The British author, Eve Garnett (1900-1991) was born in Worcestershire, England, and had a comfortable, middle-class upbringing. She became inspired to write children’s literature after moving to London in the 1920s for art school and witnessing the stark social division and living conditions of London’s poor.[1] These experiences fueled a lifelong mission to bring attention to poverty and to give children from urban, working-class backgrounds stories that reflected their own lives. Her first book, The Family from One End Street, was published in 1937. It is the first of three books about the Ruggles family, consisting of Mr. Ruggles, a town dustman¹, Mrs. Ruggles, a washerwoman, and their seven children, from teenage Lily Rose to infant William. The subsequent books, Further Adventures of the Family from One End Street (1956) and Holiday at the Dew Drop Inn (1962), take place immediately after the first. Set in the fictional English town of Otwell between WWI and WWII, the series describes the adventures and hardships of the Ruggles family with humor and poignancy. 

In the second book, Further Adventures of the Family from One End Street, a measles outbreak is the inciting event that sets the plot into motion. The eldest, Lily Rose, is the first to be stricken as “her head ached, she felt hot and cold by turns” and then she looks in the mirror to find her face is “bright pink, and covered all over with small red spots!” The doctor is called to their small and crowded home, and he advises Mrs. Ruggles, “You can’t keep her here, you know – nowhere to isolate her and no time to look after her if you had; it’s the isolation hospital for measles these days. I’ll have the ambulance round in half an hour and someone to disinfect that room for you. ‘The others?’ no, they certainly can’t go to school, but don’t you worry, they’ll probably all have it in a few days and be off your hands in the hospital too!” 

Management of measles and other infectious diseases was particularly challenging among the urban poor, who lived in crowded conditions. Because the nine Ruggles live in tight quarters in a “very old and very small” house, the remaining six Ruggles children are at risk for catching measles from Lily Rose.² Infection can also easily spread beyond the Ruggles household to the rest of the neighborhood. To help contain the infection, patients were sent to isolation hospitals, which were standalone institutions dedicated to treating infectious diseases in the pre-antibiotic and pre-vaccine era.  

The evolution of isolation hospitals was shaped by public health efforts throughout the 1800s and the medical acceptance of germ theory by the 1880s. The first fever hospital in England opened in 1801.[2] Early fever hospitals were run as private charities for the poor and featured open-planned rooms where patients suffering from different infections were packed side-by-side. These places were mocked as houses of death because someone admitted with a mild case of one fever could catch an entirely different, fatal infection from the patient in the next bed. Over time, laws established public health funding and regulation for isolation hospitals. The Sanitary Act of 1866 gave local authorities explicit power to provide hospital accommodation for infectious disease, a power consolidated by the Public Health Act of 1875.[3-5] Later, the Isolation Hospitals Act of 1893 empowered county councils to build new isolation hospitals where needed, leading to a national network of specialized isolation hospitals designed in accordance with modern germ theory.[3,6] By WWI, there were more than 750 isolation hospitals in England and Wales.[7] These new isolation hospitals emphasized cleanliness and good ventilation, and featured separate wards for different infections.[7] Thus, when Lily Rose develops measles in the 1930s, the doctor recommends she be admitted to a dedicated measles ward of a modern isolation hospital for quarantine and care.³ 

Hypothetically, if Mrs. Ruggles objected to Lily Rose’s hospital stay, the doctor may not have had a pathway to mandate her admission in the 1930s. The Public Health Act of 1936 gave local health authorities a legal mechanism to apply to a justice of peace, who could then mandate the admission of a patient to an isolation hospital if they had a notifiable disease, home isolation was not possible, and they posed a serious risk of infection to other persons.[8] However, measles did not become a nationally notifiable disease in England and Wales until 1940.[9] Before 1940, it was up to individual towns to make measles notifiable and enforce isolation, and Eve Garnett does not specify if such laws existed in Otwell. 

Despite Lily Rose’s prompt quarantine, her younger siblings Jo and Peg also develop measles and are sent to the isolation hospital. Mrs. Ruggles may have been particularly grateful for the supportive care of isolation hospitals in Jo’s case as “the doctor said Jo was a very sick boy, and told Mrs. Ruggles downstairs it was always worse if the spots stayed in, and the sooner Jo was in the hospital the better!” What the doctor is referring to is that the measles rash typically appears 3-5 days after the first symptoms of fever, cough, coryza⁴, and conjunctivitis; if the rash onset is delayed or “the spots stayed in”, it is a signal that the body is struggling to fight the virus. A late, absent, or weak rash is common in immunocompromised, malnourished, and very young children whose immune systems are not fully developed; these patients are at increased risk for severe systemic complications.[10, 11] While Lily Rose is described as a robust 13-year-old girl who only has a “mild attack”, 7-year-old Jo and 5-year-old Peg suffer more serious attacks and have a longer road to recovery. This is especially true as measles is now known to cause immune amnesia, a condition where the virus depletes patients’ pre-existing antibody repertoire, leaving them vulnerable to other infections for two to three years afterward.[12]  

Upon discharge from the hospital, Peg and Jo have clearly lost weight, are still quite weak, and need further treatment. After a conversation with the doctor, worried Mrs. Ruggles updates her husband, “Peg and Jo’s got to be fed up with malt-and-oil when they comes out, and Jo’s that pulled down, the doctor says as six weeks in the country’ll barely set him up”. The oil the doctor recommends to Mrs. Ruggles is cod liver oil, which transitioned from a folk remedy to a mainstream, multi-purpose medical treatment in the 1800s. However, doctors did not know why some patients benefited from cod liver oil until medical research in the early 1900s discovered vitamins and diseases of vitamin deficiency. Cod liver oil was discovered to contain vitamin A in 1913 and vitamin D in 1922.[13,14] And, as discussed in the first part of this MedHum series, the therapeutic value of treating measles patients with vitamin A was demonstrated in 1932.[15] The high caloric content of cod liver oil also helped with malnourishment. Unsurprisingly, children hated the taste of cod liver oil, so malt-and-oil was developed as a commercial pharmaceutical product in the late 1800s, whereby the fishy oil was mixed with thick, sweet malt extract to make it more palatable. Mrs. Ruggles, who has not tasted the malt-and-oil, puts this mixture to the test when she “hold[s] a spoonful out to” suspicious Jo and coaxes him with hopeful reassurances, “It’s not medicine, nor yet oily – more like soft toffee”. She heaves a sigh a relief when he swallows it without resistance, “Thank Heaven he liked it!” 

By sacrificing their meager savings, Mr. and Mrs. Ruggles are able to follow the doctor’s other recommendation to send Jo and Peg (along with their 12-year-old sister Kate) to stay with Mrs. Wildgoose in countryside for recovery. Throughout the 19^th and early 20^th centuries, sending urban children to the countryside to recover from illness was standard practice; the rationale was plausible in cities plagued by industrial smog, poor sanitation, and overcrowding. When Mrs. Wildgoose meets the children, she says “she could see from the look of Peg and Jo how important [malt-and-oil] was, but mark her words, before the three children had been a week at the Dew Drop Inn, eating the eggs from her ducks and hens, good farm butter, and drinking milk from Mr. Digweed’s cows, they wouldn’t know themselves!” It may be universally agreed upon that eggs and dairy are a more palatable way to consume calories and fat-soluble vitamins than cod liver oil. The children do indeed have a marvelous time at the Dew Drop Inn – their countryside explorations and misadventures make up the core of the book – and they make a full recovery attributed to fresh air, sunshine, exercise, and good food. And when they return home, “How [Mrs. Ruggles] hugged and kissed them all, exclaiming again and again at Peg and Jo’s bright eyes and round, fat, sunburnt faces – so different from the pale, skinny little creatures she had seen off six long weeks ago!” 

Although the book focuses on the children’s perspectives, Mrs. Ruggles’ measles experience is worth acknowledging. She is separated from her children for two stressful months because of measles. She is not allowed to visit them during their weeks in the hospital, as isolation hospitals of the time followed strict quarantine protocols. In fact, the doctor warns Mrs. Ruggles when Lily Rose is first diagnosed, “go down to the hospital this evening if you like but they won’t let you see her.” After Peg and Jo are discharged from the hospital, she sends them to recuperate with Mrs. Wildgoose for six weeks because she cannot afford to take time off of work and she needs to tend to her other four children. No wonder those six weeks felt long, and no wonder she is relieved and overjoyed to see her children healthy again when they return from Dew Drop Inn.  

While the isolation hospital and measles recuperation experience would have been familiar to contemporary readers, it likely feels foreign to readers today. The development of a measles vaccine in 1963 and its implementation in Britain in 1968 – about thirty years after this book is set – dramatically reduced the incidence of measles and contributed to the obsolescence of isolation hospitals.[16] Following the development of highly effective vaccines and antibiotics in the mid-1900s, isolation hospitals were systemically closed or repurposed. Measles was declared eliminated by the World Health Organization in the US in 2000 and in the UK in 2017.[17,18] For a period of time, measles was relegated to a bygone era, just like doctors’ prescriptions for malt-and-oil and country air. However, as vaccination coverage has fallen, measles has returned. The UK lost its measles elimination status for a second time on January 26, 2026, and the US is predicted to follow.[18,19] As a result, Further Adventures of the Family from One End Street is somehow pertinent again in its depiction of measles as a contemporary childhood malady.  

¹ Dustman is a traditional British term for garbage collector, which is considered old-fashioned today. 

² This quote is taken from the first book, The Family from One End Street. 

³ The development of isolation hospitals in the US followed a similar timeframe. In the US, the first isolation hospital was opened in Philadelphia in 1801 following a series of yellow fever epidemics. During the late 19th and early 20th centuries, state statutes across the US codified the mandatory construction of municipal isolation hospitals to control epidemics. Because public health powers are granted to states under the U.S. Constitution’s 10th Amendment, individual towns and state boards of health passed the earliest mandatory measles isolation laws in the late 1800s, and measles became a nationally notifiable disease in 1912. 

⁴ Coryza is the medical term for acute inflammation of the mucous membranes inside the nose, commonly known as a runny nose. It is one of the “three C’s of measles”, a traditional medical mnemonic used to teach medical students the standard early clinical presentation of measles – cough, coryza, and conjunctivitis.  

References 

1. Eve Garnett. Penguin Random House. Accessed September 7, 2026. https://www.penguinrandomhouse.com/authors/9731/eve-garnett/ 
2. Currie MR. Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service. Routledge; 2005. Accessed September 7, 2026. https://ndl.ethernet.edu.et/bitstream/123456789/9881/1/1072.pdf 
3. Parsons HF. The Hospital Isolation of Infectious Diseases: I. The History of Isolation. Hospital (Lond 1886). 1913;54(1408):357-358. 
4. Great Britain. The Sanitary Act 1866. legislation.gov.uk. Enacted 1866. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/29-30/90/contents/enacted 
5. Great Britain. Public Health Act 1875. legislation.gov.uk. Enacted 1875. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/38-39/55/contents 
6. Great Britain. Isolation Hospitals Act 1893. legislation.gov.uk. Enacted 1893. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/56-57/68/enacted 
7. Currie MR. Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service. Routledge; 2005. Accessed September 7, 2026. https://ndl.ethernet.edu.et/bitstream/123456789/9881/1/1072.pdf 
8. Great Britain. Public Health Act 1936, section 169. legislation.gov.uk. Enacted 1936. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Geo5and1Edw8/26/49/section/169/enacted 
9. Public Health Wales. Measles surveillance and epidemiology. Accessed September 7, 2026. https://phw.nhs.wales/reports/measles-surveillance-and-epidemiology/ 
10. Burrell CJ, Howard CR, Murphy FA. Pathogenesis of virus infections. In: Fenner and White’s Medical Virology. 5th ed. Academic Press; 2017:77-104. doi:10.1016/B978-0-12-375156-0.00007-2 
11. Permar SR, Griffin DE, Letvin NL. Immune containment and consequences of measles virus infection in healthy and immunocompromised individuals. Clin Vaccine Immunol. 2006;13(4):437-443. doi:10.1128/CVI.13.4.437-443.2006 
12. Mina MJ, Kula T, Leng Y, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599-606. doi:10.1126/science.aay6450. 
13. McCollum EV, Davis M. Nutrition classics from The Journal of Biological Chemistry 15:167-175, 1913. The necessity of certain lipins in the diet during growth. Nutr Rev. 1973;31(9):280-281. doi:10.1111/j.1753-4887.1973.tb07065.x 
14. McCollum EV, Simmonds N, Becker JE, Shipley PG. Nutrition classics. The Journal of Biological Chemistry 53:293-312, 1922. Studies on experimental rickets. XXI. An experimental demonstration of the existence of a vitamin which promotes calcium deposition. Nutr Rev. 1973;31(5):158-161. doi:10.1111/j.1753-4887.1973.tb05090.x 
15. Ellison JB. Intensive vitamin therapy in measles. Br Med J. 1932;2(3745):708-711. doi:10.1136/bmj.2.3745.708 
16. Sutherland I, Fayers PM. Effect of measles vaccination on incidence of measles in the community. Br Med J. 1971;1(5751):698-702. doi:10.1136/bmj.1.5751.698 
17. Centers for Disease Control and Prevention. History of measles. Updated April 29, 2026. Accessed September 7, 2026. https://www.cdc.gov/measles/about/history.html 
18. Taylor L. UK loses its measles elimination status. BMJ. 2026;392:s172. doi:10.1136/bmj.s172 
19. Bischops AC, Hulland EN, Patzakis M, Majumder MS. Will the USA lose its measles elimination status? Lancet. 2026;407(10540):1679-1681. doi:10.1016/S0140-6736(26)00466-6

Further Adventures of the Family from One End Street 
Eve Garnett 
Puffin Books, 1993. Paperback. 256 pages 
Originally published 1956 

Web image generated by Medhum.org based on the original book cover.

Five Little Peppers and How They Grew by Margaret Sidney is an early example from 1881. This book describes the daily life of the hardworking Pepper family and how they remain cheerful and loving despite challenges associated with 19^th century poverty. The Pepper family consists of widowed Mrs. Pepper or “Mamsie,” 11-year-old Ben who voluntarily takes on the mantle of “man of the house,” patient and selfless 10-year-old Polly, impulsive and food-loving 9-year-old Joel, gentle and conscientious 7-year-old Davie, and beloved baby of the family 3-year-old Phronsie.

Children’s literature during this era was heavily instructional and used relatable characters and stories to teach morals and values to young minds. Illness was rarely just a biological event; it was a test or demonstration of character. In a chapter aptly titled “Trouble for the Little Brown House,” the first challenge that the Pepper family faces is measles.

Notably, this book highlights the ophthalmologic symptoms and sequalae of measles, as first Phronsie, then Ben, Polly, and Joel all catch the infection. Common early symptoms of measles include conjunctivitis and photophobia, which occur before the obvious rash. Ben and Polly, the hardworking older siblings who earn money for the family by chopping wood and sewing respectively, are each in initial denial of infection because they understand the financial repercussions this will have on the family. But the historic reader understands the warning signs when Ben and Polly report visual complaints. Ben tries to reassure Polly by saying, “I’m all right; only my head aches, and my eyes feel funny,” alluding to the itchy and gritty sensation of conjunctivitis, before he becomes bedridden. The narrator describes Polly’s struggles more vividly, “An awful feeling made her clutch the back of a chair, but she managed somehow to get into her clothes, and go groping blindly into the kitchen. Somehow, Polly couldn’t see very well. She tried to set the table, but ‘twas no use.” Polly’s initial visual impairment can be attributed to severe photophobia, leading to blurry vision.

Modern day readers may not know that the measles virus can result in serious vision-threatening complications. It can cause deeper structural damage starting with keratitis – a painful inflammation or infection of the cornea, the clear front surface of the eye, which manifests as blurred vision and intense tearing. If keratitis is left untreated or a secondary bacterial infection occurs, corneal scarring can permanently impair vision. In rare instances, measles can also cause retinopathy and optic neuritis leading to blindness. The severity of eye damage from measles is heavily linked to nutrition. The virus actively depletes body stores of vitamin A. In low-income populations where vitamin A deficiency is already common, measles is more likely to cause permanent childhood blindness.

The Peppers live in poverty and hunger. Mrs. Pepper makes a meager income sewing “sacks and coats” for a local store and “had hard work to scrape together money enough to put bread into her children’s mouths, and to pay the rent of the little brown house.” There is never enough food to go around. Their main source of calories are coarse brown bread and unappetizing cornmeal mush, neither of which contain meaningful amounts of vitamin A. However, the generosity of the parson’s wife, Mrs. Henderson, helps protect some of the Peppers from blindness. Mrs. Henderson gives the Peppers “a little pat of butter,” which Phronsie and Ben put on their bread. Dairy, like milk and butter, is an excellent source of vitamin A. And later, Mrs. Henderson sends over “a little bird delicately roasted,” which Joel consumes with delight. Poultry and gamebirds are another good source of vitamin A.

However, selfless Polly saves the butter and bird for her siblings and ends up being most at risk for permanent vision loss. She develops very painful eyes, suggesting keratitis, and the doctor pronounces that “her eyes are very bad” and warns, “You will be blind!” if she doesn’t take care. Although the author attributes Polly’s illness severity to eye strain from sewing to earn money for the family, it is medically more likely due to vitamin deficiency. The therapeutic value of vitamin A in treating measles was not discovered until 1932 – 51 years after the publication of this book – when British physician Joseph B. Ellison found that administering vitamin A extracts roughly halved the death rate of hospitalized children suffering from measles [1]. Studies establishing the role of vitamin A in reducing blindness in children with measles did not occur until the 1980s [2,3].

Because moralizing 19^th century children’s literature rewards the virtuous, Polly ultimately makes a full recovery. However, reality is not so kind. Even today in the 21^st century, an estimated 15,000 to 60,000 children are blinded by measles every year globally [4]. The World Health Organization recommends that children in low income and developing regions diagnosed with measles receive immediate, high-dose oral vitamin A [5]. This simple, low-cost intervention protects the cornea and has successfully saved the eyesight of millions of infected children [6]. And, those who are vaccinated against measles are spared the risk and need for intervention completely.

[1] https://pubmed.ncbi.nlm.nih.gov/20777111/
[2] https://pubmed.ncbi.nlm.nih.gov/8486934/
[3] https://pubmed.ncbi.nlm.nih.gov/3492298/
[4] https://pubmed.ncbi.nlm.nih.gov/14998696/
[5] https://www.who.int/news-room/fact-sheets/detail/measles
[6] https://pubmed.ncbi.nlm.nih.gov/24407830/

Original Publication: The story was originally serialized in an 1880 edition of Wide Awake, a children’s magazine and later published in a hard cover edition.

Dover Publications, 2006. 224 pages

Web image by Medhum.org