Einar Perman, MD, PhD
Stockholm, Sweden (Winter 2014)
Nils Rosén von Rosenstein
Nils Rosén von Rosenstein was a Swedish physician who became the founder of modern pediatrics. In 1764 he published The Diseases of Children and Their Remedies, which became famous and was translated into many languages. For several years he published its content in Swedish calendars used by the general public.
Born in 1706 as Nils Rosén, he began to study medicine in 1723. From 1727–31 he travelled in several European countries, sponsored by a wealthy Swedish nobleman. He studied and worked with Boerhave, Hoffman, and other prominent physicians of his time and obtained his medical degree in 1730 in Haarderwijk. One year later he returned to Uppsala University as lecturer. He published the first major Swedish textbook of anatomy and became professor of practical medicine in 1742. In 1743 he was appointed physician to the king of Sweden. He was a contemporary and (in later years) good friend of the great Linnaeus. In 1762 he was ennobled and took the name Rosén von Rosenstein. He died in 1773.
Particularly impressive was his gentle, humane treatment of infants in distress. Writing about crying infants he first states the obvious, “It is very good if the child does not cry.” He then lists several common causes of crying and ways to treat them. If no treatable cause could be found he advocates that “one shows the child something it is not used to, or has some color, lustre or shape. One holds the child by the window, in front of the mirror, shakes its rattle, rings a bell, sings to the child . . . carries it into another room, lets someone the infant likes touch it, shows it books if a girl, or horses if it is a boy, and so on.”
Rosenstein first states that for the infant “the best food is without doubt the mother´s milk . . . therefore a mother who is able to suckle should let the child suck.” If, however, the mother cannot do so, he gives sound advice on how to select and care for a wet nurse. The plight of the wet nurse is evident in the following text: “My opinion is not that the wet nurse has to be in the child´s room at all times. On the contrary she should be free to walk into other rooms, and to perform minor tasks in the household.” These words suggest the constant fear of the Sudden Infant Death Syndrome.
About one third of the book concerns smallpox. This feared disease came to Europe in 1716 and to Sweden in the middle of that century. The overall mortality rate was about 30%, and 80–90% in small children. Treatment was only symptomatic, and survivors were often left with life-long, disfiguring skin lesions and other complications.
Because of the high mortality rate, particularly in small children, Rosenstein recommended inoculation with fluid from smallpox lesions (variolation) to provoke an attack of the disease and prevent later disease. The disease caused by variolation was usually milder than ordinary smallpox, mortality being lower than 2%. He successfully inoculated the children of the royal family, for which he received a huge reward. He also had the tragic experience of inoculating his three-year-old daughter who died.
The real breakthrough in preventing smallpox came in 1796 when Jenner found that inoculation with cowpox fluid (vaccinia) gave only minor symptoms, caused no deaths, and prevented smallpox. Vaccination of children with vaccinia fluid then became accepted practice. During the latter part of the last century, smallpox was eradicated thanks to dedicated efforts by doctors in the World Health Organization, the last known case occurring in 1975.
Rosenstein also wrote about other symptoms and diseases still common in children (measles, scabies, intestinal worms, etc.). In 1765 he reported that scarlet fever, then highly prevalent throughout Europe, could be followed by edema and bloody urine, a clear description of acute glomerulonephritis. He also wrote at length about rickets, now rare in the Western world but common in his day, particularly in children living in poverty. We now know that its cause was vitamin D deficiency. He described its symptoms and complications, and mentions many theories about its cause. He notes that “summer is for such individuals a blessed time, particularly if it is warm and dry.” Today we know why. Sunlight increases production of vitamin D in the skin.
Rosenstein did not only work with children. His cough drops for adults (Rosén’s chest drops) contained marsala wine with opium as the active ingredient. They were very popular and were in use until the middle of last century.
Rosenstein is called the father of Swedish medicine. It is a title he deserves well.
Pehrsson, Anna-Lena. 1960. Nils Rosén von Rosenstein: en medicinhistorisk biografi över åren 1706–1740.
Wahlquist, Bo and Arvid Wallgren. 1964. Nils Rosén von Rosenstein and his textbook of paediatrics.
EINAR PERMAN, MD, PhD is a retired physician living in Stockholm, Sweden. He is a member of our international editorial board.