April 21, 2019History of Medicine
Measles has been a scourge for centuries, afflicting millions of people. It has been blamed, in part, for decimating native populations of the Americas as Europeans explored the New World. In modern times, before a vaccine was developed, nearly every American contracted the virus, with its telltale skin blotches and fever. Measles was declared eradicated in the U.S. in 2000, but has staged a comeback as the inoculation rate has dropped.
In the 3rd to 10th century, early physicians in Asia and North Africa identified and diagnosed measles, which was similar to smallpox, another highly contagious disease that triggered rashes and sores. Modern scientists would later suggest that measles evolved after the rise of early civilization in the Middle East and may have come from animals; the virus was highly similar to rinderpest, which infected cattle. In 340 CE, Chinese alchemist Ko Hung described the difference between smallpox and measles. A Christian priest, Ahrun, did the same in Egypt about 300 years later. In 910, the Persian physician Rhazes published the most widely celebrated early diagnoses of the two diseases. In a pattern that would be repeated across the world for centuries,
1492: Christopher Columbus and his fellow European explorers arrived in the Americas bringing a raft of deadly diseases, including measles. Native Americans had no natural immunity to many of these diseases. Measles, smallpox, whooping cough, chicken pox, bubonic plague, typhus and malaria - already dangerous and often deadly in Europe - became even more efficient killers in the New World. By some estimates, the Native American population plunged by as much as 95% over the next 150 years due to disease. In 1529, a measles outbreak killed two thirds of the population of Cuba. Later, it wiped out half the population of Honduras and also ravaged the Incans. In the 1800s, Measles wiped out major portions of Hawaii and Fiji.
1824-48: As was the case with many diseases, the measles risk to Pacific Islanders was particularly dangerous in the 19th century as traders and travelers crisscrossed the globe. In 1824, Hawaii's King Kamehameha II and Queen Kamamalu traveled to London to meet King George IV, but instead swiftly contracted measles. Both died within a month. The virus, along with several other diseases, struck Hawaii in 1848, killing up to a third of the native population.
1846: Danish physician Peter Ludwig Panum traveled to the Faroe Islands between Iceland and Norway to study a measles outbreak that had sickened more than 75% of the islands' 7,782 residents - killing at least 102. Measles had not appeared on the isolated islands in decades, and Panum discovered that not one of the elderly residents who had been infected in 1781 was attacked a second time. Such immunity would later become key to defeating the virus. Panum observed measles' contagiousness as it leaped from village to village.
Koplik's spots are named after Henry Koplik (1858-1927), an American pediatrician who published a short description of them in 1896, emphasizing their appearance before the skin rash and their value in the differential diagnosis of diseases with which measles might be mistaken. He published two further papers on the spots, including one with a color illustration. An anonymous reviewer of Koplik's The Diseases of Infancy and Childhood refers to the illustration as the now famous colored plate.
1875: The HMS Dido brought measles to Fiji, killing 20,000 people - up to a third of the island's natives. Measles outbreaks would continue to hopscotch Pacific islands for much of the next century.
1912: The United States required physicians to start reporting measles cases, which gave scientists a precise grasp of the disease's widespread impact inside the country. Almost all Americans caught measles sometime in their life - mostly when young - and the outcome could be deadly. A study in the U.S. from 1912 to 1916 found 26 deaths for every 1,000 measles cases. By 1912, the United States started tracking the disease as an average of 6,000 people a year were dying from it in the US. It was particularly deadly to communities that had no exposure.
Nobel laureate John F. Enders and Thomas Peebles, who first isolated measles virus were careful to collect their samples from patients showing Koplik's spots.
John Franklin Enders (February 10, 1897 - September 8, 1985) was an American biomedical scientist and Nobel Laureate. Enders has been called The Father of Modern Vaccines. Enders was born in West Hartford, Connecticut. His father, John Ostrom Enders, was CEO of the Hartford National Bank and left him a fortune of $19 million upon his death. He attended the Noah Webster School in Hartford, and St. Paul's School in Concord, New Hampshire. After attending Yale University, a short time, he joined the United States Army Air Corps in 1918 as a flight instructor and a lieutenant. After returning from World War I, he graduated from Yale, where he was a member of Scroll and Key as well as Delta Kappa Epsilon. He went into real estate in 1922, and tried several careers before choosing the biomedical field with a focus on infectious diseases, gaining a Ph.D. at Harvard in 1930. He later joined the faculty at Children's Hospital Boston. Enders died in 1985 in Waterford, Connecticut, aged 88, holding honorary doctoral degrees from 13 universities. In 1949, Enders, Thomas Huckle Weller, and Frederick Chapman Robbins reported successful in vitro culture of an animal virus - poliovirus. The three received the 1954 Nobel Prize in Physiology or Medicine for their discovery of the ability of polioviruses to grow in cultures of various types of tissue.
On September 17, 1961, The New York Times announced the measles vaccine effective. Refusing credit for only himself, Enders stressed the collaborative nature of the effort. In 1963, Pfizer introduced a deactivated measles vaccine, and Merck & Co introduced an attenuated measles vaccine.
Our History of Medicine piece would not be complete without space for Dr. Maurice Hilleman, who was responsible for developing more than 40 vaccines, including measles, mumps, hepatitis A, hepatitis B, meningitis, pneumonia, Hemophilus influenzae bacteria, and rubella. His vaccines have been credited with saving millions of lives and with eradicating common childhood diseases. The measles vaccine alone has prevented approximately one million deaths. Among other accomplishments, he succeeded in characterizing and isolating many viruses, including the hepatitis A vaccine in culture.
Hilleman's interest in microbiology and science had its roots in his childhood. Born in 1919, he grew up during the Great Depression on a farm in the southeastern plains of Montana. To help his family through the Depression, he needed to be economical and tenacious. It was a building block he later used for keeping his focus. After the Depression, he entered Montana State University on a full scholarship. In a 1999 issue of Immunological Reviews, he described Montana State as a no-nonsense institution where professors taught and where teaching assistants, other than laboratory aides, did not exist. He gained a bachelor's degree in microbiology and chemistry.?chemistry. His graduate education at the University of Chicago reinforced his independence and self-reliance. It was a tough environment, in which Hilleman said you would either sink or swim. In 1944 he was awarded a PhD in microbiology and chemistry. Hilleman told his professors at Chicago that he was going into industry, where he thought he would be best positioned not only for conducting research, but also for ensuring and expediting clinical applications. His professors told him that he belonged in academia and that they had not trained him for a career in industry. Hilleman strongly disagreed, maintaining that academic institutions lacked the resources to move scientific innovations forward and to market. In 1944 Hilleman joined the virus laboratories of E R Squibb & Sons in New Brunswick, New Jersey, where he developed a vaccine against Japanese B encephalitis, urgently needed to immunize troops fighting in the Pacific. Hilleman characterized several viruses and identified changes that could result when a virus mutated. This concept, which he worked out while at the Walter Reed Institute of Army Research, helped prevent a huge pandemic of Hong Kong flu in 1957. Learning that the flu was a new strain, 40 million doses of vaccine were rapidly made available in the United States.
Hilleman joined Merck on New Year's Eve, 1957, as director of a new department of virus and cell biology research. Under Hilleman's aegis, by 1984 Merck had garnered 37 product licenses, with an additional three vaccines ready for development. He retired from Merck at age 65, but stayed on as a consultant. During his more than 60 years in basic and applied research, he earned a reputation as an often harsh, impatient fellow who tangled with industry and government bureaucracies. Hilleman defended his pushy and prickly behavior, which offended some colleagues and coworkers, as crucial for science to advance. He argued that politics, not science, determined which breakthroughs were brought to the marketplace.
Hilleman received many honors, including a special lifetime achievement award from the World Health Organization. Maurice Hilleman, died from cancer on 11 April 2005.
In March 2005 the University of Pennsylvania School of Medicine's Department of Pediatrics and The Children's Hospital of Philadelphia, in collaboration with The Merck Company Foundation, announced the creation of The Maurice R. Hilleman Chair in Vaccinology. In 2007, Paul Offit published a biography of Hilleman, entitled Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases and on 15 October 2008, Merck named its Maurice R. Hilleman Center for Vaccine Manufacturing, in Durham, North Carolina, in memory of Hilleman. A documentary film titled Hilleman: A Perilous Quest to Save the World's Children, chronicling Hilleman's life and career, was released in 2016 by Medical History Pictures, Inc.