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. XXVIII. The use and right administrations of the Indi∣cations aforesaid. (Book 28)

HAving propounded the three kinds of simple Indications, and deduced them into their lowest species, we shal in the next place con∣sider the right use & administration of them. The exact knowledg wherof seems impossible to be ob∣tained without rode and experience. For it descendeth unto Individuals, and comprehends not only the Electi∣on of a thing among so many Indicates simply to be don in the Species, but also the invention of quantity, place, form, time, order, and matter of the remedy to be exhi∣bited.

The Consent and Dissent of Indications do contribute much to this invention. Now the Consent may be two∣fold: of Coindication and Permission. Permission may be either an Advantage or a Loss to him that permitteth

or neither of them. A Permission that cannot be grant∣ed without hurt; must never be allowed without the grea∣test circumspection, and so much the greater, as the da∣mage may be the more to him that permitteth. For al∣though the Permittent may part with somwhat of his private right to advance the publick good, yet in respect that he is a member of the whol he is supposed to be a gainer.

The Dissent of Indicants is twofold; namly, either Contradictory or Contrary. The Contradictory among the Books is called Interdiction or Prohibition, and for the most part it is appropriated to the Spirits, unto w^ch in this respect we must always yeeld obedience. The Contrary is called Contra-indication, and this doth not simply forbid, but so far forth as it undergoeth the Na∣ture of an impediment, or som more urgent Indicate.

First, Where Indicants consent, either by Coindicati∣on or Permission, satisfaction if it be feasible must be gi∣ven to al the Indicates: But if this cannot be performed Medicines of that Nature are to be preferred before the rest, which are correspondent to most, or at least to the most urgent Scopes. But if such simples cannot be found out, then you must institute an apt composition of di∣verse simples one with another.

The Essential parts of this Diseas, although they are very various, yet is there not any considerable disagree∣ment among them, and nothing hindreth but in a great part they may be considered together. For Medicines temperatly hot and dry, may at once cherish the Inhe∣rent Spirits, and perhaps conduce to the scattring of the numbness in them, and withal somwhat fortify the Tone of the parts, and facilitate the equal distribution of the Blood, and consequently the equality of the Nutrition: also it may increase vigor in the Vital and Animal Spi∣rits,

proritate the Arteries in the first affected parts, and strengthen the Nervs: unto which Heads almost al the Indicates of the Essence of a Diseas may not unaptly be referred. Moreover, the Spirits also, although they pro∣hibit all extream hot things, yet they allow of these as mōderat, and very congruous to Nature. In like man∣ner there is little or no particular repugnance between these causes and the Indicates, albeit in respect of time and the order of administration som dissent may be ob∣served, as we shall see afterwards in due place.

Wherfore in what respect and how far these agree to∣gether whilst we intend a cure, we do at once respect not only the Spirits, but in som sort the causes, by choosing such curative remedies, or by mingling such ingredients with them, which are able both to attenuate the thick matter, to cut into the viscous, to open the obstructed passages, and the like. In like manner, whilst we are chiefly imployed either in preservation, or in the root∣ing out of causes, we make choice of such evacuants, or els we compound them with such remedies, as are also partly contrary to the Diseas. And all these things we do to that purpose; as that (as hath been said) we may be subservient to the most intentions we can.

Now having found out the actions simply requisit in the Species, in the next place we shal enquire out their du circumstances.

1. In regard that this is a great Diseas it requireth a great quantity of the Remedy, in respect of it self. For a Reme∣dy unequal to the Diseas cannot extirpate it. It is neces∣sary therfore that the dose of the Medicine be equally to the magnitude of the Affect. But in this Diseas the Spi∣rits permit not so great a quantity of Remedies to be gi∣ven at once. Wherfore that quantity must be divided & given by turns. For this is a Chronical Diseas, and of

slow motion, neither doth it necessarily require an hasty Cure, and although the Spirits cannot wel endure either vehement Remedies or such as are given in a large dose, yet they permit the use of Evacuant Medicins by an Epi∣crasis. Wherfore by turns, we must somtimes make use of Remedies Preparatory, somtimes Evacuant, somtimes Alterant, and somtimes strengthing.

Secondly, For so much as belongeth to the place of administration, the general Rule is, that the remedy ought to arive at the seat, and penetrate to the very Cause of the Diseas. If therfore it must have a passage into the Vessels, it must be taken at the Mouth; but if it will suffice to touch only the thick Guts, it must be in∣jected by the Fundament. If the humors be naturally ready to move upwards, expel them by vomit; if down∣wards evacuat them by siege. In like manner you must humor the inclination of Nature, and root out the cau∣ses by spitting, by Urin, or by sweating. Particular e∣vacuations must be instituted in the very affected parts, or in the parts adjacent. For so the force of the Reme∣dy doth the more surely make way to the seat of the Di∣seas and the morbifical Caus. And for the same reason external and topical Medicines must be applied to the next convenient place. Yet you must know that there is a certain Sympathy between som parts, in which case the remedies ar frequently administred to the part, wher∣with that consent intercedeth, and neither to the affec∣ted nor the adjacent part.

Thirdly, The form of the Medicament doth partly de∣pend upon the Rule last propounded. For if the scope be to lenifie the Jaws or the Windpipe, we chuse a lic∣king or lapping form, that by degrees the remedy may slide over the affected parts, and stay the longer upon them. In like manner, if the Stomach be affected, we

often prescribe Pils, Pouders or Electuaries, that they may the longer abide in the Stomach. To the Kidnies we rather design liquid things, that they may the more easily be carried down to them with the wheyish part of the Blood. The forms do also in som part depend upon the very nature of the Diseas, as in burning Feavers li∣quid things are for the most part convenient, dry things are scarce admitted; on the other side, in moist Diseases, and when the Belly is oversoluble, more solid forms are preferred. Finally, the forms of the Medicines do also partly depend upon the nature of the Ingredients. So Cassia worketh most effectually in the form of a Bolus; Hartshorn, Coral, and the like in the form of a Pouder; in like manner bitter things, such as beget a vomiting, and stinking things are concealed in the form of Pills; somtimes also they are guilded, or els they are enwrap∣ped in Wafers, and exhibited in the form of a Bolus.

Now it must here be noted, that for the most part the form of the Remedy is not so considerable, as it gives place to the more easie and commodious administration, in respect of the Admission or Reception of the Sick. For many cannot swallow Pills, others presently reject their Potions by vomit, & others are perhaps avers from other forms. In this Affect, in regard that all Children almost are loth to take Physick, that form is to be pre∣ferred before the rest, which shall be observed to be least distastful to them.

Fourthly, As for the time of action, you must so en∣deavor to sit your administrations, that they may as little as possible be interupted with times of eating, exercise, or sleep, for at this age the Spirits are scarce preserved sound and perfect, without an interposition of those things by just internals.

Remedies evacuant, opening, attenuate and incident, must be taken early in the morning upon an empty sto∣mach; and if they must be repeated the same day, four of the Clock in the afternoon (upon an empty stomach likewise) is the most seasonable hour. Strengthning and astringent Medicines, and such as provoke sleep, are to be taken rather in the evening than in the morning; but perhaps som of these are most agreable after meals.

Medicines that are mingled with the nourishment, ought to be gratful to the Palat, lest they subvert the sto∣mach and hinder concoction, or caus a loathing of the meat, or els empair the Spirits.

As for the order of proceeding, there occur two gene∣ral Rules. The former is, That that must first be don, which being premised makes way for the following Re∣medies, and therfore that ought first to be removed which hath the consideration of an impediment in respect of what must follow. The later is, That we must ever give our first help to the more urgent and weighty Indicant, unless som impediment intervene.

If the Question therfore be, Whether the Diseas, or the Caus of the Diseas doth first require the help of Physick? The answer wil be obvious according to the first Rule: For the causes are reflected upon under the notion of an impediment in respect of the Cure of the Diseas; for they cherish it, and infringe the vertu▪ of the Medicins. Wherfore, before that we are intent upon the vanqui∣shing of the Diseas, we premise all possible endeavors to root out the Caus, or at least to lessen, abate and retund it, that it may oppose no considerable force to retard the rooting out of the Diseas. Yet in the interim whilst we are busie in the removal of the Causes, the Essence of the Diseas must not be totally neglected, as we have before admonished. Yea when we have so subdued the Cause

that it cannot for the present much interupt the Cure, we may (the Causes not being utterly over-come and cast out) the more diligently and earnestly attempt the resi∣sting of the affect; yet with this condition, That if the Causes revert and becom new impediments, that then we are obliged presently to undertake the subduing and eva∣cuation of them: so that in this Chronical Affect, som∣times the Causes, somtimes the Diseas must be resisted by turns: and the Spirits do better undergo this change of action, than if we should continualy make our battery against the Causes, till they were absolutely rooted out.

Moreover, When the Causes of the Diseas in this Af∣fect are unapt for motion by reason of their toughness, grosness, and perhaps setledness; they must first be freed from this impediment and prepared before they are eva∣cuated. For according to the Rule of the great Dicta∣tor, Quae movenda sunt, fluida prius facere oportet. In like manner, that thickness, toughness and setledness of matter, if it be present, indicate Remedies attenuant, in∣cident and opening. But these things are not safly taken the impurities still flowing back▪into the first Passages, for then perhaps they are carried along with the Medi∣cines into the Veins, and more defile the Blood, or at least hinder the efficacy of the Remedies. These ther∣fore have the nature of an impediment, and must be in the first place removed.

Lastly, Universal Evacuants must be premised before Particular and Topical Remedies, especially where it is not permitted at once to mind both intentions. For the Universal Causes flowing in the Body are easily surroga∣ted in the room of Particular Evacuations, and renew the Afflux to the first affected part: but the thinner part of Particular Causes and that which is most apt for

motion is evacuated, but the thicker perhaps is more im∣pacted. Wherfore Universal Causes yet flowing to and fro in the Body, as considered are Impediments in respect of Particular Evacuation, and by consequence must be first expelled.

The latter Rule was, That we must releeve the more urgent and weighty Indicant first, unless there be an inte∣ruption of som impediment. That is termed an urgent Indicant which threatneth the most danger. Now every such Indicant is supposed to induce great afflictions into the Body, and not without manifest danger to wast the Spirits. Therfore in this respect, we must somtimes first help the Diseas, the Caus being neglected: Somtimes also we must neglect both the Diseas and the Causes, and adress our endeavors to the pacification of the Sym∣ptoms, as in a vehement Flux of the Belly, long Wat∣chings, profuse and immoderat Sweating, and the like. But even in these cases, we must have a prudent regard both to the Diseas and the Causes, and when the urgent Symptom is corrected, or the violence of the Diseas re∣pressed, then we must return to the regular Method of proceeding; for this Rule belongs not to the ordinary and legitimate order of Cure, but to the Method of Necessity.

Moreover, to perfect the right administration of Indi∣cations, there is required an exact and accurat know∣ledg of the Medical Matter whereof we shal discours in the subsequent Chapters.