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BICENTENNIAL

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Colonial pediatrics S o m e random notes

Samuel X Radbill, M.D., Philadelphia, Pa.

E A R L Y IN THE S E V E N T E E N ' T H C E N T U R Y , with settle-

ments springing up all along the eastern seaboard of North America, children in increasing numbers formed an important element of the American family. They all suffered illness of one kind or another and many of them died. Yet little has been written about sick children of colonial days or the care they received. The following random notes, a sampling of m a n y gathered through the years, should prove especially interesting to modern pediatricians in this bicentennial year. BIRTHS AND DEATHS Among the colonial settlers the mortality rate was disheartening. The causes of death were many; effectual remedies were few. The voyage across the Atlantic took from two to four months. Jammed with emigrants, the ships had inadequate supplies and sanitary conditions were dismal. Children accompanied their parents and many were born enroute. Scurvy, measles, smallpox, and diarrhea were devastating aboard ship and so was louseborne typhus, which was called "ship fever" or sometimes "spotted fever," as well as measles. Measles was a word which at that time could be a general term for any eruptive fever. When the settlers first arrived, conditions of life in this primitive land were extremely hazardous. Pestilences, often fatal, followed them from their homelands, and new world perils included Indian massacres, the rigors of the weather, nutritional deprivation, and diseases such as malaria. The birth rate was high but infant mortality effectively restrained any trend toward a population explosion. Children died singly, in groups, and in vast companies. The old family Bibles and churchyard gravestones tell the heart-rending story of this infant mortality. 1

INFANT CARE In the seventeenth century in many settlements the worst of the early hardships had been overcome. Settlers necessarily helped each other and when trained midwives were not available, neighbor women acted in their stead. They followed the ritual hygiene of the newborn brought with them from their native lands, including the initial bath near the fire, salting, and swaddling. Within a few days of birth, regardless of the weather, every baby had to be taken to the meeting house to be baptized. This protected him not only from ill health and misfortune, but also from being supplanted by a changeling. Breast feeding was taken for granted. ~ There was little cow's milk available for there were few cows. Besides, babies were more likely to be given small beer to drink than milk. Cow's milk did not come into general use for infant feeding among the English until the eighteenth century? While maternal nursing was the rule, wet nursing was common since women, as a rule, did not hesitate to suckle each other's children. Many midwives would not apply the baby to the mother's breast immediately after birth because they feared colostrum was still full of the blood's corruption. The time of weaning was a time of worry; many ills befell infants then. Often the elaborate preparations for weaning took a whole week and included such deterrent practices as the application of wormwood to the mother's teats. When it was time for hand feeding, pap and broth were first fed, followed by samp, hominy, supawn, corn pone, succotash, and other soft Indian foods. Colonial children also relished baked beans; and fruits, nuts, and berries were plentiful when in season. Growth and development excited great delight in parents. In their diaries we find recorded the arrival of the first tooth, the first words, the first step, and so on.

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Radbill

SUPERSTITIONS Intelligent people in the seventeenth century, even devout Christians, believed in astrology. The hour and minute of a child's birth would be recorded in the family Bible, as well as the day, month, and year. Even the gravest physicians wrote about the influence of the moon upon the child. Epidemics and many other misfortunes were blamed not only on sin, they were often attributed to meteorologic and planetary influences. The belief in witchcraft was the most serious prevailing superstition because of the dreadful consequences. Sir William Blackstone, eminent legal authority still quoted today, in 1792 declared that to deny the existence of witchcraft is to deny divine revelatiog, Cotton Mather, in his Memorable Providence published in Boston in 1689, provides detailed case reports of it in New England? An Indian boy captured in 1676 lay for 10 days staring with mouth agape and no sign of breathing, although his body remained warm. The authorities decided he was bewitched and he was baptized, whereupon he promptly recovered? Left-handedness was unlucky. A midwife who was discharged when it was discovered she was left-handed was later accused of witchcraft because of the misfortunes that followed upon her discharge. Still-births, premature births, breech presentations, and congenital malformations of all sorts were believed to be indications of witchcraft. Some considered them to be judgments from on high? The first colonial postmortem examination on record was that of a child in Connecticut in 1622 to determine if the cause of death was witchcraft. The parents of the child had accused an old woman of practicing black magic causing the infant to die and the court ordered an autopsy/ PUBLICATIONS OF PEDIATRIC INTEREST IN THE SEVENTEENTH CENTURY John Cotton's Spiritual Milk for Boston Babes Drawn Out of the Breasts of Both Testaments for the Soul's Nourishment, published in Cambridge, Mass., in 1656, has a promising pediatric tintinnabulation but ailing infants derived little medical benefit from it. It was entirely theological. The first real pediatric publication-- indeed, the first medical publication in the English colonies-was a broadside entitled: "A Brief Rule to Guide the Common People of New England How to Order Themselves and Theirs in the Smallpockes, or Measles." It was first printed by Thomas Thacher in Boston in 1667 and was a free adaptation from Thomas Sydenham's Methbdus Curandi Febris of 1666. By 1670 Sydenham separated measles from smallpox; until then, even though it had

The Journal of Pediatrics July 1976

been known for centuries they were clinically distinct, medical writers had followed the pattern set by Rhazes in the tenth century of always discussing them together because the cause and the cure were believed to be identical. Thacher, like Sydenham, advised, along with the innovative cooling regimen, avoidance of too much clothing, too hot a room, cordials (such as diascordium or Gascoyne's powder), bloodletting, glysters, vomits, purges, or too much cooling. These were said to be errors in treatment that interfered with the natural healing powers. Only in case of a "phrensie" (delirium), or if the circulation of the blood were hindered, should blood be let, "if the age will bear it." Another publication on measles "for the benefit of the poor" appeared anonymously in Boston in 17t3. Its authorship has been attributed to Cotton Mather. John Locke's Thoughts on Education, published in England in 1690, found many ardent followers in America. His views on child care and rearing appealed to American parents and many of his precepts appeared in early American almanacs. These almanacs, next to the Bible, were the most widely read tabloids in America in the eighteenth century. They afforded a means of communicating medical information to the public and of providing general guidance in almost every function of life: what were the prevalent diseases and when to expect them (for example, if the sun shone bright and clear on the fourth day after Christmas, measles and smallpox were surely on the way); the proper days for taking various medicines, for bleeding, for weaning calves or children; for ~ cutting a child's hair; easy recipes for country folk to prepare such as "experienced medicines for worms i n children" and so on. Birthdays, lucky and otherwise, Were enumerated: a child born on April Fool's Day (the day Satan was expelled from heaven), or on December 1 (the day Sodom and Gomorrah were destroyed), was sure to die an evil death or else live a life of shame. CHILDHOOD

DISEASES

Teething, worms, and convulsions were the most dreaded afflictions of early childhood. Diarrheal diseases were really lethal. Smallpox and measles were also feared. Those children who survived these diseases were still liable to all the other ills of children. Smallpox. Smallpox reaped a high mortality at whatever age it appeared. It was even more fatal to the Indians. An epidemic in New England in 1633 killed a great many of the colonists' children, then invaded the Indian villages, killing all but three of their children. There were many other epidemics throughout the

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seventeenth century. In 1689 America's first newspaper, the New York Public Occurrences, reported that the disease "even attacked children in the bellies of their mothers. ''8 In Virginia the disease killed many slaves. Measles. Epidemics of measles struck often, everywhere; few families escaped. When scarcely anyone died of it, the disease was most likely true rubeola. The reports of epidemic measles that were fatal to children and adults alike were probably more deadly exanthemata. During one such epidemic, in the final decade of the seventeenth century, a proclamation "appointing a day of humiliation and prayer" was issued. Self-castigation, fasting, and prayer were the chief public health measures, since the cause was supposed to be sin. Whooping cough. An epidemic of "chincough" (as it was called then) occurred in 1649 in Plymouth, Mass. Many children died and fast~ days were appointed until the epidemic disappeared when a thanksgiving day was celebrated? Other occurrences of this distressing disease were recorded throughout the colonies. Mumps. Mumps also occurred. Because it was usually mild, it attracted little attention. One diarist, however, noted "an unusual distemper called the mumps of which some were bad," but no one died. Writing about mumps in the eighteenth century, Michael Underwood noted that encephalitis was a common Complication in America. Common colds. Colds, "catarrhal" conditions, pneumonias, and all the other respiratory tract infections were widespread? ~ Even Indian children were affected and many died. John Eliot, a Roxbury, Mass., minister left this graphic description: "A very deep cold, with some tincture of fever and full of malignity," if not taken care of in time by diet, laxatives, warmth, sweats, and prayers. Diphtheria. Diphtheria was more prevalent in the colonies during the eighteenth century than it was in the seventeenth. At least it was more often recognized. As "cynanche trachealis" it proved fatal to many children of the Dutch and Swedes along the Delaware before the coming of the English. As "bladders in the windpipe" it removed many children from the Massachusetts Bay colony in 1659 according to Cotton Mather. He made the diagnosis by "opening" one of them, thus informing us of another colonial autopsy? 1 Syphilis. This disease, congenital as well as acquired, reached the colonies early. An epidemic of the "loathesome disease" began at Boston in 1646 when a man, having returned from a voyage, infected his wife with the lues venerea. Since no one suspected the presence of the disease, neighbors visited her after her child was born, allowed their children to nurse at her breasts, and permitted her newborn child to suck at theirs. In this manner 16 people were infected. It was noted that the

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disease was transmitted only by copulation or by sucking. A magistrate examined the original couple and finding that the man did not show any sign of the disease exonerated them both. His verdict was that the woman had been infected "by a mixture of so many spirits of men and women who drew her breasts." That was how it all began! 1~ Dysentery. There were many widespread epidemics, many "being visited with gripings, vomitings and flux with a fever which proved mortal to many infants and little children." Yellow fever. This was imported from the Barbadoes in 1693, just one hundred years before the great yellow fever epidemic in Philadelphia. It affected children as well as adults, causing "direful symptoms of turning, yellow, vomiting and bleeding every way, and so dying.''~ Malaria. Malaria likewise affected young and old even as it does today. Prenatal influences. Samuel Sewall's diary recorded a strange infestation of the pea crop by a plague of flies. A certain pregnant woman longed for green peas and ate some, but she regretted it later because her child was born with a pea in its forehead. This disappeared one morning, being found empty "as the pea used to be when the bug filled it." Cotton Mather was convinced that the belief in prenatal influences not only was supported by reliable authorities, but it had the backing of Holy Writ. Other diagnoses. A Quaker child died in 1682 of a "surfeit. ''1~ This was an acceptible medical diagnosis in seventeenth century England. Urinary stone also occurred in children. One was surgically removed in New England as early as 1685, but the b~y died the next day. A protracted case of chronic osteomyelitis in a child ended up in the Massachusetts court for adjudication of the medical fee. 1~A "cancerous" ulcer in the mouth of a child (which may have been noma) was another of the frequent medical cases in litigation. Accidents. A sudden infant death was explained by the belief that a cat will attack an infant in its crib. This led John Winthrop in 1640 to wonder about the case of a child supposedly killed by a cat. He seems to have concluded this death was accidental rather than a case of witchcraft, even though the cat sucking the breath out of infants was thought to be the metamorphosed agent of a witch--if not the witch herself. Accidents to children in connection with horse-drawn vehicles were relatively as common as automobile accidents today. A depressed fracture of the skull in a girl of eight was reported by Winthrop which was cured by one of the ruling elders of the church who ruled out surgical intervention and instead applied poultices to draw out the fragment of bone.

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Radbill

Epilepsy. Epilepsy was a general term for convulsions. True epilepsy was called "the falling sickness." Seizures of any sort created a fearful impression upon the eyewitnesses. Child abuse. In 1641 Governor Winthrop reported a great commotion over the rape of a seven-year-old girl by a young boy. Whipping was the penalty for rape, but since the girl was too young for generation there were some who held the act to be against nature and that is should be classified as sodomy or buggery-Biblical transgressions punishable by death. The extreme youth of the criminal does not appear to have ameliorated this puritanic view. Child abuse was not a matter of medical concern. It was a judicial matter. Indentured boys who ran away from their masters were whipped, but the courts sometimes dealt severely with those who battered children without judicial blessing. One man got six stripes for "abusing several children"; another was similarly sentenced for immoderate and cruel correction of his son "to the great danger of the boy's health and life." One sadistic woman who beat both her calf and her child cruelly with a curtle axe was fined and censured. Infanticide and abandonment also occurred. Sometimes a "jury of matrons" was assembled to determine the cause of death. 16One such jury invoked the trial by ordeal against the suspected mother. They caused the body of a dead bastard child to be exhumed and ordered the mother to touch, handle, and stroke the corpse; there was no noticeable alteration in the child's body. But when the accused father was put through the same ordeal, the black and "sotted" places about the body immediately turned fresh and red so that the blood was ready to come through the skin. A mother convicted of infanticide would be hanged. CURES Prayers for cures were carried out not only by the family but also on occassion by the entire community 9 In addition there were professionals available to pray for the sick. The Dutch settlers in 1661 even appointed an official "ziekentrooster" or consoler of the sick when scurvy and other misfortunes afflicted them9 Red cloths and draperies laid upon children or hung about the room not only helped when they had smallpox or measles but protected sick persons against demonic influences9 Cupping was a form of therapy as ancient as the animal horn used in performing it. John Winthrop's gubernatorial duties often inclffded the dispensation of medical prescriptions9 A man who wrote to him requesting more of his cordial powder which

The Journal of Pediatric, July 1976

Winthrop had sent previously for his daughter begged the governor to tell him how to make the child take it, as she refused it in beer. The father doubted it would be effective if given by force. This presents a familiar picture to pediatricians: a doting parent attempting to coax a child to take a nasty dose of medicine. Another man wrote Winthrop for some "physicke for the starting fits" (convulsive twitchings). He wanted the remedy that had helped a neighbor's child, but not Winthrop's " r u b i l a " - a famous panacea that the Winthrop family kept secret for three generations. Wormseed was a general favorite for weakness and abdominal pains presumed to be from worms. For jaundice a child received "barbaric" bark boiled in beer with saffron. For this child "lice two or three times and tumeric twice" were also suggested. Barbaric bark may have been the Peruvian bark from which quinine was derived; or it may have been rhubarb. Saffron was an old standby for jaundice mainly because it was yellow. For paralysis in general Governor Winthrop recommended hot cloths applied to the spine, rubbing in ointments, dry cupping to the heads of the "muskles," baths, etc. 17 Explaining one child's palsy he said it might have its "original in the marrow of the backbone;" and called it a dangerous disease. Was he referring to the spinal cord? Every literate person turned to a few good books for help. They all realized that a knowledge of medicine, like knowledge of botany, zoology, mineralogy, and climatology, might mean the difference between failure or survival. Rickets was not a serious problem in America during the seventeenth century because, without urban density, there was plenty of sunshine for children. It did occur, however, and'~htypically complex prescription for it was to dip the child, in the morning, head first into cold water and then, before dressing it, warm it so that it could sweat for at least half an hour. This was to be repeated on three mornings and if one or both feet should be cold while the other parts were sweating, a little blood was to be taken out of the feet on the second morning. Before the dips the child was to be given snakeroot and saffron steeped in rum and water. Several times a day it was also to be offered a syrup made of "comfry, hartshorn, red roses, hogbrake roots, knot-grass and petty morel roots sweetened with molassis.''1~

FEES Pediatric fees were not inconsiderable even by our standards9 The court ordered one man to pay a surgeon for medical care of his s o n - 3 pounds, 2 shillings; for the doctor's servant 3 pounds; for the medicine 8 shillings.TM

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Colonial pediatrics

The same court in 1662 awarded 10 shillings to a nurse for keeping a weak and sickly child, and 10 shillings to the doctor who treated it. Once when the fee was in litigation the court appointed a panel of three men to determine a fair fee. Twenty to thirty pounds was not an unusual compensation for annual services of a doctor engaged to serve the community on a yearly basis. In one instance a father offered as a prospective fee a colt valued at 9 pounds. The animal grew into a horse during the period of treatment so that by the time payment was due it was appraised at 14 pounds. By this time eleven months had elapsed and the expense of treatment had also g r o w n - t o 20 pounds. This was a goodly sum for a doctor's bill; a laborer's hire for an entire year's work might not amount to more than 9 or 10 pounds. PUBLIC

WELFARE

The earliest notice of a public institution for child care appears in the Dutch records at Albany: in 1660 an infant who had lost both parents was sent to the , o r p h a n house." An early public health measure was carried out at Northampton, Va., in 1667 when the c o m m a n d e r of the colony, during an outbreak of smallpox, ordered houses in which the disease appeared to be quarantined for 30 days. In 1678 the court at U p l a n d (Chester), Pa., ordered the c o m m u n i t y of A m a s l a n d to build a little blockhouse in which to confine a neighbor's insane son, who could not be otherwise controlled, because the father was not able to afford his care. The court also laid a small levy for building the blockhouse and for maintaining the boy. The age of the boy is not known, but this was the earliest poor tax and the first insane asylum under the first poor law in Pennsylvania. CONCLUSION The seeds of our progress were planted in the past. Although early records are sparse we can glean much information from letters, diaries, court records, and early A m e r i c a n publications. Children were here in the seventeenth century and they required care and consideration. " G r a n n y m e d i c i n e " and "kitchen physicke" call forth a ring of nostalgia; often sounding quaint and amusing, m u c h has persisted unchanged alongside the advances of scientific medicine. Knowledge of our heri-

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tage helps us understand what goes on in the minds o f some of our patients. Our ancestors also probed for better understanding. M a n y of the problems o f pediatric care within their milieu show a remarkable similarity to ours even if they did falter in the m a n a g e m e n t o f some. Knowledge of our heritage can help us understand the needs of children o f today and hopefully help us find our way in improving the welfare of the children of the future.

REFERENCES

1. Earle Alice Morse: Child life in colonial days, New York, 1906, MacMillan Company, p 2. 2. Sewall Samuel: Diary, Massachusetts Historical Society Collections, Series 5, Vol. 8, 1882. 3. Radbill Samuel X: English pediatrics in the 17th century, in Debus Allen G, editor: Medicine in 17th Century England, Los Angeles, 1974, University of California Press, p 251. 4. Guerra Francisco: American medical bibliography, New York, 1962, Harper & Row Publishers, p 3l. 5. Blanton WB: Medicine in Virginia in the 17th century, Richmond, Va., 1930, William Byrd Press, p 167. 6. Winthrop John: History of New England from t630 to 1649, Vol. 1, 1825, p 261. 7. Russel Gordon W: Early medicine and early medical men in Connecticut, Proceedings of the Connecticut Medical Society, 1892, p 17. 8. Duffy John: Epidemics in Colonial America, Baton Rouge, 1953, Louisiana State University Press, p 48. 9. Love W. DeLoss, Jr: The fast and thanksgiving days of New England, 1895, p 186. 10. Heaton Claude E: Medicine in New York during the English Colonial Period, Bulletin of the History of Medicine 17:19, 1945. I1. Packard Francis R: History of medicine in the United States, Vol. 1, New York, 1931, Paul B Hoeber, Inc, p 56. 12. Winthrop: Loc cit, Vol 2, p 257. 13. Duffy: Loc cit, p 141. 14. Levick JJ: Early physicians of Philadelphia and vicinity, 1886. 15. Radbill Samuel X: Chronic osteomyelitis as depicted in a suit for a medical fee in Massachusetts in 1660, Transactions and Studies of the College of Physicians of Philadelphia, 4th Series 14:73, 1946. 16. Cordell EF: Medical annals of Maryland, 1903, p 640. 17. Gordon MB: Aesculapius comes to the colonies, Ventnor, N J, 1949, Ventnor Publishers, p 194. 18. Hughes TP: Medicine in Virginia 1607-1699, Williamsburgh, Va. 1957, Virginia 350th Anniversary Celebration Corporation, p 46. 19. Records and Files of the Quarterly Courts of Essex County Massachusetts 1636-1656 Salem, Mass. 1:4, 1911.

Colonial pediatrics. Some random notes.

SPECIAL BICENTENNIAL ARTICLE Colonial pediatrics S o m e random notes Samuel X Radbill, M.D., Philadelphia, Pa. E A R L Y IN THE S E V E N T E E...
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