# Epidemiological characteristics and public health responses against measles in the Ottoman empire and the early Turkish Republic

## TL;DR

This paper examines the spread and public health responses to measles in the Ottoman Empire and early Turkish Republic, revealing high child mortality and early disease control measures.

## Contribution

The study provides the first detailed historical analysis of measles epidemiology and public health interventions in the Ottoman Empire and early Turkish Republic.

## Key findings

- Measles had high child mortality rates in both the Ottoman Empire and early Turkish Republic.
- Public health measures like quarantine and isolation were used in these periods, similar to modern practices.
- Under-reporting was common due to administrative disruptions and warfare in the Ottoman period.

## Abstract

Measles is an infectious disease that affects mostly children. It is caused by the measles morbillivirus, which can be spread through inhalation and direct contact with the patient. There are insufficient literary documents on the prevalence of measles in the Ottoman Empire; its seasonal variation, the public health responses and epidemiological changes it caused.

This study reviews archival documents from the Ottoman Empire and the Turkish Republic Archives, alongside relevant literature, to investigate measles cases, mortality patterns, seasonal distribution and public health interventions between the 18th century and 1938. The analysis focuses on quantifiable epidemiological data and recorded official measures such as quarantine, school closures, disinfection practices, and isolation protocols.

A total of 2716 people had measles in the Ottoman Empire, 462 (17.0%) of whom died. Among the patients, 116 (4.3%) were adults, and 2600 (95.7%) were children. Thirty-six (31.0%) of the adult patients died, and 396 (15.2%) of the child patients died. These figures represent only the documented portion that reached central administration through archival notification; the true burden in the Ottoman period was undoubtedly higher due to under-reporting and non-standardized disease registration, exacerbated by almost continuous warfare, territorial losses, population displacements, and administrative disruptions during the late nineteenth and early twentieth centuries, which further limited the completeness and continuity of public health reporting. In the early Turkish Republic (from 1920 to 1938), 67,427 measles patients were identified. Of these, 67,427 were children, and 4571 (6.8%) of the children died. The highest number of deaths from measles disease in Istanbul occurred in children aged 0–5 years (35.7%) in the Ottoman Empire.

Measles was a persistent and high-mortality childhood disease in both periods studied with marked seasonal and regional variations. Archival records demonstrate that the Ottoman Empire and the early Turkish Republic implemented a range of organized public health responses to limit transmission, many of which are comparable to modern infectious disease control practices. This historical analysis may inform current epidemic preparedness by highlighting early institutional and community-level interventions.