Praxis medicinæ reformata: = or, The practice of physick reformed Being an epitome of the whole art: wherein is briefly shewed, the true causes, signs, prognosticks, and cure, of most diseases. Published for the benefit of all persons. By Robert Johnson, Med. Professor.

CHAP. XXVII. Of the Rachites, or Rickets.

THIS Disease may be called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

It may be called in Latin morbus spinalis, it being a Disease of the Spine of the Back.

This spinal Disease is commonly called in English Rickets.

It is peculiar to Children, because they abound with a crude phlegmatick matter; for if they labour under a cold moist Distem∣per, there is presently a Penury and Paucity of the Animal Spirits; for the Brain, cere∣bellum, and spinalis medulla, being more com∣pact

than is wont, is unfit for percolation, so that the most spirituous part of the Bloud cannot pierce, or be strein'd through it: Hence the separation of the Animal Spirits is diminisht.

For the aforesaid cold, moist, phlegmatick Humours, compacting the soft substance of the Brain, &c. it is thereby too much thick∣ned and straitned in its porous passages.

The coldness of Air, Water, or Snow, ve∣hemently affecting the Head, seems to con∣firm and prove this opinion; because when the Glandules of the Brain are affected and thickned by a stuffing of the Head with Coldness, then a more sparing production of the Animal Spirits useth to follow.

The essence of this Disease consists not onely in the Animal, and vital, but natural Constitution also, all the Functions being (in time) vitiated: For the spinalis medulla being primarily affected, all the Nerves which proceed from it (in its passage through the spina Dorsi) must of necessity be stupifi'd, and vitiated with a loose Feebleness; hence also all the nervous, membranous, and fi∣brous parts, through which those Nerves are carried, or inserted into, must conse∣quently be vitiated with an inward weak Slipperiness; so that the very ends of the bones, as well as all the Faculties of the Bo∣dy, bear a share in this Distemper.

When the Rickets is confirm'd in Infants, it seems to have some affinity with divers other Diseases, viz. a Chronical fever, an extenuation or leanness of the Body, and an Hydrocephalus, and many more, which are frequently complicated with this affect.

And indeed not onely this, but most o∣ther * 1.1 Diseases (in process of time) do unite unto themselves other affects of a different kind, and therefore (for the most part) there is a complication of Chronical diseases before Death.

The Causes are either external, or in∣ternal. * 1.2

The external may be any of the Non∣naturals exceeding, either in excess or de∣fect.

All things cold and moist do powerfully contribute to this Disease, especially an over cold and moist Air, which is most frequent in the Spring; the Air being then cloudy, thick, rainy, and full of vaporous Exha∣lations.

Hereupon the Children of those which inhabit near the Banks of the Sea, or great Rivers, Ponds or Marshes; (that are ob∣noxious to too much Rain, or are fed with a great Number of Springs) are more or less subject to this affect; for by the Con∣tinuance of such cold and moisture, the Bloud and Humours becomes too slippery, and

therefore (in their Circulation) they must unavoidably cause a softness and looseness in all the parts.

Also experience testifieth that those Chil∣dren which are born, and nursed near the Lead-mines in Derby-shire, &c. are generally affected more or less with a languidness of the Limbs.

For the Air being infected with noxiousme∣talline Exhalations, which (for the most part) fight against the inherent Spirits of the parts, by a kind of venemous malignity; by which the spirituous pulsificative Force of the external parts is extinguished, and the strength of the Limbs, and whole Body much weak∣ned and diminish'd.

Hither we may also refer fine soft Linen, applied actually cold and moist, (being not well dried by reason of the moistness of the weather) to the Spine of the Back, which is near the Original of the Nerves; the use thereof being too long continu'd, it cherish∣eth the Roots of this Disease in that tender Age.

Likewise Aliments of any kind, which are too moist and cold; or too thick, viscous and obstructive, do manifestly cherish this Distemper.

And I am induced to believe that Ebriety in English people, especially the Gentry; and eating of much Flesh; and not using frequent

labour, or exercise, may be a reason why this Disease is more common and natural to Children in England, than in other Regions, perhaps far exceeding it both in cold and moisture; as Scotland, Holland, &c. wherein this affect hath not been observ'd to be very common.

And therefore ebriety and eating of much Flesh, and defect of motion, and want of exercise doth most frequently, and most effectually concur to the production of it; because the inherent heat (in stupid and sluggish People) is not sufficient to resist and expell the superfluous moisture by a due transpiration: By which means the Circula∣tion of the Bloud is become slow and lesned, and the production of the vital heat very feeble, and weak; so that nature is thereby forced to permit all the parts of the Body to be affected with a certain softness, looseness, and internal lubricity, more than is meet; which do sufficiently evince, that this is an efficacious cause, and a part of the essence of this Disease.

Hence we may easily infer that the Chil∣dren of such Parents are more inclined to this distemper, than others who drink mo∣derately, and eat less Flesh, and are more active and lively.

The internal Causes, are excrementitious Humours luxuriant in the Body, especially

Phlegm and serous humours retained, and vitiated, being naturally cold and moist, and little spirituous, and affected with an internal slipperiness, wherefore upon a su∣perfluous accumulation of these humours, the production of this affect succeedeth; because thereby a Colliquation of the parts, and a dissipation of the inherent Spirits will be easily introduced; whereby all the parts will afterwards be rendred obnoxious to this cold and moist Distemper.

Many diseases preceding this affect, may be the cause of it; especially those which do extenuate, and much weaken the Body, as all Fevers, &c. And also all cold and moist, phlegmatick, and cachochymick Distempers, which will induce a stupour and dulness in the affected parts, and cause obstructions.

Also any great Pain, Inflammation, Tu∣mour, Fracture, Luxation, or any other pre∣ternatural affect, that hinders the standing and playing of the Child, may be some cause of this Disease.

Presently after the beginning of the Di∣sease, * 1.3 a kind of slothfulness and numbness doth invade the Joints, and by little and little is increased, so that daily they are more and more averse from motion; besides in the beginning of this affect, there is usu∣ally observ'd, a certain laxity, softness, and flaccidity of all the first affected parts; af∣ter

which followeth a great debility, lan∣guidness, and enervation of all the parts subservient to motion; so that (for the most part) they speak before they walk, which is vulgarly held to be a bad Omen; and if it vehemently increase, they do not onely to∣tally lose the use of their Feet, but can scarce sit with an erected posture, and their weak and feeble Neck can hardly sustain the Bur∣then of the Head.

In the progress of the Disease, the Head and Face increaseth in bigness, but the fleshy parts below the Head, are daily more and more worn away.

There is also observ'd in this affect, cer∣tain swellings, and knotty excrescencies about some of the Joints; these are chiefly con∣spicuous in the Wrists, and somewhat less in the Ancles, and in the tops of the ribs; the Bones in the Armes and Legs, and sometimes the Thighs, and Shoulder-bones wax crook∣ed; the Teeth come forth slowly, and with greater trouble than usual, and at length the Breast becomes narrow, and the Abdomen swollen, with an extension of the Hypochondriacal parts, which hindreth the free motion of the Diaphragma downwards; and by consequence doth somewhat inter∣rupt the breathing, so that respiration be∣comes difficult, accompanied with cough∣ing, the Pulse being also weak and small;

and in the increase of the Disease, all these signs become more intense and evident, and many, and more grievous, are daily accu∣mulated.

1. If this Disease be light and gentle, the * 1.4 Children affected therewith may be easily restored to health; sometimes by the sole benefit of Age, the vital heat being increa∣sed, and summoned forth to the external parts by the force of frequent exercises.

But if it so vehemently prevaileth, that the increase thereof cannot be prevented by the best internal means, and also most prudent applications, then there is immi∣nent danger.

2. If it proceed from other Diseases, or be complicated with them, it will be the more difficult of curation; especially if the Bones of the Armes, and Legs be crooked, and there be great bending and tumour of the Joints of the Wrists, Ancles and Ribs.

But if the Symptoms decline, and the Child do easily endure agitation, and have often eruptions in the Skin, as Wheals, Pim∣ples, or Itch, then there is great hopes of recovery.

3. If they be not cured in five years, they will grow deformed and crooked, and (for the most part) will become dwarfs, and live sickly, being either Cachectick, or Phthi∣sical, till death do put a Period to their mi∣serable Life.

As for the Cure of this disease, both the Child and Nurse must keep a good diet * 1.5 which is easie of Concoction.

In the mean time you must not neglect the best Chyrurgical and Pharmaceutical means which will most conduce to the spee∣dy recovery of the weakly Infant.

Universals being premised, the most effec∣tual and approved Chyrurgical means in this affect, are Incision or Scarification of the Ears, and little Fountains or Issues; al∣though many more may be used, viz. Frixi∣ons, Blisters, Ligatures, &c.

Incision or Scarification in the Ears, is to be performed on the Ridge, in the inside of the Ear above the hole; which must be stopt to hinder the Bloud passing into it.

This Operation must be often repeated, at least once or twice in a month; which hath proved successull when many other remedies have been ineffectual.

And here it may be noted, that Scarifica∣tion being made in that place, must needs be of greater efficacy than if it were instituted in any other part of the Ear, or elsewhere.

1. First, Because the beginning of the fifth pair of Nerves is near that place, many of their Branches being distributed through the hollow of the Ear, and are thence convey∣ed into the Spinalis medulla, from whence it shooteth out little Branches which accompa∣ny

the Nerves of the marrow of the Back, to the ends of the very Legs and Feet; as ma∣ny ingenious Anatomists have accurately ob∣serv'd.

Wherefore Scarification being there made, it is probable, that the matter (which com∣monly oppresseth the very beginning of that Nerve) is immediately evacuated, by which it is freed from obstruction; and having al∣so gotten vigour (being excited by the pain and Inflammation) it driveth out all stupid∣ness from within it; by which means the Branches of the Nerves from thence arising, which are communicated to the Spinalis me∣dulla, and many other parts may be in some measure excited also.

2. Because by this means, there is a par∣ticular evacuation of the Head, which is wont to be oppressed with fullness in this affect.

Besides, the Bloud being somewhat lesned, the thickness and toughness thereof must thereby be corrected; and (by consequence) an equal distribution of it promoved to a more regular nourishment of the parts.

Issues in the Neck are also much approved in this disease, because they very much con∣duce to lessen the unusual magnitude of the Head, and to evacuate the superfluous watriness thereof, and repress the inordi∣nate increase of the bones; also it manifestly

drieth up the too much humidity of the spi∣nal Marrow, exciteth heat, strengthens the Nerves, and expelleth the astonishment.

As for the Pharmaceutical or Physical means, you must be sure to cleanse the first passages either by Clysters, Vomits or Leni∣tive purgations.

When the Belly is Costive and the excre∣ments are hardned, or some flatuous hu∣mours afflict the Bowels with vehement pain, then Clysters are chiefly required; and they may also be injected before any preparation, Vomit or Lenitive purgation.

I need not prescribe any forms, because a little Milk and Sugar, with a few Anise∣seeds boiled in it may serve.

Also an Emollient or Carminative Clyster (that is gentle) may be injectrd when there is occasion.

Emeticks if well prepared, and prudently administred are very efficacious, and will conduce much to the Cure.

And here I again commend Antimonial Vomits before all others.

1. First, because they not onely power∣fully evacuate Crude or corrupt humours, and all manner of impurities contained in the Stomach by Vomit; but by an agita∣tion and commotion, raised in all the parts, especially in the Bowels, they loosen the gross and viscous humours adhering to the

Guts, and convey them through their many involutions and labyrinths, by which they are expelled by Stool; in which respect they are also profitable against torments of the Colick, and very conducible to unlock obstructions.

2. They most effectually irritate the ex∣pulsive faculty of all the parts of the Body, by which they compell forth the hidden and unappearing causes of diseases, especi∣ally of intermitting Fevers; for by the very straining to Vomit, the Guts are also in∣stimulated to cast out by siege; the Liver poureth away the Choler by the Biliar pore; the juice of the Pancreas is voided into the small Guts; the Spleen perhaps doth unbur∣then its excrement into the Stomach; the Kidneys exern through the Ureters; the Lungs by a strong Cough eject their Phlegm through the Wind-pipe; the Head emptieth it self of salt waterish Rheums by the Palate, Nostrils and Eyes; finally the whole Body (for the most part) is rendred more prone to a Diaphoresis, either by a manifest sweat∣ing, or else by insensible transpiration.

If any are afraid of Antimonial prepara∣tions (though most safe and potent) they may administer Salt of Vitriol, from five to ten grains, either in Posset-drink or any o∣ther convenient Vehicle.

Also the following may be safely admi∣nistred.

Take the clarified Juice of Asarabacca half a drachm; Syrup of the Juice of Sorrel * 1.6 two drachms; mix it, and give it in the morning fasting.

But here we may note, that vomiting is * 1.7 not to be provoked in very weak Children, unless they are naturally apt to Vomit, and the humours tend upwards of their own ac∣cord, and they easily indure it; and then they ought to be gentle and given in a small dose.

Those that are averse to vomiting may take lenitive Catharticks, which must be made pleasant and potable, that the young Patient may not loath the taking of them.

Manna, Syrup of Cichory with Rhubarb, Syrup of Violets and Syrup of Roses solutive are all good pleasant medicines; which you may mix according to your discretion, in any proper distill'd water, or in the decoc∣tion of sennoe Gereonis.

The following drink is of excellent virtue, and will conduce much to the Cure of this disease.

Take of Anise-seed, the Barks of Ash, Ivie, * 1.8 Tamarisk, Shavings of Harts-horn and Ivo∣ry, the Roots of Sassaphras, Liquorish, Chi∣na, Sarseparilla, Butterbur, of each half an ounce; Mace one drachm; let them be clean∣sed, bruised and infused in two quarts of small Ale for two or three days; then strain

it out very strongly, and bottle it up for the Child's ordinary drink.

In the Cure you must endeavour to re∣sist all symptoms, as Fluxes, Worms, Venereal affects, breeding Teeth with great pain, &c.

In any Flux, Gripes or urgent pain, you may give half a grain of Laudanum opiat. dis∣solved in any convenient Vehicle, so often as necessity urgeth.

If Worms or venereal affects be fear'd, you may sometimes adminster this gentle purging Bolus.

Take of Mercur. dulcis six grains; Diagre∣dium, * 1.9 Rezin of Jallop, of each three grains; with Syrup of Roses solutive, make it into a Bolus; give it in the morning fasting.

In your Broths and Panadoes, you may boil Harts-tongue, Ceterach, Liver-wort, Maiden-hair, Sage, the Bark of Tamarisk, red Sanders, Saffron, the Roots of China, and Sarseparilla, &c. but let all things be made acceptable to the Palate.

All kinds of exercise unto which Children are accustomed, may be usefull in their time and season; as Rocking, Going, Swinging, Playing, &c.

Also Frixions are excellent, in which be∣gin at the Spina dorsi, and rub with a course warm linen Cloth, and also under the Short-ribs, and afterwards all other parts; let it be done gently, to cherish and incite

the natural and vital heat, and attract the Nourishment to the affected parts.

External Medicines may be also applied, to strengthen the weak parts, as Emplasters, Ointments, &c.

These forms may serve for Example.

Take Ointments of the opening Juices, * 1.10 Tobacco, Marsh-mallows; Oils of Capers, Wormwood, Elder, Earth-worms, Bricks, Balsam of Peru, of each half an ounce; mix it.

With which let the weak parts be anointed with a warm hand, before a Fire.

Take the Plasters Nervinum, De minio, ad * 1.11 Herniam, of each one ounce; the Carmina∣tive Plaster of Sylvius, Balsam of Peru, of each two drachms; mix it, and spread it on thin Leather.

It may be applied to the Back, or any o∣ther weak part after anointing.

If the Lungs be affected, anoint the Breast with the following Ointment.

Take the pectoral Ointment two ounces; * 1.12 Oil of Mace by expression, Oil of Violets, of each half an ounce; mix it.

After which apply a Plaster.

They that desire more variety of Medi∣cines, &c. let them peruse that excellent and learned tract of the Rachites written by the famous Doctours and Fellows of the College of Physicians at LONDON.

Ornari res ipsa negat, contenta doceri.

Notes

• * 1.1

  Observa∣tio.
• * 1.2

  Causes
• * 1.3

  Signs.
• * 1.4

  Progn.
• * 1.5

  Cure.
• * 1.6

  Vomit.
• * 1.7

  Observa∣tio.
• * 1.8

  Infusion.
• * 1.9

  Purging Bolus.
• * 1.10

  Linament
• * 1.11

  Plaster.
• * 1.12

  Pectoral Ointment.