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Measles Epidemic, Boston, Massachusetts, 1713whose grief can be universally understood. One of Mather’smost noteworthy sermons, preached 24 years earlier, observedthat: “Yet few outward Earthly Anguishes are equalunto these. The Dying of a Child is like the Tearing off [of]a limb…” (8).Several medical aspects of Mather’s entries are noteworthy.From Mather’s brief notations, we cannot be certainof the exact dates of onset of most of the illnesses hedescribed. However, he clearly chronicles 2 serial generationsof measles within his family (one of no more than 17days, the other of no more than 15). These intervals correspondto what textbooks began to describe, more than acentury later, about the patterns of measles spread. Measlesseems to have been brought into the household by Mather’sson Increase around October 18, 1713. Increase apparentlyinfected his mother, Elizabeth Clark-Hubbard Mather, andhis 4 youngest siblings; these 5 became ill on or shortly beforeNovember 4. A second generation of measles involvedtwins, born on October 30 and said to be ill on November14, consistent with infection at or shortly after birth (or,much less likely, given the apparent date of onset of diseasein their mother, infected in utero). It is curious that Mathercorrectly understood measles to be especially dangerousfor parturient women. He may have concluded this on thebasis of reports circulating among physicians or becausehe knew that the same phenomenon had long been documentedfor influenza; an influenza pandemic complicatedby pleuropneumonia had begun, and swept through theAmericas, during 1697–1698.Also noteworthy, and mentioned in his referenced letter(6) but not specifically in the diaries, is Mather’s realizationthat pleuritick fever, probably corresponding topneumonia, was a serious complication of measles. Viralpneumonia and secondary postmeasles bacterial pneumoniaare now considered to be among the most fatal complicationsof this disease (9,10).Today, high case-fatality rates for measles are seenonly in ill and immunosuppressed persons or in thosewho are malnourished. However, in the premodern worldmeasles was, confusingly, sometimes benign, sometimesdeadly. The reasons for this documented pattern remainobscure: differences in virulence among the various extantmeasles clades have not been found. The deadliesthistorical measles outbreaks seemed to occur disproportionatelyin the poor and disadvantaged, especially includingyoung children in orphanages or environmentsof desperate poverty, or in indigenous persons living inareas of potential relative nutritional deficiency (9). Thesefindings suggest a key role for host and environmentalfactors in measles severity. Even a modest deficiency invitamin A is now known to exacerbate measles severity,and postmeasles bacterial pneumonias appear to be muchmore common in situations of poverty, crowding, andhigh bacterial circulation.The Letter Mather promised was “published for the benefitof the poor” (6) in December 1713. It informed thoseunfortunate citizens without access to a physician’s careabout the typical clinical appearance and course of measles,and about simple treatments for it. In recommending genericremedies for unbalanced “humours,” it broke no new ground,suggesting (italics and capitalization preserved): Syrup ofSaffron and Treacle Water, Syrup(s) of Maiden-hair or Hyssop,Tea of Sage or Rosemary, Sugar-Candied, or ButteredPills, Hot Beer and Rum, Hot Cyder, Hot Honey, Water withRoasted Apples in it, Shavings of Castile Soap in a Glass ofWine or Beer, or Tea made of Rhubarb, and sweetened witha Syrup of Marshmallow (Althaea officinalis). These wereall ingredients that the poor could afford, and that might atleast be comforting, if not life-saving.The 1713 Boston measles epidemic occurred 21 yearsafter the Salem Witch Trials, in which historians still debateMather’s role as instigator or mitigator; 7 years afterMather discovered that inoculation might be able to preventsmallpox; and 8 years before Mather passionatelyadvocated inoculations in response to a deadly smallpoxepidemic. Because Mather died 30 years before preventivemeasles inoculation is known to have been attempted(11) and 225 years before the first effective measles vaccinewas developed, we have no way of knowing what hewould have thought about measles immunogens, their usein public health programs, or policies to ensure universalvaccination of children.In this writer’s opinion, however, there is little doubtthat Mather—were he alive today—would strongly supportall reasonable measles control efforts, including universaland publicly enforced vaccination. After all, he wasa proponent of smallpox inoculation, and he fought energeticallyin public forums against all who tried to preventinoculations on the grounds that it was inherently risky andmight theoretically prolong or even start epidemics. Healso had lived through the most devastating tragedy of hislife: the loss of his own wife and children from epidemicmeasles. Moreover, as the first person in the New Worldto espouse an “animalcular” theory (germ theory) of disease(3), Mather would surely have been predisposed toaccept the scientific basis of immunization, and he surelywould have been impressed that aggressive global measlesvaccination has, in little more than a decade, reduced thedeath rate by a factor of at least 5-fold and saved ≈1 millionlives each year. It seems highly likely that Mather wouldnot only advocate measles prevention and control, on thebasis of the most up-to-date medical tools and public healthinformation, but also measles elimination and eradication.Mather’s grief and despair, expressed in line after lineof his diary, should remind us not only that the risks ofinfectious diseases like measles are real and ongoing butEmerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015 1259