PAEDOTROPHIA
An analysis of a 16th
century didactic poem
about the medical care and upbringing of children
by Lindsay White
Introduction
I chose the topic of Medicine and the Arts as I have been an avid reader and musician from an early age. I believe that Medicine and the Arts, whilst seemingly different studies, can be of benefit to the medical profession by widening our outlook and developing more holistic approaches to medicine and the treatment of patients.
I was introduced to Paedotrophia by my tutors who had selected an extract on teething to illustrate the poem. My interest in literature plus my previous degree in Dentistry fired my imagination and fuelled my research into the rest of the poem.
The aim of this essay is to use extracts from Ste. Marthe’s poem and compare their suggestions with those prevalent at the time. Due to restrictions of both time and word count, I will not be discussing this in the light of current medical thinking, but will hopefully use this essay to provide a basis for a broader work where this will be included.
All illustrations used in this work are taken from the 1549 edition of von Louffenburg’s poem Versehung des Liebs.
Biography
Scevole de Sainte Marthe, or Sammarthanus as he was also known, was born in February 1536 at Loudun, France, the eldest son of a noble house [5]. He became interested in poetry at an early age and attended the University of Paris before going on to study Law at Poitiers. He composed several poems, mainly in Latin, which were favourably compared to those of classical writers such as Virgil, and he famously translated the Hippocratic Oath into Latin hexameters.
He had no formal medical training. The only family connection to the profession was his paternal grandfather, Gaucher de Sainte Marthe, who had been councillor and physician in ordinary to King Francis I, so it is perhaps unusual that one of his best known works was a didactic poem on pregnancy and childcare.
Two of his sons died from smallpox at an early age and, when a third fell ill “he was not sparing of the experience and care of the best physicians” [5]. These physicians were unable to help the child so Ste. Marthe “applied himself likewise to search curiously the natures and constitutions of infants… His researches [were] so successful that he cured his own son by remedies of his own prescribing after he was given over by the physician. Being then entreated by his friends to communicate such curious discoveries to the public he comprehended them in poem” [5].
Paedotrophia was published in 1584 and was dedicated to King Henri III who decreed that it should be translated into French “to the end that all France might have more particular understanding of this most learned and useful labour” [5]. It went through over twenty editions in both Latin and French before being translated into English in 1710 by an anonymous author.
The best known English translation is that of Dr Henry William Tytler (1752-1808), a medical practitioner from Forfarshire who, in 1795, published the poem in iambic pentameters (a meter better suited to English than the hexameters of the original) along with comments on the then current medical practice and a translation of Ste. Marthe’s biography by Gabriel Michel. Tytler inevitably “takes some liberties with the original…but on the whole keeps fairly close to his copy, and so far as its didactic theme is concerned, preserves the intentions of its author” [16]. It is from this 1795 edition that I have taken the extracts mentioned later.
The work was publicly studied throughout the universities of Europe for 200 years following its initial publication “with the same veneration as was accorded to works from classical times” [7] It is unclear as to whether it was studied for its artistic merit alone or whether its teachings were also adhered to. Medicine was at that time still very much bound to the past writings of the Greeks such as Galen and Aetios, a long way from the advent of evidence based practice, being “a matter of authority rather than research and what was written was regarded as the truth” [15]
Paedotrophia
The poem, written in Latin hexameters, is divided into three books pursuing its didactic theme and illustrating passages with references to classical literature. The first introduces the author’s subject and outlines the development of pregnancy, changes of the maternal body and the developing foetus, and advised on ante-natal care and nutrition. It ends describing labour and the practice of midwifery.
“Then, when the nine revolving moons are run,
When now the long-expected hour comes on,
Invoke Lucia’s aid, with potent voice,
And let a skillful midwife be your choice;
That death, nor danger may the birth attend,
But former pains in coming pleasures end.
Let her, with hand and voice, assist your throes,
With oft-repeated touches soothe your woes,
On your smooth belly rub disolving oils,
Relax the seats of joy by gentle wiles,
Unlock the secret bars with vapours bland,
And, for the child, the straighten’d doors expand.”
(Lucia was the patron saint of peasants and against haemorrhaging).
The second book follows on from labour, describing immediate post-natal care of the infant (bathing, swaddling etc) as well as advice on feeding, the choice of a wet nurse and weaning.
The third book is concerned with childhood diseases and ailments, and its prescriptions for treatments are very much based on the folk medicine of the time.
“When the child at once is weak and loose,
White poppy seeds into the purge infuse.”
Opium use for the treatment of severe diarrhoea was still valid when Tytler published his translation, and kaolin and morphine was used until very recently.
Despite his own experiences, Ste. Marthe still recommends consulting professional help over the use of much of the folk medicine of the time.
“Call the physician to your aid; advise
With him, and do not think yourself too wise;
Do not to ev’ry idle task attend
Nor on old woman’s recipies depend.”
One assumes that, during his researches whilst curing his son, he would have been exposed to previous and current medical writings of the time. I plan to briefly highlight these, so as to compare them with the extracts taken from Paedotrophia.
Didactic Poetry
“Poetry may seem an unsuitable form for books on child care, yet for over 300 years, these poems were among the most popular works on the subject. There is both a logical and aesthetic reason for this. In a world where literacy was limited, poetry functioned as a mnemonic device, assisting in transmitting child-raising advice from person to person. Aesthetically, at a time when printed material was scarce, the child care poem might have been read as much for its poetic value as for its contents”. [3]
The earliest poem written on the subject of childcare was composed by Heinrich von Louffenburg in 1429 and was published as part of Versehung des Leibs (Care of the body). Von Louffenburg was a priest in Freiburg, his main writings being religious poems and translations of classical works. His poem was written in Old Swabian, then translated into German and was written for the lay person rather than for the medical profession. It is because of this that we might excuse what Still describes its “mere doggerel rhyme”. The paediatric portion of the poem deals with events similar to those which Ste. Marthe would address 150 years later.
Giulio Alessandrini and Luigi Tansillo also composed didactic poems regarding child rearing but unfortunately I was unable to find a translation or commentary regarding the former and Still only found a poor translation of the latter. No doubt, the literary Ste. Marthe would have been able to read these in their original form.
Medical literature
The source material for comparison of Paedotrophia comes from both contemporary works which Ste. Marthe may have had access to, and more modern works. A short discourse on these contemporary works can be found in the Authors’ Index at the end. I must however mention a couple of them here. Of Ste. Marthe’s contemporaries, I wish to make special mention of two men: Eucharius Rösslin (dates unknown) composed one of the earliest and most popular obstetric and midwifery texts in 1513, and Thomas Phayer (15??-1560), who was the first Englishman to compose a work concerning the diseases of children.
Of more modern writers, I think it prudent to mention three: the American Dr John Ruhräh who published his comprehensive work Paediatrics of the Past in 1925, the eminent physician Sir George Frederick Still and his work The History of Paediatrics published in 1930, and Daniel Beekman, author of The mechanical baby- A popular history of the theory and practice of child raising, published 1977.
Extracts from Paedotrophia
I selected the following four extracts both for poetic quality and to be used a comparison with its contemporary medical beliefs. Still describes poetry as “expression of feeling and the portrayal of imagination in word-music. When it becomes the mere recording of facts - facts unadorned by sentiment or fancy - it ceases to be poetry, it is mere rhythm or rhyme. For this reason poetry is ill-fated to be the vehicle of scientific instruction”.
However, as Beekman hinted earlier, poetry and song were an excellent medium for the education of the illiterate and partially literate, continuing the oral tradition of teaching from the ancient Greeks, through the Celtic and Norse narrators and minstrels. It is easier to remember rhymed poetry than prose and the majority of society at that time would have relied on word of mouth to convey both stories and information.
Tytler prefaced his 1795 publication of Paedotrophia with the comment that “Didactic poetry, whether on moral duties, philosophical speculations or delivering in an agreeable manner, the principles of and particular art, or science, have in all ages been highly esteemed, and considered as holding the next place to heroic or epic poetry: and as the latter is valued on account of the dignity of its subject, the grandeur and sublimity of its ideas, so is didactic poetry for elegance of expression and utility. In the first of these the Paedotrophia yields only to the Georgics of Virgil; and in the last excuses that admired poem in so far as the lives of mankind are of more consequence than the animal creation”. With the following, I hope to illustrate Tytler’s beliefs and contradict the final statement of Still.
Wetnursing

Wetnursing was introduced into popular custom during the Roman occupation of Europe and had developed into a well established and highly organised state-controlled industry in France by mediaeval times.
Much had been written regarding the selection of a wet nurse, as it was thought that their character and traits would be conveyed to the child via the breast milk. Thomas Phayer stated that women should “…be well advised in takyng of a nource, not of ill complexion and of worse manners: but suche as shal be sobre, honeste and chaste, well fourmed, amyable and chearefull, so that she may accustome the infant vnto mirth, no dronkarde, viscious nor sluttysshe, for such corrupteth the nature of the chylde. “
Ste. Marthe states this rather more lyrically (Book II vv. 340-358) :
“Chuse one of middle age, nor old, nor young,
Nor plump, nor firm her make, but firm and strong:
Upon her cheek, let health refulgent glow
In vivid colours, that good-humour shew:
Long be her arms, and broad her ample chest;
Her neck be finely turn’d, and full her breast:
Let the twin hills be white as morning snow,
Their swelling veins with circling juices flow,
Each in a well-projecting nipple end,
And milk, in copious streams, from these descend:
This the delighted babe will instant chuse,
And he best knows what quantity to use.
Remember too, the whitest milk you meet,
Of grateful flavour, pleasing taste and sweet,
Is always best; and if it strongly scent
The air, some latent ill the vessels sent:
Avoid what, on your nail, too ropey proves,
Adheres too fast or thence too swiftly moves.”
The information is clearly and simply stated, something of benefit for a didactic poem written for people of insufficient education to be able to read themselves.
Verses 349-351 appear to be advocating the practice of demand feeding, a very modern practice, as it was not uncommon for children to be fed only at the parents’ mealtimes regardless of their requirements. Rösslin stated, “As Avicenna writeth: it shall be sufficient to geue it suche twice or thryce in a daye, And alwayes beware, ye geue not the chylde to much suche at once in this tender aege of it…”
The milk test, depicted in verses 357-8 had been first described by Pliny in the first century AD, and both Metlinger and Phayre make particular reference to this:
“That milk is good, that is whyte and sweete, and when ye droppe it on your nayle, and do moue your finger, neither fleteth abrode at euery stering nor will hange faste vpon your nayle, whē ye turne it downeward, but that which is betwene both is best.” [13]
Weaning

The age of weaning was then, as it is now, a very contentious issue. As with much of the medical literature, the recommendations (or “mumbling shibboleths” [16]) of the ancients were prominent. Galen and Avicenna had both suggested that the appearance of a child’s first teeth was the signal to totally withdraw breast milk. Both de Vallembert and Mercurialis note that it was customary for infants to start weaning as early as two months.
The following first five lines beautifully describe this (Book II vv. 455-59, 483-96, 569-86) :
“But, in short time, the growing babe will need
Not on th’ambrosial juice alone to feed,
When twice four times the moon has fill’d her orb,
And shooting teeth the swelling gums disturb,
Restrain the flowing teat;
When now you change, and give but half the breast
Food, most resembling milk, is still the best:
Nor is it good too suddenly to use
Viands, quite diff’rent from the kindred juice,
Unless you know their nature to correct,
And form the medium his desires expect.
Hence nurses give, nor shall the Muse dissuade,
Broth by itself, or often mix’d with bread:
But what affords the finest vital sap
Is soft panada, milk, or water-pap;
Which diligent the nurse, diluting well
With either liquid, bread, or flour, or meal,
Stirs o’er the fire, and boils the pleasing dish,
Till brought to what consistence she may wish.
‘Tis time to shew the careful mother, when
To shut the fountains, and the child to wean.
But such the changing lot of man below,
That none, for this, a certain rule can know:
The best-laid plans oft most deceitful prove,
And fate and fortune all our hopes remove.
But, would the fav’ring gods permit the muse
To guide the nurse, and fittest time to chuse;
She should not of her pleasing office tire,
Nor with a foetus teem, nor win her hire,
Nor die, nor feel disease, nor from the boy
Withdraw the breast, nor other cares employ
Her heart, and fost’ring hand, till twice the sun
His annual journey round the globe had run;
When, growing with his age, his frame requires
Some diff’rent food to fan the vital fires;
And the fair fluid should give place at length,
To nourishment more suited to his strength.”
These passages are incredibly musical in style, with strong rhythms and simple rhymes. It does not appear over-florid and its images and metaphors are very visual, supporting Ste. Marthe’s advice.
Pap, described in verse 492 was a concoction of flour or breadcrumbs cooked in water, whilst panada was bread boiled in milk or broth. These were both customarily given as first foods. De Vallembert discusses the suitability of certain foods and describes one of first foods that is used is cow or goat milk (i.e. II v. 484 “resembling milk”) with semolina, flour or bread boiled in it (vv. 490-6).
The third set of lines on this subject again have quite a modern outlook, suggesting that one cannot place a set time to totally wean a child (vv. 571-4) but that it should continue into the second year. Mercurialis is quoted as saying that nature intended breast milk to last into the second or third year of an infant’s life.
Bathing and Swaddling

Amongst the many topics discussed by the numerous authors of paediatric texts, the different methods of bathing and swaddling a child made for interesting reading. Ste. Marthe (Book II vv. 159-80) said :
“Remember too, that only, by degrees,
His tender skin endures the cooling breeze:
Expose not, recent from the womb, the child,
Except to gentle heat, and seasons mild:
Lest ills succeed, lest penetrating cold
Benumb his limbs, and of his joints take hold.
As when a Libyan traveler must defy
Th’ inclement seasons of an arctic sky,
Unus’d to face the blust’ring North and West,
He wraps his body in a woolen vest,
Head, limbs and feet, defends with cautious art,
In double folds involving ev’ry part,
So, from relaxing bath, still keep in mind,
That you more open ev’ry pore will find,
And more unfit to bear the cooling air:
For this, in powder, finest salt prepare,
T’annoint his skin, and all his joints around,
Constringing thus what bathing had unbound.
Nor then forget that wrappers be at hand,
Soft flannels, linen, and the swaddling band,
T’enwrap the babe, by many a circling fold,
In equal lines, and thus defend from cold.”
Again, imagery is rife and relatable in this passage.
It had been common practice to bathe newborn infants in icily cold water to harden their constitutions, a practice which was common in Russia up till the turn of last century. Unsurprisingly, many children perished. Rösslin was one of the first to condemn this practice and suggested the child “be wasshed two or thre tymes in the daye, and that anone after slepe in the wynter with hote water, in the sommer with luke warme water: nether let it tary long in the water but unto such tyme as the body begyn to ware red for hete:”
The practice of the “salting” of the newborn mentioned in verses 174-5 has origins which date back to biblical times. Gabriel Miron, physician to King Louis XII, composed a largely plagiarised treatise on medicine in 1544 in which he describes this practice but states that it was not in use in contemporary France.
Swaddling was a rather contentious issue, suggested as a means of keeping children quiet and to force their bodies to develop into the correct shape, as well as keeping the child warm. “Farthermore when the infant is swaddled and layde in cradell, the nource muste geue all diligence and hede that she bynde euery parte ryght and in his due place and order, and thet with all tendernesse and gentell entreatynge and not crokedlye and confucely, the which also muste be done oftentymes in the day: for in this it is as it is in younge and tender ympes, plantes and twygges, the which euen as ye bome them in theyr youthe so wyll they euermore remayn unto aege. And euen so the infante yf it be bounde and swadeled the membres lyenge ryght and straight, then shall it growe streate and upryght, yf it be crokedlye handled it wyll growe lykewise and to the yll negligence of many nources may be imputed the crokednesse and deformity of menye a man and woman, which otherwyse myght seme as well favered as any other” [14].
This practice was typical of the opinion of medical texts through to the time of William Harvey. Ste. Marthe is therefore recording a balanced opinion of the time.
Suffocation resulting from swaddling was common. Infants were often wrapped so tightly that they couldn’t breathe properly or move their heads when drooling. Only Würtz condemned the practice, “I have seen both mothers and nurses to bind and tie their children so hard for pity sake [it] made me weep…Young tender children are not able to speak or complain against those which deal roughly with them”, though he didn’t totally oppose it so long as “the child be not tied or packed too hard”. He described swaddling the child in “tight, neat little bundles” and stated that it was not uncommon to the child to be then tossed around the room!
Teething

The final extract I have chosen includes the lines which sparked my initial interest in this poem. It depicts teething and suggests remedies by which to soothe the child’s distress (Book III vv. 264-92) :
“When growing teeth must all your care engage.
When these are doom’d to shoot, a while, in vain,
And pirce the gums with unremitting pain,
Sharp humours flow from such intestine wars,
Nor can the points assiduous break the bars,
But tear their latent way, like smother’d fire,
And vex the swelling jaws with tortures dire.
How great, alas! appears the wrath of Heav’n!
And is it thus our teeth must still be giv’n?
Those useful instruments, that cherish life,
That break our viands with unceasing strife,
And for our stomach, grateful food prepare,
Else of the hallow’d blessing none could share.
The crying child indeed his fingers brings
Within his mouth, whence humour constant springs,
To press the gums, that swell with gnawing pain,
And strives to aid himself, but strives in vain.
The nurse must try to give the wish’d relief,
Else all his labour but augments his grief;
Anoint his fingers with the brain of hares,
Or dew the bright Sicilian bee prepares.
Thus he, by gentle friction, will assuage
With soft’ning juice the inflammation’s rage,
Till, by degrees, the growing tooth make way,
Atchieve an op’ning, and spring forth to day;
O’er the red gum appears the gift devine,
As works of iv’ry set in coral shine.”
Teething had, by some authors been described as a disease from which infants frequently died.
Verses 277-80 have echoes in Bagellardo’s writings, “At the time of dentition, children are subject to intense pains of the gums, and the more intense the pain, the more firm will be the teeth…Moreover the bulgings appearing in the gums must be assisted by rubbing them with the hands, because then the infants emit slobberings and humours”.
The mixtures suggested by Ste. Marthe as ones to place on the fingers of the child, whilst some today might seem rather repulsive (brain of hares!), were at that time amongst many common remedies used during teething. “There be diuers thinges that are good to procure an easy breeding of teeth, amōg whom the chiefest is to annoint the gummes, with the braynes of an hare, myxt with asmuch capōs greace and hony, or any of these thynges alone, is exceadyng good to supply the gummes and the synewes” [13].
Conclusion
Tytler must take a little credit for making such an accessible translation of Ste. Marthe’s work. He has been faithful to the original content and its style. I believe that the work has relevance for both its poetical as well as its medical content. It combines a clarity of purpose with imaginative images to aid retention of the information so contained.
Although the poem does allude to classical stories, the understanding of the poem is not dependant on the knowledge of them, unlike many works written at the time of both Ste. Marthe and Tytler. Its style is much akin to the old saga poetry to be found in old English (e.g. Beowulf) and the Norse sagas (e.g. Njal or Egil’s sagas), although their content is different.
Tytler stated that Paedotrophia was studied in the universities of Europe for 200 years following its composition. I expect that this was for its poetical qualities rather than its medical content as the medical advances made during the Renaissance would have superseded the beliefs of Ste. Marthe’s time.
I have thoroughly enjoyed researching this topic. I have been introduced to a work which, while not as relevant to current medical practice as it was when written, can stand alone as a lyrical and descriptive piece of poetry, retaining the ability to conjure up vivid images of life at the time. I have also had the opportunity to delve back in time and research Ste. Marthe’s medical contemporaries, providing an insight into paediatrics and childrearing practices of the sixteenth century.
I am indebted to the Wellcome Institute library and their staff for their invaluable resources and help in making the researching of this topic pass with few difficulties.
Contemporary Authors Index
Bagellardo, Paulo was author of Libellus de aegritudinibus infantium, one of the first medical treatises to be printed. Published in 1472, it described childhood diseases and followed closely the teachings of Rhazes (Abú Becr Mohammed ibn Zacariyá Arrazi AD 850-932), one of the famous Arabian physicians. His dependence upon this ancient authority was typical of medical texts of the time. “He made, as it were, a compendium of paediatric opinions, but, of course, it also expressed what he believed to be best practice of the time; a curious mixture of sense and nonsense, good and bad [like so many books of the present day]. Medicine was still a matter of authority rather than research and what was written was regarded as the truth” [15].
de Vallembert, Simon (1558-16??) was author of the first paediatric text to be written in French, entitled Cinq livres, De la maniere de nourir et gouverner les enfants des leur naissance (On the feeding and management of children from their birth), in 1565. He, like Rösslin before him, was interested in the education of the layperson and the professional midwife. Although the text “is obviously influenced by the ancient writers, as his predecessors had been, and quotes them often, nevertheless he had a mind of his own, and a sound common sense far in advance of most of the writers of the sixteenth century” [16]. He was the first to describe the connection between faulty feeding and the wasting occurring in the then unnamed rickets.
Mercurialis, Hieronymus (1530-1606) composed his treatise on children Nomothelasmus seu ratio lactandi infantes in 1552 in Latin, before being translated into German. Still states that it appeared to have been well regarded as of importance, and was quoted by several subsequent authors of paediatric texts. Again, it contained many extracts from ancient authors “but without that slavish adherence which makes most of the writers on this subject in the fifteenth and sixteenth centuries merely purveyors of ancient dogma and error…[he] uses not only his own judgements, but at times also his own observation, and sometimes it is shrewd” [16].
Metlinger, Bartholomeus (14??-1491) compiled a work entitled Ein Regiment der junger Kinder in 1473 which was essentially a compilation of the beliefs of Galen (second century), Aetios (sixth century), Paulus Aeginata (seventh century) and Avicenna (tenth century) but also included personal experience and avoided some of the more bizarre remedies in vogue at the time, “in spite of fact that the book was written at a time when it was the custom to follow slavishly the writings of the ancients, and the Arabians, the Renaissance was underway and so Metlinger added such things as he himself had found useful or thought of value. The book is one of the best, if not the best, of the early works on paediatrics. The second book is decidedly modern in feeling. In other words we advise much the same care today as Metlinger did in the fifteenth century” [15].
Phayer (Phaire,Phayr etc), Thomas (15??-1560) was the first Englishman to compose a work concerning the diseases of children. His Boke of Chyldren was first published in 1545, his purpose “to doo theym good that haue moste nede, that is to saye, children: and to shewe the remedies that god hath created for the vse of man, to distribute in englyshe to them that are vnlearned, parte of the treasure that is in other languages, to prouoke thē that are of better learnyng, to vtter their knowledge in suche lyke attemptes.”
This work, as was true of much of the contemporary medical literature, cannot claim to be very original, having echoes of the Graeco-Roman teachings and also Jonas’s translation of Rösslins Roszgarten. He was not advanced in his scientific knowledge but was a “pioneer in enabling Englishmen to read and think of diseases of children in their own language” [16].
Rösslin, Eucharius (dates unknown) was author of Der Schwangern Frawen und Hebammen Roszgarten in 1513. This was one of the earliest and most popular “authoritative obstetrical texts” [15], and was written, unusually at the time, in vernacular German being intended for a readership of both lay persons and professional midwives. (Early midwifery texts tended to be more forward thinking and modern than the contemporary poetic and paediatric medical counterparts.) Again it draws liberally from the works of the ancients. Richard Jonas translated the work into English in 1540, entitled The Byrthe of Mankynde. It is from this text that any quotes have been taken.
Würtz, Felix (1518-157?) was a Swiss surgeon whose works subsequently became overshadowed by those of Paré. His Practica der Wundartzney composed in 1563 was quite radical as, in addition to offering advice in the care of infants, he widely criticised many of the practices of the time as being either dangerous or without merit. It underwent sixteen printed editions in the century following its initial publication and was widely read throughout Europe, being translated into both French and English.
The “fanciful and magical systems of Bagallardo and
others and the essentially pragmatic approach typified by Metlinger and Würtz
existed without open conflict until the mid-seventeenth century” [3].
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