A treatise of the rickets being a diseas common to children. Wherin (among many other things) is shewed, 1. The essence 2. The causes 3. The signs 4. The remedies of the diseas. Published in Latin by Francis Glisson, George Bate, and Ahasuerus Regemorter; doctors in physick, and fellows of the Colledg of Physitians at London. Translated into English by Phil. Armin.

CHAP. VII. Of the Secondary Essence of this Diseas. (Book 7)

THe first and Radical Essence of this Diseas, and also the parts first affected being explai∣ned, now in the next place the Secondary Es∣sence; namely that which immediatly fol∣loweth this Diseas, offereth it self to our examination. And here we must refresh the memory by an intimation of that threefold Constitution already asserted, the Na∣tural, the Vital, the Animal, and thorow these particu∣lar Constitutions, shall our examination proceed. And first we will consider the Natural Constitution. This as we have taught above consisteth in the Temperament, common qualites, the plenty and disposition of the Na∣tural Spirits, in the Organization, and continuity: now we have already proved, that the first Essence of this af∣fect is radicated in the Temperament, and in the plenty and disposition of the Natural Spirits: but the other

parts of this Constitution, to wit, the common quali∣ties, the Organization, and the continuity do yet re∣main to be examined.

By Common Qualities we understand in a manner the same which some others have called the Modos Mate∣riae, and others, Qualitates Secundas. Now we cal them Common, because they are not restrained to any one Ele∣ment or Form; but in some sort may expiate and range thorow all the Bodies, and for the most part affect them more or less. Of this sort are density, rarity, consi∣stence, fluidness, tenacity, friability, laxity, tension, (or rather tensity, that the habit may be distinguished from the action) witheredness, swelling, and stifness, soft∣ness, hardness, smoothness, roughness. But it is not our meaning, exactly to reckon up all and each of the Com∣mon Qualities, nor to prosecute those already rehearsed, further then the present occasion shall require.

The Tone or Harmony of the Parts doth seem to result from some Common Qualities mutually embraced a∣mong themselves. For the Tone of the Parts properly consisteth in a du tenor and mediocrity between certain opposite Common Qualities, as between thickness and thinness, &c. But if there be a recess or departure from the just mediocrity to either of the extreams, then there is a necessity that the Tone must be vitiated. Two things therefore do here seem to be enquired after concerning the Tone of the Parts; the first, whether in this Diseas the Tone of the Parts be in any degree vitiated. The next, Whether those faults of the Tone do belong to the secondary Essence of the Diseas.

As concerning the first, It wil be unnecessary to run thorow the particular Parts of the Tone severally, it will be sufficient to examine those that seem guilty of the suspected crime.

First, Therefore we meet with an evident loosness of the Tone in this affect: But this loosness differeth both from the infirm coherence, and likewise from the Paralytical resolution of the Parts: for the infirm co∣herence or weakned stifness of the part is easily made an occasion of the loosness, because in such cases the Part can scarce be stretched forth; but a part may at the same time be both loose, and likewise sufficiently stiff, as may be seen in the strings of Instruments, which if you wind down the pins, they become loose, although in the mean time they forgo not the tenacity of their sub∣stance. And in dissected bodies we have frequently ob∣served the loose parts themselves to be sufficiently stiff; yea, and that sometimes in this affect. Wherefore this loosness is a distinct quality from the vitiated stifness of a Part. Neither doth it less differ from that resolution of the Parts which happeneth in the Paralytical Mem∣bers. For the dead Palsy first consisteth in the depraved Animal Constitution: But this loosness is rooted in the Natural Constitution. For here is no Palsy present either in respect of motion, or in respect of the sence of the Parts: Neither is the Brayn in this Diseas prima∣rily affected, as we have already demonstrated. Moreo∣ver that there is such an exceeding loosness of the Parts first affected, in this Diseas is a thing so conspicuous, that we judg it a superfluous employment to offer proof thereof. For it is obvious to the very senses, and there∣fore we have listed it among the signs of the Diseas. For whether it be a Part of the Essence or not a Part, if it be manifestly subjected to the Senses, it acquireth the propriety of a sign in respect of the other Parts of the Essence, which are removed from the Senses.

Secondly, In this Diseas there is not only a loosness but likewise a witheredness, and feebleness. Now this

quality comprehendeth somwhat more then the meer and simple loosness; for it denoteth withal a certain emptiness of the parts, wherby they sink down of them∣selves. Now such an emptiness, and such a falling down of the Parts first affected in this Diseas are so obvious to the Senses, that there is no need of further proof.

Thirdly, A a softness also may be named in the Tone of the Parts first affected in this Diseas. For sometimes it so falleth out that there is no coincidence between the softness and the aforesaid qualities; but that it inclu∣deth or excludeth some other thing, as in a suppurated Tumor there is softness, but without any laxity of the Tone, any emptiness or subsidence. For in this present supposed case the softness chiefly dependeth upon the manner of Termination, and the tenacity of the Part being vitiated. But in this affect there is for the most part a coincidence with the laxity and flaccidity before mentioned: So that it is needless to distinguish it more accurately then by the name only.

Fourthly, There happeneth also another fault in the Tone of the Parts first affected in this Diseas, and this is an extream inward slipperiness. Some perhaps may wonder what the meaning of these words may be, Inter∣nal lubricity. We confess indeed that for want of words we have been constrayned to joyn this appellation. For when in nature such a quality as hath a true existence hath by the oversight of Philosophers, and also the neg∣lect of Grammarians wanted a name, we have taken so much liberty to our selvs, as in respect of the great vicini∣ty which it hath with the superficial lubricity of the body to give it the same Name, with the distinctive Epethite of Internal. In natural bodies therfore we acknowledg a twofold lubricity; one External and Superficial which indeed consisteth in the smoothness and equality of the

Parts of the Superficies, by reason whereof the Subject of it doth easily slide by other bodies which it lighteth upon without much attrition and resistance, Now con∣trary to this lubricity, is the Superficial roughness: but these two qualities have no reference to this place, be∣cause they are Organical, neither do they any way be∣long to the Tone of the Parts. That other lubricity whereof we began to make mention, consists in that in∣ternal, profound and similary smoothness, and equality of the body. By reason wherof, the whole substance of its Subject doth easily slide by the other introsubient bo∣dies without much attrition and resistance. And to this lubricity also there is an Internal roughness. Now that there is such an internal similary slipperiness, and such a roughness also opposite unto it may be shewed almost by innumerable instances. For almost all mucilaginous sub∣stances are slippery, and that not only in respect of the outward Superficies, but also inwardly, and in respect of the universal Substance, and every particle thereof; so that, according to the definition of a similary body, e∣very particle, by reason of this quality is made like unto the whol, and therfore this quality is internal, and si∣milary, and diffused through the whol internal substance of the Subject. In like manner such an internal roughness may be observed in unripe fruits, exten∣tended thorow their whole substance and Inter∣nal flesh. But when they have attained to a just ripeness then usually, in the room of that roughness there succeedeth such a slipperiness as we have now de∣scribed. And here it must be observed, that if these bodies internally slippery be besmeared or daubed upon the Superficies of bodies otherwise rough, they bequeath a certain degree of lubricity to them, for the time they adhere▪ in like manner being inwardly taken as the slip∣pery

juyces, and mucilages of Althea, &c. They do communicate a certain lubricity to the Internal passages of the Body; yea, and not only to the passages that re∣late to the inward cavities, but also more or less to the very Similary substance of the parts of the Body, which also the blood washeth being impregnated with that slippery juyce.

But this internal lubricity is manifold: oyly or fat, watrish, spiritous, saltish, and perhaps earthy. The oyly is chiefly conspicuous in the fat of Creatures, espe∣cially such as are yong, and in many expressed Oyls, especially the moister and colder, and also the temperate; as may be observed in the Oyls of Poppy Seeds, Pippin Seeds, the four greater Cold Seeds, Time Seed, and the Oyl of sweet Almonds, and the like. A watrish lu∣bricity is in some measure found in simple water it self, although by reason of the fluidness it is less sensi∣ble; also this lubricity may most evidently be taken notice of in the mucilages, &c. The Spiritous perhaps doth never happen alone, but it is most frequently mixt with the waterish, as in the sperm of almost all Creatures, and ripe fruits. The Saltish likewise is rarely simple, although there is a man that contendeth it is to be found in salt of Tartar. But the compound saltish lubricity is frequently obvious, as in Soap and Salt of Tartar dissolved with waterish and oyly substan∣ces. The Earthy (even mixt) is scarce worthy of ob∣servation, unless it be in respect that it concurreth to the thickning of fluid bodies, as in white clayish Mud, and Fullers Earth dissolved. But in this place we have regard chiefly to that lubricity which is waterish, as be∣ing that alone which can be guilty of the crime in this affect we now handle,

And these things may suffice in general of the inter∣nal

or similary lubricity. The next enquiring must be whether the first affected parts of this Diseas be affected beyond a due proportion with an internel or similary lu∣bricity. And at first indeed it seemeth very probable that there is such an extream lubricity in the said parts, becaus moisture doth superabound in them, which ever favoreth the said lubricity, be it conjoyned either with heat or cold. Every one knoweth that the Sperm of Creatures by how much it is moister than the creatures produced by it, by so much also it is the more slippery: in like manner that the yong flesh of Creatures is more slippery than that of old. Seeing therefore that humi∣dity and lubricity of this kind are so inwardly conver∣ted: Seing also that in the parts first affected there is manifestly an extream humidity, certainly it may easily be granted that a lubricity likewise doth too much a∣bound in the said parts. And to the production of this the benummedness of those parts have no small share. For the Spirits when they are in their exaltation con∣tract a kind of acrimony and sharpness, as may be seen by comparing Must with old Wine, or with Spirit of Wine or with Aqua vitae. For the Spirits of Must may truly be said to be benummed or stupified, if they be compared with the Spirits of old Wine; and by how much more they are stupified, so much more lubricity they likewise contain, and also so much the less of sharp∣ness and acrimony. From whence it is manifest that that benummedness and dulness in the Spirits lodging in the first affected parts doth favor that extrem lubrici∣ty; for that dulness of the Spirits in the said parts is almost of the same degree with the dulness of the Spirits in Must. And becaus the Spirits are defective in the parts first affected, it is evident that this lubricity is an over-watrish lubricity. Moreover, laxity, flaccidity,

and softness do also seem to conspire. For unripe fruit as they are hard, so till they wax ripe they grow softer and softer, and withal acquire an internal lubricity; in like manner the parts are loosned by relaxant baths, and together they become more slippery; also slippery things taken inwardly, as the mucilage of Althea, &c. Do not only loosen the Parts, but they also make the passages slippery, for which case in the pains of the stone they are drank with good juyces. Again, this lubricity of the first affected parts, seemeth to be much confirmed by this, because in the dissected Bodies a manifest lu∣bricity is observable by the touch; and if they be squee∣zed a mucilaginous kind of blood, inwardly besmearing them, is crushed out with the fingers. We say nothing of the skin, which for the most part is slippery in this affect, and is seldom felt to be rough to the touch: but it is worthy to be noted, that extream slippery Medi∣cines either outwardly applyed, or inwardly taken, do usually more hurt then good in this Diseas. And thus we absolve the former question, of the manner whereby the Tone of the Parts is vitiated in this Affect. The o∣ther now presents it self to our consideration.

Whether the Tone vitiated after that manner as hath been said, be a Part of the Essence of this Diseas?

We suppose here that whatsoever is found to be viti∣ated in the Body, is either a morbifical cause, or a Symptom, or the Diseas it self; and therfore this Diseas either simple or compound, or any part of a compound, and that either primary or secondary.

We say first, That the vitiated Tone above propoun∣ded is not properly a cause of the Diseas. And this scarce need any proof. For the said Tone is a preterna∣tural Constitution, rooted in the Parts themselves, and by that reason it is most evidently distinguished from a

morbifical cause properly so called. For although, one Diseas may be the cause of another, nevertheless even then it is not properly called a morbifical cause, but a primary Diseas, and that other which it produceth, a a secondary affect. But every where there is a growing together of them both into one total Diseas, the for∣mer wil be the primary Part of the Essence, and the latter the secondary part of the Essence.

Secondly, We affirm, that the described Tone of the Parts is not a meer Symptom, for it is not under the things secured and retained, neither can it be compre∣hended under any depraved action, or any changed qua∣lity, not vitiating the action. But that the vitiated Tone is not comprehended under the things secured and re∣tained, nor under any depraved action, may by the same labor be proved by this Reason, because those kind of Symptoms are not indeed Constitutions of the body; but the said vitiated Tone without controversy is a preterna∣tural changed constitution, as we have already most playnly demonstrated. Secondly, That the said Tone vi∣tiated after that manner, is not contained under any changed quality, not depraving the action, is so clear and evident, that it needs no proof. For laxity and flac∣cidity hurteth the motion of the Parts, and an extream lubricity is an impediment to the du quickning of the vital Spirits, as shal hereafter be made manifest.

It may be Objected, That some bare changed qualities which are comprehended under the Genus of Symptoms, may also vitiate an action: as the colour changed in the skin yeeldeth an unpleasant prospect to the beholder, so that it begetteth deformity and defect of du comliness?

We answer, That the changed colour of the Skin in as much as it vitiateth the beauty therof (which is the proper action of the Skin) doth in rigor (in a large

acception) fall under the Notion of a Diseas. But se∣ing this action of the Skin is only Objecture and Ad ex∣tra, and seing that altered color doth hurt no Internal action of that individual: Physitians, who in the defi∣nition of a Diseas, have respect only to the Internal ac∣tions of that individual, do usually exclude it from the Classis of Diseases. Or if the vitiated color of a part do chance in some place to deprave an internal action (which is known only to happen in the Tunicle of the Eye, called Corura) the best Physitians do ever reckon it for a Diseas, although perhaps secondarily. But that we may return into the way from whence we have a lit∣tle erred: seing that the vitiated Tone may hurt, as we have said, the internal actions, it doth not properly be∣long to that kind of Symptom, which is wont to be cal∣led by the name of a changed quality.

Thirdly we say, That this vitiated Tone, seing it is neither a Morbifical caus, nor a Symptom, and yet is somthing preternatural, must needs be the Diseas it self. Moreover, the same is clearly proved by the very definition of a Diseas. For this vitiated Tone is a pre∣ternatural Constitution, primarily or immediatly hur∣ting the internal action; therfore it is a Diseas. For to what the definition is competible, to that also the thing defined is competible. That it is a preternatural Con∣stitution is manifest by this, because it is inherent in the solid parts of the body: that it likewise depraveth the Internal actions, is manifest from hence, because an ex∣tream laxity, lubricity, and flaccidity of the parts being granted, presently the agility is weakned, no other cause approaching, and a certain sluggishness deadeth the ir∣ritation of the vital Spirits. In agility, the matter is plain, seing that firm and stretched bodies, other things being answerable are more active, and so on the con∣trary:

that the same thing also happeneth in the dulness of the irritation shal be shewed in its place, for the present we labor to prove no other thing then that the vitiated Tone in this affect is a Diseas.

We say fourthly, That this vitiated Tone in this Di∣seas is not any simple affect, having an existence apart by it self, but that it is so conjoyned and compounded in those same parts with the primary Essence, that the whole Essence of the Diseas (wherof we dispute) may be said to consist of many Diseases united together (in themselvs indeed simple, if they be considered asunder) and therfore that the vitiated Tone is only a part of the whol Diseas. And this needeth no other proof, then be∣cause the first Essence proposed above, and the said viti∣ated Tone▪ are both found in those same parts. For that is properly called a compound Diseas, which is produ∣ced by many simple Diseases conjoyned in the same Part.

Fifthly, We affirm that the vitiated Tone is not only a part of the whole Essence, but such a part as hath some dependance upon the primary Essence, and therfore that it is a secondary part of the Essence.

Before we proceed to the proof of this Proposition two grants or concessions are to be premised.

We grant first, That the said Tone may be even im∣mediatly vitiated in other causes perhaps, and likewise by other causes, although that happen not in this pre∣sent Diseas. For the inherent Tone of the Parts may be primarily loosned in the Animal Constitution, and that suddenly, as may be observed in the dead Palsy. For the natural tensity (and not the Animal only) of the Para∣lytical member is loosned, and indeed suddenly without any conspicuous intervention of any part of the aforesaid primary Essence. After the same manner in a Lipothymy

or defection of the mind, loosness and languishing sud∣denly attatcheth al the parts. Now we cannot in either of these two causes refer the cause of the loosness to the cold and moist distemper of the natural Constitution, seeing that cannot be so suddenly and so sensibly chang∣ed. Which let them consider (that we may give warn∣ing of it by the way) who wil have these common qua∣lities to be always second and dependent upon the first alone: yea, on the other side let them in that cause ob∣serve how a cold and moist distemper doth afterwards by degree, follow that loosness suddenly introduced. A∣gain, as for the flaccidity of the parts that may be imme∣diatly produced by large evacuations, as a flux of the bel∣ly, sweatings, and the like immoderate vents, the tem∣perament being not yet considerably changed, although we deny not but this may easily and doth usually follow. Moreover an internal lubricity may be manifestly sepa∣rated from coldness, though very difficultly from moisture.

Secondly, We grant that in the present Diseas, the vi∣tiated Tone doth not in any manner depend upon the first admitted Essence, nor that in every respect is subor∣dinate unto it. For first the qualities of the Tone here vitiated, do also ow somwhat to common causes, namely to themselves, and also to those that are common, to the first granted Essence. For extream moistening things by one and the same operation are apt to produce both too much moisture, and also loosness. In like manner from violent evacuations, a want of Spirits, and withal a witheredness doth arise. Also from things too too slippery, either outwardly administred, or inwardly ta∣taken, or both, an internal lubricity is augmented, to∣gether with a moist distemper. For there is so great a connexion of the whole Essence, hitherto propounded

with the common causes, that there is scarce any thing which doth augment the first essence of the Diseas, but at the same time more or less it hath an influence upon the vitiated Tone.

These things bring granted, We say notwithstanding that in the present affect there is a very great dependance of the vitiated Tone upon the first Essence of this Diseas; for which respect alone we have here referred the vitiated Tone to the secondary Essence. If any list to contend, That the said Tone in another respect may relate more clearly to the Secondary Essence, because he may imagine that the primary Essence of every Diseas is necessarily si∣milary and perpetually grounded upon the first qualities alone; or because he may conceive that the qualities wherein the Tone consisteth are perpetually secondary, and that they follow the first only (as the shadow doth the Sun) that man may take notice that we purposely decline such questions, least we should straggle into an unwarrantable digression.

It remaineth therefore only that we prove the Depen∣dance of the vitiated Tone upon the first Essence of this Diseas to be very great, and that we shal do by parts. We wil begin at the laxity. We grant indeed that a laxity may be somtimes suddenly produced, and in that cause a moyst distemper may often follow upon it, Namely, when the laxity primarily dependeth upon the fault ei∣ther of the Animal or Vital Constitution; but in this Diseas, seing that neither the Animal nor the Vital Constitution are primarily affected, there is a necessity that it must flow from other causes. Moreover, such is the condition of laxity and tensity, that they are obnox∣ious to sudden alterations. For the strings of a Lute may almost in a moment be stretched and loosned again; the same thing likewise from some causes befalleth the Fi∣bers

of the Parts, But in this affect the laxity stealeth on by degrees and slowly; therfore necessary it is that it must begin, be ruled and moderated by some caus lei∣surely and slowly augmented. Although therfore we granted even now, that the laxity doth own somwhat to the common causes of the Diseas; yet the augmentati∣on therof is chiefly restrained and moderated by the primary Essence of this Diseas. For moistning Medi∣cines although they loosen withal, yet they scarce loo∣sen more than they moisten, becaus for the most part they loosen by moistning. Seing therfore that the common causes of this Diseas do flow into the Tone, chiefly by the Mediation of the first Essence of this Diseas: And seing that neither the Animal nor the Vital Constitution can here supply the vertue of a caus, we may Lawfully infer that the laxity of the Tone doth chiefly depend upon the first Essence of the Diseas. This is further confirmed, there is of it self a certain proness and tendency of the Body to be through wet, so that the fibers of the parts must needs be loosned by it: Moreover, the defect of the Spirits and the stupefaction of them doth caus a remission of the Tone by dimini∣shing the vigor of the part. Therfore we may conclude that the Diseas, laxity principally dependeth upon the primary Essence of the Diseas. As for the flaccidity because it comprehendeth the laxity, it springeth from the same causes as that doth; but in as much as it in∣cludeth also a subsidence and a certain emptiness, it evi∣dently dependeth upon the defect and benummedness of the inherent Spirits; the plenty and vigor whereof be∣ing augmented the lank and flagging member is easily rendred turgid and swelled. In the interim we deny not but that that subsidence doth withal depend upon the extenuation and atrophy of the parts.

Lastly, How the slipperiness doth proceed from these causes is sufficiently manifested by what hath been said above.

That we may at the length put a period to this mat∣ter, it may be observed for the higher confirmation of those things already spoken that there is such a strict de∣pendance between the Tone and the first granted Es∣sence, that throughout the whol cure of the Diseas they are intended & remitted together almost in equal pace. For at firstthe Children that are afflictedwith this affect; do only go slowly & leisurely whilst the Tone of the parts is yet but a little loosned; but in the progress they scarce and with much ado trust to their feet, then they play only sitting or as thay are carried about. Afterwards they can scarce sit upright; and at the last when the Diseas hath attained the highest exaltation, the feeble neck cannot without much difficulty support the burden of the head; all which things as they attest the primary Essence of the Diseas to be gradually augmented, so al∣so they make it manifest that the vices of the Tone are intended by an equal pace. And so all these things be∣ing rightly weighed, we refer the viciated Tone to the secondary, not the primary Essence of this affect, and by consequence we conclude, indeed the thing that was in question, that that depraved Tone is a secondary part of the Essence of this Diseas.