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. XXIX. The Medical Matter answering to the In∣dications proposed, and first the Chy∣rurgical. (Book 29)

THE Medical Matter must be found out by Experience and Analogismes, or Arguments drawn by an answerable necessity from the Caus to the Effect; although the truth is we conceive not any other Reasonings to be absolutly excluded. It is vulgarly and not unaptly distributed in∣to three kinds, The Chirurgical, the Pharmateutical, and the Diatetical: Of these in their order.

The Chirurgical commonly received and approved in this Affect, and famous above the rest, are chiefly two; Scarification of the Ears, and little Fountains or Issues. But our enquiry (as we shal see anon) shal be extended to many more, namly of Cuppin-Glasses, Leeches, Blisters, Ligatures, and Swathing-bands: But the ope∣ning of a Vein the Spirits cannot brook, as every one knows, who but observes the frailty of the age, the ex∣tenuation of the habit of the parts, and the smalness of the Veins.

The Scarification of the Ears shal lead our discours. The Empericks who undertake the cure of this Diseas, make more of it than one would imagin. For in their practice they celerate it with great vaporing, and with∣out it scarce hope for a happy cure. But we, although we

disallow not this kind of remedy, have seen many Chil∣dren successfully recovered without the use therof. And they themselves who attribute most unto it, for the most part take away no considerable portion of Blood. Yet some affirm that they have seen a large quantity of Blood drawn away with good event. However it be, it is credible that those Children do with most ease en∣dure this remedy, and obtain most profit by the use of it, which are of a Sanguin complexion and wel habited, and who are affected with an Alogotrophy, rather than an Atrophy or a Consumption, or any other remarka∣ble extenuation of the parts. Our Practitioners for most part repeat this operation two or three times in a week. They seldom do it with an Instrument or sharp Pen-knife, but most commonly with an ordinary blunt Knife, taking no notice of the pain and crying of the Child. Moreover, For the most part they perform it in the hollow of the Ear, but some extend it to the inward and outward circumference of the upper part of the Ear, yea to the whol circumference. No man hitherto as we know have attempted the Scarification of the hinder side of the Ear, although indeed it is not easie to give a reason, why it should conduce less being administred there than in the hollow part.

Yet it may be lawful for us to offer our conjectures why the hollow of the Ear should be chosen before the other parts for this operation, which notwithstanding we will not confidently assert, although we suppose we can at least probably assert it, if that be true which the most diligent Chyrurgion Fubricius Hildanus hath written in his Observ. 4. Centur. 1. de nervo quinti parts: For this conjecture is grounded upon this Observation, and if that be ruinous this perhaps must perish with it. The Conjecture is this, The distribution and use of the

Nerve and of the fifth Pair before mentioned being sup∣posed, Scarification in the hollow of the Ear may very conveniently both free that Nerve from any kind of op∣pression, and likewise shake off the numbness, and give it vigor. For the hollow of the Ear is the next place unto it which we can come at with an instrument. Wherfore evacuation being here made may immediatly drive away the matter which commonly oppresseth the very begin∣ning of that Nerve, and withal causing pain and en∣creasing the heat, and may drive out all stupidness from within it, and ad vigor unto it. If this Nerve therfore (as that famous Chyrurgion affirmeth) or a part therof be distributed unto the Marrow of the Back and never forsakes the Marrow of the Back, but shooteth out little Branches with the Nervs of the Marrow of the Back to the ends of the very Legs and Feet; it may easily be granted, that this Nerve thus delivered from obstructi∣on, thus excited and having gotten vigor, may likewise in some manner excite the Marrow of the Back it self, and all the Nerves from thence arising, which by that opinion it doth accompany to the very end of the Body, and imprint some vigor in them. Wherfore Scarificati∣on being made in that place must needs be of greater ef∣ficacy, than if it were instituted in any other part of the same Ear, more remote from the aforesaid Nerve. The same may almost be said concerning the little wound here made by a blunt Knife. For some Practical Phy∣sitians affirm that the excellency of this operation relats not so much to the quantity of the Blood to be drawn, as to the stirring up of pain in that part; which any man may easily reduce to the stirring up of the vigor of the Nerve of the Fifth Pair.

But omitting this Conjecture we will propound some other Considerations, in respect wherof this Scarifica∣tion

may be useful in this affect. First, By this means we obtain a certain particular evacuation of the Head, which part, if any other is in this Affect oppressed with a particular fulness. Secondly, By the very evacuati∣on of the Blood we somwhat correct the thickness and toughness therof, and by consequence we promove the more equal distribution of it, and a more regular and e∣qual Nourishment of the Parts. Thirdly, By this means we in some sort drive away the astonishment of the parts.

It must be noted that this operation when it perfor∣meth a particular and local evacuation, doth not simply deserve the first place in the Method of Cure, but must follow in its order, Universals being premised.

Lastly, It seems to be ridiculous and superstitious which some are busie about when they administer this Scarification; whilst they fasten the Blood of the right Ear suck'd up into Wool to the left Hypochondry, and the Blood of the left to the right. Thus much of Scarification.

Issues in this Diseas are much approved, and we have known some Children cured only by the help of this means. For it doth not only perform all those things, which even now we ascribed to the Scarification of the Ears, but more particularly it is a powerful remedy a∣gainst the Hydrocephalus, both Curative and Preserva∣tive, and very much conduceth to lessen the unusual mag∣nitude of the Head, and to evacuate the superfluous watriness therof. And lastly, to repress the inordi∣nate encreas of the Bones. Also it manifestly drieth up the too much humidity of the Spinal Marrow, exciteth heat, strengthens the Nerves, and expelleth the asto∣nishment.

Now becaus this kind of remedy is properly a little

Ulcer▪ and causeth some small pain to the Child that hath it, and bringeth dayly some trouble to the Nurs, it ought not to be prescribed, unless the greatness of the Diseas be such that we despair to conquer it by other re∣medies without the concurrence of this.

This little Fountain must be made between the Se∣cond and Third turning Joynt of the Neck. Some Burn it with actual Cauterising, but we disapprove of this way in regard of the vehemence of the pain: Some effect it with a potential Cauterising: but neither do we like this, becaus all Causticks are advers to the Na∣ture of an Infant, insinuating some venemous quality, and at least do too much dissipate the Spirits, and wea∣ken the parts. Therfore we allow rather of an Issue made by Simple incision with a sharp Penknife.

Some make use of Iron tongues contrived for this purpose, wherwith they take hold of the Skin, the place of incision being first mark'd with ink, and by a mode∣rate compression they dull the sens of the part, and then they thrust in the Pen-knife through the middle of the tongs which is pierced with a longish hole, and so they make the incision. Having made the wound they stop in either an Artificial or a Natural Pease, putting upon it a digestive Plaister: upon this they wrap a Paper or a linnen cloath divers times doubled, and fasten to it as it were a Buckler made of some solid matter, unto which four swathing bands are sewed; thus much of Issues. In the next place we shall examin some other kind of Chyrurgical Operations.

And first Leeches offer themselves. Truly we have not yet sufficiently tryed how beneficial the application of them may be in this Affect. But if we consult Rea∣son, we suppose that more hurt than advantage may be expected from this remedy. For if they are applied to

any part of the Head, by reason of their continual suc∣king they would easily caus a more violent afflux of the Blood to those parts. And if they be applied to other parts, they draw the Blood from the parts which before had too little.

Secondly, Cuppinglasses are not (we conceive) so dangerous as needless; indeed we altogether reject those that are ministred with Scarification, not only for the Reasons just now deduced from the Leeches, but being moved both by fear of dejecting the Spirits by reason of the pain, and also in regard of the troublesomness of the administration. Cuppin Glasses without Scarification, as we began to say, seem not refusable either by the Spi∣rits, or the Diseas, or the causes of the Diseas. But these are very little effectual, and we leave it to be perpended, whether the profit arising from the use of them, whatso∣ever it be, can recompence the trouble of the applicati∣on.

Nevertheless it may happen by reason of the compli∣cation of some other Diseas, that the use of them may be of some moment, as in a Pleurisie, a Phrensy, and wher som dangerous Flux is iminent against som princi∣pal part; in which case, those perhaps that are adhibited with Scarification, may be admitted in great and strong Children. But then you must apply them to the tur∣ning Joynts of the Neck, the Shoulders, the Hanches, to the inner parts of the Thighs, to the soals of the Feet, and to other places as the peculiar complicated af∣fect shall require.

In the mean time it must be noted, that in an age so tender, you must make use of very smal Cuppin-glasses, and that they must be applyed with a less flame then they are wont to be in others of mans estate, and that the scarifi∣cation, if at all it be admitted, must be don with a gentle hand.

Thirdly, As for Blisters, although hitherto we have not had sufficient trial of them, and although we banish from this Diseas both septical applications, becaus they dissolve the parts, and also caustical, because they pene∣trate deeper and produce a crusted substance, yet we con∣jecture that those Pyrotical remedies which only raise Blisters in the Skin may be somtimes profitably admit∣ted.

You wil say that Cantharides wherwith they are com∣monly made are extream hot, and besides suspected to be of a venemous quality.

We answer, That we may not here insert any thing of the qualities of Cantharides, we grant that which is asserted. But becaus they are administred only to the out∣ward little Skin, and only to a little part therof not much extended, and becaus as soon as the blisters are raised they are removed, the excess of their heat and their poyson scarce penetrates deeper into the Body, than the bottom of the Epidermis, and therfore this remedy may be applyed without any notable harm or danger. But then you may demand what profit can arise from hence? We affirm, that it doth effectually correct a cold and moist distemper, and potently dissipate the astonishment of the Marrow of the Back, the Brain, Nervs, and the Nervous parts, and withal that they make all the parts more firm and steady, and stir up a stronger Pulse in the external parts; al which things are of no smal mo∣ment in the cure of this Diseas.

One amongst us affirmeth, that among other things he prescribed this remedy to a Child of two years old who was troubled with the Rachites, and was also fallen into a continual and malignant Feaver, and grown al∣most frantick. Hereupon the Child found present and manifest eas, and after a few days was delivered from his

Feaver. Afterwards having purged him twice or thrice with an infusion of Rhubarb, &c. Beyond the expecta∣tion of all that saw it, he also subdued this Affect almost without any other remedies. But as you can scarce find any commodity without a discommodity: so neither is this remedy exempted from al inconveniences. For it is unpleasing, ful of pain and molestation to Children: Moreover, for a time it interrupteth their exercise and pastime, in respect of which things, unless perhaps som other complicated affect do point at an interdiction of exercise, it may do much more prejudice than advan∣tage. Again, the force of it suddenly wasteth, and af∣terwards by degrees is consumed, which doth not in all respects keep touch with a Chronical Diseas. Finally, an Issu which is proper to Chronical Diseases, may very wel supply its place in this affect. Wherfore we scarce admit the application of blisters in the cure of this ma∣lady, unless som acute Diseas be complicated, which may require this kind of Remedy, as it fals out in the Cause propounded.

Now wher this administration is requisit, it is most commodiously performed upon the turning Joynts of the Neck, unless som Issu have prepossessed the place; in which case you must administer them either behind the Ears, or four Fingers below the Issu. We deny not but it may be fitted to several other places in respect of the complication of other Diseases. But we here design the place which a peculiar reference to the present Diseas.

Fourthly, Ligatures also may be referred to this Ti∣tle, and indeed we grant, that somtimes they are not al∣together unuseful in this affect; namly, if they be very moderate, and adhibited by just distances, and unto convenient places; but you must beware that they hin∣der not the growth of that part, wherunto they are ap∣plyed;

which is don if they be sufficiently loose, and made of soft wool, if in the Day time, or for som part of the Day they are tyed up, and unbound at night, if they be fitted to the Thighs and Legs upon the Knee, and to the Arms upon the Elbow.

Yet Ligatures do here seem to conduce much to the stoppage of the Blood from flowing to the Head, and that it ought to be fastned to the outward parts that are extenuated: besides, this Remedy is good to retard the over slippery return of the Blood in those parts, unto which the Ligature is applyed.

Fifthly, Hitherto also belong the Fasciation or swa∣thing of certain parts, for this hath an affinity with Li∣gatures. For som use to enwrap the weak parts in wollen blankets, therby to strengthen them, and to cherish their heat; namly, the Feet, the Legs, the Knees, and the ad∣jacent parts of the Thighs. But you must be careful that the overstraightness of them hinder not their growth.

Others, instead of these swathing bands use buttond Boots lined with woollen Cloth; thes they do not make use of only for strength and heat, but also to correct the crookedness of the Bones, and to erect the bending of the Joynts. Som ad little Shingles, or pieces of Whale-Bone, but there are three things worthy of observation in the making of these. 1. That they may somwhat crush the prominent and convex part of the Bone. 2. That they scarce touch the hollow, but rather that they defend it from compression. 3. That they be well fitted to the part, and do as little as possible hinder the motion of

[illustration]

[illustration]

F

C

[illustration]

B

[illustration]

A

C

D

[illustration]

D

G

the Joynts, to this purpose those Boots upon the out∣ward part to the knee may be cut overthwart, or, acros In like manner if there be any need that the Shingles upon the knee be extend∣ed to sustain and erect the bending therof, then it is necessary that you fashion them with a double Joynt in the bending place, after this manner.

[illustration]

A

B

C

D

The Form of the Arti∣culation of the Splents.

A B Two Iron rings.

C D The Diameter of the Joynts of the Splents.

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The Nails wher with the Rings are fastned.

F G The two Splents.

Instead of the Splents you may more commodi∣ously use thin plates of Iron, and the whol In∣strument may be made of Iron.

The two Axel trees or Diameters C D upon which the Shingles or Splents are bended F G are fastned with two rings or hoops. But the hoops themselves A B C are made of plates of Iron of an exquisit thinness, that they may not be burthen∣som, and withal they ought to be wel smooth∣ed, and polisht that they hinder not the motion of the Splents. These rings must be of an equal Lati∣tude,

suppose about two fingers a cross, and they must be so fitted together, that on every side they may be paralels; only let there be so much distance between them, that they may fitly receive the tops of the Splents. More∣over, Those hoops must not only be coupled with a double Axel C and D, but also with five smal Iron Nails. Lastly, The whol composition of the Instru∣ment must be so made, that it may be fast and fitly tied to the side of the bended knee sticking out, and withal that it may serve as well for the extension as the ordina∣ry bending of it, but let it restrain the deflexion of it to either side, especially to the part sticking out. Which is the caus why the Axels are fastned with a double Hoop, namely lest the Joynts should be loos, and yield to the deflexion of the Knee.

In like manner the torsion and mishapen writhing of the Feet is also frequently corrected with Swathing Bands. If the Toes are outwardly distorted, they must every night be bound up, little balls of Cotton being put between the Heels and the Ankles. But if the Toes bend inwards, then you must bind the Ankles, and put a little Cotton between the great Toes.

Lastly, To straighten the trunk of the Body, or to keep it straight, they use to make Breastplates of Whale∣bone put into two woolen Cloaths and Sewed together, which they so fit to the Bodies of the Children, that they may keep the Backbone upright, repress the stic∣king out of the Bones, and defend the crookedness of them from a further compression. But you must be careful that they be not troublesom to the Children that wear them, and therfore the best way is to fasten them to the Spine of the Back with a handsom string fitted to that use.