Underrättelser om barn=sjukdomar och deras bote-medel: Tilförene styckewis utgifne uti de sma Allmanachorna, nu samlade, tilökte och förbättrade

Stockholm: Lars Salvius, 1764. First edition. A seminal treatise on paediatrics.

First edition in book form, rare, of this seminal treatise on paediatrics. "Sir Frederic Still considered this work 'the most progressive which had yet been written;' it gave an impetus to research which influenced the future course of paediatrics. Rosen was particularly interested in infant feeding. The Underrattelser were originally published in the calendars of the Academy and were later collected and issued in book form in 1764" (Garrison-Morton). "In 1764 a very important work on the diseases of children and their treatment was published in Stockholm by a physician who had already become famous" (Still). The book contained chapters on such topics as smallpox and smallpox inoculation, teething, and measles. Also included were suggestions on the frequency of breastfeeding and information on how breastfeeding affects an infant's health. He was ahead of his time when he recommended feeding young children with diluted cow's milk by means of a bottle for sucking. He also advised that children's foods be covered to avoid contact with insects, along with other hygienic precautions. He accurately described and prescribed care for scarlet fever, whooping cough, diarrhoea, and other illnesses. "Nils Rosén lived and worked in a time when Sweden was a poor country with a low average life span and a child mortality rate exceeding fifty per cent ... In 1753, when the Gregorian calendar was introduced and Sweden got a new chronology, Nils Rosén started to publish articles in small almanacs published by the Royal Academy of Sciences. The articles dealt with children ́s diseases, breast-feeding, nursing and preventive medical treatment, e.g., what then constituted fresh and new results of his empirical research work. Later, the articles were collected, re-edited and published in a book, Underrättelser om Barn-Sjukdomar och deras Bote-Medel (1764). It was the first veritable textbook of paediatrics. In 1771 it appeared in a new, improved and enlarged edition. The book was soon translated into many other European languages and became the Swedish textbook - all categories - that has been the most spread throughout the world. It was published in twenty-six editions and in ten different languages within the eighteen and nineteenth centuries. One of Linné's 'apostles', Anders Sparrman, translated it into English during a round-the-world sailing tour with the legendary captain James Cook on board The Resolution (1772-75). This book, The Diseases of Children and their Remedies, was printed in London in 1776" (Sjögren). RBH lists three copies. OCLC lists, in the US: Yale, New York Academy of Medicine, NLM, Minnesota, Indiana, Austin, Harvard.

"Nils Rosen was born in Westgothland in 1706. In his youth he studied theology at Lund, but later deserted this subject for medicine. He was a pupil of Stobaeus at Upsala, and later of Friedrich Hoffmann at Halle. After a short period of study in Paris he returned to Sweden and took his M.D. at Harderwijk in I73I. For a time he taught anatomy and practical medicine at Upsala, and published a Compendium Anatomicum (Stockholm, 1738). He was early marked out for distinction, for in 1735, at the age of twenty-nine years, he became physician to the King of Sweden. The Swedish Academy of Sciences was founded in 1739 and Rosen became one of its original members. In 1740 he was appointed Professor of Natural History at Upsala, and Carl von Linné was Professor of Medicine. To the good fortune of posterity these two agreed to exchange appointments, so that the great naturalist and botanist occupied his proper position whilst Rosen became Professor of Medicine. With two such distinguished occupants of chairs, the University of Upsala became renowned as a seat of learning. Honours were poured upon Rosen. He was appointed 'Archiater' - Physician-in-Chief - at Upsala, and in 1762 was ennobled under the title of Rosen von Rosenstein. Upon his death in 1773 the Swedish Academy of Sciences had a medal struck in his memory, and another medal in his honour was struck as late as 1814.

"He contributed important papers to the Academy of Sciences, one, in 1744, describing for the first time an epidemic of scarlet fever in Sweden, a rather late successor to Sydenham's description of an epidemic of scarlet fever in 1675, and in the same year also he described a case of hyoscyamus poisoning in a boy and drew attention to the mydriatic effect of certain drugs. But by far the most important of his writings was his book on diseases of children, Underrattelser om barnasjuk- domar och deras botemedel (Stockholm, 1765). It was at once recognized as a work of great value ...

"Rosenstein's outlook is evident from the authorities he quotes. Only once, I think, does he mention the name of any of the ancient writers, and that only to give a synonym for epilepsy used by Hippocrates. His references are to the latest writers, and to recent contributions to scientific societies, and to his own personal observations. Now and again the influence of tradition shows itself, and one realizes how strong is the hold of error when it has been inculcated for centuries. Of the mother's milk he says 'it frees the child from many disorders and makes it acquire her own temper and disposition. Therefore we see that young lions who have sucked a cow or a goat have by this means been as it were tamed; and dogs, on the contrary, who have sucked a she-wolf have become beasts of prey' [quotations are from the English edition of 1776]. In the testing of the breast-milk he has gone little further than Soranus. It is to be tested 'By its consistence because when thin it is always better than when thick: therefore a drop of it on your nail ought easily to run off on inclining it, even on shaking the finger hastily there ought not to remain the least white streak on your nail: By the touch, because not any pain ought to be felt on letting a drop of it fall into the eye: With rennet, for if the milk gives much cheese on coagulating it, you may judge it to be good for nothing. By keeping it several hours in a glass because if it then gives much cream it will also prove bad. The same is to be observed upon weighing the milk, for the more cream it gives the lighter it will be found.' He mentions artificial feeding 'by means of a little instrument or sucking-bottle (called Biberon), which is universally used in Eastern-Bothnia with great advantage, but this machine ought always to be kept clean: it is to be made of horn, the smaller end of which may be fastened to a tanned skin of a cow's teat, or if that is not to be procured, we may use any other thin skin, pierced with many small holes'.

"He was in advance of his day in advising that all 'food for children ought to be well covered over, that no insect or any such thing can get at it', advice which was sounder than he realized.

"For teething 'the fresh brains of a hare or calf or any other animal may be used for rubbing the gums ... it will equally be of service to let the child bite upon a wolf's tooth or any other hard thing'. But he is careful to add that 'the brains of a hare or the blood from the comb of a black cock has no preference to other softening remedies, as also that a wolf's tooth is not preferable to either polished chrystal or any other hard substance'. 

"The classification of the varieties of infantile diarrhoea has been the bugbear of writers on diseases of children down to our own day; a division into four or five varieties seems a complication hardly to be endured. But Rosenstein has no qualms on the matter; he divides infantile diarrhoea into fourteen different varieties! He was one of those people who revel in divisions and subdivisions, a type of mind which is apt to mince things up so small that it is difficult to recognize the original. In his chapter on vomiting he describes eleven 'species' of vomiting! If for 'species' he had substituted the word 'causes' it would have described his meaning more accurately. 

"Like other writers of his time (vide de Sauvages, p. 404) he describes what is obviously varicella as a variety of small-pox. He calls it 'the chrystalline or watery smallpox', which he says breaks out 'within 24 hours and disappears within 5 or at most 6 days, and mentions a case in which it was associated with what he calls the warty or stony small-pox, probably meaning that the papular or pre-vesicular stage was unusually marked. He says of this case: 'The report would certainly have spread that she was affected with the smallpox for the second time had not I myself together with several other physicians seen and known the disease. The same is perhaps the case with all who are said to have had the Smallpox twice or several times: therefore physicians ought not to assert anything but what they have seen themselves.' Von Rosenstein here seems to have recognized that the milder disease was something quite distinct from true small-pox, and that the one did not protect from the other: so that their differentiation except in name was practically complete. 

"His description of scarlet fever is based on his own notes of cases seen during an epidemic in 1741 when, he says, 'it was to be met with almost in every house at Upsala where children were to be found'. It is a masterly description, accurate in clinical detail, and a great advance upon the meagre sketch which constituted the first account of the disease by Sydenham in 1675. He mentions the occurrence of dropsy with bloody urine as a sequela of scarlet fever; the relationship of these to nephritis was not yet known. In regard to the aetiology of scarlet fever some progress had been made since the days of Sydenham, who said: 'I reckon this Disease is nothing else but a moderate effervescence of the Blood, occasion'd by the Heat of the foregoing Summer, or some other way'. Von Rosenstein says: 'The cause of the Scarlet fever is as unknown to us as that of the Smallpox and measles. We only know that it is propagated by the contagion and that people would be secure from being infected, provided they could avoid the contagion'. 

"How near von Rosenstein came to the conception of bacterial infection is seen in his remark on whooping-cough: 'The true cause of this disease must be some heterogeneous matter or seed which has a multiplicative power as is the case with smallpox ... Whether this multiplicative miasma be a kind of insects I cannot affirm with certainty; however, we find that it is communicated by infection and that a part of it is attracted by the breath down into the lungs.'

"It has been said that Rosen von Rosenstein laid the foundation of paediatrics as a specialty. This may be too strong a statement, but certainly his book on the subject was the most progressive which had yet been written, and it gave an impetus to research which influenced the future course of paediatrics. Of all the many writers on diseases of children in the eighteenth century, Nils Rosen von Rosenstein and his near contemporary, Michael Underwood, stand out as the most scientific and the most illuminating" (Still, pp. 434-8).

Garrison-Morton 6323; Blake, p. 387; Norman 1849; Waller 8215. Sjögren, 'Nils Rosén von Rosenstein - The Father of Paediatrics,' Upsala Journal of Medical Sciences 111 (2006), pp. 3-16. Still,The History of Paediatrics: the progress of the study of diseases of children up to the end of the XVIIIth century, 1931.

8vo (157 x 96 mm), pp. [ii], [1], 2-363, [11]. Contemporary calf, spine gilt in compartments with red lettering-piece, marbled endpapers (rubbed). Modern bookplate on front paste-down.