This is part of a series on the history of measles, as described and treated in medical or childcare manuals of their times. Today I’ll be looking at what Thomas Phaer, the father of English pediatrics, had to say about measles in his book, The Boke of Chyldren, published in 1544.
In the mid-16th century, in Europe, smallpox and measles were considered two sides of the same coin owing to their presentation and how the ancient Greeks classified them.
Seven years after Phaer’s book was published, the young King Edward VI, then 14 years old, in April of 1552, wrote in his journal,
“I fell sick of the measles and the smallpox.”
Historians believe that he had measles first and then came down with smallpox. Sir John Hayward, his contemporary biographer wrote,
“In Aprill, in the sixth yeere of the reigne of the King, hee fell sicke of the meazles, whereof in a short time hee well recovered: afterwards he sickened of the small Poxe”.
By May, he was fully recovered from both and in good health. Huzzah!
But then in January of the following year the cough started.
Tuberculosis was endemic in Tudor England (and continued to be so for hundreds of years). For healthy people, the body keeps TB in check, but it’s an opportunistic bugger, waiting until your defenses are down. Unfortunately for King Edward VI, and everyone else who contracts measles, the measles virus suppresses host immunity to tuberculosis.
And for today’s readers: the measles vaccine also suppresses host immunity to TB. This may explain why certain countries still struggling with endemic TB do not provide it. Therefore they are at higher risk for measles outbreaks. But before you refuse the vaccine, it’s about timing: if you already have TB and then you get measles/vax you might be at risk of symptomatic TB. If you have concerns about your TB status, you can ask to be tested for TB before you get the MMR vaccine. But if you are vaccinated for measles first and then contract TB, your body will do what it was already going to do. Imagine a whiteboard, your immune system has met TB and wrote down how to keep it in check, then the measles/vax comes along and erases the whiteboard. If it was the measles vaccine, you’re not nearly as weak as you would be if you had full-blown measles, so you can still hopefully keep TB in check, but you will still need to rewrite the formula on the whiteboard.
King Edward IV didn’t have any vaccines. He got full-blown measles, followed by pneumonia, then full-blown smallpox. Consider all that and realize that the rumours of him always being this weakling boy is nonsense. He survived early childhood in the 16th century which is beating the odds already, and then he survived measles, pneumonia, and smallpox in succession.
Everyone briefly thought he was okay, all the while TB was mobilizing. By looking at Thomas Phaer’s book we learn what the medical men of the era thought about measles and smallpox, and how royal physicians may have treated King Edward VI.
King Edward VI died from tuberculosis on July 6th, 1553, very likely due to his previous infection with measles. They could not have known the connection at the time, nor does it seem that Phaer recognized the association with pneumonia that often follows measles today.
Of small pockes and measylles
Thys dysease is common and familier, called of the Grekes by the generall name of exanthemata, and of Plinie papule et pituite eruptiones. Notwythstandyng, the consent of writer hath obteyned a destinction of it in .ii. Kyndes, that is to saye: varioli the measels and morbilli, called of us the small pockes.
They be bothe of one nature and procede of one cause, savynge that the mesyls are engendered of the inflammation of blood, and the smal pockes of the inflammation of bloode myngled wyth choler.
The sygnes of them bothe are so manifest to syght that they nede no farther declaration. For at the fyrste some have an ytche and a fretyng of the skyn, as yf it had ben rubbed wyth nettles, payne in the head and in the backe, the face redde in coloure and flecked, feare in the slepe, great thyrst, rednes of the eyes, beatynge in the temples, shotyng and pryckyng through all the bodye. Then anone after, when they breake out, they be sene of dyvers fasshyons and fourmes: sometyme as it were a drye scabbe or a leprye spreadyng over all the membres, other whyles in pushes, pimples, and wheles, rennyng with moch corruption and matter, and wyth great peyne of the face and throte, dryenesse of the tonge, horcenes of voyce, and, in some, quiverynge of the harte with swownyge.
This disease is common and familiar, called of the Greeks by the general name of exanthemata, and of Pliny papule et pituite eruptiones. Notwithstanding, the consent of writer hath obtained a distinction of it in two kinds, that is to say, varioli the measles and morbilli, called of us the smallpox.
They be both of one nature and proceed of one cause, saving that the measles are engendered of the inflammation of blood, and the smallpox the inflammation of blood mingled with choler [yellow bile].
The sings of them both are so manifest to sight that they need no further declaration. For at the first some have an itch and a fretting of the skin [rash], as if it had been rubbed with nettles, pain in the head and in the back, the face red in color and flecked, fear in the sleep, great thirst, redness of the eyes, beating in the temples, shooting and pricking all through the body [pins and needles?]. Then [soon] after, when they break out, the be seen of diverse fashions and forms: sometime as it were a dry scab or a [dry scales] spreading over all the members [limbs, body], otherwise in pushes [hives], pimples, and [blisters], running with much corruption and matter [pus], and with great pain of the face and throat, dryness of the tongue, hoarseness of voice, and, in some, quivering of the heart with swooning.
Considering the variations Phaer describes, it is possible that what they called measles and smallpox could be what we’d recognize as different diseases (in addition to measles and smallpox), for example, German measles or rubella, fifth’s disease, chicken pox, and so on.
The causs of these evell affections are rehersed of authours to be chyefly foure:
Fyrste, of the superfluyties whych myght be corrupte in the woumbe of the mother, the chylde there beyng and recyvynge the same into the poores; the whyche at the tyme of debility of nature coulde not be expelled but, the chyld increasynge afterwards in strengthe, is dryven oute of the veynes into the upper skynne.
Secondarilie, it maye come of a corrupte generation, that is to saye whan it was engedred in an evyl season, the mother beynge sycke of her natural infirmitye. For suche as are begotten that tyme very seldome escape the disease of leprye.
The thyrde cause maye be an evylle dyete of the nourse or of the child it selfe, whan they feade uppon meates that encrease rooten humours, as milk and fyshe both at one meale, lykewise excesse of eatynge and drynkynge and surfeyte.
Fourthlye, this dysease commeth by the waye of contagion whan a sycke person infecteth an other, and in that case it hath great affinitie wyth the pestylence.
First, of the superfluities which might be corrupt in the womb of the mother, the child there being and receiving the same into the pores; which at the time of debility of nature could not be expelled but, the child growing afterwards in strength, is driven out of the veins into the upper skin.
Secondarily, it may come of a corrupt generation [conception], that is to say when it was engendered in an evil season, the mother being sick of her natural infirmity [menustrating]. For such as are begotton that time very seldom escape the disease of lepresy.
The third cause may be an evil diet of the [wet]nurse or of the child itself, when they feed upon meats [food] that increase rotten humors, as milk and fish both at one meal, likewise excess of eating and drinking and surfeit.
Fourthly, this disease come by the way of contagion when a sick person infects another, and in that case it has great affinity [similarity] with the pestilence [plague].
Phaer gives four causes of measles and smallpox, and they are:
- contracting them while in the womb from a mother who is infected
- being conceived during the mother’s menstrual cycle
- from a diet that upsets the balance of humors in the body, for example combining fish and dairy in one meal
- Catching it from someone who is infected. Yes, this is hundreds of years before germ theory. Yet, even then they vaguely understood the concept of contagious disease due to their experiences with plague.
The best and most sure helpe in this case is not to meddle wyth any kynde of medicines, but to let nature woorke her operation.
Notwythstandynge, yf they be too slowe in commynge oute it shall be good for you to gyve the chyld to drinke sodden mylke and saffron, and so kepe hym close and warme whereby they may the soner issue forthe, but in no case to administre anye thynge that might eyther represse the swellynge of the skynne or to coole the heate that is wythin the membres. For yf thys dysease, which shuld be expelled by a natural action of the body to the long healthe afterwarde of the pacient, were by force of the medicine cowched in agayne, it wre even ynough to destrye the chyld.
Therfore, abide the ful breakng out of the sayd wheales, and then (yf they be not ripe) ease the chyldes peyne by makynge a bath of holihock, dil, camomyl, and fenel; yf they bbe rype and matter, then take feneel, wormewood, and sage, and seeth them in water to the thyde part, wherin ye maye bathe hym with a fyne cloth or a sponge. Alwayes provyded that he take no colde durynge the tyme of hys sycknesse.
The wyne wherin fygges have ben sodde is singuler good in the same case, and may be well used in all tymes and causes.
Yf the wheles be outragyous and great, with moche corrosion and venim, some make a decoction of roses and plantayne in the water of oke, and dissolve it in a lytle Englysh honye and camphore.
The decoction of water betonye is approved good in the sayde dyseases. Lykewyse the oyntment of herbes, wherof I made mention in the cure of scabbes, is excedynge holsome after the sore are rype.
Moreover it is good to droppe in the pacientes eyes, .v. or .vi. tymes a daye, a lytle rose or fenel water to comforte the syght, lest it be hurte by contynuall renning of matter. This water must be mynistred in the somer colde; and in the winter ye ought to aply it luke warme.
The same rose water is also good to gargle in hys mouthe, yf the chylde be then payned in the throte.
And lest the condytes of the nose shuld be stopped, it shall be very expedient to let hym smell often to a sponge wete in the juce of saverye, stronge vyngere, and a lytle rosewater.
The best and most sure help in this case is not to meddle with any kind of medicines, but to let nature work her operation.
Notwithstanding, if they be too slow in coming out it shall be good for you to give the child to drink sodden [boiled]milk and saffron, and so keep him close [bundled up] and warm whereby they may the sooner issue forth, but in no case to administer anything that might either repress the swelling of the skin or to coll the heat that is within the members [body]. For if this disease, which should be expelled by a natural action of the body to the long health afterward of the patient, were by force of the medicine couched in again, it is even enough to destroy the child.
Therefore, abide the full breaking out of the said wheales [hives, blisters], and then (if they be not ripe) ease the child’s pain by making a bath of hollyhock, dill, chamomile, and fennel; if they be ripe and matter [pus filled], then take fennel, wormwood, and safe, and seeth [soak] them in water to the third part [1:3 herb to water ratio], wherein you my bath him with a fine cloth or a sponge. Always provided that he take no cold during the time of his sickness.
The wine wherein figs have been sod [boiled] is singular good in the same case, and may be well used in all times and causes.
If the wheles [hives, blisters] be outrageous and great [large], with much corrosion and venom [puss, discharge], some make a decoction of roses and plantain in the water of oak, and dissolve it in a little English honey and camphor.
The decotion of water betony [herb] is approved good in the said diseases. Likewise the ointment of herbs, whereof I made mention in the cure of scabbies, is exceeding wholesome after the sores are ripe.
Moreover it is good to drop in the patient’s eyes 5 or 6 times a day, a little rose or fennel water to comfort the sight, lest it be hurt by continual running of matter [pus]. This water must be administered in the summer cold; and in the winter you ought to apply it luke warm.
The same rose water is also good to gargle in his mouth, if the child be then pained in the throat.
And lest the conduits of the nose should be stopped [stuffy nose], it shall be very expedient to let him smell often to a sponge wet in the juice of savory, strong vinegar, and a little rosewater.
To take awaye the spottes and scarres of the smal pockes and measels.
The blood of a bulle or of an hare is moche commended of authours to be annoynted hote upon the scarres, and also the lycour that yssueth out of shepes clawes or gootes clawes, hette in the fyer. Item, the dryppyng of a cygnet or swanne layed upon the place oftentymes hote.
The blood of a bull or of a hare is much commended of authors to be anointed hot upon the scars, and also the liquor that issues out of sheep’s claws or goat’s claws, hot in the fire. Item, the dripping [grease] of a cygnet or swan laid upon the place oftentimes hot.
Phaer’s book was intended for a general audience, so most of his remedies are based on ingredients that might be found in the pantry of a fairly well-off but not medically trained household. Even if the treatments did little or nothing for the patient, it likely helped caregivers feel that at least they’d done something.
He does not describe measles as a fatal condition, though he warns that trying to repress the disease with medicine may cause it to be even worse later, possibly killing the child. In Dr Tuley’s 1913 description of measles, he describes the “black measles” which is a rare but incredibly virulent form of measles that causes the blood to pool under the skin giving the patient a dark color and I wonder if that is what Phaer is warning against.
Something that is important to remember is that these diseases are not static entities, they evolve over time and geographies, and it’s possible that through the centuries we will be able to see changes in the symptoms. It’s possible that smallpox, which medieval writers associated with measles- and which Edward VI caught directly after the measles– was the most common secondary infection, whereas, in later centuries to this day, it is pneumonia.
I hoped you enjoyed or at least learned something, measles isn’t the cheeriest of topics. If you’d like to support The Baby Historian please share, like, subscribe and/or become a patron on Patreon.
Holmes, Grace, Frederick Holmes, Julia McMorrough. 2001. “The Death of Young King Edward VI.” New England Journal of Medicine, 345(1), 60-62.
Phaer, Thomas. 1544. The Boke of Chyldren. London: Whitechurche.