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. XXXV. External Remedies. (Book 35)

HAving finished the Disquisition of the matter and kinds of internal Remedies, we shall now direct our Discours to external Reme∣dies. Which indeed we have reserved for the last place, not becaus they must perpetually be last put in execution, but becaus they are altogether of a different kind from the internal: now Universals are to be ad∣ministred immediately after Evacuants, or at least after those that are electively Purgant, and withal with the Specifical Alterants, unto which kind they belong, al∣though indeed as they are external, they differ from them. Now we desire that we may here be understood by external Remedies to signifie and intend every kind

of Medicament which cannot properly be referred to Chyrurgery, or those things that are inwardly taken, pro∣vided that they have their use in the Cure of this Af∣fect.

Therfore we divide it into two Kinds, namely, The manner of Exercise, and things externally Applicable.

The Manner, or Kinds of Exercise.

All kinds of Exercise, unto which Children are accu∣stomed, may be useful in their time and season. But becaus Children who are molested with the Rachites are somwhat avers from motion and by reason of their weakness of Spirit, and unaccustomedness of Exercise do scarce after the beginning of the cure, or indeed not at all endure violent motions; therfore they must begin perpetually with gentle Exercises, and afterwards pro∣ceed by degrees to stronger; in like manner at first they must continue but a short time, but afterwards a longer space without any intermission.

We therfore distinguish Exercises into gentle, and vehement or Masculine. The gentle we refer first to the manner of lying down. Secondly, To the agitation of the Body in the Cradle. Thirdly, To the carrying them about in the Nurses Arms. Fourthly, To seden∣tary pastimes.

First, Lying upon the Back among all the postures of the Body doth chiefly recede from Exercise, and is al∣most only allowable in the extream weakness of the Spirits, as in accute Feavers when the Spirits are spent, likewise in many cases of the Chest and Hy∣pochondriacal parts, as frequently in an inflamation of the Liver, Spleen, Lungues, in a Pleurisie, in the growing of the Lungues with the Pleura, and an Im∣posthume, &c.

The lying upon one side either right or left cometh neerest to the Supine Position, and participates very lit∣tle of the Nature of Exercise. Wherfore it is also allo∣wable in any great weakness of the Spirits, at least in re∣gard of altering the posture of the Body, as also when a profound sleep is not expected. Moreover, it is som∣what profitable to strong Bodies in the time of the first or second sleep, after just internals still changing sides. But afterwards perhaps it is not so agreable unto, nor beneficial for them, especially when the Body is fully refreshed with sleep. For then that posture is best which draweth neerest to the Nature of Exer∣cise.

The Simple Lateral Position containeth somwhat more of Exercise, and is inconvenient for weak Bodies and such as are not used to it in the time of profound sleep: but otherwise it may be made familiar, if for a while they will accustom themselvs unto it. It is at all times good for strong Bodies, provided that a due care be had to alter and vary it.

The lying on one side towards the Belly is laborious and troublesom, and not to be continued long by strong and robustious Bodies that are not used to it. But the molestation being overcome by custom, it is more easily tolerated: and becaus it easeth the pains in the Head, helpeth the Concoction of the Stomach, mi∣tigateth the pains of the Chollick, and loosneth a co∣stive Body, it may be somtimes useful when Nature is throughly satisfied with sleep, and in this affect it may supply the place of Exercise. For it somtimes hapneth in this Diseas, that Children for some time are not without disadvantage trusted to their own Feet, yea many times they gain more by rest than walking up and down. For walking rather confirmeth than cureth the

bended Joynts; but lying down, when the parts are well swathed, conduceth not a little to their erection. Then again, lying down helpeth very much to stretch and lengthen the short parts, as may be perceived by the growth of the parts in length after a Diseas. Third∣ly, Lying down, in regard of the common Coverings of the whol Body, advanceth an equal dispersion of the heat through all the parts. Lastly, lying down, if you observe a right way of placing and making the Bed, may contribute very much to correct the crookning of the Back-bone and the whol Body, for when they lie upon the gibbous and bunched Side, a little bag made for the same purpose may be laid under the parts sticking out, and so made fit that the gibbous parts may in a manner sustain the weight of the whol Body, and so they may be compelled as it were to straightness. But when Children roul to the other side, the bed should be so made, that if the little Pillow or Bay be taken away the hollow part should scarce touch the bed unless he con∣form himself to a straight line, that by his weight it may be depressed to a straightness.

Secondly, That kind of exercise which is performed by the rocking of the Cradle somwhat emulates this lying down. The Cradles are sustained upon two Arches, or two parts of a Circle: now the more they have of a Circle, the more effectually they exercise the Infant. This motion in time of sleep must be intermitted, or at least remitted; but whilst the Child waketh it must be somtimes intended, and somtimes remitted. It is most profitable for weak Infants that can scarce stand upon their Feet, or are otherwise hindred from waking.

Thirdly, The bearing them about in the Nurses Arms is almost agreable to the same Children; and under the same conditions: in like manner the rejoycing

of the Child whilst the Nurs singeth, either as it sits in her Lap, or is held up in her Hands, as also the tossing of it up and down, and waving of it to and fro, and if the Child be strong by holding it gently up by the Hands, if it be weak, under the Arms, yet so that the Thighs and the whol Body may hang down. Also the drawing of the Children backward and for∣ward upon a Bed or a Table between two Nurses, the one holding it by a Hand, the other by a Foot. The two last motions seem to contribute somwhat to the e∣rection of the crooked or bended Back-bone, especially if the Hand which is laid upon the depressed Shoulder, and the Foot which is belonging to the elevated Hip be drawn with more strength and vehemence than the o∣ther hand or foot. To the same end also tendeth the lifting up of the Child, taking him by his Feet only, so that the trunk of his Body and his Head may for a time hang down in an inverted posture; although indeed this action may also seem in some manner to relate un∣to the growing to of the Liver, if any such at that time be: as also that convolution of the Body, whereby the Head being lowermost the Feet are lifted up; and then again the Head being lifted up the whol Body is inver∣ted. Hitherto also may be referred that rouling of the Child, which som use, upon a Bed or Table, the Body being laterally declined: which we more approve if it be not rouled quite round about, but only backwards and forwards, laying a little hard Cushion underneath, wheron the gibbous part may rest, & sustain the weight of the Body. This exercise being rightly practised doth help much to straighten the Body.

Fourthly, Sedentery Games and pastimes are the least profitable among all exercises for Children that have the Rachites, and indeed they are only allowable to still

and quiet them. But the more beneficial wil be to tempt them to a frequent use of their Feet by playing some little Ball or Cat before them that they may be often kicking them. But if the Body of the Child be croo∣ked, such sports must be invented as may allure him to move his Body to the contrary side. When therfore one Shoulder is higher than another hold up som Gewgaw or Rattle before the Child that he may stretch out the Hand belonging to the lowest Shoulder to reach after the offered object. But a thousand such like inventions may be found out, and we leave them to the Nurses in∣dustry.

The Masculine Exercises of greater note we reduce to these three Titles.

1 To Going. 2 To an Artificial hanging of the Bo∣dy. 3 To Friction, rubbing, and contrectation of the Hypocondries and the Abdomen.

First, Ostentation or waking may be numbred amongst the more noble Exercises. For Children that are big and strong, and used to run up and down every day, do by walking and stirring about, the more easily rid away this Diseas. But this kind of Exercise must be refused unto them whose Joynts are not knit and confirmed, and whose Ankles, Knees & Back are so weak that they cannot sustain the Body. For when Children by the negligence of their Nurses are too soon committed to their Feet, it easily coms to pass, that they suffer those Joynts to be bended either inwards or outwards, back∣wards or forwards, and consequently they are the occa∣sion of that deformity which befalleth the Bodies of most men and women. Moreover, those Children which have already contracted such a bending in their joynts, either by the natural weakness and loosness of the Ligaments, or by the bad usage or indiligence of

their Nurses, must be trusted to exercise their Legs, till some splents or other instruments be provided, which may be able to erect the bended Joynts and to keep them in an erected posture. The driving of Children up and down in their Coaches or Chariots is much to the same purpose, provided that they be so contrived that there be no danger of stumbling or overthrowing.

Secondly, The artificial suspension of the Body is performed by the help of an Instrument cunningly made with swathing Bands, first crossing the Breast and coming under the Armpits, then about the Head and under the Chin, and then receiving the hands by two handles, so that it is a pleasure to see the Child hanging pendulous in the Air, and moved to and fro by the Spe∣ctators. This kind of Exercise is thought to be many waies conducible in this Affect, for it helpeth to restore the crooked Bones, to erect the bended Joynts, and to lengthen the short Stature of the Body. Moreover, it exciteth the vital Heat, and withal allureth a plentiful distribution of the Nourishment to the external and first affected parts: and in the mean time it is rather a pleasure than a trouble to the Child. Some that the parts may the more be stretched, hang Leaden Shoos upon the Feet, and fasten weights to the Body, that the parts may the more easily be extended to an equal length. But this exercise is only proper for those that are strong.

Thirdly, Friction or rubbing may in some manner be likewise referred to Masculine Exercises: nor in∣deed in respect of any active motion in the Child re∣quisite to the administration therof (for it is performed by an action of the Nurs rather than of the Child) but in respect of a like force and efficacy which it hath in the curing of this Affect. Now Friction seemeth to be

twofold, as partly belonging to the kind of Exercise, and partly to those things which are outwardly to be ap∣plied, for which caus we have reserved it unto this place, that it might be the last in the number of the Exercises, and immediately precede the external applications. This must be done (at least in the Winter time) by a warm fire, the Child being in all respects well fortified from the injuries of the weather, and the violences of the cold Ayr. Some Nurses administer this Friction with a hot hand, others with Linnen Cloathes dried and heated; others with woolen Cloathes; and o∣thers again with a little Brush, and indeed some do most commend the Brush, and prefer it before the other waies, but becaus there seemeth to be so little difference in all the waies, we approve them all, and leave the choice to the Nurses wisdom. But let them begin this Friction at the Back Bone, the Child being laid upon his Belly, and let them stir their Hands now up∣wards, now downwards, now on each side, then to the Thighs, Hips, Legs, Ankles, the Soals of the Feet, and all the parts of the Body, those excepted where there is a sticking out of the Bones, and there let them rub the hollow part of them. This action must not be conti∣nued beyond a moderate ruddiness raised in the parts, lest the Natural heat should be scattred, rather than che∣rished. This kind of exercise is most agreable to weak Children; and such as are scarce able to stand or go. For it supplieth the defect of running up and down, ex∣citeth the Natural heat, summoneth the Vital, and at∣tracteth the Nourishment to the affected parts. Yet we grant that Friction doth not so powerfully summon the heat and nourishment to the Flesh of the Muscles, al∣though perhaps it doth more to the Skin, as exercise doth properly so called, and consequently that it must

yield in dignity and nature to true exercises. To Fri∣ction also belongeth that contrectation of the Belly, or of the Abdomen and the Hypochondries, somtimes lifting up the Bowels, somtimes depressing them, som∣times removing them towards the right, somtimes to∣wards the left hand, and somtimes thrusting in the tops of the Fingers under the Bastard Ribs. And Physiti∣ans hope, and not without reason, that by this action they may deliver the Liver from any preternatural gro∣wing with the Peritoneum, if any such should chance to be. And here we note by the way that such growing of that Bowel may easily happen in this affect by reason of the greatness of the Liver and the stretching of the Hypochondriacal parts, wherupon the Peritoneum and the Membrane of the Liver are are most neerly and strictly conjoyned, and being conjoyned may remain long in the same Position, and so by the help of time they may easily grow together. This growing together in as much as it dependeth (as we have said) upon the stretching of the Hypochondries, and the bigness of the Liver, it may not incongruously be referred to the secondary Essence of this Diseas, namely, to the orga∣nical parts viciated, among which it deserves to be rec∣koned, although above we chanced to omit it in its proper place, and therfore we thought good to mention it here. Thus much of Exercises, now follow the Ex∣ternal Applications.