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. XX. The differences of the Diseas, called the Ra∣chites. (Book 20)

THere are many differences of the Rachites in regard of the concourse of several evils, and more than any man would easily imagine; some wherof are of great importance, and o∣thers less considerable we have resolved here briefly to propound the chiefest. For the knowledg of them is not only profitable to define the prognostical causes, wherby the various events of a Diseas are distinctly fortold ac∣cording to those differences; but it also much conduceth both to the prevention and the cure of a Diseas; namly, that by a consideration of them apt and fit remedies may be chosen.

Now these differences arise either from the Essence of the Diseas, or from the causes therof: or lastly, from Di∣seases conjoyned with it. The Essence of a Diseas may va∣ry many ways: First, By reason of the parts of the Se∣condary Essence either present or absent. Secondly, In regard of the magnitude of it. Thirdly, In respect of the vehemence. Fourthly, in regard of the Spirits; And fiftly in respect of the times.

We grant indeed, That there is a certain agreement between som differences comprehended under these ti∣tles; yet seing that the formal conceptions of them are distinct, it must be confessed that they deserve distinct

considerations. For although a Diseas, even in that ve∣ry respect may be called greater, because it containeth many parts of the Secondary Essence in the same Patient yet this is a different & distinct consideration from that of the magnitude of that Affect. For the magnitude pro∣perly hath respect unto the degree of recess from the Natural State, and not to the Nature of the part of the Essence either present or absent, for hereupon resul∣teth more then a gradual difference. In like manner some of the other differences do perhaps signify the same thing, in •• concrete and restrained acception, which notwithstanding in an abstracted and formal considera∣tion denote a diversity. But let us proceed.

The first difference of this Diseas is that which ari∣seth from the presence of few or many of the parts of the Secondary Essence therof. For although all the parts of the Primary Essence are perpetuàlly present with the Diseas it self, yet there is no necessity that all the parts of the Secondary Essence should be always present. For these are after-comers to the first Essence, and do by de∣grees come upon it: Yea, some of them may be so high∣ly intercepted by the intervention of resisting causes that they may not at all appear. Hither you may refer that difference, which we propounded at the foot of the precedent disputation, and which we shewed might pos∣sibly▪ though indeed very rarely, befal those that were grown to ful age. But because our purpose here is only to handle the Diseas as it is incident to Children, we shall be content to pass by that difference thus noted by the way. But even in Children themselves there somtimes happen some parts of the Secondary Essence, which have a most strict conjunction with the Primary Essence, at least they succeed them in the order of Nature. For the Primary Essence hath the efficacy of a cause, which in

Nature doth ever go before the effect. But in order of time some parts of the Secondary Essence do conspire as it were, and concur with the Primary Essence in the in∣vasion; and others again do come afterwards, these we must here distinguish. For the former sort are absolute∣ly inseparable, the latter sort separable from this Af∣fect.

The inseparable parts of the Secondary Essence may be reduced to these Heads. First to the afflicted Tone of the first affected parts. Secondly, to the unequal and imperfect distribution of the Vital Blood. Thirdly, to the too smal participation of the Vital influx in the first affected parts. Fourthly, to the Secondary faults of the Animal Constitution. These faults are sufficiently unfolded above in our discourse of the Secondary Es∣sence of this Diseas; where likewise because of their strict carriage with the Primary Essence, any man may perceive with eas (though they have a casual dependance upon the Primary Essence) that they begin together at the same time.

But al the Organical faults which we have also already recited, are found to be separable, and somtimes actually separate from this Diseas. For the magnitude of the Head, and the leanness of the Joynts, the crookedness of the Shank-bone, or the Elbow, the inflexions of the Joynts, the sharpness of the Breast, do not necessarily accompany this Diseas presently from the beginning, but in process of time they bewray themselves by degrees and supervene upon the Affect. And although the Con∣sumption of the parts, which in some sort hath an in∣fluence into the said faults, may be said to be present in some slight degree from the begining of the Diseas, yet is it indeed only a Symptom, and not a Diseas; neither is it able presently to produce those Diseases of magni∣tude,

Figure and Place. Moreover it is not necessary, that these Organical faults should equally and at the same time invade one that hath the Rachites, we grant indeed that the extenuation of the first affected parts, when the Diseas is of some continuance, doth alwaies and necessarily succeed it, neither can it afterwards up∣on the perseverence of the Diseas be removed, that it is likewise a principal part of the separable parts of the secondary Essence; yea that the extenuation whilst it is making doth immediatly follow the smalness of nourish∣ment of the first affected parts, almost no otherwise than the smalness of nourishment immediatly followeth the primary Essence of the Diseas in the said parts; but withal we affirm that the extenuation being made which is it self a secondary part of the Diseas wherof we dis∣cours, doth necessarily presuppose the motion and time of the Diseas, and that it cannot be in the first moment of the existence of the Diseas. We say moreover that Physitians do not acknowledg any change made in the parts exposed to the sens, which doth not yet appear to the sense, and by consequence they affirm that extenua∣tion befalleth the first affected parts, til it be made ob∣vious to the senses which certainly doth necessarily pre∣require some duration of the Diseas. But the impro∣portionat magnitude of the Head, doth begin almost at the same time with that extenuation of the first affected parts, but it may so fall out, if a consuming Phtisick be joyned together with this Diseas, that that magnitude of the Head may vanish before death, as we have alrea∣dy proved by one example in our Anatomical Observa∣tions. The Magnitude of the Head therfore is more separable from this affect than the extenuation of the first affected parts, for this cannot be removed without the Diseas be cured. The sticking out of the Bones

appear somtimes sooner, somtimes later, and they somtimes grow out more, somtimes less, but upon any long continuance of the Diseas they are seldom (if ever) seen to be absent. The narrowness of the Breast doth not appear, but after a long time when the Diseas is confirmed, and for the most part is the forerunner of a Ptysick. Again, the crookedness of the Bone in the Arm, and the Shank-bone, as also the inflexion of the Joynts may be absent through the whol cours of the Diseas, and may be more or less present, and indeed is the most chanceable among those things which follow this affect. We conclude therfore that these Organical parts of the Secondary Essence are separable after that manner as we have said, and as a more or fewer of them are present, so the Difference of the Diseas is constitu∣ted, as being more or less compounded.

The Second Difference of this Diseas resulteth from the magnitude therof. And the magnitude is estimated from the greater or lesser recess from the natural condi∣tion of it. There is a vast difference in this Diseas in respect of the magnitude. For some are so gently affe∣cted with it that you would scarce suppose them to be sick. They complain of nothing, they eat, they drink, they sleep like those that are sound in health; only they play with more unchearfulness, and shew forth some o∣ther very slight signs of sickness, By the only benefit of Nature likewise without any assistances of Art they per∣fectly recover, neither their Parents, Nurses, nor the By-standers so much as once suspecting that they are af∣fected with this evil. On the contrary, Others are so vehemently afflicted that they cannot be rescued from death or the danger of imunient death by the most ap∣proved remedies.

The Third Difference is from the vehemence of the

affect. Now this is valued by the violent motion of the Diseas and the resistance of Nature, and also by the sharpness of the conflict of these things among them∣selves. This Diseas, although it be otherwise very great, yet is it slow in motion unless some fewer, or some other urgent affect be conjoyned with it, and stir up the Nature of it to a fiercer opposition, yet is the mo∣tion therof somtimes more vehement, and somtimes ve∣ry dull, and thereupon it happeneth to be differenced.

The Fourth Difference, is from the strength of the sick Child or Infant. This is estimated by the greater or lesser presence of those things which are according to Nature. Hither belongeth the condition of the tempe∣rament, the plenty of inherent Spirits, the activity and strength of the Tone, the vigor of the Vital and Animal Constitution, and the structure of the Organs. For as these are more or less obedient to the prescriptions of Nature, so their Spirits ought to be judged more or less strong, and according to them the evil must be determi∣ned the more or less dangerous. For this caus the yon∣ger Children caeteris paribus are more dangerously af∣fected than the elder.

The Fifth Difference, is from the times of the Dis∣eas. And this difference in a qualified and limited ac∣ception includeth almost all the precedent; for what difference soever hapneth to any Diseas, must necessari∣ly happen at some time of the Diseas. Physitians reckon up four times of a Diseas: The Begining, the Aug∣mentation, the Consistance, and the Declination. But it must be noted that Physitians are not so exact in di∣stinguishing the seasons of things as the Phylosophers, for they do not restrain the beginning of a Diseas to that point of time wherin the Diseas begineth; but so far they extend it, till there appear so great an alteration

of the Diseas, that it may be known by certain and sen∣sible evidences. For the indivisible begining is not the time, wherin the Physitians help is perfected, and why should that distinction of a Diseas be profitable which could not be grounded upon any alteration of it known to us?

Galen therfore hath rightly deduced the times of Fea∣vers and Inflamations from the understandible alterati∣on of them: that is, The begining from the crudity of the matter causing the diseas, the augmentation from the manifest coction therof; the state from the Excretion, and the Declination he computes from the Reduction of the Reliques to the Natural state; and indeed these times do sweetly agree in the general, and differ in parti∣cular from the crudity and coction of Feavers and In∣flamations. But the truth is, That this distinction of times hath not the like success in many other diseases: For in these Nature doth not so regularly proceed from crudity to coction, so to expulsion, and at last to redu∣ction; neither by thes can we truly and safly know the progress of the diseas. Other alterations therfore of these Diseases, such as are more cleer and easily known must be weighed. Yet we grant that even thes diseases when they are directed to health, do run thorow those four seasons, the begining, the augmentation, the state or consistence, and the declination. But when they tend to the destruction of the Patent, they scarce attain to the consistance, but are daily more and more augmented e∣ven to the lest period of life. Wherfore in thes the aug∣mentation admitteth the greatest latitude, neither doth it deserv a higher difference, or a lower subdivision: but when an indifferent state of a diseas of the same kind is made the Middle term between the begining and the end of such an augmentation, than we can convenient∣ly

distinguish. The encreas into an augmentation on this side, or beyond, or beneath, or above the consi∣stence. An encreas of the first kind about the consistance we may cal a simple encreas, in regard that it differeth not from the thing it self commonly received by that name, an encreas beyond or above the state, we call an encreas excrescent, excessive, transcendent and desperate.

Moreover, Two kinds of declination may be obser∣ved in a Diseas. The first is legitamate when the Dis∣eas simply declineth towards health and recovery. The later is spurious, when a diseas remitting changeth into another of a different kind. And so although there are in thos that recover health, only four times of a diseas, yet in others two more differences may be discerned: Yet it must be noted, that thes six times are never to be found in the same diseas, or the same patient, but where there is the same diseas in the Species in divers subjects. Let us now apply these things to the present affect. We affirm therfore that six differences of this diseas do oc∣cur in respect of the times therof. For it hath a begin∣ning, and may be called incipient: it hath an encreas, and may be said to be confirmed; it hath a state, and then it it may be termed consistant; it hath an encrease be∣yond the state, and may be called desperate: it hath a tru declination, and may be said to be an affect remiting or simply declining; and it hath a spurious declination, and may be called a change, as when it chancheth into som other diseas. Of al which we wil speak in their order.

First, The Rachites is called a Diseas begining, when the first Rudiments and impressions thereof are, though very obscurely, first observed, and before there hapneth any manifest extenuation of the first affected parts.

Secondly, This diseas is said to be confirmed, when an evident and manifest extenuation of the first affected

parts becoms obvious to the Senses. And here the Rea∣der perceiveth we do not distinguish thes two times from crudity and coction, but from another alteration of the Body, namly, The Extenuation made in the parts first affected; for the begining of this diseas can no ways be discerned from the encreas therof by crudity and cocti∣on: But otherwise, so far as the nature of the thing is capable of it, we shal willingly follow the example of Galen, and as he distinguisheth the encreas from the be∣gining by the manifest coction, so we also put a different between thes times in this affect from a manifest altera∣tion, namly, the extenuation made in the said parts.

Thirdly, This diseas advanced to its consistence, is that, which having attained the highest vigor and exhal∣tation, is arrested, and for a time is neither sensibly en∣creased, or lessened, but continueth at a stand.

Fourthly, This diseas exceeding the Mediocrity of the consistance is called desperat, namly, Becaus in mag∣nitude and vehemence it surpasseth the very state of the same diseas in another Patient indifferently affected, and withal is continually encreased, neither is there any hope but that it will daily encreas til it hath altogether subdued and dissolved the Patient For which caus this condition of a diseas is termed desperat.

Fifthly, This diseas is said to be truly remitting or declining, when the Essence therof is by little and little diminished, and when the Signs and Symptoms of it are daily mitigated.

Sixthly, This diseas is said to be illegitimatly decli∣ning, or passing into another diseas of a divers species, when the Essence, Signs and Symptoms therof are so lessened, that new ones of a different kind, and perhaps more outragious appear in their stead. Thus the Ra∣chites frequently degenerat into a Consumption, a He∣ctick,

and somtimes perhaps into a slow putrid Feaver; yet for the most part the same diseas doth accompany thes supervening affects to the dissolution of the Pati∣ent. And let this suffice concerning the differences of this diseas deduced from the Essence.

This diseas in like manner in respect of the Causes is as it were taken into pieces, or divided into parts, namly into a natural affect, and into an after-coming or new∣ly contracted malady. Again, This diseas may be ter∣med natural in a twofold sens▪ In the first properly, As when the Sick is born actually affected with this diseas. In the later improperly, when the Patient at his birth is not actually affected with it, but strongly disposed by his native principles to fall into it. If it pleas the Rea∣der to summon those things to his memory which were said above concerning the causes of this Effect on the Parents parts, he wil easily conceive the reason and foun∣dations of this difference, and consequently that wil ex∣cuse us from any further explication: Only we ad, that this difference is of great use in the judicial part of cure, which consisteth in applications antidotal and preven∣tive, but it is not of so great moment in the Method of Cure. In like manner this Affect is meerly coming af∣ter, when being fomented by no Natural disposition, it is newly contracted after the birth▪ & here also it is two∣fold. For it either succeedeth som foregoing Diseas; or it is immediatly produced by an erroneous use of the six non-Natural things: We have sufficiently discoursed of both, where we hammered out the causes of this Diseas after the birth, and thither we direct the Reader.

Again, this Diseas admitteth som differences by rea∣son of other Diseases wherwith it is conjoyned in the same subject. It must not be expected that we should give in a Catalogue of all Diseases, wherwith this Af∣fect

may possibly be conjoyned, we shal only reckon up those which ate the usual Companions of this Malady▪ Som wherof have a certain dependance upon this Diseas and the causes of it; others have not any, or at least not any worthy of a distinct consideration.

Of the former kind are a Hydrocephalus, the faults of breeding Teeth, an Asthma, the Ptysick, an Hectik fea∣ver, a slow, and erratical Feaver, and the Ascites, which is that kind of Dropsy when water hath gotten between the flesh and the Skin.

The Hydrocephalus hath a great correspondence with this Affect, seing that this Affect also doth for the most part suppose an increas of the Head preternatu∣rally encreased, and an overplentiful afflux of the Blood unto the Brain by reason of the largeness of the Arteries thither extended. And hereupon it easily coms to pass that the Brain being oppressed w^th the abundance of the Blood, must somtimes needs suffer the more serous por∣tion therof (as being the most permeable) to evaporate or sweat out into the Ventricles and cavities within the Menynges, and by consequence to produce the Dropsy of the Brain. But this, as we have already noted, doth always appear.

The faults of breeding of Teeth also are somtimes just∣ly ascribed to this Diseas going before. For it is well known that they who are affected with this Diseas do commonly breed Teeth with extream pain, and many times the Teeth themselvs fal out by pieces. But we have above reduced this fault to the unequal nourish∣ment of the parts, and there the Reader may find further satisfaction. In the mean time it must be observed, that a painful breeding of Teeth may likewise precede this Diseas, and sustain the force of a caus in reference to this subsequent evil, as we have likewise shewed above.

Moreover, An Asthma or difficulty of breathing doth familiarly follow upon this Affect, because the Blood is somwhat cooled in his circulation thorow the first affe∣cted parts, and is rendred more thick, viscous, and slug∣gish in motion, neither is it always perfectly corrected before its return to the right Ventricle of the Heart. Wherupon being unapt for passage, it is powred back from the right Ventricle thorow the Arterious Vein in∣to the substance of the Lungs, and for that Reason doth easily introduce obstructions, hard tumors, difficulty of breathing, somtimes inflammations, impostumes, Ulcers, the Ptysick, the Dropsy of the Lungs, a Hectick Feaver, or els a slow erratical Feaver.

An Ascites is also somtimes consociated with this Af∣fect. But whether it proceeds from a copious flowing of the Blood to the Bowels of the Abdomen, we dare not yet attest for an undoubted truth. Yet certain it is that the flowing of the Blood to this Belly is very copious and sufficiently active in this Diseas. For the Liver is great, and the other Bowels are observed to be rather more ful than ordinary, than pined away. Wherupon it may happen, that that watry moisture from the Bowels which are oppressed with a fulness may be carried into the hollowness of the Abdomen, but we affirm this with a distrustful confidence, because we have not yet given our selvs ful satisfaction in this matter.

Nevertheless these recited Diseases may happen to Children although the Rachites have not preceded, and may be the caus to introduce it. Yea, they may likewise com upon this Diseas from other causes; as for exam∣ple, by som errors in the Regiment of health; although in this case also this Affect may be partly guilty, if it went before: And thus much of complicated Diseases of the former kind.

But of the latter kind, namely, such as have little or no nependance upon this Affect, are a malignant Fea∣ver, the French Pox, the Scurvy, and the Strumaticall Affect.

First it is certain, That a Malignant Feaver may come upon this Affect, because for the most part it is produced by infection, from which this present Affect leaveth not Children free, we ad only, that this Feaver doth seldom or never ow his Origin to this Diseas.

Secondly, If the French Pox chance to be complicated with this Diseas, it is either derived from the Nurses in∣fection, or from the Parents by Inheritance. For it is a Diseas altogether Distinct from this, and hath scarce any affinity with it.

Thirdly, The Scurvy is somtimes conjoyned with this Affect. It is either hereditary, or perhaps in so tender a Constitution contracted by infection, or lastly, it is pro∣duced from the indiscreet and erroneous Regiment of the Infant, and chiefly from the inclemency of the Ayr and Climat where the Child is educated. For it scarce hold∣eth any greater commerce with this Diseas, then with o∣ther Diseases of longer continuance, wherin after the same manner the Blood in time contracteth for the most part this peculiar infection, yet it must be granted, that this Affect doth somwhat the more dispose to the Scur∣vy in regard of the want of motion and exercise.

Fourthly, and lastly, The Strumatical Affect doth somtimes associate this evil. But it is credible that it ow∣eth more to other causes proper unto it, then to this pre∣cedent Diseas. Although we deny not, but this may mi∣nister som occasion of invading, in as much as it ren∣dreth the humors more viscous and gross.

Some other Diseases are peradventure somtimes com∣plicated with this, but because they happen exceeding

rarely, and have yet scarce fallen under our observation, we pass them by, for the present and proceed to the signs of the Diseas, and the difference of the signs.