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. XXII. The Signs of the differences of the Rachites, or the Diacritical Signs therof. (Book 22)

WE shal insist in the same Method we propoun∣ded above, wher we discoursed of the diffe∣rences, whose Signs we now enquire after. We have above deduced five differences from the very Essence of the Diseas. The first was separable from the parts of the Secondary Essence, whether they were present or absent. But no other Signs must be ex∣pected besides the very pars present or absent, which of themselvs are subjected to the senses, and therfore they are numbred among the Diagnostical Signs in the second Classis in in the precedent Chapter.

The second difference was from the magnitude of the Diseas; the signs of this are many and great, or few and gentle and present signs; namely, to be fetched from among the Diagnostical Signs above described.

The third difference was taken from the vehemence of the affect. This is distinguished by the slow or quick encreas of the Diagnostical Signs.

The fourth was from the strength of the Sick; we have shewed the way to judg of the strength above: But the difference of a Diseas arising from hence hath re∣spect unto the danger, and therfore we refer the Signs therof to the Prognosticks.

The fifth difference was deduced from the times of the

Diseas. In which respect we have above reckoned up six divers apparitions of this Diseas: to wit, The begining, the encreas, the state or consistence, the encreas beyond the State, the true declination, the superious declinati∣on, or the passing into another affect.

It must be known that the beginning of this Diseas, besides the signs that difference this time from the encrease, doth likewise require some peculiar Signs of the presence of this Diseas: for it is a time of the grea∣test obscurity, wherin the Diseas doth as it were lurk and hide it self, neither can an unattentive and in expert Physitian easily distinguish it from the Diagnostical Signs above rehersed. For by this time most of the Di∣agnostical Signs aforesaid do not yet openly break forth; and such as make a discovery of themselves, present on∣ly some obscure impressions to the Physitians Observa∣tion. Therfore the indication of this time requires an accurate and peculiar collection of the first appearing Signs, and a diligent consideration of them; but the o∣ther times, besides the Diagnostical Signs above gran∣ted, want only a difference among themselves, which is performed by an easie industry. Wherfore in the first place we will declare the Signs of the presence of this Diseas, being newly begun or rather beginning, and then the difference between that and the encreas.

The Signs of the present Diseas of the Rachites newly begun.

First, Diligent Observation must be employed about the three kinds of Signs ascribed above to the Animal A∣ctions; namely, the loosness and softness of the parts, the weakness and languidness, the slothfulness and num∣ness. For these do in a remiss degree, and subobscurely

yield advantage to circumspection and heedfulness pre∣sently a principio principiante, as they phrase it.

Secondly, The colour must be considered, and the ha∣bit of the Head and Face in relation to the Joynts. For if the colour or the habit be more fresh and lively in those than in these, it presenteth a strong suspition that this Diseas hath taken root. For although the Bulk of the Head which is evidently encreased, and also the ex∣tenuation of the parts affected do pre-require some con∣siderable motion and duration of the Diseas before they appear, yet from the beginning a certain difference may be observed by an accurate attention or intuition in re∣spect of the heat and the habit of these parts compared one with another.

Thirdly, The Wrests and the extremities of the Ribs must be noted. For before the end of the beginning cer∣tain rudiments of knurls or knots begin to appear in the Wrests, and Excrescencies also in the tops of the Ribs.

Fourthly, A kind of swelled fulness and stretching the Belly is conspicuous immediately after the beginning e∣specially in the Hypochondriacal parts. For the magni∣tude of the Belly compared with the magnitude of the Breast exceeds the just and due proportion.

Now these Signs collectively taken do assuredly de∣monstrate the presence of the Diseas even from the very beginning. But if no sensible and manifest extenuati∣on of the first affected parts do appear at the same time, in that very respect it is cleerly distinguished from the encreas therof.

The Signs of the other times are with eas differenced from one another by the descriptions of those times al∣ready laid down; yet becaus they may point to this place, and be dispatched in a word, we shall not decline the Annotation of them.

All those Signs which appeared at the beginning be∣come more intense and evident in the encreas of the Dis∣eas, and many other and more grievous are daily accu∣mulated. This time, as hath been said, is distinguished by the manifest extenuation of the first affected parts; but after the consistence by the continual aggravation of the Symptoms and Signs aforesaid.

In the State of the Diseas the Signs and Symptoms are most outragious and conspicuous. But so long as this time lasteth it neither manifestly encreaseth or de∣creaseth.

In the encreas beyond the State, the Signs and Symp∣toms exceed that condition which they retained in the indifferent State, both in respect of their magnitude and vehemence, and likewise in respect of the dejection of the Spirits, and from that time forwards they dayly grow worse and worse; for which considerations this time is distinguished, as well from the ordinary encreas, as from the means of the consistence.

But in a true declination A kind of simple remission of the Symptoms and Signs tending to a perfect restaura∣tion of health begins to discover it self; no other Signs of the invasion of any other Diseas appearing.

On the contrary, in a spurious and illegitimate decli∣nation, Other Signs of a new and succeeding affect are involved and complicated with the Signs and Symptoms of this Diseas: and these are distinguished according to the various condition therof, and must be fetched from their proper Fountains, and ought not to be expected here. Moreover, if any particular Signs of any of these times do occur, which concern the event of the Diseas, they must be reserved among the Prognosticks; and thus much of the Signs of the Differences of this affect de∣duced from the Essence therof.

The Differences of the Causes distinguish the Diseas into Natural and Accidental, and the Natural again into that which is properly so called, and that which is so termed improperly. A Natural Diseas properly so called, becaus it is supposed to be actually present from the very Birth, requireth no other Signs than the Di∣agnostical recited in the former Chapter. For upon their appearance presently after the Birth the Diseas is certainly known to be Natural.

But if those Signs appear not presently after their Birth, yet a Natural disposedness to this Diseas may be inherent from the Birth, which afterwards actually breaketh out, and the Diseas produced by it, may (though with some impropriety) be termed Natural, in regard of that dependance upon the Native faultiness. A Natural Diseas in this sens, requireth other Signs than those which we have recited above, to distinguish it from the same Diseas when it is altogether and plain∣ly Accidental.

The Signs of a Natural Diseas improperly so called.

First, A weak and sickly Constitution, and the Dis∣eases of both or either of the Parents: As a cold and moist distemper, a Cacochymy, especially the Phleg∣matical, a Cachexy, a Dropsy, an Atrophy, the Phtisick, the Gonorrhea, the Whites, the Venereous Pox, the Scurvy, and the like affects.

Secondly, The Slothfulness, Effeminacy, and Seden∣tary life of the Parents.

Thirdly, The Errors of the Mother during her going with Child, all which things we have discussed above more at large, when we examined the Causes of this Diseas in relation to the Parents.

Fourthly, The Debility of the new born Infant when it proceedeth not from the difficulty and labor of the Birth.

Fifthly, The invasion of the Diseas before he is exact∣ly a year old; for this argueth some Natural dispositi∣on to the same.

Sixthly, If the elder Brothers or Sisters were before affected with the same Diseas; for then it may well be suspected that some Infection was contracted from the Parents.

Seventhly, If no remarkable error was committed in looking to the Child after the Birth, and before the inva∣sion of the present Diseas. Of which we have spoken a∣bove in the Chapter of the Causes after the Birth.

Eighthly, If this affect hath not succeeded some other which was apt to leave this behind it. Of the Diseases of this kind we have also discoursed above.

The Signs of a Diseas newly and totally contracted after the Birth, are in a manner contrary to these, and therfore we shall only run them over.

First, If the Diseas cannot be imputed to any weak or diseased Constitution of the Parents, or their manner of life, or the errors of their customs.

Secondly, If no debility appeared presently after the Birth.

Thirdly, If the Diseas began when the Child was a∣bove eighteen months old.

Fourthly, If the Brothers and Sisters were free from the Diseas.

Fifthly, If any notorious errors were committed about the Child after the Birth.

Sixthly, If any Diseas went before which might occa∣sion a suspition that this followed it. If there be a con∣fluence of most or all of these Signs, they do sufficiently

witness that this Disease must not be attributed to any Natural Infection, but to the future Errors and Irregu∣larities. And thus much of the differences of this Dis∣ease in respect of the Causes.

Lastly, Som differences happen to this Diseas by rea∣son of other Diseases, wherewith they are peradventure complicated; in which case, besides the Diagnostical signs already reckoned, some other may be desired as pe∣culiarly proper to the complicated Diseas. Nevertheless an accurat Description of them cannot be here expected, becaus for the most part they are the same which are eve∣ry where artributed to those Diseases by practical Wri∣ters. But becaus som Diseases do more frequently ac∣company this than others, we wil briefly look into their Signs.

First therfore a Hydrocephalus or Dropsie in the Head being complicated with this Affect needeth somtimes no signs to make it known, but is sufficiently, yea abundant∣ly manifest of it self: namly, either by the exceeding mag∣nitude of the Head, or by the water that is outwardly contained under the Pericranium (which notwithstan∣ding we suppose doth very rarely happen) or by som ex∣tream opening and wideness of the seams in the Head, Water having gotten into them, and lifting up the Dura Mater, so that a soft and waterish tumor is outwardly perceivable by the touch in the spaces between the Bones. Many times the Hydrocephalus is somwhat obscure and requireth signs to discover it. First, Therfore all the in∣ward and outward senses are more dull than otherwise they use to be in this effect. Secondly, The magnitude of the Head is somtimes greater than at other times. Third∣ly, The Sutures, or seams in the accustomed places do gape more wide, and are closed again more slowly than they are wont to be. Fourthly, The Bone in the Forehead is

more outwardly sticking out, and in the other Bones of the Head you may observe certain inequalities and bun∣chings out of an unusual bigness.

Secondly, The conjoyned evils of breeding Teeth are thus known. 1. If the accustomed time of breeding Teeth be either approching, or now at hand; for from hence a∣riseth some suspition of pain from thence proceeding. This time ordinarily begineth in the seventh month af∣ter the birth, and continueth til the Child be a year and six months old, and longer, if the Teeth come slowly; which hapneth very commonly in this affect; and it endeth when the number of the Teeth is compleat. 2. Children to mitigat the raging pain do use to put their Fingers into their Mouths, according to that old saying, ubi dolor ibi Digitus. 3. The Gums wax white on that side where the Tooth is to break out, and are somwhat hot in the touch. 4. The Teeth that come forth sometimes wax black or are loos, or fal out by pieces. 5. To these you may ad watchings, the loosness of the Belly, Feavers and Convulsions, which notwithstanding are chanceable Symptoms.

Thirdly, An Asthma is perceived by the very diffi∣culty of breathing, when it doth not proceed from the stretching and fulness of the lowest Belly. But if with∣al there be a swelling or Imposthum, & that in either side of the Lungs, they can scarce endure to lie on the contrary side; but if it be on both sides, then they desire to lie er∣rect or with their Faces upwards. The same thing for the most part hapneth in an Inflamation, with a growing together of the Lungs with the Pleura, as also in a Pleu∣risie, but then there are added, an acute Feaver, a Cough and spitting of Bloud, moreover in a Plurisie a pricking pain in the Side. The Phtisick is known by a diuturnal Cough, and a roundish and somtimes a purulent spittle

(although indeed Children do seldom spit out, becaus that matter which the Cough fetches up into the Mouth they swallow by the oesphagus) also by a putrid Feaver conjoyned, and by a sudden Colliquation in the parts. An Ascites is discovered by the unreasonable bigness of the Abdomen.

Fourthly, A Hectick Feaver bewrayeth it self by a con∣tinual heat, being somwhat more vehement than that in a Quotidian Ague, especially about the Arteries, and stil encreaseth after the receiving of meat; also by the swift and speedy consumption of the parts: a putrid fea∣ver is known by the urin being at the begining cude, af∣terwards more concocted, then also from the extream high color of it. Moreovor, if it be an intermitting A∣gue, it is discernable by the inequality of the heat, the ex∣ternal parts being at the begining extream cold, & after∣wards excessive hot; also from the fits either constant or erratical; again, by the contraction of the Puls upon the approach of the fit, afterwards unduly encreased. A continual Feaver is known by an intensive and un-inter∣mitting heat, also by thirst, roughness of the Mouth, and the altered color of the Tongue, and the like.

Fifthly, The Venerious Pox is supposed to meet in complication, if either of the Parents or the Nurs were before infected; if any ulers appear in the Head, Mouth and Nostrils; or if any eminent and crusted Wheals break out, especially such as ordinary Medicins cannot subdue▪ if hard tumors grow conspicuous, or knots defiling the Bones in the Fingers with rottenness, or any other parts; if unquietness and bitter pains in the night-time alarum the sick; or if Buboes break out in the Groyn.

Sixthly, The Scurvy complicated with this affect hath these signs: 1. They that labor under this affect do im∣patiently endure Purgations; but they who are only af∣fected

with the Rachites do easily tolerate the same. 2. They are much offended with violent exercises, neither can they at all endure them. But although in this affect alone, ther be a kind of slothfulness and aversation from exercise, yet exercise doth not so manifestly, at least not altogether so manifestly hurt them, as when the Scurvy is conjoyned with the Rachites. 3. upon any concitated and vehement motion they draw not breath without much difficulty, they are vexed with divers pains run∣ning through their Joynts, and these they give warning of by their crying, the motion of the Puls is frequent and unequal, and somtimes they are troubled with a Falpi∣tation of the Heart, or threatned with a Lypothymie, which Affects ar for the most part soon mitigated, or alto∣gether apeased by laying them down to the rest. 4. Tumors do very commonly appear in the Gums. 5. The urin up∣on the absence of the accustomed Feaver is much more intens and encreased.

Seventhly, The Strumatical Affect, if extreamly com∣plicated with the Rachites, is sufficiently conspicuous by Swellings obvious to the senses; yea, where many knot∣ty Excrescences do outwardly occur, it may be justly su∣spected that the like Tumors do lurk in the Bowels. But if the knots grow inwardly only, they are scarce discer∣nable by any certain sign; for that Rule which some have observed, namly, That those who have short Necks, low and narrow Forheads, with compressed Temples, and wide Cheek-bones, are subject to these strumatical Tumors and Excrescencies, is too uncertain and fallible; Others affirm, That Purging Medicines taken otherwise in a just proportion will scarce work with those who are thus affected; but we answer from our own Experience That it is somtimes only, and not alwaies true. Thus much of the signs of the differences.