“What We Don’t See”
Margaret Kendrick Hostetter, M.D. (NEJM)
“One has but to view the tombstones in colonial
cemeteries to understand that death in childhood
represented a grievous but seemingly inexorable
trajectory. The death toll from infection among
the very young was often obscured in colonial epidemics, when smallpox, diphtheria, cholera, dysentery, and measles typically killed without respect to age. In November 1713, for example, the
wife of the Puritan minister Cotton Mather died
in a measles epidemic, along with her newborn
twins, a 2-year-old daughter, and a servant. Two
sons and four daughters, all older than 7 years of
age, survived.13 Apart from these individual tragedies, however, there was little recognition of the
special susceptibility of children, particularly those
under 5 years of age, until the diphtheria epidemic in New England (1735 through 1740), in which
80% of its 5000 victims — almost 2.5% of the
population — were children.13
By the middle of the 19th century, a child’s
death, far from intolerable, was frequently viewed
as blessed,”
“In the mid-1950s, twice as many children died
from measles as from poliomyelitis,13 and the immunologic principles and clinical efficacy of the
attenuated measles virus vaccine in a variety of
childhood populations were thoroughly detailed
in a series of eight landmark articles, all published
in the July 28, 1960, issue of the Journal.
32-39 The
combined measles, mumps, and rubella vaccine,
developed by Maurice Hilleman in 1971, was a
boon for pediatrics and obstetrics alike”