamic Golden Age. He lived from about
Speaker 1: eight sixty four to nine thirty five CE. Alrazi wrote
Speaker 1: at least two hundred medical and philosophical tree, including his
Speaker 1: Catab Alhawi, or Comprehensive Book on Medicine, and one of
Speaker 1: these treatises was a treatise on smallpox and measles.
Speaker 2: This is the first known medical text to clearly differentiate
Speaker 2: between these two diseases.
Speaker 1: Of course, this was also written during a time when
Speaker 1: medicine was focused on the idea of humors and keeping
Speaker 1: those humors in balance. So Alrasi's thoughts on the causes
Speaker 1: of smallpox and measles don't align with today's evidence based
Speaker 1: ideas of medicine. As translated into English in the nineteenth century,
Speaker 1: he wrote, quote, every man, from the time of his
Speaker 1: birth till he arrives at old age is continually tending
Speaker 1: to dryness. And for this reason the blood of children
Speaker 1: and infants is much moister than the blood of young men,
Speaker 1: and still more so than that of old men. Now
Speaker 1: the smallpox arises when the blood putrefies and ferments so
Speaker 1: that the superfluous vapors are thrown out of it, and
Speaker 1: it is changed from the blood of infants, which is
Speaker 1: like must, into the blood of young men, which is
Speaker 1: like wine perfectly ripened. And the smallpox itself may be
Speaker 1: compared to the fermentation and the hissing noise which take
Speaker 1: place in must at that time.
Speaker 2: So this offered an explanation for why it seemed like
Speaker 2: most people contracted smallpox before reaching adulthood, because under this
Speaker 2: arose from the process of transforming the blood from the
Speaker 2: blood of a child into the blood of an adult.
Speaker 2: He thought adults were only likely to contract smallpox if
Speaker 2: they were exposed to quote pestilential, putrid, and malignant constitutions
Speaker 2: of the air in which this disease is chiefly prevalent.
Speaker 2: He also claims that quote bodies that are lean, bilious, hot,
Speaker 2: and dry are more disposed to the measles than to
Speaker 2: the smallpox, and quote when the summer is excessively hot
Speaker 2: and dry, and the autumn is also hot and dry,
Speaker 2: and the rains come very late, then the measles quickly
Speaker 2: seize those who are disposed to them, that is, those
Speaker 2: who are of a hot, lean, and bilious habit of body.
Speaker 2: In terms of symptoms, Selrazi wrote that quote inquietude, nausea,
Speaker 2: and anxiety are far more frequent in the measles, and
Speaker 2: he recommended treatments for measles that included barley water mixed
Speaker 2: with acid, pomegranate juice, as well as expectorants to make
Speaker 2: it easier for people to cough up any chest congestion.
Speaker 2: But Arazi also understood that smallpox was a more serious
Speaker 2: disease than measles, and a lot of this volume is
Speaker 2: devoted to recommendations for the treatment of smallpox, regardless of
Speaker 2: the questions around exactly when measles may have diverged from
Speaker 2: render pest. It was clearly widespread in Europe, Northern Africa,
Speaker 2: and much of Asia by the medieval period, especially in
Speaker 2: places where cities were large enough to sustain ongoing epidemics.
Speaker 2: Measles was introduced into the Americas through colonization in the
Speaker 2: fifteenth and sixteenth centuries. Although smallpox gets a lot of
Speaker 2: the focus in terms of introduced diseases and their devastating
Speaker 2: impact on the continent's indigenous peoples, other diseases, including measles,
Speaker 2: proved to be deadly as well. There were huge deadly
Speaker 2: measles outbreaks described in Cuba, Honduras, and Brazil in the
Speaker 2: fifteen twenties and thirties. The first written record of an
Speaker 2: outbreak in North America was in Boston in sixteen fifty seven.
Speaker 2: A lot of medical writing in Europe and North America
Speaker 2: in the seventeenth and eighteenth centuries focused on both measles
Speaker 2: and smallpox, as al Razi had done back in the
Speaker 2: ninth century. Doctors and other researchers wrote about how to
Speaker 2: tell these two diseases apart, and how to treat each
Speaker 2: of them. One example is Englishman Thomas Sydenham, who had
Speaker 2: a chapter on the measles in his sixteen ninety three
Speaker 2: complete Works, which was followed by a chapter on smallpox.
Speaker 2: Sydonham's description of measles is thorough, describing it as generally
Speaker 2: attacked children with chills, followed by fever, loss of appetite,
Speaker 2: running eyes and nose. And then on the fourth day
Speaker 2: or the fifth quote, there appear on the face and
Speaker 2: forehead small red spots, very like the bites of fleas.
Speaker 2: These increase in number and cluster together so as to
Speaker 2: mark the face with large red blotches. They are formed
Speaker 2: by small papules so slightly elevated above the skin that
Speaker 2: their prominence can hardly be detected by the eye, but
Speaker 2: can just be felt by passing the fingers lightly along
Speaker 2: the skin. The spots take hold on the face first,
Speaker 2: from which they spread to the chest and belly, and
Speaker 2: afterwards to the legs and ankles. On these parts may
Speaker 2: be seen broad red macule on but not above the
Speaker 2: level of the skin. This is so much more detailed
Speaker 2: than so many ancient historical texts that are sort of
Speaker 2: like the Great plague passed through the town, bringing a
Speaker 2: rash and death and it's like, okay, what rash though.
Speaker 1: Them.
Speaker 2: Goes on to describe the way that this rash developed
Speaker 2: over the days that followed, and then made recommendations for treatment,
Speaker 2: including syrups of violet and maiden hair and a draft
Speaker 2: made of black cherry water and syrup of poppies for
Speaker 2: use at night. He also recommended bleeding for patients who
Speaker 2: developed diarrhea after the rest of the disease had resolved.
Speaker 2: In seventeen forty, German physician Friedrich Hoffmann differentiated rubiola from
Speaker 2: rubella or German measles. It's not entirely clear whether the
Speaker 2: German moniker came from the diseases description in German medical texts,
Speaker 2: or if it's from the Latin germanus meaning similar. In
Speaker 2: seventeen fifty seven, Scottish physician Francis Holme tried to develop
Speaker 2: a vaccine for measles. He was inspired by the use
Speaker 2: of variolation to prevent smallpox. That is, intentionally exposing someone
Speaker 2: to smallpox in a more controlled way, with the goal
Speaker 2: of giving them a milder case of the disease that
Speaker 2: would leave them immune to it. Later. In Holmes's words,
Speaker 2: quote considering how destructive this disease is in some seasons,
Speaker 2: considering how many die, even in the mildest epidemical constitution,
Speaker 2: considering how it hurts the lungs and eyes, I thought
Speaker 2: I should do no small service to mankind if I
Speaker 2: could render this disease more mild and safe, in the
Speaker 2: same way as the Turks have taught us to mitigate
Speaker 2: the smallpox. Here's the potentially gross bit, So hit that
Speaker 2: skip ahead button if you are particularly squeamish. Smallpox produces sores,
Speaker 2: and variolation involved introducing matter from those sores into another
Speaker 2: person's skin, but a measle's rash doesn't produce anything comparable
Speaker 2: that could be used in this way. So Home tried
Speaker 2: to use the blood of sick patients to expose other people. Obviously,
Speaker 2: there are other bloodborne diseases, so this is not aut
Speaker 2: a medically safe thing to do, and people were hesitant
Speaker 2: to try it at the time. In Homes's words quote
Speaker 2: from the prejudices of mankind, I found it difficult to
Speaker 2: get the blood as I wanted it, and much more
Speaker 2: difficult to find subjects for inoculation. Okay, this was the
Speaker 2: reasonable concern. It's like fancy that h Holmes experiments with
Speaker 2: measles inoculation. They were limited. It's maybe fifteen total people
Speaker 2: he tried this on, and they weren't particularly successful. Those
Speaker 2: who did get sick with what seemed like it could
Speaker 2: have been measles generally had a mild case of it,
Speaker 2: but some of them later contracted measles from some other exposure.
Speaker 2: Others did not get sick from Holmes's attempt to expose them.
Speaker 2: But this experiment did lead Home to conclude that measles
Speaker 2: was definitely caused by some sort of contagion, one that
Speaker 2: could be carried in the blood in sufficient quantities to
Speaker 2: cause the disease in another person, not by something like
Speaker 2: miasma's or bad air, which was still a common idea
Speaker 2: at the time. As we said earlier, measles is incredibly contagious,
Speaker 2: and that can make it difficult to track the progression
Speaker 2: of an outbreak. But in the nineteenth century, an outbreak
Speaker 2: started in a remote location and researchers were able to
Speaker 2: gain some insights by tracking how it moved, and we're
Speaker 2: going to talk more about that after a sponsor break.
Speaker 2: By the end of the nineteenth century, measles had been
Speaker 2: introduced to virtually the entire world, including northwest North America
Speaker 2: in the early nineteenth century, Australia and New Zealand in
Speaker 2: the eighteen fifties, and more distant Pacific islands in the
Speaker 2: late nineteenth century. In places where measles was already endemic,
Speaker 2: there were typically major outbreaks every few years, so the
Speaker 2: disease usually affected children under the age of five because
Speaker 2: virtually everybody else still living had already gotten it in
Speaker 2: an earlier outbreak. Babies also had some protection in their
Speaker 2: first months of life due to antibodies that they got
Speaker 2: in utero, but in virgin soil epidemics, meaning that when
Speaker 2: the virus was introduced to places where nobody was immune,
Speaker 2: the disease affected virtually everybody at the same time, no
Speaker 2: matter their age. One such outbreak took place in the
Speaker 2: Faroe Islands in the North Atlantic between Norway and Iceland
Speaker 2: in eighteen forty six. It wasn't technically a virgin soil
Speaker 2: epidemic since there had been an earlier outbreak in the
Speaker 2: islands in seventeen eighty one, but the vast majority of
Speaker 2: the island's residents had not been born when that earlier
Speaker 2: epidemic took place. There were seven eight hundred sixty four
Speaker 2: people living in the Faroe Islands in eighteen forty six,
Speaker 2: and about sixty one hundred contracted measles. In this epidemic,
Speaker 2: one hundred seventy people died, for a mortality rate of
Speaker 2: about two point eight percent. The government of Denmark sent
Speaker 2: physician and pathologists Peter Ludvigpayanum to the islands to try
Speaker 2: to control the outbreak, and he personally treated about one
Speaker 2: thousand of the sixty one hundred people who became ill,
Speaker 2: and he also studied how the disease spread through the islands.
Speaker 2: Unlike in a city where there are a lot of
Speaker 2: people living very close together, continually interacting with people from
Speaker 2: other neighborhoods through things like work and school and errands,
Speaker 2: the pharaoh Islands were made up of small villages on
Speaker 2: a collection of islands that were largely isolated from one another.
Speaker 2: People did travel between the different villages and the different islands,
Speaker 2: or people from multiple villages might all come together for
Speaker 2: some reason, but this was not just like a continual
Speaker 2: daily occurrence.
Speaker 1: Paynham pinpointed how measles was introduced to the Pharaohs in
Speaker 1: eighteen forty six writing quote. The first person on the
Speaker 1: Pharaohs who took the measles was a cabinet maker now
Speaker 1: living in Thorsham. He left Copenhagen on the twentieth of
Speaker 1: March and reached Thorsham on the twenty eighth. On the way,
Speaker 1: he had felt quite well, but was attacked by measles
Speaker 1: early in April, on what day he did not know.
Speaker 1: Shortly before his departure, he had visited some measles patients
Speaker 1: in Copenhagen. About fourteen days later, his two nearest associates
Speaker 1: were attacked, so.
Speaker 2: Painam acknowledged that these men's accounts weren't entirely accurate, like
Speaker 2: one of them was saying, I don't remember what day
Speaker 2: this started, and they were also just trying to reconstruct
Speaker 2: where they had been two weeks previously. But their description
Speaker 2: of the basic timeline quote determined me to give attention
Speaker 2: in my travels about the islands to the length of
Speaker 2: the stage of incubation.
Speaker 1: Paynam was able to identify the index case in fifty
Speaker 1: two villages in the Faroe Islands, that is, the first
Speaker 1: person to develop measles. From there, he traced when and
Speaker 1: where they had been exposed to the disease, and how
Speaker 1: long it had taken other people in their village to
Speaker 1: get sick. With these observs, he narrowed down the illness's
Speaker 1: incubation period to about fourteen days on average. That was
Speaker 1: a far more precise estimate than had been in use before.
Speaker 2: He also found that there were ninety eight people in
Speaker 2: the islands over the age of sixty five who had
Speaker 2: survived that earlier seventeen eighty one outbreak. None of those
Speaker 2: ninety eight people got measles in eighteen forty six. There
Speaker 2: were already doctors and others who thought that people were
Speaker 2: immune to measles after recovering from it, but there were
Speaker 2: also various reports of people getting it a second time.
Speaker 2: So Paydam thought that what he observed in the Faral
Speaker 2: Islands outbreak offered clear evidence that there really was lifelong
Speaker 2: immunity to measles. So he thought that these other reports
Speaker 2: where people seem to have gotten measles more than once,
Speaker 2: the people involved may have actually contracted some other illness.
Speaker 2: Painam reported one village in which people believed a midwife
Speaker 2: had carried measles. She herself had previously had it in Debat,
Speaker 2: but she had spent several days taking care of measles
Speaker 2: patients and everyone she came into contact with. In the
Speaker 2: next village she visited developed measles fourteen days later. That
Speaker 2: included the girl who laundered the clothes that the midwife
Speaker 2: had been wearing. Painam's account included a list of communities
Speaker 2: that were spared from measles because they had kept a
Speaker 2: strict quarantine. About fifteen hundred residents of the island's avoided
Speaker 2: measles because their communities cut off all contact with the
Speaker 2: ones where measles was circulating. This outbreak happened just as
Speaker 2: European medicine was starting to move toward the germ theory
Speaker 2: of disease, and there was still debate about exactly what
Speaker 2: caused measles. Painam's report on this outbreak concluded, quote, if
Speaker 2: among six thousand cases of which I myself observed and
Speaker 2: treated about one thousand, not one was found in which
Speaker 2: it would be justifiable on any grounds whatever to suppose
Speaker 2: a miismatic origin of measles, because it was absolutely clear
Speaker 2: that the disease was transmitted from man to man and
Speaker 2: from village to village by contagion, whether the latter was
Speaker 2: received by immediate contact with a patient, or was conveyed
Speaker 2: to the infected person by clothes or the like. It
Speaker 2: is certainly reasonable, at least to entertain a considerable degree
Speaker 2: of doubt as to the miismatic nature of the disease.
Speaker 2: By the early twentieth century, researchers had concluded that measles
Speaker 2: was caused not by just some contagion, but specifically a virus,
Speaker 2: and they were trying to learn about and isolate it.
Speaker 2: That finally happened in nineteen fifty four, when John F
Speaker 2: Enders and Thomas C. Peebles collected samples from patients during
Speaker 2: a measle's outbreak in Boston. They isolated the virus from
Speaker 2: samples collected from an eleven year old patient named David Edmonston.
Speaker 2: The next step was to try to weaken or attenuate
Speaker 2: this virus into a form that would confer immunity to
Speaker 2: measles without making the people who received it sick. Enders,
Speaker 2: Peebles and their collaborators went through a process that involved
Speaker 2: human kidney cells, human amniotic cells, and chicken eggs. Researchers
Speaker 2: tested the vaccines on monkeys before moving on to human trials,
Speaker 2: and the first humans they tested the vaccine on were themselves.
Speaker 2: This is probably more of a safety check because presumably
Speaker 2: all of them at this point had already had measles
Speaker 2: when they were children. In October of nineteen fifty eight,
Speaker 2: the team tested their vaccine on eleven children, and all
Speaker 2: of them developed antibodies to measles morbilivirus, but nine of
Speaker 2: them also developed a rash, and they did not want
Speaker 2: this vaccine to cause any kind of illness in people,
Speaker 2: so after working to further attenuate the virus, the team
Speaker 2: started larger trials in the nineteen sixties.
Speaker 1: There are ethical questions around these larger trials. Some of
Speaker 1: them were carried out at institutions for disabled children, the
Speaker 1: Walter E. Fernald State School in Waltham, Massachusetts, and Willow
Speaker 1: School in Staten Island, New York. Both of these institutions
Speaker 1: were also home to research that was obviously and inherently unethical.
Speaker 1: This included children at Fernaud State School being fed oatmeal
Speaker 1: containing radioactive trackers in the late nineteen forties and early
Speaker 1: nineteen fifties, and children at Willowbrook being intentionally given hepatitis
Speaker 1: in the nineteen fifties and sixties to study the progression
Speaker 1: of the disease and efficacy of gamma globulin injections. Neither
Speaker 1: of these studies had the potential to benefit the children involved,
Speaker 1: and the full nature of the experiments was not explained
Speaker 1: to the parents who gave permission for their children to participate.
Speaker 1: So these early measles trials were conducted on an inherently
Speaker 1: very vulnerable population and a group that doctors often perceived
Speaker 1: as less than human at institutions that were also already
Speaker 1: involved in unethical research. That said, there were a couple
Speaker 1: of different between those studies and the measles vaccine trials.
Speaker 1: Being immune to measles would benefit the children involved. Since
Speaker 1: they lived in close quarters with other children in facilities
Speaker 1: where disease outbreaks were common, they were at an even
Speaker 1: greater risk for measles than a lot of other kids
Speaker 1: would be. A severe measles outbreak had started at Willowbrook
Speaker 1: in the spring of nineteen sixty and so the vaccine
Speaker 1: was given to children who were actively at risk from
Speaker 1: this ongoing outbreak, and Enders and the rest of his
Speaker 1: collaborators seemed to have been ahead of their time around
Speaker 1: ideas of informed consent, explaining the vaccine to the parents
Speaker 1: getting their permission and administering the vaccine only when that
Speaker 1: permission was actually given. Other trials were carried out in
Speaker 1: Nigeria through the University of Ibadan. At that time, the
Speaker 1: university hospital was seeing more than one thousand measles cases
Speaker 1: annually with a mortality rate of about percent, so measles
Speaker 1: was a particular threat there as well. One phase of
Speaker 1: these trials was on the children of the university's faculty
Speaker 1: and staff, who were invited to participate.
Speaker 2: The trials in the US and Nigeria demonstrated that this
Speaker 2: vaccine was highly effective at preventing measles, and it was
Speaker 2: licensed for use in the US on March twenty first,
Speaker 2: nineteen sixty three. A team led by Maurice Hillman developed
Speaker 2: a more attenuated version of the vaccine in nineteen sixty eight.
Speaker 2: This more attenuated strain became known as the Edmonston Enders strain,
Speaker 2: and it ultimately became the only measles vaccine distributed in
Speaker 2: the US.
Speaker 1: The development of a measles vaccine marked something of a
Speaker 1: shift in how vaccines were approached in most of the world.
Speaker 1: Prior to this, the focus had been on diseases that
Speaker 1: were extremely serious and deadly, including smallpox and polio, but
Speaker 1: especially in the US and Europe, measles had come to
Speaker 1: be seen as a root disease of childhood and not
Speaker 1: a deadly scourge that needed to be stopped. On top
Speaker 1: of that, people typically only got measles once in their lives,
Speaker 1: and many people had fears about the safety of the vaccine,
Speaker 1: as has been the case with every vaccine, so this
Speaker 1: made it harder for health officials to convince people to
Speaker 1: have their children vaccinated. But even with those challenges, measles
Speaker 1: cases dropped dramatically in the United States after the start
Speaker 1: of a coordinated vaccine campaign. In nineteen sixty seven, there
Speaker 1: were four hundred and fifty thousand cases of measles reported
Speaker 1: in the US. It was a reportable disease.
Speaker 2: Health officials were required to report all the cases, but
Speaker 2: in nineteen sixty eight, just a year later, there were
Speaker 2: only twenty two thousand. But there were also some clear
Speaker 2: disparities and who had access to this vaccine. It was
Speaker 2: mostly being administered by doctors who were working in private practice,
Speaker 2: meaning that most of the people who were getting it
Speaker 2: were middle or upper class. So while the total number
Speaker 2: of measles cases dropped precipitously, cases became really clustered among
Speaker 2: the populations that were underserved by the medical community, including
Speaker 2: non white communities and people living in poorer areas. It
Speaker 2: did not take long after the introduction of measles vaccines
Speaker 2: for nations to start looking at the idea of eliminating
Speaker 2: the virus entirely, especially as it became clear that the
Speaker 2: vaccine conferred long term immunity, and initially researchers thought it
Speaker 2: might be possible to eradicate measles if as little as
Speaker 2: fifty five percent of the population was vaccinated. That turned
Speaker 2: out to be way too low a target. Measles is
Speaker 2: so contagious that roughly ninety to ninety five percent of
Speaker 2: the population needs to be immune to keep it from spreading,
Speaker 2: but nations started efforts to eliminate the disease pretty quickly.
Speaker 2: In nineteen seventy eight, the US Centers for Disease Control
Speaker 2: announced a plan to eliminate measles in the US by
Speaker 2: nineteen eighty two. That did not happen, but the number
Speaker 2: of measles cases in the US did drop another eighty
Speaker 2: percent between nineteen eighty and nineteen eighty one. That was
Speaker 2: so ambitious of a goal to me, especially considering like
Speaker 2: living through however, many years of like COVID nineteen pandemic response,
Speaker 2: the idea of like, we're going to eliminate this in
Speaker 2: three years, and like that's wild.
Speaker 1: Uh.
Speaker 2: In nineteen ninety eight, though, efforts to eradicate measles worldwide
Speaker 2: faced a huge setback when The Lancet published an article
Speaker 2: by Andrew Wakefield and various co authors which claimed that
Speaker 2: the measles mumps rubella or MMR vaccine caused a form
Speaker 2: of colitis that then caused autism. This paper was not
Speaker 2: just wrong, it was fraudulent, and Wakefield had been funded
Speaker 2: by an attorney who was representing parents who were trying
Speaker 2: to sue vaccine manufacturers. The Lancet retracted this article in
Speaker 2: twenty eleven after in depth reporting on the many many
Speaker 2: problems with it, and Wakefield was ultimately struck from the
Speaker 2: medical register in the UK. Numerous follow up studies since
Speaker 2: then have concluded that there's no link between the MMR
Speaker 2: vaccine and autism, and autism advocates have also noted that
Speaker 2: it's extremely offensive to suggest that it's better to risk
Speaker 2: a potentially fatal disease than to be autistic. Measles was
Speaker 2: declared eliminated in the United States in the year two thousand,
Speaker 2: but there have been outbreaks since then when measles has
Speaker 2: been reintroduced from other places. One of the most high
Speaker 2: profile outbreaks was connected to Disneyland in California. The first
Speaker 2: case of measles associated with this outbreak was reported to
Speaker 2: the California Department of Public Health on January fifth, twenty fifteen.
Speaker 2: Four other measles cases were reported to the department on
Speaker 2: the same day, and two were reported in Utah. Everyone
Speaker 2: involved had been to Disneyland or a neighboring park between
Speaker 2: December seventeenth and twentieth, twenty fourteen. Most cases involved in
Speaker 2: this outbreak were in southern California, but there were also
Speaker 2: cases in sixteen other states, Canada, and Mexico. Under vaccination
Speaker 2: was cited as a key factor in this outbreak. Of
Speaker 2: the unvaccinated patients in California, twelve were infants who were
Speaker 2: too young to be vaccinated, but almost seventy percent of
Speaker 2: the patients who got it and were eligible for the
Speaker 2: vaccine had not been vaccinated because of their personal beliefs.
Speaker 2: This outbreak contributed to the passage of a law in
Speaker 2: California that removed personal beliefs as a reason for people
Speaker 2: to be exempt from vaccine requirements to attend schools and
Speaker 2: daycares in California.
Speaker 1: On September twenty seventh, twenty sixteen, the Pan American Health
Speaker 1: Organization declared measles to be eliminated in the Americas, but
Speaker 1: this only lasted for a couple of years. Venezuela lost
Speaker 1: its measles free status in twenty eighteen and Brazil in
Speaker 1: twenty nineteen in the wake of civil unrest and an
Speaker 1: anti vaccine movement.
Speaker 2: I'm just sort of continually waiting for the US also
Speaker 2: to lose its measles free status, because we just keep
Speaker 2: on having outbreaks and at some point they're they're going
Speaker 2: to call it stopped. According to a report from the
Speaker 2: Centers for Disease Control, as of twenty twenty two, there
Speaker 2: were eighty three countries around the world that have achieved
Speaker 2: measles free status, most of them in the Americas and Europe.
Speaker 2: But deaths from measles also increased forty percent worldwide in
Speaker 2: twenty twenty two, with epidemics in thirty seven countries. That
Speaker 2: is up from twenty two countries that experienced outbreak the
Speaker 2: year before. In January of twenty twenty four, the World
Speaker 2: Health Organization warned of a sharp uptick in measles cases
Speaker 2: in Europe, with thirty thousand cases reported in forty of
Speaker 2: the European region's World Health Organization members states. That is
Speaker 2: up from less than one thousand cases in twenty twenty two.
Speaker 2: The European Center for Disease Prevention and Control reported that
Speaker 2: in twenty twenty two, only eighty nine point seven percent
Speaker 2: of people in Europe had had their second dose of vaccine,
Speaker 2: that is below the level needed to maintain heard immunity.
Speaker 2: Health officials in various parts of the world has cited
Speaker 2: the COVID nineteen pandemic is a big reason for this
Speaker 2: increase in measles cases in epidemics, both because of people
Speaker 2: not having access to routine medical appointments in the first
Speaker 2: years of the pandemic and being fearful of going to
Speaker 2: those appointments once they were available, and because of increasing
Speaker 2: vaccine hesitancy in connection to the rollout of COVID nineteen vaccines.
Speaker 2: There's also some conjecture about the impact that the SARS
Speaker 2: CoV two virus, which causes COVID nineteen has had on
Speaker 2: the immune system, and whether it is similar to the
Speaker 2: immune amnesia that can follow measles infection. But there's a
Speaker 2: pretty clear connection between an overall drop in vaccination rates
Speaker 2: and increasing rates of measles. Yeah, we're still very early
Speaker 2: in understanding long term effects of COVID nineteen on the body,
Speaker 2: but the like, there's just obvious lines that can be
Speaker 2: drawn in decreasing numbers of people who were fully vaccinated
Speaker 2: for measles and increasing numbers of measles cases. It is
Speaker 2: absolutely a disease that is possible to eradicate around the world.
Speaker 2: But only but you gotta participate. Yeah, only with everyone vaccinated.
Speaker 1: Uh yeah, do you have contagious listener, ma'am?
Speaker 2: I have listener mail. I would not call it contagious.
Speaker 2: It is about healthcare though.
Speaker 1: Uh.
Speaker 2: This is from Judy and Judy's subject line made me laugh.
Speaker 2: It says you made me realize I'm old, not a
Speaker 2: bad thing. In relation to mammograms, uh. And Judy wrote,
Speaker 2: Dear Holly and Tracy, listening to the mammogram episode in
Speaker 2: your Friday comments, I was amused by your amazement of
Speaker 2: the changes in your lifetime then I started thinking and
Speaker 2: realizing that I am too. I'm in my seventies and
Speaker 2: remember when mammograms could not only squish your breasts but
Speaker 2: cause burns from the X rays if the tech wasn't
Speaker 2: careful and the texts were usually males back then then
Speaker 2: you had to wait for days, sometimes weeks to get results.
Speaker 2: The new digital machines with mostly lovely female texts as
Speaker 2: a joy. Some differences with PAP exams actually general medical
Speaker 2: interactions for women. Now I now I'm thinking I should
Speaker 2: make lists of things I've seen changed, usually for the better,
Speaker 2: in my lifetime. It could be scary fun by the way.
Speaker 2: This includes color TVs, email, walkman CDs and audio books,
Speaker 2: a great thing for gardening, and backup cameras in cars.
Speaker 2: All in all, things are better. I hope you can
Speaker 2: make a similar list for your lives. Maybe everyone who
Speaker 2: listens should do that and send it to you, and
Speaker 2: miss in History could start a new segment changes in
Speaker 2: our lives as you trace the technology or organization or person. This,
Speaker 2: of course, is in addition to all the other research
Speaker 2: you too. I've attached photos for pet tax in the
Speaker 2: vein of history. I have attached a baby picture of JJ,
Speaker 2: an abandoned neonate kitten I fostered. The second picture is JJ,
Speaker 2: now still in my house as I couldn't give him
Speaker 2: up as an eighteen pound cat. Enjoy. Thanks for all
Speaker 2: the learning and joy and giving me a new way
Speaker 2: to look at the world, Judy, So thank you Judy.
Speaker 1: This.
Speaker 2: I love this idea. Kitty What a tiny little kitty
Speaker 2: cat face reminds me? I mean, my cats we brought
Speaker 2: home at a reasonable age to bring kittens home, right,
Speaker 2: but this little kitten face really reminds me of their
Speaker 2: kitten faces, even though they were a bit bigger than
Speaker 2: this one. And then of course this uh, very large
Speaker 2: I moved I moved the picture to underneath my window
Speaker 2: that it has Holly Holly's face on it. Uh. And
Speaker 2: then of course adult black cat reminds me of my
Speaker 2: adult black cats, especially because this one is on like
Speaker 2: a fluffy bed type thing and we have a very
Speaker 2: similar bed that uh. Sometimes kitty cats at my house
Speaker 2: like sometimes not. Uh. So I love these cat pictures.
Speaker 2: I love all these stories. I do think pretty often
Speaker 2: having been born and starting to go to school at
Speaker 2: an age where there was no email, there was like
Speaker 2: prototype email, but like not not in the actual things
Speaker 2: that consumers had.
Speaker 1: Actually we did, yeah, we were not using it.
Speaker 2: We were not. We were not in the worlds of
Speaker 2: universities or the military who were like working on early
Speaker 2: prototypes of what would become the World Wide Web. But like,
Speaker 2: you know, having been a kindergartener when there was nobody
Speaker 2: was emailing reports home, having not had a cell phone
Speaker 2: as a child, carrying quarters to put in the payphone,
Speaker 2: being dropped off at the mall, to walk around there
Speaker 2: with a quarter to call my mom if I needed
Speaker 2: her anyway, I think about these things all the time.
Speaker 2: The world has changed so so so much in Holly's
Speaker 2: in my lifetimes in memory. So yeah, one of my
Speaker 2: favorite lists of this nature was not a list per se,
Speaker 2: but Brian's aunt Beth, who I loved dearly, died three
Speaker 2: weeks before her hundredth birthday. Oh goodness, and she was
Speaker 2: really sharp and wonderful right to the end. And I
Speaker 2: remember and I just had a soft spot for her.
Speaker 2: We just I adored that woman.
Speaker 1: And I remember one point when she was in her
Speaker 1: early nineties sitting down and talking about everything that existed
Speaker 1: that was common that when she was like you know,
Speaker 1: I know I'm old and that sometimes when I'm in
Speaker 1: the car because she wasn't driving anymore and you and
Speaker 1: Brian are driving, I get very nervous about the speed
Speaker 1: and She's like, I remember when there weren't cars, and
Speaker 1: I was like, whoa. Yeah, she was pretty amazing and
Speaker 1: had an encyclopedic knowledge of the area she grew up
Speaker 1: in and of the world, and she was world traveled,
Speaker 1: so she was a great one for that. And I
Speaker 1: wish I had written down that entire conversation or recorded it. Yeah,
Speaker 1: but we have lots of great pictures of her doing
Speaker 1: things that I'm like, Aunt Beth is the human encyclopedia
Speaker 1: from like the late eighteen hundreds to you know, the
Speaker 1: the I think I forget what year she was born.
Speaker 1: I want to say it was nineteen oh four, but
Speaker 1: they lived on a farm, so they did not have
Speaker 1: a lot of modern stuff, so it was little. Yeah,
Speaker 1: she was amazing, amazing.
Speaker 2: It's in my house somewhere, I'm pretty sure a video
Speaker 2: of my grandmother and one of her sisters talking about
Speaker 2: their childhood being raised in a rural parsonage during the
Speaker 2: Great Depression reminds me of that a little bit. So anyway,
Speaker 2: Thank you again, Judy for this email. Honestly, I love
Speaker 2: this whole idea of thinking of ways that the world
Speaker 2: has changed during our lifetimes, and I know that that's
Speaker 2: going to be vastly different recollections for different people with
Speaker 2: different experiences, But thank you so much for sending that
Speaker 2: and sharing it with us. If you would like to
Speaker 2: send us some notes about this or any other podcast
Speaker 2: or history podcast at iHeartRadio dot com and we're on
Speaker 2: social media's miss and History on Facebook and Instagram and
Speaker 2: the thing that used to be Twitter. You can subscribe
Speaker 2: to our show on the iHeartRadio app and wherever else
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Speaker 2: History Class is a production of iHeartRadio. For more podcasts
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