The first serious outbreak of measles occurred in Carthage in A.D. 251. It spread to the rest of the Roman Empire and its height it was killing 5,000 people a day in Rome. Early symptoms include shivering, headache, and a running nose. After four days small red spots appear on the body. The disease lowers resistance and is sometimes followed by pneumonia. Before the 19th century measles killed large numbers of people in Britain. Since the introduction of a measles vaccine and antibiotics very few people die from the disease.