The Boke of Chyldren (1544) by Thomas Phaer was the first book on paediatrics published in English. At the time, many medical professionals and lay people believed that disease and illness in children could not be treated because they were too young and fragile for common treatments recommended in humoral medicine, for example, bloodletting, purging with emetics and enemas, and blistering the skin. It was also a time when most medical texts were written in Latin, which prevented lay people from learning about medicine.
Thomas Phaer wrote The Boke of Chyldren with a mind to change all of that:
“I entende in this boke […] to treate onely of the thynges necessarye, as to remove the sycknesses wherwith the tender babes are oftentymes afflycted and desolate of remedye, for so moche as manye do suppose that there is no cure to be ministered unto them by reason of theyr weaknesse.”
While there have been significant advances in medicine and science in the past 475 years, many of the infant-care issues Tudor-era parents dealt with are the same that modern parents struggle with: low milk supply, getting baby to sleep, newborn eczema, cradle cap, teething, colic, bed wetting, nightmares, ear infections, and even picky eaters.
Imagine if there were no expert guides on infant care in your country or in your language? That was the case for 16th-century English parents until Phaer published his The Boke of Chyldren.
First, let’s situate ourselves in time and place: England in the mid-sixteenth century, 1544, the Tudor era, three years before King Henry VIII died. This was a time before vaccinations, antibiotics, fever reducers, or germ theory. To survive disease or injury the majority of people relied on folklore, herbology, and appeal to religious faith. While there were rudimentary surgeons, physicians, midwives, and even hospitals (operated by religious orders for the very poor) the most common person to handle healthcare issues in the home was the family matriarch.
Physicians were an exclusive bunch employed only by the wealthiest people. They considered themselves a higher class than surgeons because physicians were university-educated professionals and surgeons were tradesmen, ala barber-surgeons. Physicians didn’t like to get their hands or clothes dirty and surgeons healed with steel but both surgeons and physicians considered themselves above midwives. However, all three specialities were regulated in England and had to swear oaths in The Bishop’s Court that they would not use their knowledge to do harm.
One of the ways that physicians maintained their exclusivity was through the use of Latin which was a universal scholastic language, so that no matter where you came from, if you were educated in Europe, you knew Latin and could communicate with other educated people. Scholarly books could be shared across the continent without having to be translated and hand copied but with the advent of the printing press in the 15th century, things began to change across Europe. Knowledge once exclusive to those who knew Latin (or Greek) was translated into the vernacular (local languages) and printed books became more affordable, when combined with Protestantism which required adherents to read the Bible, literacy rates began to soar even for women and children.
Thomas Phaer was a strong advocate for creating medical books for English people in English:
“Why grutche they [latin physicians] phisik to come forth in Englislysshe? Wolde they have no man to knowe but onely they?Or what make they themselves? Marchauntes of our lyves and deathes, that wee shulde buy our health only of them and at theyr pryces? No good phisicion is of that mynde.”
Historians credit Thomas Phaer not only as being the first to publish a book exclusively on children’s diseases but with changing the way the English thought of medicine and medical knowledge as something for the “weale publicke” (common people) and it changed the way medicine was practiced.
Who was Thomas Phaer? Thomas Phaer was born in Norwich and took a place in the household of William Paulet, 1st Marquiss of Winchester. He became both lawyer and physician, and after publishing Boke of Chyldren, he became a politician, serving four terms as an MP for Wales.
Prior to 1544, he translated Jehan Geourot’s The Regiment of Lyfe and authored two other medical texts, A Goodly Bryefe Treatyse of the Pestylence and A Declaration of the Veynes (which were published in one volume by Edward Whytchurche, for you book history nerds). It was one of thirteen English medical best sellers between 1486-1604 according to historian Paul Slac.
The Boke of Chyldren
To better understand the advice given, it’s important to understand humoral medicine, you can read my brief introduction to the topic here.
Before we get into the medicine, please note that nothing in this article is intended to diagnose or treat any conditions: Do not feed your wet nurse ground-up quartz, or tie a branch of mistletoe gathered during the waning moon in March to your epileptic infant’s neck.
Thomas Phaer begins by explaining that he’s not going to get into the things that are the “office of a mydwyfe” such as
“as of the generacion, the beinge in the wombe, the tyme of procedying, the maner of the byrth, the byndyng of the navyll, settynge of the membres […]”
Or to translate: gestation, fetal development, birth, postpartum recovery, and something we aren’t familiar with today: setting of the members, which is the practice of binding the limbs of the newborn to ensure that they grew straight. In other words, there wasn’t much skin-to-skin kangaroo care happening circa 1545.
He gives two reasons for omitting midwifery, the first is that there were already books in English available. For example, The Birth of Mankind had been translated into English by Richard Jonas in 1540. And curiously, given Phaer’s belief that the “weale publicke” have a right to learn about medicine, he seems ambivalent about letting the public learn about pregnancy and birth, “for the reverence of the matter, not mete to be disclosed to every vyle person”. He may have had concerns that common people, who didn’t have to swear oaths in the Bishop’s Court, would use knowledge of midwifery to control fertility or to cause harm to pregnant women.
“Wherfore as it is agreing to nature so is it also necessary and comly for the owne mother to nource the owne child. Whyche yf it maye be done, it shall be moost commendable and holsome; yf not yet must be well advysed in takyng of a nource not of yll complexion and of worse maners, but suche as shal be sobre, honest and chaste, well fourmed, amyable and chearefull, so that she maye accustome the infant unto myrthe, no dronkarde, vycious nor slyttysshe, for such corrupteth the nature of the chylde.”
His first advice on infant care was that of proper feeding and he advocates for maternal breastfeeding. Today the issue is breast milk vs formula, but back then it was mother’s milk vs wet nurse’s milk as there were no safe alternatives to human milk. Today parents stress about the ingredients in formula, in the Tudor era parents stressed about the “ingredients” in the wet nurse’s milk, which were influenced by her character as much as her physical health.
“If lambes be nouryshed with the milke of gootes, they shall have course wolle like the heere of gootes: and yf kyddes in lyke maner sucke upone shepe, the heere of them shal be softe lyke woll.”
In other words: you are, or become, what you eat. To avoid the risk of having the dubious mannerisms or morals of a lowly wet nurse imprinted upon a child, it was preferable for their own mother to breastfeed them. But while Phaer strongly encourages women to breastfeed their own babies, all of his following advice references wet nurses, which probably says something about the maternal breastfeeding rates of literate women at the time. So what to look for in a wet nurse?
Wet Nurse Qualifications:
- Her last child was male and born no more than two months ago
- not currently pregnant
- Nice skin and body (no acne, no scars, no disfigurements or disabilities)
- Sweet disposition, calm, and honest.
- A bit of a prude and doesn’t drink
- Not to thick and abundant
- Not too thin and watery
- Black, blue, red or yellow are all evil colors of milk
- Doesn’t taste bitter, salty, or sour.
“That mylke is good that is whyte and sweete, and when ye droppe it on your nayle, and do move your fynger, neyther fleteth abrode at every stering nor wyll hange fast upon your nayle when ye turn it downeward; but that whyche is betwene bothe is best.”
This fingernail test was used to test breast milk well into the twentieth century.
Then as now, low milk supply was a concern for parents and wet nurses. In the Tudor era, as it still is in many parts of the world today, it was a matter of life and death. Phaer provided five recipes for increasing milk supply, from cheap to steep:
To Increase Breastmilk Supply
- parsnip and fennel roots in chicken broth, and afterwards, have a little fresh butter.
- Powdered earthworms drunk in cow-tongue broth.
- Some mint, cinnamon and mace in the broth of an old cock (eh-hem, a rooster)
- One for the crystal healers: take some powdered quartz and mix it with “muche” fennel seed and sugar and drink it in some warm wine.
- 1-2 handfuls fennel and horehound (kind of mint) + 4 drams of aniseed, scruple of saffron powder, 3 oz sweet butter mixed in a bit of water, spread into a paste and applied directly on the “nources” (wetnurse’s) breasts wrapped in cloth.
Then he just goes ham and lists random ingredients that are purported to increase milk supply: dill, aniseed, fennel, quartz, horehound, fresh cheese, honey, lettuce, beets, mint, carrots, parsnips, nipples or utters of cow or sheep, goats milk, blanched almonds, rice porridge, cow’s tongue (dried and powdered), poached eggs, saffron, and roasted veal drippings (as a beverage).
Diseases of Children
Having sorted out the feeding, Phaer lists the diseases “mooste commonlye the tender age of chyldren is chefely vexed and greved with” as a proto table of contents:
- Aposteme of the brayne
- Swellyng of the heed
- Scalles of the heed
- Watchyng out of measure
- Terrible dreames
- The fallying evyll
- The palsye
- Styfnesse of lymmes
- Bloodshotten eyes
- Watryng eyes
- Scabbyness and ytche
- Diseases in the eares.
- Nesyng out of measure
- Cankre in the mouth
- Quynsye, or swellynge of the throat
- Straytnesse of wynde
- Feblenesse of the stomake and vomytyng
- Yeaxyng or hycket
- Colyke and romblyng in the guttes
- Fluxe of the belly
- Stoppyng of the bellye
- Swellyng of the navyll
- The stone
- Pyssyng in bedde
- Fallyng of the fundament
- Chafyng of the skynne
- Small pockes or measles
- Swellyng of the coddes
- Sacer ignis or chingles
- Burnyng and scaldyng
- Gogle eyes
- Breedynge of teeth
- Absess of the brain
- Cradle cap
- Waking too often
- Stiffness of limbs
- Bloodshot eyes (pink-eye?)
- Watery eyes
- Psoriasis and ringworm
- Ear infections
- Sneezing too much
- Canker sores
- Quincy (throat abcess) and swollen throat
- Reflux and Vomiting
- Colic, Gas and indigestion
- Swelling of the naval (possibly umblical hernia)
- Kidney stone
- Bed Wetting
- Brusting (hernitated bowels)
- Falling of the fundament (rectal prolapse)
- Chaffing of the skin (diaper rash)
- Smallpox or Measles
- Swelling of male genitals
- Burns and Scalds
- Chillblaines of the heels
- Consumption (TB)
- Leanness (failure to thrive)
- Gogle eyes (squinting)
As we will see, from the selection of diseases I will expand on, the majority of the treatments are herbal or physical but for very serious conditions an appeal to religious faith or magic often prevailed. And I want to emphasize that it’s not that they were less intelligent back then, it’s simply human nature when the available treatments aren’t accessible or are not effective. Even today people do this all over the world when medicine reaches the limit of knowledge and technology.
“Not only other ages but also lytle chyldren are oftentymes afflicted wyth thys sycknes, somtyme by nature recyved of the parentes, and then it is impossyvle or dyfficile to cure, sometyme by evyl and unholsome dyete, whereby there is engendred many colde and moyst humors in the brayne wherupon thys infirmitie procedeth; whych yf it be in one that is younge and tender, it is verye harde to be removed, but in them that are somewhat stronge, as of .vii. Yeres and upwarde, it is more easye.
“I fynde that manye thynges have a natruall vertue agaynstethe fallyng evell, not of any qyality elemental but by a singulaer propertie, or rather an influece of heaven, whyche almythtye God hath gyven unto thynges here on earthe, as be these and other:
“Saphires, smaragdes, redde coral, pyonie, mystletow of the oke taken in the monethe of Marche and the moone decreasynge, tyme, savein, dylle, and the stone that is founde in the belle of a yong swallow, beyng the fyrste broode of the dame. These, or one of them, hanges about the necke of the childe saveth and preserveth it from the sayde syckenes.”
“Not only other ages but also little children are oftentimes afflicated with this sickness, sometimes by nature received of the parents [inherited], and then it is impossible or difficult to cure[.] sometime by evil and unwholesome diet, whereby there is engendered many cold and moist humours in the brain whereupon this infirmity proceeds; which if it be in one that is young and tender, it is very hard to be removed, but in them that are somewhat strong, as of 7 years and upward, it is more easy.
“I find that many things have a natural virtue against falling evil [epilepsy], not of any quality elemental [physical property] but by a singular property, or rather an influence of heaven [metaphysical property], which almighty God hath given unto things here on earth, as be these and other:
“Sapphires, [emeralds], red coral, peony, mistletoe of the oak taken in the month of March and the moon decreasing [waning], thyme, [clubmoss/firmoss], dill, and the stone that is found in the belly of a young swallow, being the first brood of the dame. These, or one of them, hang about the neck of the child saves and preserves it from the said sickness.”
Today medical professionals recognize many types of seizures, with multiple causes. But in the Tudor era, all of them were referred to as “the falling evil” or “epilepsy”. Phaer explains that the items he recommends don’t in and of themselves cure epilepsy but that a supernatural (or metaphysical) power is channelled through them.
Notice that the first three “medicines” are precious stones, not exactly an accessible treatment. One has to wonder if the cost of the treatment was so high that parents convinced themselves it must be working. But it’s not as though the placebo effect is going to work on an infant. However, to this day emeralds (smaragdes) are rumoured to help with seizures.
Cradle cap was thought to be caused by “sharp” milk and will get better after weaning, or by an “evyll complexion of humours” caused by eating raw fruit or other “evyll meats” or sitting too long in the sun. Or, Phaer adds, cradle cap is “many times” caused by dropping raw meat on the heads of infants and children.
If the scales look like the shells of oysters, black and dry, one within another, you are to wash the skin with a concoction of “hot moist” herbs such as fenugreek, holyhock, linseed, in “neetes feet broth” (neetes = cow) and bath the sores in it. Or try bull’s urine. And you must shave the baby’s head no matter what. Consider how tricky clipping nails are, now try shaving a baby’s head with a straight edge.
For infants, the wetnurse must avoid all salty and sour foods that engender choler (yellow bile), such as mustard, vinegar, and all fruits save pomegranates. She is to eat no eggs and no white meats, no dates, figs, or purslane. And make sure the baby doesn’t get too hot.
Waking Out of Measure:
The Young Living EO cultists will appreciate this: annoint the forehead and temples with oil of violet and vinegar, putting 1-2 drops in the nostrils. Let the child lick syrup of poppy (opium) and mix up the seeds and heads of poppy with rosewater and mix with breastmilk and make a plaster (bandage) to lie on the baby’s head.
In other words, if your baby won’t sleep knock them out with opioids. This may be one of the most dangerous recommendations in the book– and the use of opioids is a serious problem today.
For the record, being made unconscious with anaesthetics is physiologically different from actual sleep. It is not restful. Your mind, your body, will still be sleep deprived. There’s the withdrawal pain, dependence/addiction when the body stops producing its own pain relief, and opioids suppress breathing. I’d much rather deal with a restless insomniac for a child than grieve a dead one. Seriously, if you or someone you know is using opioids to “sleep”, they are risking their lives and they will need professional medical help to stop– if they are giving opioids to their children to make them sleep, call the police immediately because it’s a life threatening situation.
Bad dreams and nightmares are thought to be caused by the rising of “stinking vapors” from the child’s stomach into the brain, evidenced by bad breath. To treat them, give the kid some honey, powdered peony seeds, or treacle (molasses) with milk. And to prevent them: don’t let the kid go to bed with a full stomach and do not rock them too much.
Ear Ache/ Ear Infection:
Phaer explains that there are many causes of ear aches and infections, some dangerous and hard to cure, and “some other expelled of nature without medicine”.
To treat the pain: grind up the worms you find under the bark of trees add some oil and mix in the rind of a pomegranate. Roast the mixture on hot embers, strain it, then add a few drops to the ears while lukewarm. Supposed to work for all ages.
To treat sneezing fits, combine the juice of purslane, nightshade, and sorrel, combine with the oil of roses, breastmilk and vinegar. Make a plaster with egg white and the juice mixture and apply it to the child’s forehead.
The sneezing fits are associated with a runny rose: make a plaster of mastic, frankincense, myrrh and wine, and apply it to the back of the head. And burn incense of the same recipe into a linen cloth and have the child sleep on it. And once the kid has recovered tell them to get a job because frankincense and myrrh don’t grow on trees… okay, they do… sort of, but far away, expensive trees.
The most highly recommended treatment: anoint the gums of the baby with the brains of a hare mixed with equal parts capon grease and honey. The hare is used because… wait for it… it has big teeth.
Another treatment is to bathe the child 2-3 per week with a decoction of chamomile, hollyhock, and dill. If the teething is associated with a fever use this bath recipe every morning, to purge the “superfluous humors” from the brain through the “seams of the skull”, and draw excess humours from sore places, and comfort the brain and the “animal virtues” of the child.
For really horrible pain, with swelling and redness, use the oil of roses and nightshade or if you don’t have it, use honey and fresh butter. Essential oils or honey and butter– same difference– certainly when it comes to effectiveness, for sure.
Or try turpentine and honey, equal parts. Tangent time: Turpentine is made from pine resin and it’s still used in products like Vicks Vaporub, which one of my friends swears by to put off migraines, she rubs it on her forehead and temples. And when I was in India, getting pressured to have my nose pierced, a young girl told me that it hurts but she put turpentine on her nose when she had it done and that made it feel better and heal faster. I politely declined to put another hole in my head but it’s interesting that turpentine is still used to soothe the pain.
To prevent painful teething: caste the teeth of a colt [a male horse under 4 years of age] in silver and have the baby wear it as a necklace. Or have the baby wear a teether of red coral hung around the neck. Phaer notes that all the experts agree that coral resists the force of lightning and also helps children with epilepsy, and it’s a good treatment when ground into powder and drunk for bloody noses or bums. The more you know.
To correct a picky eater, get a good handful of “ranke and lustye rewe” [stinky rue] and steep it in a pint of vinegar in a 1:3 or less ratio to make it very strong. Then get some brown toast, and “stamp” it with this vinegar then lay it, like a plaster, on the child’s belly. For older kids who. are. picky. eaters., make them eat it morning and evening. Good luck.
Phaer explains that the cause is eating too much, too fast. The treatment is to make the kid barf with a feather, then put the kid to sleep and put castor oil or the oils of spikenard, chamomile and/or dill on their stomach, warmed.
However, if the hiccups occur on an empty stomach, it’s caused by “sharpe humors” in the mouth of the stomach and the cure is difficult and dangerous. [The cure is time, the most difficult and dangerous force in the universe.]
Colic and “Rumbling in the Guts”:
The causes of colic and rumbling in the guts are worms or from getting cold or “evylle milk”.
You’ll recognize that it’s colic by the crying and by the baby not peeing because gas is “oppressing the neck of the bladder”. Phaer adds that you will notice a male infant will have an erection (which is a sign that male babies are about to pee, forewarned is fore-armed) and you can hear a rumbling sound in the belly.
The treat colic and rumbling, the wetnurse must avoid all gas-producing foods: beans, butter, peas, hard eggs, etc. Wash the baby with hot water containing cumin, dill, and fennel; and afterwards, make a plaster of oil and wax and put it on the baby’s belly while still hot (an old-school heating pad I suppose).
Phaer notes that the cause for bed wetting is the same for old men and babies: their bladder isn’t strong enough.
To treat bed wetting, avoid all fatty foods until the “virtue” of the bladder is restored. In addition, add the following as a powder to all food and drink: wesande [windpipe/throat] of a cock [rooster], pluck it [?], make it into a powder [how?] or use the stones [?] of a hedgehog, or the claws of a goat. Same difference.
And if that treatment isn’t bizarre enough, Phaer suggests that if the patient be “of age” make plates of lead with holes in it and let them lie on them with a naked back regularly.
While many of the treatments recommended in The Boke of Chyldren are now recognized as ineffective or even dangerous, at the time they were the best advice available. To a modern reader, many of the treatments seem fussy and are useless but for a Tudor parent having something they could do for their sick child would have been a comfort. Thomas Phaer nearly always provided multiple recommendations with different levels of accessibility (i.e. cost) but more importantly, he often assured caregivers that they shouldn’t attempt to interfere with an illness and to focus instead on providing comfort for the child.
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Phaer, Thomas. 1544. The Boke Chyldren. London: Edward Whitechurch.