A Treatise of the RICKETS: Being a Disease common to CHILDREN. Wherein (among many other things) is showed, 1. The Essence 2. The Causes 3. The Signs 4. The Remedies of the Disease. Published in Latin by Francis Glisson, George Bate, And, Ahasuerus Regemorter; Doctors in Physic, and Fellows of the College of Physicians at London. Translated into English by Phil. Armin. LONDON: Printed by Peter Cole, at the sign of the Printing-Press in Cornhill, near the Royal Exchange. 1651. The Preface to the Reader. Courteous Reader: BEfore the space of five years, we have mutually communicated by written Papers something concerning this Affect in private meetings (which some of us Physicians use sometimes to have for Exercise-sake in the works of Art) When thes things had opened a way in some sort to the deeper enquiry and search after the condition and cure of this Disease; We thought it might prove a very successful undertaking to recall those Papers once again to a Review; and (those things being called out which might be best accommodated to this use) to prepare a perfect Tractate of this Disease. That Care by common suffrage was entrusted to Dr Glisson, Dr Bate, and Dr Regemorter, who purposed at first to divide this business among themselves according to the parts of the future Tractate, and to assign to each one his proper task. But when Dr Glisson in the judgement of the rest had accuratly interweaved his part (which comprehended the finding out of the Essence of this Disease) and in that had propounded many things different from the common Opinion of Physicians (though perhaps the less different from the truth) we altered our Resolution, and committed the first Stuff of the whole Work to be woven by him alone, lest at length the parts should arise deformed, misshapen and heterogeneous to themselves. He accepted the offer, but with this condition, that whilst he was employed in beautifying and adorning this part, the other two should often hold consultation with him, and confer unto the Wouf their Covenanants of free commerce by their own observations concerning this Affect, and that those things which should be delineated and shaped by his labour and study, should presently undergo the examination and judgement of the rest, as if they had been fashioned by their hands. And so at the length we have brought this Work (such as it is) to perfection, and have offered it to the public view, being by no means moved thereunto by an itch of writing (which is the Epidemical ill custom of this age) but by this Consideration only, That because we are not born for our selus, we might make these (such as they are) common, which in some measure may advance the health of Infancy and tender age (in which for the present a great part of Mankind, but for the future all Mankind is comprehended) and likewise propagate an Encreas unto Learning: with this hope also, That by this Example we may invite the Wits of other most learned men to make inquisition into the Essences of Diseases and their Causes, and to examine these our Labours that posterity may enjoy them yet more perfect. But the obscure Essence of this Disease, and this our daring to tread in unbeaten paths (were we silent) might obtain a pardon, and modestly challenge a candid interpretation for all defects, lapses, and errors in these our Endeavours. Finally, expect no flashes of Rhetoric and Courtly-Language; Nobis non licet esse tam dicertis, Musas qui colimus severiores. And indeed the condition of the matter forbids all such Painting; in such a manner, Ornari res ipsa negat, contenta doceri. Farewell (kind Reader) and peruse them as we dedicate them, that is, with an ingenious and candid mind. F. G. G. B. A. R. The Names of those Doctors who by written Papers contributed their Observations to our first Exercise upon this Affect. Dr Francis Glisson. Dr T. Sheafe. Dr G. Bate. Dr A. Regemorter. Dr R. Wright, dead. Dr N. Paget. Dr J. Goddard. Dr E. Trench. Fellows of the College of Physicians at London. The Names of several Books printed by Peter Cole, at the sign of the Printing-Press in Cornhill, by the Exchange, LONDON. Three several Books, by Nich. Culpeper, Gent. Student in Physic and Astrology. 1 A PHYSICAL DIRECTORY: Or a Translation of the Dispensatory, made by the College of Physicians of London. Whereunto is added, The Key to Galen 's Method of Physic. 2 A DIRECTORY for Midwives; or a Guide for Women. 3 An EPHEMERIS for the year 1651. Amplified with Rational Predictions from the Book of the Creatures. 1 Of the State of the Year. 2 What may probably be the effects of the Conjunction of Saturn and Mars, July 9 1650. in Scotland, Holland, Zealand, York, Amsterdam, etc. and about what time they may probably happen. To which is joined, An Astrologo-Physical Discourse of the Humane Virtues in the Body of Man. A Godly and Fruitful Exposition, on the first Epistle of Peter. By Mr. John Rogers, Minister of the Word of God at Dedham in Essex. An Exposition on the Gospel of the Evangelist St. Matthew. By Mr. Ward. Seven Books of Mr. Jeremiah Burroughs lately published; As also the Texts of Scripture upon which they are grounded. 1 The Rare Jewel of Christian Contentment, on Phil. 4. 11. Wherein is showed, 1. What Contentment is, 2. It is an holy Art and Mystery, 3. The Excellencies of it, 4. The Evil of the contrary sin of Murmuring, and the Aggravations of it. 2 Gospel-Worship, on Levit. 10. 3. Wherein is showed, 1. The right manner of the Worship of God in general; and particularly, In Hearing the Word, Receiving the Lord's Supper, and Prayer. 3 Gospel-Conversation, on Phil. 1. 17. Wherein is showed, 1. That the Conversations of Believers must be above what could be by the Light of Nature, 2 Beyond those that lived under the Law, 3. And suitable to what Truths the Gospel holds forth. To which is added, The Misery of those Men that have their Portion in this Life only, on Psal. 3. 20. 4 A Treatise of Earthly-mindedness. Wherein is showed, 1 What Earthly-mindedness is, 2 The great Evil thereof, on Phil. 3. part of the 19 Verse. Also to the same Book is joined, A Treatise of Heavenly-mindedness, and walking with God, on Gen. 5. 24. and on Phil. 3. 20. An Exposition, on the fourth, fifth, sixth, and seventh Chapters of the Prophecy of Hosea. An Exposition on the eighth, ninth, and tenth Chapters of Hosea. An Exposition on the eleventh, twelfth, and thirteenth Chapters of Hosea. Twelve several Books of Mr. William Bridg, collected into one Volumn. Viz. 1 The great Gospel-Mystery of the Saints Comfort and Holiness, opened and applied from Christ's Priestly-Office. 2 Satan's Power to Tempt; and Christ's Love to, and Care of his People undar Temptation. 3 Thankfulness required in every condition. 4 Grace for Grace; or, The Overflowings of Christ's Fullness received by all Saints. 5 The Spiritual Actings of Faith, through Natural Impossibilities. 6 Evangelical Repentance. 7 The Spiritual-Life, and In-Being of Christ in all Believers. 8 The Woman of Canaan. 9 A Vindication of Ordinances. 10 Grace and Love beyond Gifts. 11 The Saints Hiding-place in time of God's Anger. 12 Christ's Coming is at our Midnight. Six Sermons, Preached by Dr. Hill, collected into on● Volumn. Dr Sibbs on the Philippians. The Best and Worst Magistrate, by Obadiah Sedgwick● The Craft and Cruelty of the Church's Adversaries, b● Matthew Newcomin. A sacred Panygrick, by Stephen Marshal. Barriffs' Military Discipline. Dr Ponnet's Treatise of Politic Power. The Immortality of Man's Soul. The Anatomist Anamized. Cum multis aliis— A Treatise of the RICKETS. CHAP. I. The Antiquity and first Origine of this Disease, the Name of it, and the Derivation of the Name. THAT some new Diseases altogether unknown to the Ancients, have, for some Ages lately passed invaded divers parts of Europe, is a known & undoubted truth (whether we attribute it to the vicissitude of things, or impute it to the Sins and Impieties of men, and their corrupt manners) as the French-pox, the Scurvy, the * A most loathsome and horrible Disease in the Hair, unbeard of in former times, bred by modern luxury and excess: It seizeth specially upon Women; and by reason of a viscous venomous humour, glues together (as it were) the hair of the head with a prodigious ugly folding & entanglement: sometimes taking the form of a great Snake, sometimes of many little serpents: full of nastiness, vermin, and noisome smell: And that which is most to be admired, and never eye saw before, pricked with a needle, they yield bloody drops. And at the first spreading of this dreadful Disease in Poland, all that cut off this horrible and snaky hair, lost their eyes, or the humour falling down upon other part of the body, tortured them extremely It began first, not many years ago, in Poland: It is now entered into many parts of Germany H Saxo▪ Professor of Physic in Milan. Plica, and the like; in which number this very affect we are now about to handle may be justly Registered. For if we examine all the diseases of Infants & children described either by the Ancients or Modern Writers in their Books of the Diseases of Infants, we shall meet with none which with a sufficient exactness doth delineate the condition and Idea of this evil. For although it may seem to hold a correspondence, or to have some affinity with a chronical Fever, a Consumption, the extenuation or leanness of Infants, and the ‡ A Disease in the head, coming from Rhewm. Hydrocephalos; yet to speak truth it is an affect evidently different from them in the Species. For you may observe many to be vehemently afflicted with this Malady without any Feaverishdistemper, or any cause of such suspicion: in like manner although a Consumption doth frequently supervene upon this Disease before the dissolution of the Patient, yet is it seldom seen to accompany the first invasion thereof, as for the meagerness or leanness, although some parts are perpetually observed in this affect to be made lean, yet this doth not happen in all alike, as in a right and true leanness, but you may perceive the parts about the head and face to be in a thriving condition as to outward appearance, and well complexioned, even to the last day of life. Finally, The Hydrocephalus is very frequently complicated with this affect, yet we have dissected some whose Brain hath been sufficiently firm, and not overmoistned with this superfluous humour. Some have conjectured that this Disease is an imp or fruit of the French-pox or Scurvy, descending from the vitiated Bodies of the Parents upon the Children: For we deny not but the Parents, being infected with the Scurvy or the venerous Pox, may propagate and bring forth an Issue, not only affected with that Pox & Scurvy, but likewise infected with this evil, and this even hath also fallen under Observation: yet for the most part this Disease in the propriety of its Essence, hath neither affinity nor familiarity with those affects, and besides it requireth a different progress of cure; we have sometimes likewise observed a strumatical and swelling Malady to be complicated with this; but we have also many times beheld this to be well distinguished from that, and that from this. But why do we dwell so long upon this inquisition? seeing that he, who will accurately contemplate the signs of this affect, as in their due places they shall be propounded, may most easily persuade himself, That this is absolutely a new Disease, and never described by any of the Ancient or Modern Writers in their practical Books which are extant at this day, of the Diseases of Infants. But this Disease became first known (as near as we could gather from the Relation of others after a sedulous enquiry) about thirty years since in the Counties of Dorset and Somerset, lying in the western part of England; since which time the observation of it hath been derived unto other places, as London, Oxford, Cambridge, and almost all the Southern and Western parts of the Kingdom: in the Northern Counties this affect is very rarely seen, and scarcely yet made known among the Vulgar sort of people. The most received and ordinary Name of this Disease is, The RICKETS: But who baptised it, and upon what occasion, or for what reason, or whether by chance or advice it was so named, is very uncertain▪ However it obtained that Name, yet in so great a variety of places through which it hath ranged, it hath not to this day been known by any other Denomination. But it is an accident well worth our admiration, That this Disease being new, and not long ago nameless, at least not known by this Name, neither spreading so much in remote as in adjacent places, yet no man hitherto could be found out, who knew, or could show, either the first Author of the Name, or the Patient to whom the appellation of the Disease was first accommodated, or the peculiar place where it was done, or the manner how it come to be dispersed among the common people: for the inhabitants having gotten a Name for the Disease, receive it with acquiescence as a thing done with diligence and deliberation, and are not at all further solicitous either about the Name, or the Author of the Name. But because they which are expert in the Greek & Latin tongues, may peradventure expect a Name from us, whereof some kind of Reason maybe given, we have made fit together divers Names to this Disease, yet we conceive it somewhat unnecessary to make a particular rehearsal of them in this place: Nevertheless it may perhaps be proper and profitable to commemorate the Rules which we propounded to ourselves in the designation of the Name: The First therefore was, That the Name should comprehend some notable condition of the Disease. The Second was, That it should be sufficiently distinct from the Names of other Diseases and Symptoms. The Third was, That it should be sufficiently familiar, easy of pronounciation, accommodated to the Memory, of no undecent length, and not studiously, and laboriously compounded. Whilst we bend our employments to the satisfaction of these Rules, One of us by chance fell upon a Name which was complacenceous to himself, and afterwards pleasing to the rest; now this was 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉. or indeed 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 (for that termination is not altogether abhorrent from the common Gender) the Spinal Disease, also 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, the disease of the Spine of the Back: For the Spine of the Back, is the first and principal among the parts affected in this evil. Then no other Malady or Symptom did by the prerogative of time vindicate this appellation from it; besides the Name is familiar and easy. And finally, The English Name Rickets, received with so great a consent of the people, doth by this Name seem to be excused, yea, justified from Barbarism. For without any wracking or convulsion of the word, the name Rickets▪ may be readily deduced from the Greek word Rachitis, or Rachites; provided, That we will but allow that consideration of change, which in vulgar pronounciation usually happeneth to words transplanted from one Language to another. Object. You will say, That they which imposed first the English name Rickets, were peradventure altogether unskilful in, and ignorant of the Greek tongue, or that they never thought of the Greek word Rachites, at least understood not that the Spine of the Back was the principal among those parts which were first affected in this Disease? Answer. We Answer, It concerns not us whether they were ignorant of, or thought not upon the Greek word, or whether they did not understand the principal part that was first affected; yet are thes things freely asserted. For we knew many at that time when the Disease did first spring up, and the Name was imposed, indeed learned men and skilful in the Greek tongue, to have their Residence in those places, to whom it was not perhaps any difficulty to observe that conspicuous debility of the Spine in this affect, and thereupon they might assign this Name unto it; although 'tis very possible, yea probable, That the common people by the error of pronounciation might somewhat pervert the Name so given, and express it, as to this day they retain it by the word Rickets. But whether it were, or were not so, we are not at all solicitous. If the matter were so, the imposed Name will (as is manifest) be altogether congruous, and perhaps also at the last will most fitly correspond with it. For suppose you should fall upon some Name, received not so much by choice as chance, yet so fit, that a more comodious Name could scarce be devised by council and deliberation, nor one more consonant to Reason; in such a Case, What would you do? Would you extirpate and banish the received word, to introduce one that was new and nothing better? This practice would usurp upon the privilege of Conversation, and be injurous to the custom of Speaking: Words contract a value by their use, and ought not to be denizened with rashness, or innovated by timerity: Or would you not rather confirm the Name received, yet as a new one, and from that time to be deduced from a new Origine: for this would be at the least like a chosen Science inoculated upon a new stock, which by reason of the affinity with the Root, would without any difficulty receive strength and nourishment: Or if this please you not, suppose if you please, That we now newly devised the English name of this Disease, and deduce it from the Greek word Rachites: the English word resulting from hence would be the Rachites: and how little is the difference between that and the ordinary word Rickets? Certainly so little, That the vulgar pronounciation is not wont to be greatly solicitous about so small a difference: But we trifle too much in staying so long upon these trifles. Let the Greek Name therefore of the Disease be nósos Rachitis, or Rachites (if the word may be allowed to be of the common Gender) or taes Rácheos; in Latin Morbus Spinali●, vel Spine Dorsi: and by coining a Latin Substantive out of the greek Adjective Rachitis— idis let the ordinary English name Rickets be retained, or in stead of it, to gratify more curious ears, you may substitute the Rachites. And thus much, if not too much, of the Name. CHAP. II. Anotomical Observations collected from the Dissection and Inspection of Bodies subdued and killed by this Disease. BEfore we attempt an enquiry into the Nature and Causes of this Disease, we hold it convenient to premise some few certain and undoubted things, as being obvious to the Senses, which both demonstrate the real existence of this Disease, and may also be cast for a foundation, whereon to build the Superstructure of our judgement & opinion concerning this new Disease. For we would not have any man to imagine that we here treat of some Fictitious & Imaginary Evil, much less to expect that our Opinion should be credulously embraced without examination. But this we rather aim at, That the matter of our Discourse to all possibility may be known and preconceived in the very entrance, that we may confirm those things which we shall propose, by those things that are obvious to the Senses, as occasion shall require; and that the Reader being instructed in these, may become a competent judge of our Reasons, and with the more facility be able to interpose his judgement concerning each of them. We attest therefore that many of us have been present at several Dissections of Bodies which have been separated by this Disease, and that we will in this Chapter briefly and faithfully declare those things which we have hitherto Observed by long experience and frequent Dissections, namely, Those things which we have seen with our eyes, and have handled with our hands. In the mean time Two things are here to be premonished: The former is, That the Reader carry in his memory, That the dead Bodies which we opened were most vehemently afflicted with this disease whilst they were animated, for they are supposed for the most part to have yielded to the very magnitude of the Disease, and therefore he must not expect that magnitude of the Affect or Symptoms which we here describe, in other Bodies yet living or newly besieged. For every Disease is moved to a Consistence, and then also Nature being oppressed and unable to maintain the conflict groweth worse and worse. The latter is that the Reader take notice, That almost all Diseases in process of time, do unite unto themselves other affects of a different kind, and therefore that chronical Diseases are for the most part complicated before death: Let him not therefore imagine that every preternatural thing that is found in dead Bodies, though destroyed by this affect, must of necessity belong to this evil; for perhaps it may rather have reference to some other Disease supervenient upon this before death, then to this very Malady: And the truth is, Anatomists through inadvertency, and want of due regard to this Caution, have foully ered in their Observations, whilst they ascribe those things which concern another Disease, to another wherewith it was complicated before the dissolution. The best prevention therefore or rectification of this error is, Not to make a rash judgement from the inspection of one or two bodies, but first by a reiterated and sedulous experiment, to be able to distinguish what things perpetually occur, what for the most part, what frequently, and what but seldom, in the dissected bodies that have perished of the same Disease: for you must know, That whatsoever is not perpetually conspicuous in the opened Bodies dissolved by the same Disease, cannot appertain to the intimate and chief Essence of it: for neither the Disease itself can have an existence being separated from its Essence, nor the Essence being separated from the Disease. But enough of these things; let us now proceed to the Observations themselves. These our Anatomical Observations are distinguished into those which do extrinsecally occur, the Body being not yet opened, and those which present themselves only upon the Dissection of the Body. I. These of the former kind are they which are outwardly visible upon the first appearance of the naked dead Body. 1 An irregularity, or disproportion of the parts; namely, The Head bigger than ordinary, and the Face fat and in good constitution in respect of the other parts. And this indeed hath appeared in all those whom hitherto we have beheld to perish by this affect, one only excepted, who together with this Disease had suppurated Lungs, and was pined and disfugured with the Physic. Yet he also throughout the whole progress of the Disease, was full faced, and had his head somewhat big; but for about fourteen days before he Deceased, on a sudden all the fleshy parts about his head consumed away, and his face was like the picture of Hypocrates, not without the just wonder of all those who beheld so sudden a change. 2 The external members, and the muscles of the whole Body were slender and extenuated, as if they had been wasted with an Atrophy, or a Consumption. This (for so much as we know) is perpetually observed in those that die of this Disease. 3 The whole Skin, both the true, and also the fleshy and fattish Membrane, appeareth lank and hanging, and lose like a Glove, so that you would think it would contain a far greater quantity of flesh. 4 About the joints, especially in the wrists and ankles certain swellings are conspicuous, which if they be opened, not in the fleshy or membranous parts, but in the very ends of the bones, you may perceive them to be rooted in their appendances; and if you will file away those prominencies of the bones, you will easily perceive them to be of the same similary substance with the other parts of the bones. 5 The articles or joints, and the habits of all the external parts are less firm and rigid, and more flexible then at another time they are observed to be in dead bodies; and in particular the Neck after death is scarce stiff with cold, at least much less than in other Carcases. 6 The Breast is outwardly lean, and very narrow, especially under the arms, and seemeth on the sides to be as it were compressed, the ‡ That part of the breast where the ribs meet. Stern also is somewhat pointed, like the Keel of a Ship, or the breast of a Hen. 7 The top of the ribs to which the stern is conjoined with gristles, are knotty, like unto the joints of the Wrest and Ankles, as we have already said. 8 The Abdomen indeed outwardly in respect of the parts continent is lean, but inwardly in respect of the parts contained it is somewhat sticking out, and seemeth to be swelled, and extended. And these have been our Observations before the opening of the bellies. II. The Abdomen being opened, we have Noted these things: 1 The Liver, in all that we have dissected, hath exceeded in bigness, but was well coloured, and not much hardened, nor contaminated by any other remarkable vice. We desire some bodies should here be excepted, in which other Diseases before death were complicated with this, as in a Dropsy & an extreme Consumption we remember to have happened. 2 The Spleen (namely so far as hitherto it hath been lawful for us to observe) for the most part is not to be contemned, whether you consider the magnitude, the colour, or the substance of it; notwithstanding we do not deny but it may otherwise happen in regard of a complication with other Diseases. 3 We have sometimes espied a wheyish water to have glided into the cavity of the Abdomen, but indeed not often, nor in any great plenty. 4 The Stomach and Guts are somewhat more infected with flatulent humours, then sound bodies usually are, which partly may be the cause of that extension of the hypochondriacal parts above mentioned. 5 The Mesentery is sometimes faultless, and sometimes affected with glandulous excrescences bigger than ordinary, if not with swelling bunches: But concerning the sweet-breadwe declare nothing for a certainty; only we suspect that obstructions, if not a schirrhus, may sometimes invade that part. But thus we delegate, to the enquiry of others. 6 The Kidneys, Ureters, and Bladder, unless there be a concomitancy of some other Disease, are laudably sound. We observe in general of all the Bowels contained in this Belly, that although the parts containing them, as we have noted above, are very much extenuated and emaciated, yet are they as large and as full, if not larger and fuller, than those seen in sound bodies, as hath been said of the Liver. III. The Stern being with-drawn, these things have presented themselves in the breast. 1 A certain adherence or growing to of the Lungs with the ‡ A thin and smooth skin which clotheth the ribs in the inner side. Pleura which hath been more or less discernible in all the Bodies which hitherto we have cut up. Yet we suppose that this affect may happen without any such nourishment, although in the advancement of the Disease for the most part it cometh before the Patient die. 2 The stopings or stuff of the lungs are no less frequent, especially in those coadhering parts. Hard humours also engendered by a thick, viscous, and blackish blood, sometimes in one, sometimes in many of the strings of the Lungs, yet are not these always conspicuous, many times also Imposthums and Ulcers. 3 One amongst us doth attest, That he once saw glandulous knobs and bunches, so numerous, That they seemed to equalise, if not exceed the magnitude of the Lungs themselves▪ They were situated on both sides between the Lungs and the Mediastinum (that is the Membrane that divides the middle belly) and were extended from the Canel-bone to the Diaphragma. 4 In the cavity of the Breast we have sometimes seen a collection of wheyish waters, & indeed more frequently then in the cavity of the Abdomen, but not in all. 5 One amongst us hath likewise seen this affect complicated with a great Impostume, and with the Ptysick: the Stern being removed, all the Lungs on the left side were infected with an Impostume, and on every side growing to the Pleura, and the humour being lightly crushed, a copious, thick and stinking Matter of a yellowish colour, flowed out thorough the sharp artery into the very mouth: The outward Membrane of the Lungs whereby they firmly adhered to the Pleura, appeared thicker than ordinary, and by the mediation of it, the strings on that side did so grow together, that you could scarce distinguish them ●or such: the same Membrane also, involved both the Lungs and also the Impostume itself▪ which being opened the magnitude of the Imposthume was discernible, which by the estimation of those that were present, contained at the least two pound of water. 6 The kernel in the Canel-bone in Childhood is always observed to be great, and perhaps greater yet in those who have died of this Disease. IV. The Skull being sawed thorough in a circular Figure, and the little cover being removed, we have observed these things: 1 The Dura Mater hath been more firm, and adhered to the Skull in more places than is usual in men of ripe years: perhaps the same may be observed in other Children not affected with this evil, although, as we suppose, not in so great a manner: for certain it is, That in new born Infants there are many and strait connexion's between the Pericranian and the Dura Mater which are afterwards broken off and are scarce discernible. 2 In some Bodies that we have dissected, between the Dura and the Pia mater, and in the very ventricles of the Brain, we have found wheyish and waterish humours; from whence it is manifest, That this affect is complicated with the Hydrocephalus. 3 We have found the Brain in others that we have opened, to be firm and inculpable, and not overflowed with any waterish congestions. 4 Lastly, We have observed in some Bodies lately opened, That the Carotides have exceeded their just proportion, and so also have the jugulary Veins; but the Arteries and the Veins which are delated to the outward parts, were of an unusual slenderness. But whether or no this be perpetual in this affect we cannot yet witness by an ocular testimony; yet we conjecture, That it happeneth so perpetually, but it came not sooner into our minds to examine it, since the beginning of our Anatomical inquiries into this subject. These things being premised, our next Disquisition shall be to find out the Essence of the Disease. CHAP. III. Certain Suppositions are proposed for the easier finding out of the Essence of the Disease. First of the Essence of Health. Secondly of the Essence of a Disease. Thirdly of a threefold Division of Health and Diseases. The Explication of the third Division, and the Use of the same. The Description of a natural Constitution, and the exaltation of it. The Fourth Supposition of the Combination of three Constitutions in the same parts. THat we may proceed the more distinctly and clearly in the finding out of the Essense of this Disease, we judged it very advantageous to premise these subsequent Suppositions: I That the Essence of Health doth consist in some Constitution of the Body according to Nature. But seeing this is twofold in the kind, one Essential and necessary, respecting the tò esse simply, which during life continueth immovable and immutable under various affections, and is indivisible: The other Accidental, having reference to the tò bene esse, which in respect of the whole Animal, is both movable and mutable▪ and hath a great latitude, and can be present or absent without the dissolution of the whole. Health consists not in the former, but in the latter Constitution. II. That the Essence of a Disease in like manner consisteth not in the Essential Constitution: For so the dissolution of the whole would by and by follow: But in the Accidental Constitution, namely such an one, as in respect of the whole can be present or absent without its dissolution. We have said (and not without reason) that this Constitution wherein Health and Sickness are founded, is movable and accidental in respect of the whole; for even this also in respect of some part may be essential: as for example, a finger being cut off, a Disease ariseth in the defective number of the parts, which in respect of the whole, is founded upon an accidental Constitution; for that finger may be present or absent without the dissolution of the whole; but in respect of the lost member it is founded upon an Essential Constitution, for this Disease being supposed, the Essence of that finger perisheth. III. That the Constitution wherein the Essence both of Health and Sickness consisteth, admits a threefold manner of division or distinction in the method of Discipline. The first is somewhat thick, and is resolved into parts altogether Concrete, namely, It proceedeth Kata topous, according to the division of the parts from head to heel. The second is purely abstracted, and searcheth out all the Elements of the movable Constitution, from whence cometh the division of Diseases into similar, organical, and common; and then again those various subdivisions into distempers, faults of figure, superficies, cavities and passages, of magnitude, number, site and continuity. The third is as it were a middle manner, and although it hath been hitherto neglected, yet we dare avouch, That it may have its use, and that no contemptible one, in the handling of Diseases, and the finding out of the causes of the Disease; and it is divided into a Constitution Natural, Vital, and Animal. The first is proper to, and inherent in every part, absolutely compatible to it, and without any dependence upon the other parts according to the Essence of it simply: This remaineth a while after death, till it be resolved by Putrefaction, Ambustion, simple Exiccation, Mummification, Petrification, and the like violent Causes. This Constitution in respect of its simple Essence, doth not depend upon those Members which minister an Influx, but it dependeth upon them both in respect of its Conservation, and likewise of its Operation. For the vital influx ceasing after death (which is as it were the salt and condiment of it) quickly perisheth, and as long as the creature liveth, this is variously affected by the influxes, and thereupon the actions are either promoved or interupted. The Second is the Vital Constitution, which is produced by that continual influx from the heart thorough the arteries into the parts of the whole Body. This also it admitteth degrees, and is often subject to variations more or less, and sometimes also seemeth to suffer a kind of eclipse, as in a swooning, a syncope, etc. yet it persevereth from the beginning to the last period of life (at least in its fountain, and in some other parts. The Third is the Animal Constitution, which is derived from the Brain thorough the Nerves into the Organs of Sense and Motion. This is many times totally wanting in many parts, the life notwithstanding remaining; yea it might for a long time together be defective in several parts, or all the parts, did not respiration, which is absolute necessary unto life, depend upon it. These Constitutions therefore keep such a connexion between themselves, that the second doth eternally and continually presuppose the existence of the former, and the third of the second; but there is not back again so absolute a dependence between them, because (as we have even now said) the former can for some time subsist without the second, and the second commonly altogether without the third: And these three Constitutions may in most bodies be manifestly perceived, yet we affirm not that they may be found in all. The Natural indeed and the Vital are wanting to no part: but the Animal is defective in the Bones (though the teeth will admit some doubt) gristles, perhaps ligaments, and some substances as of the Liver, Spleen, etc. we assert therefore this threefold Constitution to be in all those parts, to whom the Natural, Vital, and Animal Faculty is communicated. For although these Faculties as to the first act may be said to depend upon the Soul (which relation hath indeed no relation to the Medicinal art) yet in respect of the second act they are necessarily rooted in some material Constitution of the parts to which they belong. For whereas some say that the Vital Faculty is derived from the Heart, and the Animal from the Brain unto the other parts, that must not so be understood, as if the Faculties themselves in a wand'ring manner were transient from part to part (for the passing of an accident from subject to subject cannot be conceived by any understanding) but that the Vital Faculty is derived with, and in the vital Spirit from the Heart unto the parts, or at least is excited by some motion of the Heart and Arteries in the parts themselves, and in like manner the Animal Faculty doth descend in and with the Animal Spirit by the Nerves, or is produced in the parts by some motion of the Nerves in the Brain. Which way soever it comes to pass, we must needs confess that some alteration is imprinted in the part itself receiving it either from the said Spirits, or from their motions. Which alteration as it is here granted to be the root of the Faculty, either Vital, or Animal in the respective parts, so is it a movable Constitution, because it can be variously changed, remitted, and intended without the dissolution of the whole; and it is the Constitution wherein either Health or Sickness may consist, seeing that whensoever alteration is deficient unto the parts wherein it ought to be, or any other ways administered then is requisite, the action will thereupon be unavoidably depraved; but if it be rightly performed, then sound and perfect health is said to be present from the part of that Constitution. Considering therefore that there are two kind of Alterations besides the natural and inherent Constitution, one from the influx of the Heart, another from the influx of the Brain in most parts; and seeing the said alterations, as they themselves are more perfect or more imperfect, do render the Faculties in the respective parts (at least as to the second act) more perfect or imperfect, and that the actions are thereupon depraved or sound, it is necessary that this threefold Constitution reside in most of the parts, and that the said kind of alterations be medical constitutions whereon Health and Sickness may be grounded. That this Division or Distinction is not frivolous or altogether unprofitable, appeareth from hence, because the practical Physicians in their Methods do rightly admonish, that in obscure Diseases the Faculties must be accurately observed, when their actions are seen to be depraved, which diligence may serve as it were for a Manuduction to guide us to the Origine of the affect; now if it be a consideration of so just importance to note the interupted Faculties in Diseases, certainly it will be an exercise of no less moment to take cognizance of the Constitutions themselves, upon which those Faculties have an immediate and strict dependence. Now lest any man should conceive that there is almost a coincidence between this third Division and the second, he may observe, if he will diligently weigh the matter, That every member of this division doth in some manner include all the members of the next precedent, namely that the natural Constitution doth comprehend primarily indeed the similar Constitution, but that secondarily and in order to the whole creature, it containeth in a sort the conformation and continuity; in like manner that the Vital and Animal Constitution do in their way so clearly participate of all the Members of the said Division, that to offer proofs of it were an unnecessary undertaking: Only we desire the Reader to take notice (which also we even now intimated) That the natural Constitution primarily and principally hath respect unto the temperament, the common qualities, the plenty of the Spirits, and the peculiar disposition of them (which by some are refered to the form and the whole substance) but that it hath respect unto the manner of the Organ and the continuity as it were secondarily, and in order to the whole creature, and that it can scarce be otherwise hurt or vitiated by them. Yet we must not deny but that the natural Constitution is sometimes vitiated as it is merely Organical, for thus it falleth out in the obstructions of the natural passages; as for example, when a stone is impacted or grown to hardness in the passage of the Meeter or the yard, and in the like cases: but this happeneth unto it especially in as much as the passage is ordained for the use and conservation of the whole; but for the most part the Organical vices in the natural Constitution are of less note and consideration than the similar. These things may suffice to be spoken in a general way of this triple Constitution. We will now in particular speak a few things of them in few words. The Natural Constitution which is proper unto and inherent in every part, may be known by this description, That it is the manner of the natural Being, settled in the parts, compatible to them, in as much as they are aptly constituted by their temperament, and common qualities, by their sufficient portion and convenient disposition of ingenerated Spirits, and by their just conformation and continuity, to a perfect performance of natural actions, together with the concurrence of the Vital (and perhaps the Animal) influx. Therefore when there is in any part a just temperament, convenient common qualities, an exquisite proportion, and harmonious disposition of inherent Spirits. Finally, when there is a laudable conformation and unity, and yet notwithstanding all this, the natural action is depraved, we may well conclude that it is not vitiated by the natural Constitution, but by reason of the concurrent cause, namely the vital or natural influx, or of both together; for the natural actions in creatures in regard of the union and wedlock of life, are exalted to a more eminent condition then otherwis they would attain unto by the natural Constitution alone. And from hence it comes to pass, That although the natural Constitution in slain Creatures remaineth after death undepraved for a while, yet the attractive and retentive Faculty, the concoction of the aliment, and the expulsion of the exctement do altogether cease: And in Diseases also many times the natural Constitution is at first untouched, yet the natural action is vitiated merely by the defect of the due concurrence of the vital influx: after the same manner somttimes the natural and vital Constitution being sound and healthful, yet some natural action is depraved by reason of the defect of some animal influx and concurence: but this for the most part happeneth only in the Nervous, Fibrous, and Membranous parts, especially where they make a hollowness, but seldom or not at all in the substance of the parts: As in the Palsy the excrements are many times unduly retained, by reason only of the astonishment and insensiblnesse of the guts, the other constitutions being sound. Therefore in these cases, when some natural action is hurt, we must not presently conclude that the natural Constitution is first vitiated, but we must with diligence inquire out that Constitution which is first vitiated, for that is to be looked upon as the root and first essence of the evil; in like manner if some vital action be depraved, we must not presently infer that the vital Constitution is primarily vitiated; because sometimes the first Origin is more rightly deduced from the natural, or perhaps the animal Constitution: as for example, Through the intensiveness of cold, a finger is mortified by inflammation: in this case it is true that the influx of the vital blood is plainly intercepted; yet the beginning of that interception must be sought out in the natural Constitution of that very part so benumned: So also in a Convulsion the circulation of the blood is perhaps something disturbed and interupted; but the first depravation must be ascribed to the animal, not to the vital Constitution. On the contrary, in a Fever the Head is invaded, but the source of the evil will peradventure be found out in the vital Constitution: so perhaps the Flesh is wasted, and all the natural Spirits are decayed; yet the root of the evil will be found out in the vital, not in the natural Constitution: So that any Constitution of the three before named may be in several Diseases, sometimes the first, sometimes the second, and sometimes the third cause of vitiated actions. Not only many other parts of the body (yea simply all the sensible) which exhibit not an influx, neither are subservient as delatory parts, do naturally admit this threefold Constitution, but besides also even the Heart itself, and all the arteries, and the Brain and all the nerves, so that the Brain (excepting the fault in its natural Constitution) may be cherished and helped by the vital Spirit which is transmitted thorough the veins and the arteries, being well affected, or vitiated and hurt if that be ill affected: And after the same manner also may the Heart by the animal Spirit which hath an influx thorough the recurent nerve of the sixth pair, the arteries also by the animal influx thorough the nerves by a way perhaps not yet found out: And Finally, The Nerves also by the vital Spirit deduced thorough the Arteries. CHAP. IU. That the Essence of this Disease consists not in the Animal or Vital, but in the Natural Constitution; not as Organical, but as Similar: Three Limitations are Propounded. THese things being Presupposed, We shall proceed to enquir in what Constitution of the parts the first Root or Essence of this affect is lodged. Be the first Conclusion therefore this, The First Root of this Affect is not in the Animal Constitution, or in that which dependeth upon the Influx of the Brain into the parts. Indeed we confess that all the nerves which without the Skull proceed from the spinal marrow, are found to be loose and weak in this affect; yet this doth not here seem to arise from a defect of the influx of the Brain, which we thus prove, First the looseness and weakness of the nerves, which cometh primarily from the Brain, is almost always consociated with somnolency and drowsiness; but this Symptom happeneth but rarely, and by accident only in this affect. Secondly, As we remember, we never knew the Palsy, or the Apoplexy to supervene or follow upon this Disease; but it ought necessarily so to do, and that very often (at least in the confirmation of the Disease) if this looseness and weakness of the nerves should take beginning from a defect of the influx of the Brain. Thirdly, We have observed the Brain to be sufficiently firm and inculpable in many dissected after death. Fourthly, For the most part those that are afflicted with this evil are ingenious in respect of their age, which doth evidently attest the vigour and vivacity of the Brain. The Second Conclusion. The first root of this affect is not in the Vital Constitution, or in that which dependeth upon the Influx of the Heart into the parts. An unequal distribution of blood indeed almost (if not altogether) perpetual may be observed in this affect: nevertheless the chief reason of this inequality must be ascribed, not to the inequasity of the influx of the Heart or Arteries, but to the unequal reception and unaptness in the parts themselves to receive it; for the Heart and the Arteries do for their part indiscriminately or equally distribute the blood with the Spirits every way into the parts. But if it so fall out that an Artery of some part be interupted in his function by reason of the benumnednesse and stupefaction of that part, or the parts adjacent, there is a necessity that the blood must be minutely transmitted thither, and so unequally in respect of the other parts which expeditely and aptly receive the blood. Therefore in this case this inequality of distribution doth properly and primarily depend upon a preexistent fault without the artery pertaining to the natural Constitution of the parts. Object. But some may Object, Although perhaps the aforesaid inequality hath no dependence upon the Heart, yet it may so happen that a weak Pulse may suffice to distribute the blood thorough the lesser Circulations in the inner parts, which nevertheless may not be altogether so sufficient to undergo that duty thorough the greater Circulations in the outward parts which are more remote from the Heart, the fountain of blood. Answ. We Answer, That this Objection was formerly of so great importance with one of us, that he supposed such an inequality of the vital influx did belong to the prime Essence of this Disease, and did therefore endeavour to deduce the reason of the first Symptoms from it. But after second thoughts, the matter being more nearly and deeply examined, he was of Opinion, That this inequality of the vital influx had no relation to the primary, but to the secondary Essence of the Disease. But we return to the solution of the Argument. And First we grant indeed that in this affect there is an unequal distribution of the blood; and that in the internal parts and in the head it is more liberal, in the external more sparing. Secondly we grant that the Circulation of the blood may be kept in the inward parts, even although no Pulse appear in the outward parts; but this happeneth only in a vehement either weakness or oppression of the vital Spirits, as in a swooning, and a strong hysterical paroxysm, or fit of the Mother, in which affect some that have been accounted for dead have been seen to revive again. Thirdly we grant that a more liberal Circulation of the blood may be in the internal than the external parts, yea and in some one external part more than in another, as it happeneth in the inflammation of some external member. These things being granted, we affirm, that in the first Case the inequality of the distribution of the blood doth not principally depend upon the weakness of the Pulsifical virtue for as much as concerns the heart; and the reason hereof is plain. For the heart, as we have already said, doth emit the blood indiscriminatly or equally, and with one continuation from itself into the Aorta or chief artery, even at such time when as the Pulse is most weak. This artery doth exonerate or disburden itself again with all possible expedition, and from hence proceedeth the inequality of the diffusion of the blood, as the blood is more easily impelled from on rivelet then from another. This inequality notwithstanding must not properly and primarily be attributed to the heart, but to the recipient parts, and to the particular transmitting arteries. For any primary affect of the heart is necessarily universal, and communicated to all the parts of the body: wherefore although we grant this enequality of the Circulation of the blood to be in the secondary Essence of this Disease, yet we exclude it from the primary. Moreover in the Second Case propounded, we say that there is a great disparity between the cases of extreme necessity, and ordinary cases. Neither indeed do we know whether in the said cases the circulation in the inward parts, howsoever it be granted, be of any moment. And for so much as concerneth the present business, we deny any such debility of the heart in this affect, that the Pulse should be defective in the outward parts; yea we have not observed that any one afflicted with this Disease hath been prone to fall into an extacy, or a swooning; which would readily happen if the origin of the Disease were rooted in the debility of the heart itself. Besides when we have seen such as were sick in their tender age, to endure without any loss of strength sometimes a liberal eduction or flowing forth of the blood from the opened veins of their ears, yea and seen it sometimes reiterated with good success. Finally, When also they have very well endured purgations, with respect had to their age, it doth not appear to us how the first root of the evil can be ascribed to the weakness of the vital constitution. In the Third Case it is evidently manifest that the first cause of this unequal circulation of the blood is some disposition of an outward part, as in an inflamed member, labouring under some private Disease, there happeneth a more full and impetuous Pulse by reason of the accidental heat of the artery, infused by the immoderation of heat which is in that outward part. Therefore seeing that the Essence of this affect cannot be primarily rooted in the animal nor the vital Constitution of the parts (as we have now showed) it followeth (which shall be the Third Conclusion) That the primary Essence, or first root of this affect, consisteth in the proper or inherent constitution of the parts. But because the natural Constitution (as we have said above) consisteth partly in the common qualities and the temperament, and partly in a just plenty and disposition of the inherent Spirits, and again partly in the organical construction and continuity; our next enquiry must be to find out in which of the prementioned constitutions it lodgeth, and whether it be rooted in one alone, or in many, or in altogether. Be the Fourth Conclusion therefore this: This affect is not radicated in the Organical Constitution of the parts. For although in progress of time the Organs themselves are divers ways affected in respect of their conformation, quantity, and site, as it is sufficiently manifest from the increased bulk of the head, liver, etc. from the tumors of the bones unto the wrists, the ankls and the extremities of the ribs; from various obstructions and the extenuation of the outward parts; seeing nevertheless that all these things depend upon a higher origin▪ and howsoever also we may necessarily admit these things in a Disease confirmed, and now variously compounded; yet in the original Essence, we presume, for the subsequent reasons they are to be rejected. First, Because the depravations aforesaid in the Organical parts do not appear presently in the beginning of the Disease, but increase afterwards by little and little: And although perhaps some of these may be said from the beginning to have taken root in the body, notwithstanding they cannot as yet be immediately discerned by the sense, neither do they manifestly hurt any actions, and for that reason they cannot appertain to the first Essence of the Disease. Secondly, Because the Organical vices aforesaid are not the Causes but the Effects rather of the chief Symptoms which from the beginning exhibit themselves in this affect. For the augmented figure of the head, liver, etc. the standing out of the bones, and the leanness of the external parts, are more rightly refered to the inequality of the nourishment, then on the contrary the inequality of the nourishment should be ascribed to them: For when one part doth excessively increase, and another is defrauded of a due & decent augmentation, there is a necessity that a disproportionate and an unequal nourishment must not only be present in the parts, but also have had a preexistence in the body, whereby one part is nourished, and another neglected beneath a mediocrity. But seeing this unequal nourishment is a depraved action, and so a Symptom presupposing some preexistent Disease, and yet withal (as we have said) doth precede, as a cause, the organical vices aforesaid, it is manifest that those organical vices are not the first root of this Disease. As for the obstructions which indeed are for the most part conjoined with this affect, yet nevertheless there is a great deal of reason to exclude them from the first Essence of this Disease, because they neither specificate the Disease, neither can any reason of the Symptoms be rendered from them, neither do they perpetually besiege some certain and determinate noble part. Some man perhaps, who hath respect to the excessive magnitude of the liver, may object that in this affect that is perpetually obstructed, and thereupon the sanguification being vitiated the other things are preposteriously derived; but if this swelling of the Liver did always proceed from the obstruction of it, than a paleness of complexion, a cachexia or indigestion, and by the advantage of time, the Dropsy itself should necessarily and perpetually accompany this affect: Moreover, The Liver should always be seen to be vitiated in the colour, and at the dissection hard tumours and knots should be observed in the substance of it, especially in an inveterate affect, and that which killed the Patient; but seeing these things do not frequently (much less perpetually) occur in dead bodies, the augmented bulk of it must rather be refered to the irregular nutrition: Moreover, we deny it not but that we have observed by Anatomy in those who have perished of this Disease, obstructions, various tumors, and knotty excrescencies in the Lungs, but we attest withal, That we have seen some Infants, yea Boys lightly affected with this evil, in whom there was no suspicion of vitiated Lungs, for there was no cough, no impediment of respiration, which necessarily is an individual companion of the obstruction of the Lungs. Thirdly, Because a sufficient reason of all the Symptoms proper to this Disease, may more clearly and easily be derived from other fountains, as we shall see anon. And thus we have sufficiently proved, That this affect in respect of the first Essence of it, consists not in the Organical Constitution of the natural parts. The same arguments will more effectually convince (more might be produced, but we judge accumulations unnecessary) That this evil is not radicated in the continuity of the natural parts, so that there needs no more words to prove it. The Fifth Conclusion. This Disease is primarily rooted in the similary Constitution of the natural parts: And therefore in respect of the radical Essence thereof, it is a similary Disease. And because a similary Disease, as such, is not perpetually Simple, but sometimes variously compounded (namely a Distemper is either Simple, or Compound, and this becomes such, not only by the first qualities among themselves, but perhaps by hidden qualities conjoined together; or, which is more agreeable to our Conceptions, especially in the present business, by a kind of sure proportion and medification of the inherent Spirits) We judge this to be a Compound Disease, and we assert the prime and radical Essence thereof to consist in a cold and moist Distemper, with a Defect and stupefaction of the inherent Spirits, concurring in the inherent constitution of the parts primarily affected. But before we proceed to an higher Explication of this Opinion, we will premise some Limitations of it. The First shall be this: That in this Disease, some parts of the Body are Primarily, and others Secondarily affected: And truly, to us the External parts seem sooner to be affected than the Brain and Bowels, as we shall declare more at large when we come to speak of the parts affected. The Second is this: That in those parts alone which are Primarily affected, do labour under a notable cold Distemper with penury and stupefaction of spirits: For the Brain perhaps and the Bowels may be moderately hot, and sufficiently abound with Spirits, by reason of the copious vital influx; and moisture may exceed in them by reason of the affusion of our over-plentiful aliment: but the other External parts are always affected with a cold and moist Distemper, and a benumedness of the natural Spirit, etc. Whereupon we assert, that in this Disease they are primarily affected, and that they alone are the seat of the first Essence of this Disease. Be this the Third: All the External parts, and those first affected, do not equally labour under a cold and moist Distemper, and with benumedness of Spirits, etc. For the Ligaments, Tendons, and Nerves, are in their own nature more cold, and less moist; the Muscles, or fleshy parts are rather more moist, and less cold: the skinny parts usually retain a mediocrity, yet all the said parts recede more or less from the natural towards a cold and moist temper. And in like manner, although some of the said parts do require a greater plenty and activity of Spirits than others, yet all of them a just proportion, being observed to the plenty and activity respectively due to each of them, are defective and destitute of that just proportion. CHAP. V. The preposed Opinion is examined by Parts. First, That this Disease is a cold Distemper. An Objection, and the Answer thereunto; That it is moist: That it consisteth in the penury or paucity of the Spirits. An Objection, with the Answer. Finally, That this Disease consisteth in the stupefaction of the Spirits. NOw let us more nearly examine the Opinion proposed, and assert it by parts. First, That the parts first affected do labour under a cold distemper may be proved. First, from the unequal and diminished nutrition of the said parts; for as the inborn heat when it is augmented to a just proportion doth very much conduce to further the concoction of the Aliment; so if it be too remiss, it easily retardeth and lesseneth the same. Secondly, The same distemper is proved from the slowness and unaptness to motion; and also from the aversation to exercise, and desire to rest. For as the activity and agility of the Body is attributed to the Heat, so the tardity and slothfulness of it is in great part ascribed to Cold, Namely, supposing (as before) that this slothfulness hath no dependence upon the fault of the animal influx. Thirdly, It is further confirmed, because this Disease many times followeth other acute Diseases, whereby they end not seldom (after the Waste or Consumption of the Natural heat) in a cold distemper. Besides, It also receiveth Chronical Diseases which extenuate the Body, and such as in any manner are prone to leave a cold distemper behind them as Pertinacious Obstructions, the Scurvy, Cachexy etc. Moreover, Because it succeedeth the importune suppression of Scabbedness, and Impetiginous effects, as we have often observed, when the Scabs have newly broken out again, and the Itch is revived, such Boys have been easily restored to health, because by that means the Natural heat is reaugmented in the outward Members. Lastly, Because many times it happeneth after a continual use of cold, thick, and viscous aliment, after surfeiting and idleness, and the like evident causes, either diminishing or overwhelming the Natural heat. Fourthly, It is yet more plainly evinced, because those helps which excite, augment, and cherish the heat in the outward parts, as various agitations, rubbings, and anointing of the Body, do contribute a large share to the advancement of this Cure. These things being all cast together into a heap, it is sufficiently conspicuous that a cold distemper of the Natural constitution of the parts first affected is contained in the primary essence of this Disease. Object. But here we meet with a specious Objection, That a little Fever, especially a slow one, or such as is erratical and wandering, is frequently conjoined with this affect, which at the same time seemeth absolutely inconsistent with a cool distemper. For all Fevers by all men are accounted to be a hot distemper which is diametrically opposite to the said essence. We Answer (that we may not here interpose any thing concerning the essence of a Fever) we freely grant, for so much as concerns the present Question, that a Fever is a hot distemper; but this doth not chiefly consist in the Natural constitution of the parts, but in the vital constitution, namely in the influent heat preternaturally affected. For a Fever is not some private Disease, but universal, and is diffused from the Heart through the Arteries in and with the vital Spirit, be it either overheated, or otherwise vitiated. For this preternatural heat hath only a respect to that inherent as a cause potent and able variously to alter it, yet indeed by degrees and little and little. For first the influent heat is manifestly an actual heat, but the heat of the natural constitution is only potential: wherefore we affirm that a cold distemper in respect of a natural and potential heat may consist with a hot distemper in respect of an actual and influent heat. For indeed an actual heat is not so directly averse to a cold distemper▪ which is so called by reason of a defect of the potential heat, but it may (the cause persevering) consist for a good while with it. As for example, there is an actual heat in Simple Water, Barley Water, divers Juleps and the like being made hot, although at the same time they are potentially cold. So that to be actually hot, and potentially hot differ not in the Degree, but in the Species, neither are they so directly contrary to one another, that one must presently expel the other out of a subject. Moreover, Secondly, The influent hot distemper doth not so much correct the inherent cold distemper, as by accident it augmenteth it, namely by a waist and dissipation of the Natural Spirits, wherein chiefly the natural and potential heat resides: Just after the same manner as the actual heat introduced by the fire diminisheth the potential heat of the Wine. Whereupon any kind of Fever supervening upon this Disease, usually brings more damage than advantage to the sick. Secondly, We affirm, a moist distemper to be lodged together in the parts first affected; this is manifest from the laxity and softness of the said parts: and this sign likewise doth more strongly confirm the same thing, because the said parts are extenuated, so that unless there were a redundancy of moisture in them, a certain rigidity and roughness would assault the touch; again, a cold distemper doth very rarely continue long without a moist: and lastly, things helpful and hurtful attest this truth, for drying things are helpful, and moistening things are hurtful. Thirdly, we affirm, That in the parts first affected there is a penury of natural spirits. This is proved by the very same arguments which we produced to evince it to be a cold distemper. For first the unequal and imminute nutrition of the parts first affected doth not only argue a coldness of temper, but withal, a want of natural spirits, for otherwise this defect of nutrition might be easily corrected. For the cause of that coldness wherewith the defect of the spirit is conjoined, or some peccaut humour is not impacted, is easily cashired, and sooner than is wont in this disease, as may b● seen in the parts grown extreme cold in the winte season; for example sake, in the handling of snow; the parts so extremely cooled provided that they be rightly handled, will return to their pristine temperament in few hours: but where there is a distemper with the matter of it, as a case conjoynd, or where there is a defect of the inherent spirits, such a distemper indeed is not so soon nor so easily removed. But in the present affect we cannot affirm that a conjoined or impacted matter of any note is (at the least alwise) caused in the parts first affected, because they are observed to be more withered, feeble, and extremely extenuated, and seeing this affect is very different from Cachexia and the Virgin's disease; in the which for the most part, it is not the want of Spirits, but the conjoined matter that cherisheth the cold distemper: wherefore we may rightly infer that the pertinacity of this evil doth chiefly depend upon the defect of the natural Spirits. Secondly, The same is proved after the same manner by the second argument before alleged for the cold distemper, namely from sloth and averseness to excercise. For activity hath not only a dependence upon the temper, but chiefly upon the fullness of the Spirits: as may be seen in strong and heathful men, who in winter time, and hardest frost, are more prompt and inclinable to violent exercises, then in summer, when the inherent Spirits are wont to be somewhat dissolved. Thirdly, Fevers, and long extenuating diseases, as they often introduce a cold distemper, so they evidently diminish and dissipate the inherent Spirits. To these we add that argument which is deduced from the constitution of the Parents▪ the Parents that are more strong and lusty (experience witnesseth it) and accustomed to labour, seldom bring forth children obnoxious to this disease: on the contrary, such as are weak, sickly, idle, tender, delicate, very prone to immoderate, premature, or decriped Venery, such as are troubled with a Gonorrhoea, etc. for the most part beget children subject to this affect: Namely, because the Seminary principles are furnished only with a deficiency of Spirits. We should now proceed to the fourth assertion, but must first remove a remora that cometh in the way. Object. For some may object. That the natural cold distemper is subordinated to the want of Spirits, and not contradistinguished to it, as is here supposed. For the paucity of the Spirits seemeth to be the very cause of the cold distemper, and the natural heat be it more intense or more remiss, seemeth respectively to follow the proportion of the natural Spirits, as being radicated in them as their first subject. We answer. First, That the inherent heat is indeed first grounded and subjected in the inherent Spirits. Moreover as the inward heat is divided into two par s, namely, the natural, and the acquired heat; so the inward Spirit must be also conceived to be twofold, the primigenial or seminal derived from the Parents in the seed, and the acquired Spirit contracted from a perfect assimilation of the aliment, the former Spirit is the basis of the engrafted natural heat, the latter of the inward acquired heat; we mean, not that these heats and Spirits are in themselves distinct in the species▪ but only in their origin and degree of perfection, which is sufficient to invest them with a various appellation. For in nutrition the assimilation of the aliment proceedeth even to a specifical identity, and not an individual, although sometimes, also it attaineth not the degree of original perfection. For which cause it seemed sufficient to us to have named the implanted heat, and the implanted Spirit, without any higher distinction; and therefore we grant that the implanted heat is first subjected and rooted in the Spirits, and that it is nothing else then a certain modification of the said Spirits, whereby they being irradiated by the vital heat do delight to endeavour to diffuse themselves and to enlarge their dominions, by attracting, retaining, assimilating the aliments like unto themselves by severing the excrements, and lastly, by disposing the things acquired in due places: we say, likewise that this endeavour (wherein we place the essence of heat) by reason that it is diffusive doth somewhat dissipate and waste the implanted Spirits, which because of this effect are vulgarly called by the name of radical moisture continually devoured and consumed by the heat. Thus far we grant the argument: But in the second place we affirm that the implanted heat doth differ from the hot implanted temperament; for the implanted heat is only a part of the hot implanted temperament, for not only a Spirit, but sulphur also, and salt, or perhaps choler, contribute their heat to the constitution of the whole hot implanted temperament, whereof the implanted heat is only a part. Wherefore it is falsely suggested in the propounded argument, that a plenty of Spirits is the sole cause of a hot distemper, and a paucity of a cold distemper: for a pound of the flesh of an infant containeth more implanted Spirits then a pound of a youngman's flesh: yet it is most evident that the temperament of a young man is far more hot than that of an infant: a hot temperament cannot therefore depend upon the sole plenty of the Spirits, nor a cold temperament upon a want of Spirits. Moreover in many maladies a hot distemper is consistent with a paucity of Spirits; as in a Hectic of the third degree; in like manner of a cold distemper with a competent plenty of Spirits, as in the Green sickness. We say thirdly, That a plenty or paucity of Spirits is not perpetually a sufficient cause to determine the temperament either hot or cold; as on the contrary, neither doth a hot, nor a cold temperament certainly and necessarily demonstrate a plenty or paucity of Spirits, as is manifest from the instance given. So that the temperament is no sure sign of the quantity of the Spirits, nor the quantity of the Spirits a sure sign of the temperament; and therefore purposeth not without just cause, these things come to be considered and examined as contradistinct, if we will procure a certain and inconfused knowledge of them. Fourthly we answer, That although it were granted, that the implanted heat is subjected in the implanted Spirits, yet notwithstanding that heat is not intended nor remitted according to the sole plenty, or paucity of Spirits: for the Spirits howsoever sufficiently copious, yet if they be too much fixed, torpid, and as it were frozen; they exhibit not any implanted heat worthy of consideration. As for example, the white of an egg swelleth with copious Spirits, yet are they so benumbed, and the inward heat is thereupon so small, that it obtaineth not the formation of a chicken, unless it be first excited by incubation, or some such other heat; therefore we may lawfully conclude, that a consideration from the want of Spirits is sufficiently distinct from the consideration of a cold implanted temperament, although the objected argument doth seem to insinuate the contrary. Moreover from this fourth article of our answer, there resulteth a fourth assertion of the essence propounded, Namely, That beside the distemper and want of Spirits a certain benumdness of them, must be added as a distinct part also of the essence of the disease. This benumdness of the engrafted Spirits appeareth chiefly by the defective nutrition, and aversation from exercise, which proceed not primarily (as we have proved above) from any defect of the influx of the brain. It is also manifest from hence, because all those things which drive out that stupefaction of the Spirits, although they do not altogether drive it away, yet they conduce very much to the cure of this disease; as exercises of any kind augmented by degrees, frictions, anointings, etc. and things inwardly taken, of a heating, cutting, purging, and gently opening quality. But that this benumdness is sufficiently distinct from the want of Spirits (besides that which we have said in the 3. article of our Answer is sufficiently manifest from hence, because an excessive excitation, contrary to a benumbedness is often conjoined with a penury of Spirits: as it commonly falleth out in a Hectic fever, in dissolving fluxes, and the like diseases, in which howsoever there be a want of Spirits, yet no benummedness is consociated; but on the contrary that vehement excitation, & propensity to motion, must be restrained. On the contrary, copious Spirits may consist with a benummedness, as in wheat or meal. For although it may seem to have but little Spirit, because the Spirits of it do yet lurk in their fixation, and benummedness; yet indeed the Spirits do abound in it, and may be summoned out by a simple fermentation, and excited to a manifestation of their activity: As strong Beer made thereof doth plainly declare. In like manner juice newly pressed out of immature grapes, is very mild and pleasant, containing in the mean time plenty of Spirits, which afterwards the due fermentation being finished, reveal themselves in generous wine. Let us conclude therefore that the benummedness of the Spirits in this affect deserveth a particular and distinct consideration. CHAP. VI Of the Part first affected in this Disease. WE have already propounded the first Essence of this Disease, it remaineth now that we inquire after the first Subject in which that Essence is radicated. The heart and the brain do here seem rightly to be excluded, for the reasons before alleged, the repetition whereof for brevity sake we shall omit. The liver and the Lungs are not as yet exempted from all suspicion of this fault, we will therefore examine these bowels apart, and first we demand, Whether the Liver be the subject of the first essence of this Disease? The principal Argument is for the Affirmative, because this Disease may seem to proceed from a vicious sanguification, the Shop and Workhouse whereof (at least in probability) the Liver is supposed to be, but that a vitiated sanguification is the first origine of this disease seems to be made manifest by many signs. First, because this disease for the most part followeth after many other great diseases, either acute or chronical, which in great measure have beforehand weakened the sanguifical virtue of the Liver. Secondly, Because this disease doth not only depend upon outward, but inward causes, namely the vicious humours. And seeing the vicious humours are generated in and with the mass of blood in the liver, the first essence of this affect seemeth to be referred hither. Thirdly, The Liver is perpetually observed to be bigger than ordinary in this affect; which manifestly witnesseth the Liver to be affected. Fourthly, those internal Medicines which have a faculty to putrify the blood are requisite to the cure of this disease▪ and being exhibited are found to be very profitable. 5. The missian of blood from the veins of the ears (which is not the meanest help to vanquish this affect) doth more than sufficiently argue some fault to be in the blood, which seemeth to be ascribed to the constitution of the Liver, in as much as it doth sanguificate. These Arguments have so far prevailed upon some very famous Physicians, that thereupon they have attributed the first essence of this disease to the Liver alone. But we conceive that these things may be sufficiently answered, if we shall first grant what can be further or what hath already been rightly said concerning this matter, and then dissolve those things which are inferred by bad and invalid consequence. First, Therefore we grant that the mass of blood is vitiated in this affect, and that from thence is conveied a continual ●●●●editati●● 〈◊〉 the disease. We grant also for the present that the Liver is the Officin of sanguification: but we deny that every viciosity of the blood doth depend upon the vitiated sanguification constitution of the Liver. For first, the blood may be corrupted by unwholesome aliment, the Liver in the mean time remaining sound, in like manner if the first concoction in the ventricle by any cause whatsoever be rendered imperfect; yet it cannot be fully corrected by the second concoction in the Liver be that bowel never so sound. Besides, although the generation of vicious blood should be solely ascribed to the Liver, yet the other parts should necessarily concur to the conservation of that which is generated, as the Kidneys, the Spleen, the Pancreas, the Womb etc. yea, and it seemeth undeniable, that all the parts which the blood washeth in his circulation, do variously alter it, whilst according to the capacity of the subject they imprint their qualities in it: for they are natural agents, and act by necessity and continually without any suspension of their actions or intervenient pauses, unless they be estrained by some predominant power: therefore if these be il affected, they give a greater or a less tincture of pollution, to the blood which passes through them, as may be seen in a contagion gotten by an external contact communicated to the inward parts. Moreover, sometimes a great pollution from the other diseased parts is insinuated into the blood, the liver in the interim being safe, as hath been sometimes observed in opened bodies, that have perished by a Dropsy, in whom the Liver was found to be sufficiently sound and whole. Moreover, We grant that the faults of the Blood do frequently derive their beginning from the depravedness of their sanguifical constitution of the Liver, and that that depraved▪ constitution is an affect of the Liver. But we deny this to be the same Disease whereof we now treat, because it differs from it in the whole Species. For that same depraved constitution of the Liver is alike common to men of full age, to Boys, and Children; but this disease is solely apropriated to boys and infants. Again, We grant that a vicious constitution of the Liver may by generating a corrupt blood be a common cause, and foment the augmentation of this affect: but we deny that to be the disease itself, whereof we now speak, or any part of the first essence thereof. For it is one thing to produce a common cause of a disease, and another thing to be of the first essence of a disease. We deny also that to be the continent cause of this disease, or to be a sufficient cause of itself alone, or to be always a cause. For the vicious constitution of the Liver, of what kind soever you will suppose it, doth not produce this affect in those that are come to ripeness of years, nor perhaps always in young boys: and this our answer in general to the argument: we proceed now in a like method to the confirmation of it. First, Therefore we grant that this affect doth often follow other diseases be they either acute or chronical, but not so much because they had hurt the sanguiffical constitution of the Liver, as because they had left the outward parts cold and benumbed the engrafted Spirits exhausted. Although we may easily admit the vitiated liver to be able to foment the evil by reason of the depraved sanguification. Secondly, We grant that this affect doth not only depend upon outward causes, but also upon inward, namely the faults of the blood itself; but that all these faults have their beginning from the Liver, that we flatly deny for the Reasons before alleged. Thirdly, We grant that the mole or substance of the Liver is augmented in this affect, but we deny that to be the first essence of the Disease, for the reasons above rehearsed, where we reject the organical vices from the primary essence of this evil. Yet we admit this and the like diseases in a secondary essence of this affect, as we shall see hereafter. Fourthly, We grant that internal Medicines can both alter and purify the blood, but in the present Affect they conduce to the cure, in this regard, principally, because they facilitate the distribution of the blood to the outward members, attenuating the thicker and cutting the viscous parts thereof, and because they also do impregnate the blood, with a copious and benign Spirit, whereupon it happens, that the implanted Spirits of the parts before languishing, are cherished, augmented, and excited. In the mean time we acknowledge that general benefit which accrue to the whole body, by the purging of the blood, by siege, vomit, urine, or any other ways of evacuation. Only this is it which we affirm, that the more specifical part of the cure is wrought by way of alteration with the medicines aforesaid, as we have intimated already. Fifthly, and lastly, We grant that the opening the veins in the ears doth somewhat attenuate the blood, and conduce to the renovation of it, as also to the distribution of it to the external parts, and the withdrawing of it from the internal parts oppressed with too much plenty, and in that respect very much to advance the cure▪ yet we deny that it can from thence be rightly inferred that the first Essence of the disease is radicated in the Liver. And thus we suppose we have satisfied the reasons brought for the confirmation of this opinion. We will now produce some arguments that seem to persuade the contrary. The first is this, The first Essence of a disease doth Specificate the Disease. But the vitiated sanguifical constitution (however it be conceived) doth not specificate this Disease. For seeing that this Disease doth appertain to infants only and children; it behoveth them who adhere to the contrary opinion to design some certain way of the depraved sanguifical Constitution of the Liver, which may be proper to the tender age alone, but no depravation of the sanguifical Constitution of the Liver can be imagined, which is not also common to those of ripe years. If therefore the first Essence of this Disease should consist in that, this Disease would at least sometimes be observed in those of ripe years, which notwithstanding hath never been hitherto observed. Secondly, The subject of the first essence of a Disease is so long affected with that Essence, as the Disease continueth. For neither can the Disease Exist without its Essence, neither can that Essence wander from one part to another: If therefore the Liver be the subject of the first Essence of this Disease, then should it be affected throughout the whole progress of the Disease; which nevertheless doth not seem credible, seeing that the Livers of those who have died of this Disease, and have been dissected, have excepting the augmented bulk thereof, been seen inculpable in respect of the other conditions. Thirdly, If the Liver be the subject of the first Essence of this Disease, necessarily it is, that upon the daily increase of the Disease that should be more grievously and evidently afflicted, and before death certainly it should be marked by some manifest signs. For seeing that every Disease is contrary to the nature of that part it besiegeth, and doth daily more and more damnify and empair it: And although the beginnings of Diseases are many times obscure, yet in process of time (especially if they continue till the last day of life) they imprint most evident marks in the parts primarily affected; so that it can scarce be avoided, but that upon the opening of the body they will be apparent to the first sight: although also when an enquiry is appointed into some Chronical Disease, by dissection of the body that perished by it, the finding of it out be grown difficult by reason of some other intervenient Diseases, or otherwise complicated: Yet the part first affected is ever observed to be grievously and manifestly hurt. Seeing therefore in those whom this Disease hath destroyed, the Liver is oftentimes sound, excepting the augmented bulk, or at least not considerably hurt, it will be to infer, that that bowel is not the subject of the first Essence of this Disease. Fourthly, If the liver were the subject of the first essence of this disease, it should labour under a cold and moist distemper, and also under a penury and benummedness of spirits, as is sufficiently manifest from what hath already been spoken. But in this present affect the liver doth not always labour under a cold distemper, nor with a penury and stupefaction of spirits. For in this affect the vital blood being sparingly distributed to the outward members, it must needs be superabundantly poured upon the bowels, especially the brain and the liver; and seeing this blood, which is circulated thorough the bowels so near the heart, is made very hot and full of spirit: as even now issuing out of the fountain of the vital spirits, it is impossible that it should permit a cold distemper, or any defect of spirits to be in those parts, which it watereth with so copious an afflux. Fifthly, In this affect we often behold the face to be well coloured, & the cheeks ruddy, which can scarce happen in a cold distemper of the liver if it be of any continuance. Sixthly, From a bad habit of breeding blood in the liver; a sufficient reason cannot be rendered of the symptoms proper to this affect, a Cacotrophy indeed, or a vicious nourishment, and an Atrophy, or a defective nourishment: nay many times and peradventure not unjustly be ascribed to the fault of the liver: but an Alogotrophy, or a disproportional nourishment cannot immediately be referred to that bowel, For the liver maketh the blood equally and without difference, for all the parts; neither is it liberal to our part in the dispensation of it, and reserved to another. Moreover the debility of all the muscles, the dislike of exercise, the affectation of rest, seemeth to have no correspondence with the Liver, wherefore neither do we acknowledge the Liver to be the first seat of this disease. Seventhly, This disease in strong children is cured sometimes, only by exercise, play, stirring, and rubbing of the body; by which means the heat is summoned to the outward parts, new spirits are raised up, the stupefaction of them is chased away, and the aliment is with a more plentiful benignity drawn to the outward members, which benefits without doubt are more properly accommodated to the outward parts then to the Liver. And this question being thus solved, we proceed to the other; namely, Whether the Lungs be the subject of the first Essence of this disease? The symptoms which seem to persuade the affirmative, are the frequent narrowness of the breast, the difficulty of breathing, an astma, a cough, the inflammation of the Lungs, the hard swellings of the Lungs, the imposthume in the Lungs and the Ptisick. First, The narrowness of the breast doth not presently arise from the very beginning of the disease, & therefore cannot be attested to be of the first Essence of this Disease, in like manner the difficulty of breathing & the astma do not perpetually accompany this affect, and therefore an indication of the part first affected cannot be borrowed from them. Thirdly, the cough is sometimes present, sometimes absent, and is often times variously intended and remitted, till the essence of the disease persisteth in the same state; which also happeneth from very many of the aforesaid symptoms. Fourthly, An inflammation of the Lungs doth not frequently molest the patient, and when it invadeth him, it is an acute and not a chronicle disease; as this, whereof we now speak, so that we cannot lawfully conclude any certainty of the first affected part from a symptom so unusual and so Fugitive. Fifthly, Hard swellings of the Lungs, little swellings, impostumes; yea, and bunches may precede, associate, and follow after this affect, but these diseases are altogether of a different kind from that we now speak of; yea, and are common as well to men of ripe years as to children, and infants: moreover the Ptysick doth not usually superveen unless after a long continuance of this affect, as being far from the first Essence of this Disease; and that it may manifestly appear to be very remote from the first esteem of it, so that can confer little or nothing to the finding out of the part affected. Moreover, those inseparable and vulgar symptoms of this Disease, as the impotency of the external parts to motion, and the inequality of nutrition, can by no reason be deduced from the affected Lungs: and therefore we cannot admit this Bowel for the first seat of this Disease. And thus at length we descend to point out the parts first affected. The special marrow issuing out of the skull doth seem to deserve the first place: The second, all the Nerves produced by it; the third all the membranous and fibrous parts unto which those Nerves are carried along. And in these parts we affirm the first essence of of this disease to be rooted, neither do we think it needful to join other parts with these. For the softness, looseness, and Atony of the whole Spine without the Skull, of all the Nerves arising from thence, of all the Fibers of the Universal Body, and by that means an inability to motion, a slothfulness and affectation of rest, which bewray themselves from the very beginning of this affect, do abundantly evince these parts to be affected with coldness, defect and benummedness of Spirits, and from hence it comes to pass that they are extenuated and afflicted with an incompetency of nourishment. For they do somewhat communicate their benummedness to the tops of the Arteries, whereupon the Flux of blood that is distributed unto them, suffers diminution; and because they are cold and labour under a defect of Spirits, they imperfectly concoct the affused blood, so that there is a necessity that they must be unduly nourished and less than the other parts, and by consequence be extenuated. Therefore we justly and deservedly ascribe the first essence of this Disease to those parts alone. Yet it may be here doubted whether the bones may not also be numbered among the parts first affected, seeing that certain tumours of the bones may be observed presently after the first invasion of the Disease in divers places, but especially in the appendancies of the Bones to the Wrists and tops of the Ribs, where they are conjoined with the grizles of the Stern? We answer, That indeed it cannot be denied, but that the said tumours of the bones, both in respect of the increased greatness, and also by reason of the vitiated figure are really and truly Diseases, and therefore we grant that the bones must be referred to the primary or secondary essence of the Disease: but that they do not pertain to the primary essence of the Disease is manifest from hence, Because the said tumours of the bones depend upon the first essence of this Disease, and suppose the preexistence of it. For they spring from the unequal nourishment of the parts which is a Symptom of the first essence of this Disease. But here the inequality of the nourishment can depend upon the first essence of this Disease, shall more fully be declared in its due place; namely, where the reason of the secondary essence is to be rendered. We will only here show that those swellings of the bones are rightly deduced from the improportionate nourishment, to wit when in respect of the rest it is too much augmented in the swelling parts. That is proved by this argument, Because the protuberant part of the bones are altogether of the same Species with the other parts of the bones; whereupon it is necessary, that they come out by the same way of generation, by which the rest are augmented and encreas. Therefore seeing that the other bones are augmented by nutrition, that is, by the introsumed aliment, and the assimilation of it, certainly we must judge that these bones also acquire their augmentation by the like reason (although without reason, measure and proportion) You will say, That tumours are usually generated not of an alimentory or good, but a corrupt and vicious juice. True it is indeed that this is for the most part true, but as true it is that it is only for the most part true. For some tumours swell from a legitimate and alimentary juice, as caruncles or little pieces of flesh, knobbed swellings, and perhaps some hard bunches, but even these swellings do also differ much from the present standing out of the bones. For those tumours which we use to call excrescences, have somewhat in them without the habit of the part and in the whole kind beside nature: but these tumours do not grow without the habit of the part, neither do they include or contain any other preternatural thing beside the sole magnitude disproportionately increased, and by that means the vitiated figure of the parts. For otherwise these swellings should not be of the same Species with the rest of the Bone, to which they are continued, but that is repugnant to the experience of the senses. If therefore it be granted that some tumours (even among those which are altogether preternatural and consist without the habit of their body) are generated of alimentary juices, certainly much less hard is it to be understood that these swellings of the bones are generated and form of the legitimate matter of the bones, by the inherent nutritive faculty. And this is clearly confirmed by this, because the bones according to their similary nature are by no means legitimately produced by an illegitimate matter, that is, an indisposed and disagreeable matter to the other similary bones. Ex quolibet ligno non fit Mercurius, Every natural agent disposeth the matter before it can introduce the form. It is necessary also that the matter so disposed be legitimate. Now the matter of the swelling bones is manifestly disposed; for otherwise it could not actually receive the specifical form of a bone. Moreover that these tumours of the bones are generated by the nutritive faculty is likewise evident, because in all our body there is not any other ossifical virtue besides that nutritive Faculty inherent in the bones themselves, because also these tumours are generated and augmented by the introsumed aliment, and assimilated by the bones themselves: although perhaps in respect of the whole Bone this reception of the aliment may be unequal, and a sufficient cause of error in the nutritive faculty, whereby one part of those Bones may be too sparingly nourished, and another part too plentifully even to a tumour. CHAP. VII. Of the Secondary Essence of this Disease. THe first and Radical Essence of this Disease, and also the parts first affected being explained, now in the next place the Secondary Essence; namely that which immediately followeth this Disease, offereth itself to our examination. And here we must refresh the memory by an intimation of that threefold Constitution already asserted, the Natural, the Vital, the Animal, and thorough these particular Constitutions, shall our examination proceed. And first we will consider the Natural Constitution. This as we have taught above consisteth in the Temperament, common qualites, the plenty and disposition of the Natural Spirits, in the Organization, and continuity: now we have already proved, that the first Essence of this affect is radicated in the Temperament, and in the plenty and disposition of the Natural Spirits: but the other parts of this Constitution, to wit, the common qualities, the Organization, and the continuity do yet remain to be examined. By Common Qualities we understand in a manner the same which some others have called the Modos Materiae, and others, Qualitates Secundas. Now we call them Common, because they are not restrained to any one Element or Form; but in some sort may expiate and range thorough all the Bodies, and for the most part affect them more or less. Of this sort are density, rarity, consistence, fluidness, tenacity, friability, laxity, tension, (or rather tensity, that the habit may be distinguished from the action) witheredness, swelling, and stifness, softness, hardness, smoothness, roughness. But it is not our meaning, exactly to reckon up all and each of the Common Qualities, nor to prosecute those already rehearsed, further than the present occasion shall require. The Tone or Harmony of the Parts doth seem to result from some Common Qualities mutually embraced among themselves. For the Tone of the Parts properly consisteth in a du tenor and mediocrity between certain opposite Common Qualities, as between thickness and thinness, etc. But if there be a recess or departure from the just mediocrity to either of the extremes, then there is a necessity that the Tone must be vitiated. Two things therefore do here seem to be enquired after concerning the Tone of the Parts; the first, whether in this Disease the Tone of the Parts be in any degree vitiated. The next, Whether those faults of the Tone do belong to the secondary Essence of the Disease. As concerning the first, It will be unnecessary to run thorough the particular Parts of the Tone severally, it will be sufficient to examine those that seem guilty of the suspected crime. First, Therefore we meet with an evident looseness of the Tone in this affect: But this looseness differeth both from the infirm coherence, and likewise from the Paralytical resolution of the Parts: for the infirm coherence or weakened stifness of the part is easily made an occasion of the looseness, because in such cases the Part can scarce be stretched forth; but a part may at the same time be both loose, and likewise sufficiently stiff, as may be seen in the strings of Instruments, which if you wind down the pins, they become loose, although in the mean time they forgo not the tenacity of their substance. And in dissected bodies we have frequently observed the loose parts themselves to be sufficiently stiff; yea, and that sometimes in this affect. Wherefore this looseness is a distinct quality from the vitiated stifness of a Part. Neither doth it less differ from that resolution of the Parts which happeneth in the Paralytical Members. For the dead Palsy first consisteth in the depraved Animal Constitution: But this looseness is rooted in the Natural Constitution. For here is no Palsy present either in respect of motion, or in respect of the sense of the Parts: Neither is the Brayn in this Disease primarily affected, as we have already demonstrated. Moreover that there is such an exceeding looseness of the Parts first affected, in this Disease is a thing so conspicuous, that we judge it a superfluous employment to offer proof thereof. For it is obvious to the very senses, and therefore we have listed it among the signs of the Disease. For whether it be a Part of the Essence or not a Part, if it be manifestly subjected to the Senses, it acquireth the propriety of a sign in respect of the other Parts of the Essence, which are removed from the Senses. Secondly, In this Disease there is not only a looseness but likewise a witheredness, and feebleness. Now this quality comprehendeth somewhat more than the mere and simple looseness; for it denoteth withal a certain emptiness of the parts, whereby they sink down of themselves. Now such an emptiness, and such a falling down of the Parts first affected in this Disease are so obvious to the Senses, that there is no need of further proof. Thirdly, A a softness also may be named in the Tone of the Parts first affected in this Disease. For sometimes it so falleth out that there is no coincidence between the softness and the aforesaid qualities; but that it includeth or excludeth some other thing, as in a suppurated Tumour there is softness, but without any laxity of the Tone, any emptiness or subsidence. For in this present supposed case the softness chiefly dependeth upon the manner of Termination, and the tenacity of the Part being vitiated. But in this affect there is for the most part a coincidence with the laxity and flaccidity before mentioned: So that it is needless to distinguish it more accurately then by the name only. Fourthly, There happeneth also another fault in the Tone of the Parts first affected in this Disease, and this is an extreme inward slipperiness. Some perhaps may wonder what the meaning of these words may be, Internal lubricity. We confess indeed that for want of words we have been constrained to join this appellation. For when in nature such a quality as hath a true existence hath by the oversight of Philosophers, and also the neglect of Grammarians wanted a name, we have taken so much liberty to our selus, as in respect of the great vicinity which it hath with the superficial lubricity of the body to give it the same Name, with the distinctive Epithet of Internal. In natural bodies therefore we acknowledge a twofold lubricity; one External and Superficial which indeed consisteth in the smoothness and equality of the Parts of the Superficies, by reason whereof the Subject of it doth easily slide by other bodies which it lighteth upon without much attrition and resistance, Now contrary to this lubricity, is the Superficial roughness: but these two qualities have no reference to this place, because they are Organical, neither do they any way belong to the Tone of the Parts. That other lubricity whereof we began to make mention, consists in that internal, profound and similary smoothness, and equality of the body. By reason whereof, the whole substance of its Subject doth easily slide by the other introsubient bodies without much attrition and resistance. And to this lubricity also there is an Internal roughness. Now that there is such an internal similary slipperiness, and such a roughness also opposite unto it may be showed almost by innumerable instances. For almost all mucilaginous substances are slippery, and that not only in respect of the outward Superficies, but also inwardly, and in respect of the universal Substance, and every particle thereof; so that, according to the definition of a similary body, every particle, by reason of this quality is made like unto the whole, and therefore this quality is internal, and similary, and diffused through the whole internal substance of the Subject. In like manner such an internal roughness may be observed in unripe fruits, extentended thorough their whole substance and Internal flesh. But when they have attained to a just ripeness then usually, in the room of that roughness there succeedeth such a slipperiness as we have now described. And here it must be observed, that if these bodies internally slippery be besmeared or daubed upon the Superficies of bodies otherwise rough, they bequeath a certain degree of lubricity to them, for the time they adhere▪ in like manner being inwardly taken as the slippery juices, and mucilages of Althaea, etc. They do communicate a certain lubricity to the Internal passages of the Body; yea, and not only to the passages that relate to the inward cavities, but also more or less to the very Similary substance of the parts of the Body, which also the blood washeth being impregnated with that slippery juice. But this internal lubricity is manifold: oily or fat, waterish, spiritous, saltish, and perhaps earthy. The oily is chiefly conspicuous in the fat of Creatures, especially such as are young, and in many expressed Oils, especially the moister and colder, and also the temperate; as may be observed in the Oils of Poppy Seeds, Pippin Seeds, the four greater Cold Seeds, Time Seed, and the Oil of sweet Almonds, and the like. A waterish lubricity is in some measure found in simple water itself, although by reason of the fluidness it is less sensible; also this lubricity may most evidently be taken notice of in the mucilages, etc. The Spiritous perhaps doth never happen alone, but it is most frequently mixed with the waterish, as in the sperm of almost all Creatures, and ripe fruits. The Saltish likewise is rarely simple, although there is a man that contendeth it is to be found in salt of Tartar. But the compound saltish lubricity is frequently obvious, as in Soap and Salt of Tartar dissolved with waterish and oily substances. The Earthy (even mixed) is scarce worthy of observation, unless it be in respect that it concurreth to the thickening of fluid bodies, as in white clayish Mud, and Fuller's Earth dissolved. But in this place we have regard chiefly to that lubricity which is waterish, as being that alone which can be guilty of the crime in this affect we now handle, And these things may suffice in general of the internal or similary lubricity. The next enquiring must be whether the first affected parts of this Disease be affected beyond a due proportion with an internel or similary lubricity. And at first indeed it seemeth very probable that there is such an extreme lubricity in the said parts, because moisture doth superabound in them, which ever favoreth the said lubricity, be it conjoined either with heat or cold. Every one knoweth that the Sperm of Creatures by how much it is moister than the creatures produced by it, by so much also it is the more slippery: in like manner that the young flesh of Creatures is more slippery than that of old. Seeing therefore that humidity and lubricity of this kind are so inwardly converted: Seing also that in the parts first affected there is manifestly an extreme humidity, certainly it may easily be granted that a lubricity likewise doth too much abound in the said parts. And to the production of this the benummedness of those parts have no small share. For the Spirits when they are in their exaltation contract a kind of acrimony and sharpness, as may be seen by comparing Must with old Wine, or with Spirit of Wine or with Aqua vitae. For the Spirits of Mu may truly be said to be benumbed or stupefied, if they be compared with the Spirits of old Wine; and by how much more they are stupefied, so much more lubricity they likewise contain, and also so much the less of sharpness and acrimony. From whence it is manifest that that benummedness and dulness in the Spirits lodging in the first affected parts doth favour that extreme lubricity; for that dulness of the Spirits in the said parts is almost of the same degree with the dulness of the Spirits in Must. And because the Spirits are defective in the parts first affected, it is evident that this lubricity is an over-watrish lubricity. Moreover, laxity, flaccidity, and softness do also seem to conspire. For unripe fruit as they are hard, so till they wax ripe they grow softer and softer, and withal acquire an internal lubricity; in like manner the parts are loosened by relaxant baths, and together they become more slippery; also slippery things taken inwardly, as the mucilage of Althaea, etc. Do not only loosen the Parts, but they also make the passages slippery, for which case in the pains of the stone they are drank with good juices. Again, this lubricity of the first affected parts, seemeth to be much confirmed by this, because in the dissected Bodies a manifest lubricity is observable by the touch; and if they be squeezed a mucilaginous kind of blood, inwardly besmearing them, is crushed out with the fingers. We say nothing of the skin, which for the most part is slippery in this affect, and is seldom felt to be rough to the touch: but it is worthy to be noted, that extreme slippery Medicines either outwardly applied, or inwardly taken, do usually more hurt then good in this Disease. And thus we absolve the former question, of the manner whereby the Tone of the Parts is vitiated in this Affect. The other now presents itself to our consideration. Whether the Tone vitiated after that manner as hath been said, be a Part of the Essence of this Disease? We suppose here that whatsoever is found to be vitiated in the Body, is either a morbifical cause, or a Symptom, or the Disease itself; and therefore this Disease either simple or compound, or any part of a compound, and that either primary or secondary. We say first, That the vitiated Tone above propounded is not properly a cause of the Disease. And this scarce need any proof. For the said Tone is a preternatural Constitution, rooted in the Parts themselves, and by that reason it is most evidently distinguished from a morbifical cause properly so called. For although, one Disease may be the cause of another, nevertheless even than it is not properly called a morbifical cause, but a primary Disease, and that other which it produceth, a a secondary affect. But every where there is a growing together of them both into one total Disease, the former will be the primary Part of the Essence, and the latter the secondary part of the Essence. Secondly, We affirm, that the described Tone of the Parts is not a mere Symptom, for it is not under the things secured and retained, neither can it be comprehended under any depraved action, or any changed quality, not vitiating the action. But that the vitiated Tone is not comprehended under the things secured and retained, nor under any depraved action, may by the same labour be proved by this Reason, because those kind of Symptoms are not indeed Constitutions of the body; but the said vitiated Tone without controversy is a preternatural changed constitution, as we have already most plainly demonstrated. Secondly, That the said Tone vitiated after that manner, is not contained under any changed quality, not depraving the action, is so clear and evident, that it needs no proof. For laxity and flaccidity hurteth the motion of the Parts, and an extreme lubricity is an impediment to the du quickening of the vital Spirits, as shall hereafter be made manifest. It may be Objected, That some bare changed qualities which are comprehended under the Genus of Symptoms, may also vitiate an action: as the colour changed in the skin yieldeth an unpleasant prospect to the beholder, so that it begetteth deformity and defect of du comeliness? We answer, That the changed colour of the Skin in as much as it vitiateth the beauty thereof (which is the proper action of the Skin) doth in rigour (in a large acception) fall under the Notion of a Disease. But seeing this action of the Skin is only Objecture and Ad extra, and seeing that altered colour doth hurt no Internal action of that individual: Physicians, who in the definition of a Disease, have respect only to the Internal actions of that individual, do usually exclude it from the Classis of Diseases. Or if the vitiated colour of a part do chance in some place to deprave an internal action (which is known only to happen in the Tunicle of the Eye, called Corura) the best Physicians do ever reckon it for a Disease, although perhaps secondarily. But that we may return into the way from whence we have a little erred: seeing that the vitiated Tone may hurt, as we have said, the internal actions, it doth not properly belong to that kind of Symptom, which is wont to be called by the name of a changed quality. Thirdly we say, That this vitiated Tone, seeing it is neither a Morbifical cause, nor a Symptom, and yet is something preternatural, must needs be the Disease itself. Moreover, the same is clearly proved by the very definition of a Disease. For this vitiated Tone is a preternatural Constitution, primarily or immediately hurting the internal action; therefore it is a Disease. For to what the definition is compatible, to that also the thing defined is compatible. That it is a preternatural Constitution is manifest by this, because it is inherent in the solid parts of the body: that it likewise depraveth the Internal actions, is manifest from hence, because an extreme laxity, lubricity, and flaccidity of the parts being granted, presently the agility is weakened, no other cause approaching, and a certain sluggishness deadeth the irritation of the vital Spirits. In agility, the matter is plain, seeing that firm and stretched bodies, other things being answerable are more active, and so on the contrary: that the same thing also happeneth in the dulness of the irritation shall be showed in its place, for the present we labour to prove no other thing then that the vitiated Tone in this affect is a Disease. We say fourthly, That this vitiated Tone in this Disease is not any simple affect, having an existence apart by itself, but that it is so conjoined and compounded in those same parts with the primary Essence, that the whole Essence of the Disease (whereof we dispute) may be said to consist of many Diseases united together (in themselves indeed simple, if they be considered asunder) and therefore that the vitiated Tone is only a part of the whole Disease. And this needeth no other proof, then because the first Essence proposed above, and the said vitiated Tone▪ are both found in those same parts. For that is properly called a compound Disease, which is produced by many simple Diseases conjoined in the same Part. Fifthly, We affirm that the vitiated Tone is not only a part of the whole Essence, but such a part as hath some dependence upon the primary Essence, and therefore that it is a secondary part of the Essence. Before we proceed to the proof of this Proposition two grants or concessions are to be premised. We grant first, That the said Tone may be even immediately vitiated in other causes perhaps, and likewise by other causes, although that happen not in this present Disease. For the inherent Tone of the Parts may be primarily loosened in the Animal Constitution, and that suddenly, as may be observed in the dead Palsy. For the natural tensity (and not the Animal only) of the Paralytical member is loosened, and indeed suddenly without any conspicuous intervention of any part of the aforesaid primary Essence. After the same manner in a Lipothymy or defection of the mind, looseness and languishing suddenly attatcheth all the parts. Now we cannot in either of these two causes refer the cause of the looseness to the cold and moist distemper of the natural Constitution, seeing that cannot be so suddenly and so sensibly changed. Which let them consider (that we may give warning of it by the way) who will have these common qualities to be always second and dependent upon the first alone: yea, on the other side let them in that cause observe how a cold and moist distemper doth afterwards by degree, follow that looseness suddenly introduced. Again, as for the flaccidity of the parts that may be immediately produced by large evacuations, as a flux of the belly, sweatings, and the like immoderate vents, the temperament being not yet considerably changed, although we deny not but this may easily and doth usually follow. Moreover an internal lubricity may be manifestly separated from coldness, though very difficultly from moisture. Secondly, We grant that in the present Disease, the vitiated Tone doth not in any manner depend upon the first admitted Essence, nor that in every respect is subordinate unto it. For first the qualities of the Tone here vitiated, do also owe somewhat to common causes, namely to themselves, and also to those that are common, to the first granted Essence. For extreme moistening things by one and the same operation are apt to produce both too much moisture, and also looseness. In like manner from violent evacuations, a want of Spirits, and withal a witheredness doth arise. Also from things too too slippery, either outwardly administered, or inwardly tataken, or both, an internal lubricity is augmented, together with a moist distemper. For there is so great a connexion of the whole Essence, hitherto propounded with the common causes, that there is scarce any thing which doth augment the first essence of the Disease, but at the same time more or less it hath an influence upon the vitiated Tone. These things bring granted, We say notwithstanding that in the present affect there is a very great dependence of the vitiated Tone upon the first Essence of this Disease; for which respect alone we have here referred the vitiated Tone to the secondary Essence. If any list to contend, That the said Tone in another respect may relate more clearly to the Secondary Essence, because he may imagine that the primary Essence of every Disease is necessarily similary and perpetually grounded upon the first qualities alone; or because he may conceive that the qualities wherein the Tone consisteth are perpetually secondary, and that they follow the first only (as the shadow doth the Sun) that man may take notice that we purposely decline such questions, lest we should straggle into an unwarrantable digression. It remaineth therefore only that we prove the Dependence of the vitiated Tone upon the first Essence of this Disease to be very great, and that we shall do by parts. We will begin at the laxity. We grant indeed that a laxity may be sometimes suddenly produced, and in that cause a moist distemper may often follow upon it, Namely, when the laxity primarily dependeth upon the fault either of the Animal or Vital Constitution; but in this Disease, seeing that neither the Animal nor the Vital Constitution are primarily affected, there is a necessity that it must flow from other causes. Moreover, such is the condition of laxity and tensity, that they are obnoxious to sudden alterations. For the strings of a Lute may almost in a moment be stretched and loosened again; the same thing likewise from some causes befalleth the Fibers of the Parts, But in this affect the laxity stealeth on by degrees and slowly; therefore necessary it is that it must begin, be ruled and moderated by some cause leisurely and slowly augmented. Although therefore we granted even now, that the laxity doth own somewhat to the common causes of the Disease; yet the augmentation thereof is chiefly restrained and moderated by the primary Essence of this Disease. For moistening Medicines although they loosen withal, yet they scarce loosen more than they moisten, because for the most part they loosen by moistening. Seeing therefore that the common causes of this Disease do flow into the Tone, chiefly by the Mediation of the first Essence of this Disease: And seeing that neither the Animal nor the Vital Constitution can here supply the virtue of a cause, we may Lawfully infer that the laxity of the Tone doth chiefly depend upon the first Essence of the Disease. This is further confirmed, there is of itself a certain proness and tendency of the Body to be through wet, so that the fibers of the parts must needs be loosened by it: Moreover, the defect of the Spirits and the stupefaction of them doth cause a remission of the Tone by diminishing the vigour of the part. Therefore we may conclude that the Disease, laxity principally dependeth upon the primary Essence of the Disease. As for the flaccidity because it comprehendeth the laxity, it springeth from the same causes as that doth; but in as much as it includeth also a subsidence and a certain emptiness, it evidently dependeth upon the defect and benummedness of the inherent Spirits; the plenty and vigour whereof being augmented the lank and flagging member is easily rendered turgid and swelled. In the interim we deny not but that that subsidence doth withal depend upon the extenuation and atrophy of the parts. Lastly, How the slipperiness doth proceed from these causes is sufficiently manifested by what hath been said above. That we may at the length put a period to this matter, it may be observed for the higher confirmation of those things already spoken that there is such a strict dependence between the Tone and the first granted Essence, that throughout the whole cure of the Disease they are intended & remitted together almost in equal pace. For at firstthe Children that are afflictedwith this affect; do only go slowly & leisurely whilst the Tone of the parts is yet but a little loosened; but in the progress they scarce and with much ado trust to their feet, than they play only sitting or as they are carried about. Afterwards they can scarce sit upright; and at the last when the Disease hath attained the highest exaltation, the feeble neck cannot without much difficulty support the burden of the head; all which things as they attest the primary Essence of the Disease to be gradually augmented, so also they make it manifest that the vices of the Tone are intended by an equal pace. And so all these things being rightly weighed, we refer the vitiated Tone to the secondary, not the primary Essence of this affect, and by consequence we conclude, indeed the thing that was in question, that that depraved Tone is a secondary part of the Essence of this Disease. CHAP. VIII. The Secondary Essence of this Disease in the Vital constitution. WE have already propounded that part of the Secondary Essence of this Disease which is radicated in the natural constitution, in as much as it comprehendeth the common qualities; it remaineth now that we examine the organical vices, and the faults of continuity, if any such be found out. But seeing that no proper faults of continuity do accur in this affect, and seeing that the organical vices do depend partly upon the Essence above given, and partly upon the vital constitution being vitiated, it seems necessary in the next place to search into these faults of the vital constitution. The vital constitution is aptly distinguished into the original, or that which maketh an influx, and the participative or that which is produced by that influx. The subject of the original vital constitution are the Spirits themselves excited in the blood of the Arteries. You will say, The heart rather seemeth to be the subject of this constitution. But it is not so, for the heart itself through the coronary Arteries receiveth the vital Spirits brought down with the Arterious blood from its left Ventricle. But it is absurd to suppose the walls of the Heart to be the first subject of the vital heat, and in the mean time for those to receiv that heat from the Arteries. We must say therefore that the solid substance of the heart is indeed the first & principal subject of his natural and inherent constitution; but seeing that receiveth the Vital Spirits (as hath been said) it cannot be accounted the first subject of the Vital Constitution, which is imprinted in it by those Spirits, and continueth no longer than the substance of the Heart is shedded and besprinkled with the Vital Spirits. For neither can life subsist in any place without the Vital Spirit. Wherefore the substance of the Heart doth so far participate of the Vital constitution, as it is washed and bedewed with the Vital Spirits, and by Consequence tha● Constitution in the substance of the heart is not original or influent, but participative or produced by that influx. This is also confirmed in that, because the vital heat of the blood in the hollow Parts, or Ventricls of the Heart (which heat is at least a part of the Vital Constitution) is for greater and more intensiv than that which is within the walls of the Heart, as any man may observe by the opening of the Bodies of living Creatures, the Ventricle of the heart being wounded, and the Finger presently thrust in. For he shall feel a far more augmented heat in the blood, than in the very substance of the Ventricle, however it be handled. Moreover the vital Constitution is a thing transient and consisteth (as the Philosophers Phras is) in motu & fieri; therefore it is rooted. In the movable and decaying Spirits (such as the Vitals which are contained in the Arterious Blood) for some Member being cut off, the Life vanisheth almost in a moment, and by Consequence the vital constitution: but the natural (as we have already insinuated) continueth (though not in such an exaltation as when the Vital remaineth) for a while after death. And indeed the Life and the Vital constitution is suddenly taken away in the case aforesaid not by any positive contrary Cause, But by a mere privation of the Conservant and Continent CAUSE. This is most evidently confirmed, because the Vital constitution is suddenly intended, remitted and altered in all the parts in respect of the model or measure of the Vital Constitution, excited in the Ventricles of the Heart, so in a Lipothymy, the heart fainting, the life of the parts presently vanisheth, at last languisheth; but assoon as the Ventricles of the heart are refreshed with Spirits by some proper cordial applications, strait way we behold the vital Constitution to be suddenly in some measure repaired in all the Parts. In the suppression of the breath sudden death followeth the torrent of the vital Blood from the right to the left Ventricle being intercepted. In the opening of a Vein or in any other immoderate profusion of Blood there happeneth a swooning by the sole defect of the Vital Spirits. Therefore seeing the Vital constitution is transient and fugitive in any of the solid parts, and seeing it dependeth upon the proportion of the vital spirits flowing into them from the Ventricle of the heart, we may rightly infer that in the solid parts, it is not original but participative. But in the Vital Spirits themselves, by whose function the Vital constitution is diffused and transmitted into all the Parts, it must necessarily be original: For there is no other original subject of it to be found in the Body. Yet we grant that the solid substance of the heart by his Natural Constitution (especially being watered by the Vital) is the assistant cause of the excitation of the Vital Spirits in the blood included their Ventricles, although it cannot be the first subject of that same Vital Constitution, as we have even now abundantly proved. And these things for the present may suffice in general concerning each vital constitution, the original and the participative, and to prov that that must properly be ascribed to the Vital Spirits, this to the solid Parts as the immediate Subjects of the inherence. Three kind of vices belonging to this Constitution do still await our examination: The two former whereof relate to the Original: And the third pertaineth to the participative Constitution. The first vice concerneth the Generation of the Vital Spirits. The second hath reference to the distribution of them: And the third appertaineth to the participation of the Vital Constitution. Of these we shall make enquiry in their order. CHAP. IX. The vitiated Generation of the Vital Spirits in this Affect, and whether that fault be a Part of that Secondary Essence? THe Vital Spirits are first excited or generated within the Ventricles of the Heart; namely, in the very mass of the Blood, and properly they discriminate the Blood in the Arteries, from that in the veins, after that they are generated they are cherished and conserved within the cavities of the Arteries, until they are distributed into the habit of the Parts. Yea, they are not only cherished in the Arteries, but in them also rightly disposed, perhaps some new ones are excited, though with less efficacy then in the heart. This being Preadmonished. We say first, That in the very Substance of the heart there doth not occur any fault repugnant to the Generation of the Vital Spirits, which properly can be a part, even of the secondary Essence of this Disease. For the heart itself, for his doth rightly perform his function in this Disease: and if any imperfection happen in the Generation of the Vital Spirits, it cannot be properly ascribed to the heart, but to the ineptitude of the matter, to receive the form of the Vital Spirits. As the ingested aliment if it be extremely crude, it may frustrate the perfection of a laudable concoction, the Stomach being otherwise sound and faultless: So the unapt and unprofitable blood exported to the ventricles of the Heart, may render the action thereof imperfect, in respect of the operation and effect, how sound soever it may be in itself: In which case the ascription of the fault is usually and truly attributed to the indisposed matter, and not to the Heart. You will reply, a Fever is sometimes complicated with this affect, and at such time the heart doth unaptly Generate the Vital Spirits, But that Fever is a Disease of a different kind, and by no means either the whole or any Part of the Essence of this affect. Secondly, We affirm that the lesser Arteries inserted into the first affected Parts, are in some degree really cooled and benumbed by them, through their adjacency and contact, and for that cause they do unaptly conserv the Vital Spirits contained in them, whereupon the Vital Constitution of them is rendered somewhat imperfect, before they can be effused into the Parts themselves. And this fault of the little Arteries seemeth by very good right to be ascribed to the Generation of the vital Spirits. For although it be not the function of the Arteries to propagate the Vital Spirits according to the first signification of the word; yet for this very reason, that they are obliged to conserv them when they are propagated, namely by such a conservation as in a manner includeth a certain continuate Generation of them, their faults are rightly to be referred to the Generation of the Vital Spirits. For the Vital Constitution is a certain transient action (as we have showed before) which, while it lasteth, is in a continual flux and motion, and which like a flame, when the continual fomentation and reparation of it is suspended and suppressed, suddenly extinguished. Therefore are the Arteries as a continuate Heart to all the parts of the body, unto which they transmit and power out their contained Spirits; and what faults soever of the Spirits happen before the effusion of them into the habit of the Parts, seeing that they necessarily belong to the Original Vital Constitution, and cannot otherwise be ascribed to the distribution of the Spirits, they must be referred to the very Generation of them; namely, a continuate Generation in the Arteries, whereby they are continually preserved from a sudden extinction. Moreover, This fault of the Vital Spirits is the depravation of the Vital and Original Constitution, and seeing that it is somewhat preternatural, first hurting the action, from whence the participative constitution, floweth in like manner depraved, and seeing that it merely dependeth upon the primary Essence aforesaid and is complicated in the same parts, it will be a part of the secondary Essence of this Disease. Thirdly, We say that the matter of the Vital Spirits, to wit the Blood of the Veins impregnated with his Natural spirits returning in his circulation from the first affected parts towards the Heart, is somewhat disabled by them to admit the form of the Vital Spirit. For it is necessary that the Blood, whilst it passeth through the parts affected with a cold distemper, want and benummedness of inherent Spirits, must also thereupon affected with some kind of frigidity, benummedness, and perhaps with a thickness and viscous quality beyond the usual degree of Nature. For as the blood doth give a tincture of his qualities to the parts thorough which it glideth; So on the contrary, the parts themselves bequeath also as much as they can of their qualities to the flowing blood. But here likewise we must grant withal that this indisposition in the parts first affected (especially when it is light and small) in the return to the inward parts, is very much corrected by their heat, before it ariseth at the Ventricles of the heart, nay that it is sometimes subdued or if any such contracted fault remain, it is commonly totally abolished by the length of the journey before the return of the Blood to the left Ventricle of the heart, whilst it floweth down by the right, and the substance of the Lungs, the same thing also may be thus confirmed, because if that indisposition should continue till the return of the blood to the left Ventricle of the Heart, the whole mass of blood in the Arteries would become crude and imperfect; and seeing that this blood thus abounding with imperfect Vital Spirits should be transmitted from the Aorta to all the Parts, it would more or less affect them all; which very rarely is observed in this Disease. For the head, & many bowels, however some of them are found to be greater than ordinary yet they seem to be watered with a perfect Vital Spirit. But although, as we have said, the slight indisposition of the Blood may be corrected, before its return to the right ventricle, yet when the contracted fault is great and more considerable, it cannot be altogether overcome, whereupon the Lungs in this Disease are commonly afflicted with the most grievous Evil. For, when the less Spiritous, and therefore the less passable Blood, is continually transmitted thorough the Lungs, cold and thick, or viscous, in process of time it must needs more or less infect and obstruct the weaker parts of the Lungs; from whence proceed difficulty of drawing breath, a stubborn cough, hard tumours, inflammations, impostumes, and the Ptysick. Fever's also both Erratic and Hectic, may from hence dirive their Origen. But seeing that fault may be suddenly introduced from the first affected parts, it is credible (although we have said the Lungs are often infected by it) that it is for the most part overcome, before the Blood can come to the left Ventricle. And this may be the reason why the Head and the adjacent parts do look so well and flourishing, namely, because neither the Natural nor the Vital Constitution is hurt in them, seeing that the perfect Vital Spirits generated in the left Ventricle, and distributed from thence, do excite that fresh colour in the face; when on the contrary the Lungs do oftentimes labour under the faults aforesaid, the viciousness of the Blood not being corrected before it enter the right Ventricle and the Arterious vein. Moreover, This imperfect production of Vital Spirits in the right Ventricle of the Heart, by reason of the crudeness of the affluent Blood, flowing in the Veins, totally appertaineth to the secondary Essence of this Disease, and must be accounted a part of it: for the Vital Constitution is vitiated, whereupon the actions in the Lungs are depraved, and it dependeth wholly and in every respect upon the primary granted Essence, neither in the mean time, doth it reside in the solid Substance of the Heart, that it should therefore deserv the name of a a new disease. Here we note by the way, That Physicians in the cure of this affect do ever intermingle such things with their remedies as have respect to the benefit of the Lungs; and not without reason, seeing that it is apparent by what hath been said, to how much danger that Bowel is continually subject. And this may suffice concerning the faults in the Generation of the Vital Spirits: Now follow the faults of the distribution of those Spirits. CHAP. X. The vitiated Distribution of the Vital Spirits in this Affect, and whether it be a Part of the Secondary Essence thereof? THis vitiated distribution seemeth to consist in three things: namely, in the Dimunition, Slowness, and the Inequality of it. The defective, and also the slow distribution of the Blood and Spirits, may be seen in some one Part, and perhaps in all those that are first affected: But the inequality cannot be observed in any one, seeing that it resulteth from a collation of a various swiftness and slowness, greatness and smallness of the torrent of the Blood in respect of the other parts. The defect and slowness of the distribution: seeing that they depend almost upon the same causes in the present affect, they may be handled together, and seeing those differences are more simple than the inequality, the handling of them seemeth deservedly and justly to be premised. But first we must grant that the passages and circulation of the Blood, thorough the first affected parts is not very difficult in this affect. For although a cold distemper, a want and benummedness of Spirits, do seem very difficultly to admit a transition of the Blood thorough the parts affected, with these qualities; yet indeed other conjoined qualities; as moisture, looseness, laxity, flaccidity, softness, and internal lubricity, can at the least contribute as much power to facilitate the passage of it, as the qualities aforesaid can oppose to the interruption of it. Yea, if you valu them by a just estimation, perhaps they can do more, but we will not in this place assert it, only we flatly deny the difficulty of the circulation to be greater. For, if we may compare hard bodies with soft, low bodies with strait, moist with dry, slippery with rough, we shall easily perceiv that the circulation of the blood is much more quick and expedite in those, then in these. And this is manifest in young Creatures in whom those qualities abound, in such as are new born, although the Heart be very tender, the Arteries less firm, the pulsificative vertu, yet feeble and weak, yet the passing too and fro of the blood are readily and easily exercised; which in those that are older is not accomplished without a stronger pulse, and an endeavour or a kind of labour of the Heart and Arteries. Again, according to the opinion of Galen and Hypocrates, the Bodies of children are most passable; namely, by reason of their humidity, laxity, and softness. Besides, if we observe the formation of the chicken in the egg, the matter will be yet more plain. Within few days after the incubation the Heart of the chicken is sensibly and evidently seen to beat, and to begin the circulation of the Blood: but if at the same time we consider the frailty of the Heart itself, and how weak a coherence there is between the parts of it, till in the interim it finisheth the circulation of the blood according to the manner of it, such as it is▪ we must necessarily grant that in that shapeless lump, moisture, and internal lubricity do expediate and facilitate that motion. Some perhaps may object that in these cited cases the liberty and readiness of the circulation of the blood, depends not so much upon the moisture, softness and slipperiness, as upon the plenty of the inherent Natural Spirits. For in the Cachexia, Green sickness, and the dropsy, the flesh is very soft, moist; and perhaps slippery, when in the mean time the transition of the Blood is very difficult. We answer, those Bodies that wax tender and soft by a paucity of inherent Spirits, are less indisposed, and more apt to admit the circulation of the Blood then the other parts. But it is not simply true that such bodies which most abound with Spirits do perpetually obtain the most expedite and unrestrained circulation of the Blood: for the Blood is more easily circulated in Fish, then in Creatures of the Land, as is manifest by the tender and frail Constitution of their Heart, and Arteries; yet they enjoy a less quantity of Inherent Spirits. But because they live perpetually in the waters, therefore is their flesh more moist and slippery. Whence it most evidently appeareth how effectual the inward lubricity and moisture are to facilitate the passage of the Blood. As for those that are invaded with the Green sickness or afflicted with a Cachexia, we grant indeed that the circulation of the Blood is difficult in them, yet not only through a defect of inherent Spirits, but by reason of stubborn obstructions lodging in the whole body. Wherefore it must be granted, notwithstanding the cold distemper, the penury, and stupefaction of the Spirits, which procure a difficulty to the circulation, that such a Mediocrity is imposed upon it, by the moisture, softness, and internal slipperiness, that the passage of the Blood may be reduced to a just, if not an extreme facility. But if the moisture, softness, and inward slipperiness be so considerable to effectuate an easy circulation of the Blood, Truly, the distribution of it through the parts first affected seemeth to be expected more swift and not more slow. We answer that the facility of the transition of the Blood is opposed to the slowness of the motion, or to the smallness of the passage. For a swift motion may be slow, and in a small Channel. But the facility is here opposed to difficulty, striving, and labour, which in this case, if the circulation were difficult, should happen to the Artery in the passage of the Blood. But that the Arteries do undergo some labour in expediting the circulation of the Blood into the first affected parts, shall anon be demonstrated; we only affirm in this place that the facility, of the passage of the Blood doth not sufficiently argue either the swiftness of the motion, nor the widness of the passage. For, two causes do chiefly conspire to hasten the course of the Blood through the habit of the parts. One is the aptitude of the part recipient, or that through which the blood ought to flow; and this cause is merely passive and slothful: the other is the impulsion of the Heart and Artery, and also of the Arterious Blood contending to stretch and dilate itself. This cause is active and full of vivacity. For upon the cessation of this impulsion, the distribution of the Blood will presently after totally cease, however the passage may be otherwise supposed to be most easy, manifest therefore it is that this impulsion is the principal & active cause of the swiftness and slowness, and also of the quantity of the distribution of the Blood. Wherefore those causes which do any way advance or hinder this impulsion, do now come to undergo a more accurate examination. For by these we shall know whether the destribution of the Blood in the parts first affected, be really more sparing or slow than is meet. These causes do chiefly concur to excite that impulsion. First, the plenty and activity of the Vital spirits contained in the Blood. Secondly, the perfect soundness of the Heart. Thirdly, The firmitude, heat, and just magnitude of the Arteries. Fourthly, An irritation both of the Heart and Arteries, whether extrinsecally or intrinsically caused. These we will run over in their order, that it may appear in what condition they are in this present Disease. First, As for the plenty and activity of the Vital Spirits, we have already showed that in this affect the imperfect Vital Spirits are frequently excited in the right Ventricle of the Heart. Seeing therefore that the Blood tainted with these imperfect Spirits, must be driven into the Lungs, there is a necessity the destribution must there become more sparing and slow by reason of the defect of the Spirits. Again, seeing that the vital blood, as we have also showed above, is somewhat cooled in the Arteries, which are terminated in the first affected parts, it is necessary likewise that the passage of it through the said parts must be diminished and more dull. Secondly, The virtue of the Heart, unless peradventure by accident through the complication of some other Disease, is seldom seen to be vitiated in this affect. Thirdly, For so much as concerneth the Arteries, we cannot accuse their condition of any notable defect in reference to their strength. But there is a manifest fault both in their heat and magnitude. First, in their heat, the Arteries inserted into the first affected parts, must necessarily by their cold distemper be somewhat affected with the like distemper. For seeing that a distemper of the parts first affected is active and permanent, it is unavoidable but they must more or less introduce a like quality into the parts so nearly bordering to one another, For natural agents are busily industrious to assimilate all Bodies placcd within the Sphere of their activity, but especially such as are circumambient and nearly adjacent. But if any man doubt whether that coldness of the Arteries can retard and lessen the current of the Blood through the first affected parts, let him consider that frigidity is of itself an enemy to any kind of motion. For it is the quality of cold by its own Nature to arrest Violences, and impetuous oppositions, to condensate, to induce sloth, to superinduce Somnolency, stupefaction, and immobility, and when it attaineth a more intensive degree, to congeal and mortify the parts. Therefore it must needs cast a Remora to the torrent or the Blood waving through the parts affected with that quality. Besides, In the opening of a Vein we have often observed upon the cooling of the member that the Blood hath flowed more slowly and sparingly, and if the member be warmed again, or the pulse be excited by rubbing or any other motion or means, that then the Blood floweth again with a more plentiful and liberal current. Moreover, the application of cold things is sensibly effectual to stop Blood preternaturally bursting out of any part, as on the contrary, hot things do provoke the ebullition of it. It may be objected, That the Pulse is many times actuated and intended by the cold outwardly opposed; as by the handling and playing with snow, we see that not only the Pulse but the heat also is augmented in the hands of those that sport themselves with it. We answer, Cold things of themselves do always move the passage of the Blood through the habit of the parts; but that by accident they may intend the circulation of the Blood, if at length they provoke the pulses of the Arteries (as in the said case of the snow it happeneth) to beat stronger marches. But this never comes to pass in this present affect. For (as we have already showed) the circulation of the Blood in this Disease, however it may suffer Immunitior or Retardation, yet it continueth sufficiently easy and expedite, neither doth any irritation of the pulls arise from thence, as anon we shall perceiv more plainly. For seeing it is manifest by what hath been said, that the Arteries reaching to the first affected parts, become more cold than ordinary, or is meet, we may easily believe that they become likewise more slender; so in any cooled member we see the Veins and the Arteries become more slender than they were wont to be; and it cannot be denied, but that actual cold doth straighten the Vessels. But it is more than probable that a Potential coldness (such as perhaps that may be said to be which is of an inward distemper) doth likewise make the Veins and Arteries more slender. So we see cold Complexions, and also cold and moist, to have less Veins and Arteries than the hot. Corpulent bodies, women, children, have narrower Vessels, then lean, men, or youths. Besides, the very heat itself is an expansive quality, that it may enlarge the Vessels, and cold a contractive quality, that it may restrain and straiten the Vessels. Finally, one of us observed that upon the dissection of the Bodies perishing by this affect: He hath sometimes found the Veins, and the Arteries, tending towards the first affected parts to be of an undue slenderness: but that those Arteries called Carotides, and the jugulary Veins were disproportinatly amplified; and in is credible that this might have been perpetually observed, had they that opened the bodies minded it with a attentive contemplation. But this we peremptorily affirm not, but leave it to future inquiry: in the interim seeing that it sufficiently appeareth by what hath been said that the circulation of the Blood, in the first affected parts is diminished, it is likewise agreeable to reason, that the Vessels also of those parts are straitened. And seeing that the left Ventricle of the Heart, doth pour so great a quantity into the Aorta as may suffice all the parts, and seeing that so many parts primarily affected do sparingly sip, that blood it is very probable that it is distributed with an unusual liberality thorough the other parts, and namely thorough the Head and Liver, and therefore the Vessels of these parts are somewhat dilated and amplified. Concerning the lessened circulation of the Blood in this affect: We add this experiment only, a ligature being wound about the arm or thighs of a young boy grievously tormented with this Disease, the Veins did not so easily swell beyond the ligature, neither did the habit of the part full of Blood appear in that place so swelled and coloured as it usually doth in those that are sound. From whence apparent it is, that the transition of the Blood thorough those parts is more dull and less plentiful, than it ought to be as a river stopped by a dam or wall doth sooner or later overflow the Banks, according to the various swiftness and magnitude of the Torrent: So likewise it happeneth here, the retiring of the Blood thorough the Vein, to the inward parts, is intercepted by the force of the ligature, which if it were violent, would in a short time fill the Veins, and the habit of the parts beyond the ligature; as we see it to happen otherwise in sound Persons; but because in this Disease it filleth them slowly, and very dully, we must conclude that the circulation of the Blood in those parts is extremely lessened and slow, and that the Arteries inserted into those parts are more cold and slender than they ought to be, as we have most abundantly proved, that the Arteries of the first affected parts are vitiated by a defect of just magnitude. Fourthly, As for the irritation of the Heart and Arteries (which perhaps is the principle cause of many differences in the pulses) it is manifestly found to be weak and ineffectual in the Arteries of the first affected parts. We purpose not at this time to discourse of the nature, causes, differences and effects of irritation in the pulses; only we observe in general that it may be either natural or violent; and that each of them may be universal or particular, and withal may arise either from within or from without. And lastly, that it may be excessive or defective: In the handling of the present Disease it will suffice to touch upon the particular Irritation of the Arteries, and afterwards to accommodate our Diseases to the present business. 1. Therefore, we affirm that the Arteries impel the Blood into the substance or habit of the parts, by a certain labour and contention; and that the parts which receiv that Blood do make some resistance and opposition: that by reason of this conflict the Arteries are Irritated to make stronger resistances or pulses; and that that Skirmishing is of so great moment to fortify the pulse and render it more vigorous, that when it is weak, the Pulls can scarce be strong: but where the contention is somewhat more increased, yet so, that it doth not overcome the opposition of the Arteries, the pulse becomes more strong and lively, provided that no impediment from some other cause doth intervene. This we might illustrate by divers instances, but we will exemplify it only in a few: in the winter the pulses are more full, hard, strong and constant, then in the summer; but it is certain that at that time the outward parts of the body being bound up with cold, are more firm and less passable, and therefore that they do more strongly then at other times resist the Blood, contending to pass thorough the substance of them in his circulation; whereupon the Arteries, when no other intervening matter hindereth, must needs move more vigorously, and drive the Blood more forcibly, if they perform their office in perfecting the circulation of the Blood. Hereupon those Arteries are irritated, unless they be totally suppressed, or by some other means charmed, and by degrees yield stronger strokes; and withal the Spiritous Blood being penned in & striving for more room they do wax a little more hot, and are somewhat enlarged, and sometimes having a little triumphed over the subdued opposition, they drive forward the blood into the parts, with a more swift & copious torrent then before. This is further confirmed by the heat augmented by handling snow, for although at the first the Hands wax presently cold, yet in a short time after they grow hot, & withal they are died & coloured with Blood, as the intensiveness of the heat doth justify. For upon the first contrectation or touch of the snow the parts are bound up, and strongly resist the circulation of the Blood, the Arteries also in those parts are at the same time contracted But, unless the cold prevail to a total suppression of the Spirits contained in those Arteries, and to a stupifying of the Arteries themselves, or at least a benummedness, those Arteries are by degrees irritated, and the interrupted Blood more forcibly contends for wider room, and so at length by this counteropposition, the Arteries wax hot and are dilated, and the pulls being increased, they extrude the Blood more plentifully into the part before overcooled. On the contrary, in the summer, when less resistance is opposed against the passage of the Blood, the pulse becomes more feeble, more languid, and more soft. From whence it appears that the defect of a du irritation, proceeding from the weak resistance of the parts which receav the Blood from the Arteries▪ doth diminish the vigour of the pulses. Secondly, The same is yet more evidently seen when the Pulse is augmented by the motion of the Body; for in any violent motion almost all the Muscles are stretched, by reason whereof they somewhat more resist the passage of the Blood; hereupon the Arteries are provoked to contention, their heat is increased, and therefore more nimble, strong and full Pulses are emitted. Thirdly, As the inflammation of a part doth sensibly irritate the Arteries thereof, so it exciteth a more vehement Pulse and bauseth a more liberal Flux of the Blood. The same may be said of pain. Fourthly, Hither also must be referred the bruising of any part. For a bruised part doth difficultly receive the Blood flowing to it: hereupon the Arteries provoked, they beat more strongly, and swell the bruised part resisting them into a tumour. This might be demonstred by many more examples, but we conceive these to be very sufficient and satisfactory. Moreover, It must be noted that the parts caused by the reception of the Blood in the Arteries, may be very great, and yet not sufficient effectually to irritate the Arteries; in which case it rather remitteth and disturbeth them, increaseth, or facilitateth the force of the torrent of the Blood. For that opposition of itself interrupteth the channel of the Blood thorough the substance of the parts; but because it doth withal irritate the Arteries to emit more lively strokes, it quickeneth the torrent of it by accident. Wherefore we are here compelled into another involuntary digression, by distinguishing between the resistance of the part that irritate, and that which doth not, or doth very little irritate the instances already alleged will suffice for the former, and to explain the latter we will add a few. First, Therefore there is a resistance that totally suppresseth the torrent of the Blood. Such a one is caused by a strong ligature, which doth altogether intercept the pulse in those parts beyond it, neither yet doth it irritate the Arteries on this side of it, because it overcometh all the force of the Artery beyond the Ligature and doth wholly break off the action thereof. The same is seen in the parts mortified with cold, or by other causes corrupted with an inflammation; and perhaps in some hard swellings, contractures and some confirmed wounds. Secondly, There is a resistance pressing down the Arteries even by the compression of the Arteries, and this happeneth in a ligature indifferently bound. Also in the compression of an Artery by some tumour in the adjacent parts as in a raw swelling; also in a compression from any outward cause, many things which belong to the lying down on the right side especially, and the left are referred hither; so in tumours on the right side, the lying on the left side is many times endured with the least patience by the compression of the sound parts by those that are swelled etc. and this compression however it resisteth the circulation of the Blood, yet it doth not seem much to irritate the Arteries, because it doth no less intercept the very pulsificative force, than it diminisheth the action thereof. Although perhaps it may sometimes irritate in the Lungs by reason of their vehement heat, just as it useth to do in aching and inflamed parts. Thirdly, There is a resistance in part repressing the circulation of the Blood, but without compression of the Arteries, nor yet totally suppressing them, nor very much irritating the Artery. Such an one occurreth in obstructions caused by cold, slow, thick, and moist humours, which although they may somewhat retard the free passage of the Blood, yet they provoke the Artery very little, because at the same time they superinduce a certain benummedness in them, at least a cold distemper, as also in the Blood which they contain. The same almost may be said of paralytical members, but that in these a benummedness is more evidently introduced in their Arteries, and the channel of the Blood is less retarded in them, Moreover, We affirm secondly that the parts first affected in this Disease do not sufficiently irritate the Arteries, by which the Blood is distributed through them. For although in these parts, both by reason of their solidity, and also in respect of their coldness, we grant some kind of resistance, yet it is extreme feeble and slow, and very little provoking. First, because in those paris a moist is conjoined with the cold distemper, which of itself tempereth and qualifieth all manner of provocations. Secondly, Because there is a penury of inherent Spirits, which otherwise, where they abound, are wont to cherish the vigour of the Arteries, and the blood contained in them. Thirdly, Because those parts are loose, weak, and soft, and therefore more prone to receive with facility that which the Arteries send in, than to exasperate them by resistance. And that the Arteries do not convey the Blood by any vigorous and considerable force into these parts, is manifest by this sign, because after the influx of the Spirits, and the Blood they still continue loose, soft and feeble, when on the contrary strong Pulses are wont to render the parts otherwise weak, full, swollen, and stiff, on a sudden. Fifthly, because the first affected parts have in them a similary lubricity. For as the superficiary or external lubricity suffereth any thing to pass by, without attritition: so also the Internal or similary lubricity facilitates the circulation of the Blood, so that the passage is accomplished with very small opposition. We conclude therefore that the proirritation of the Arteries is in this Disease deficient; and therefore that the Arteries are very dully and ineffectually excited to strengthen the pulls. Having at the length weighed all things which we propounded concerning the causes which actuate and advance the Blood in his circulation, it sufficiently appeareth, that the circulation of the Blood in this affect is easy and expedit enough, but that it is lessened and passeth dully thorough the parts first affected, both by reason of the sluggishness of the Arterious Blood contained in the Artery of the said parts, and also because of the defective heat, and slenderness of those Arteries; and finally, in regard of their ineffectual irritation. And let these things suffice concerning the two former faults belonging to the distribution of the Blood in this affect, namely, the diminution and slowness thereof. It remaineth in the next place to examine the inequality of that distribution. CHAP. XI. The Inequality of the Distribution of the Blood in this Affect. THis inequality is to be estimated by a comparison of the greatness & swiftness of the current of the Blood, made in divers parts. For if the circulation of the Blood according to a Geometrical proportion be either equally small and slow, or equally great and swift, that must be judged equal by the scope of the present inquiries: on the contrary, if in some parts it be little and slow, and in others great and swift, that must be reputed unequal and disproportionate. And this is the State of the present disquisition. It is manifest by what hath been said, That the stribution of the Blood thorough the parts first affected, is extremely sparing and slow: It remaineth therefore only that we consider whether it be transmitted thorough the other parts with a quicker and more plentiful motion. We have already affirmed that the root of this evil is not fixed in the Heart itself, and that this Bowel of itself is not primarily il affected in respect of the left Ventricle thereof. It is credible therefore, that the Heart (unless perhaps some other Disease be conjoined or supervene) doth rightly execute his function, and expel a sufficient quantity of Blood, for our turn by every stroke into the Aorta. Seeing therefore (as hath been already proved) that the Blood is niggardly dispensed from the Aorta into the first affected parts, a superfluous portion of it must needs be distributed into other parts not so affected: for otherwise the Aorta should not sufficiently discharge itself, nor disburden the Blood received from the Heart, but it would be obstructed and oppressed with the plenty thereof; and this repletion upon every slight occasion would fly back, even to the left Ventricle of the Heart, and there kindle a Fever. And we grant indeed, for this very cause, among others, that in this Disease a Fever is easily and frequently produced. But seeing that the Fever is another Disease conjoined, and separable and different from this, and seeing that this Disease very often happeneth without a Fever; it must needs be granted, that by how much more sparingly the Blood is distributed to the first affected parts, by so much the more plentifully conv●●ed to the other parts, at least in the absence of the Fever. For seeing that quantity of Blood, as we said even now, is extruded into the Aorta, as may suffice the whole Body, and seeing all of it must be distributed into several parts, it most plainly follows, that the less is transmitted into one part, the more is dispensed into another. And thus it may be perceived that the inequality of the distribution of the Blood is inferred from the sole diminution thereof, in the first affected parts above asserted, (at least probably) namely, from the small and slow current of the Blood thorough the parts first affected, there may be rightly collected à more quick and plentiful stream of it, into the inward parts not so affected. Now let us see whether the other appearances relating hither are correspondent to this Discourse. First, It seemeth manifest by what hath been alleged, that the Head, the Brain, the Liver, and the other Bowels, are not afflicted with that cold distemper, nor that stupefaction and penury of inherent Spirits, wherewith the parts primarily affected are oppressed. For the bowels and the said parts do not receive their Nerves from the Spinal Marrow, without the Skull, but they are involved in the same condition with the other parts. Moreover, those parts, as far as we can judge by the touch are (at least outwardly) moderately hot, and as far as we can guests by the sight they retain their native and flourishing colour, besides they are more full and fleshly, than the first affected parts. Moreover, Children afflicted with this Disease have an indifferently good appetite, they do not il concoct the introsumed aliment, and about the Head they retain their senses very acute: they see, they hear, they taste, they smell as subtly as others, and as for their wit, they many times surpass those of equal years with them; unless an impediment from some other cause. All which things put together do abundantly witness, that a cold distemper, nor a benummedness or penury of Inherent Spirits, hath none, or at least a very small predominancy in those parts. These things being granted, we must likewise needs grant that a more liberal distribution of the Blood is dispensed to the said parts. For as for the heat, we have already showed that that doth both amplify and stir up the Arteries to send forth a stronger pulsation; and we have also noted above that the plenty of the Spirits, doth not only cherish the pulsificative force of the Arteries, and conserv the vigour of the Blood contained in them, but that it doth somewhat enliven and excitate both of them, and that by so much the more effectually, by how much the less the inherent Spirits are affected with a stupefaction. Secondly, unless those parts were watered with a more liberal circulation of the Blood, they would become more soft, loose, and feeble, than they are, even as the parts first affected are observed to be. For upon the defect or languishing of the Pulls in any part, the part presently becomes loose and weak, as it happeneth to all the Parts in a Lipothymy. On the contrary, when the Pulls beats strongly, the Part whereunto it belongeth, is seen to be somewhat rigid and swelled. For a full Pulls doth presently fill up those parts, which were before sunk down by emptiness; as the Lypothymy being driven away, and the Pulls being restored, the Parts of the Body, which were before loose and languid, are not only well coloured, but full of vivacity and turgid: seeing therefore that those Parts are not affected with that softness, looseness, and weakness, we must conclude that they are actuated with a full Pulls. Thirdly, The very augmented magnitude of thes parts, in comparison of the parts primarily affected in this Disease doth witness, that they are more liberally fed with their aliment, namely, the Blood, (which is reputed the common and last aliment of the Parts) for otherwise scarce any sufficient reason can be imagined, why, when the first affected Parts are so extenuated, these should be (especially the Brain and Liver) in so good a condition, so full and so plump. The same thing is confirmed by the lively colour of the same parts. For if the Pulls languish in any part, somewhat of the fresh and amiable colour presently retireth from that Part. Fourthly, The Arteries called Carotides, and the Jugulary Veyn, which belong to the Brayn, and the parts about the Head, are observed to be very broad in this affect; but the Vessels tending to the first affected parts to be unduly slender; from whence we may clearly infer, That the dispensation of the Blood to those Parts is unequal. And here we entreat and beseech those who have an opportunity to open such Bodies as this affect hath destroyed, that they would accurately contemplate whether the swelling Arteries inserted into the swelling parts of the Bones do more liberally, and more commodiously transmit the Blood into those, than into the other less nourished parts of the Bones, and whether the Arteries of those parts are more broad than of these. Although indeed we confess that this enquiry is most difficult, both because of the slenderness of those Arteries, and in regard of the obscurity of their insertion, and also in respect of the hardness of the Bones. Fifthly, Hither also belong things hurtful and helpful for children afflicted with this Disease are manifestly benefitted by rubbings, motion, and various agitation of the Body, by exercises, strengthening Ointments, and the like means which raise the heat in the Members on the rightside, and the other parts primarily affected, and irritate the Pulses and augment them after any sort, whereby the distribution of the Blood may be more nearly reduced to some equality; with the contrary things they are damnified. In like manner such Medicines which promove the dispensation of the Blood to the first affected parts (as those which are moderately hot, benign and familiar to Nature, and so attenuant, incident, and deobstruent that at the same time they do not in the least degree wast but cherish and augment the Spirits) help very much towards the cure of this Disease; the contraries do either produce or foment it being produced. All these things being considered we must conclude that the destribution of the Blood in this affect is irregular and unequal. And thus at length we have finished the disquification of the faults in the destribution of the Vital Blood; we now proceed to the examination of the faults, if any such there be, of the Vital participative Constitution in this Disease. CHAP. XII. The faults of the Vital participative Constitution in this Affect. WE have already said that the Origine of the Vital Constitution is grounded in the Arterious Blood, and especially in the spiritous part thereof: but because the solid parts also do somewhat truly participate the nature of Life we justly ascribe unto them the Vital participative Constitution. Now this Constitution consisteth in Three Things. First, In a certain union of the Arterious Blood with the substance of the solid parts through which it passeth. Secondly, In the Vital heat excited in those parts. Thirdly, In the enlivening and exaltation of the Natural Constitution, and of all the Natural faculties of those parts. First, As for that union of the Arterious Blood, it must be justly reputed, the first part of the participative Life. For the solid parts are therefore said to participate of the Nature of Life, or the Vital Constitution, because the Vital Spirits are contained in them. For Life cannot consist without a Vital Spirit. Therefore when the Vital Spirit is distributed in and with the Arterious Blood to the solid parts through the Arteries, and these parts do suck in that Blood into their substance, it comes to pass, that the said parts are counited with the Vital Spirits, and so they participate of the Nature of Life. Moreover, Seeing this union is not permanent but transient and consisteth in motion, it seemeth to consist in the confluence and mutual embracement of the inherent natural and influent Vital Spirit: but the conditions which are requisite to make this a natural concourse, are, First, That it be in all respects, moderate, and not impetuous. Secondly, That it be in all respects strong, and not feeble and stupefied. Thirdly, That it be friendly and peaceable, not hostile and Turbulent, that it be gentle not tumultuous; that it be neither too slippery and smooth, nor too rough. Fourthly, That it end not in any kind of dissipation of the Spirits, but rather in the appeasing and apt disposition of them for their return into the Veins. More such conditions might perhaps be added; but because they very little belong to this Disease, we shall here superseded any further examination of them. We only note that the mutual concourse and union of the Vital and natural Constitution by their Spirits, doth not occur in this affect, with that activity, vigour and complacency, as it usually doth in sound Bodies. And this scarce needeth any proof, seeing that it is manifest by what hath been said above, that not only the natural constitution of the first affected Parts doth labour under a cold and a moist distemper, a defect and benummedness of Spirits, but that the Vital Blood itself is also somewhat damped and stupefied in the tops or ends of the Arteries, before it can be conveyed into the first affected parts, so that that union must needs be performed without either a sufficient vivacity, or pleasure. For when the vigorous Vital Spirits do meet together with the Natural Spirits no less vigorous, they are united with a kind of courteous strife and delightful contention. Whether, that we may illustrate this matter by an example, the natural Spirits as a Bride do here allure and in a manner repel the Vital Spirits who as it were act the part of a Bridegroom: But the Vital Spirits provoked with their heat, and driven on by the vigour of the Pulses do more confidently invade the Natural Spirits and penetrate into their confines and regions, whilst the Natural Spirits in the mean time (however as it were with modest resistances repulsing the assault) receive them at length not without a certain pleasure. For the very corporal pleasure is established upon, and increased by a kind of amorous strife, and the principal part of Life itself consisteth in such a contention about the Reciprocal union of the Spirits; for to that end the Vital Spirits are both▪ generated and distributed, that at length they may pass through the solid Natural Constitution of the Parts, and may profoundly imbue them with their vital power and virtue; but seeing this peneration cannot be effected without endeavour and resistance, it must needs be, that the vigour of that contention & resistance, be either more or less according to their copiousness, vivacity, and heat of those Spirits that maintain the conflict. Therefore because in this affect, both the Natural and the Vital Spirits are more cold, fewer, and less active; their concourse and union must needs be dull and undelightful. Moreover it must be noted in this affect (which also we have showed above) that the permeation of the Blood thorough the first affected parts is to easy and slippery, whereupon even for this reason, that concourse and union of the Spirits in those parts is rendered more slothful, and less pleasant. Besides, hot exhalations although for the most part they are sparingly raised in this affect, yet being raised, by reason of the softness, looseness, and internal lubricity of the first affected parts, parts, they evaporate sooner than is meet, whereupon they leave those parts cold and feeble. Secondly, As for the Vital heat communicated to the solid parts (which is the second part of the Vital participative Constitution) that partly depends upon the aforesaid union, or the Incorporation of the Arterious Blood, with the solid parts; but partly it consisteth in a certain expansive motion or endeavour (like to that expansive endeavour of the Arterious Blood) excited in the very solid parts. The first is very perspicuous, for the Arterious Blood through the impregnation of the Vital heat, when it is received into the solid parts, must needs with their substance communicate their heat also unto them. The second is likewise proved without difficulty, For if the Vital heat radicated in the Arterious Blood consisteth in a certain motion or endeavour of that Blood uniformly diffused and withal at the same time somewhat restrained, it must avoidable excite the same motion in the solid parts thorough which it passeth, seeing that natural causes do always act to the extremity of their power, and as much as is possible by way of assimilation. If any man doubt whether the Essence of the Vital heat consist in such an uniform diffusive motion, moderately restrained and intrinsically advancing: let him know that the Essence of heat doth in general consist in motion or a rerefactive endeavour somewhat interrupted, as Sr. Thomas Bacon doth most clearly demonstrate in his Novum Organum. But this I say, the Vital heat, seeing that it containeth in itself the true nature of heat, it will be also necessarily such a rarefactive endeavour somewhat restrained. But that this heat may be restrained to the Vital; more conditions must be added, which nevertheless we cannot in this place either reckon up, or accuratly search into, lest we should run into an unreasonable digression: In the interim that we may have the matter, and the manner of enquiring, whether or no in this affect the Vital heat be moderated according to nature, it seemed good unto us, to propound these subsequent conditions. First, That the Vital heat may be called Natural, or according to Nature, it is requisite that the Origin thereof be Internal; namely, in the Arterious Blood, and that it be derived to the solid parts, as hath been said, by the implantation and union thereof; for that any thing may be called, Natural, it must needs flow from an Internal Principle, although it be likewise true that what things soever do moderately cherish, augment, and excite that Internal Principle, may in that respect deserve this appellation. Secondly, It is required, that that heat be moderate, not unequally, remiss, or intensive, but communicated to the parts, in an even degree. Thirdly, It is required, that it be in some measure uniform, and like itself in those parts, that rejoice in the same similary constitution, provided, that they be equidistant from the fountain of heat, and after the same manner affected by some other concurrent and adjacent causes. But in the parts further distant from the fountain of heat; yet otherwise, as hath been said, after the same manner affected, that it may be uniformly diminished: And in like manner in the colder parts in respect of the inherent constitution, that it may be also proportionably more remiss. Lastly, In the parts diversely affected by other causes, so that one may be much more intensively hot then another: it is requisite, that between the hotter and the colder part there be found a heat gradually, and as it were uniformly more remiss (if you proceed gently from the hotter towards the colder part.) And even a certain uniformity may be observed in this deformity or disparity of heat, so long as it continueth within the bounds of Nature. For the parts immediately and intermutually touching one another, are in a preternatural capacity, or condition: If one of them be extremely hot in comparison of the other. For seeing that this Vital heat consisteth in a rarefactive endeavour somewhat restrained, if it be very unequal and disproportionate in the Parts bordering upon one another, it will happen, that that part which endeavoreth with vehemence, doth withal endeavour to separate itself, from that which useth no such vehemence, and so that it will become a preternatural endeavour, causing pain: for pain consisteth in the solution of continuity, not yet made, but to be made. Fourthly, That this heat may not actuate or assist the action of any other hurtful conjoined quality whatsoever. For although in this case the conjoined hurtful quality is chiefly peccant, and meriteth the greater part of blame, yet cannot the heat be altogether excused. For an acrimonious and malignant heat, denoteth other qualities to be conjoined besides the bare heat, yet the Vital heat itself, in as much as it exasperateth and provoketh the activity of those conjoined qualities to a more potent depravation and annoyance, it must be judged partly culpable of their vicious actions. Fifthly, On the part of the resistance moderation is also required, both in respect of the appeasing of the irritated Vital Spirit, and also in regard of the passage of the Arterious Blood, and finally in respect of the transpiration of the unappeased exhalations. Sixthly, A certain proportion must be observed between the expansive endeavour of the Vital heat, and the resistance that restrains it, an excess therefore in either of them in itself is not a fault, but if one be disproportionate to another, in that regard it must be reputed faulty. Seventhly, A certain harmony and order is observable both in the endeavour, and in the resistance. For they do not always proceed in one form and continuation, but as it were fight, they are sometimes intended, sometimes remitted. And indeed they are chiefly increased in the Diastole of the Arteries, where the blood not being contained in his Marrow Vessels, struggleth for more room, and so stretcheth the Arteries, till a competent portion of it falleth down, into the habit of the parts, and is there digested; for then the place doth not compel the Blood into such straits, but after a short time it desisteth from that impetuosity, and among the causes of the pulsation this motion of the Blood is not the least considerable. Now that we may apply these things to the present business, amongst all the conditions now proposed, the second alone seemeth manifestly to be desired in this affect. For the Vital heat is not here moderate, but defective and more remiss than the just and Natural Degree. For seeing that the first affected parts are besieged with a cold and moist distemper, and with a penury and benummedness of Spirits, they must necessarily (as we have already demonstrated) somewhat rebate the heat of the Arterious Blood before it is transmitted into the substance of them; whereupon those parts participate a more remiss degree of Vital heat, than is due unto them. And this shall suffice concerning the communication of the Vital hear to the Parts. Thirdly, As for the last part of the participative Life, which indeed dependeth upon the two former, and which is the first in the intention, though the last in the execution of Nature; we say, that it is in some sort the end both of the Original Vital Constitution, and also of the distribution thereof, and finally of the aforesaid union and heat communicated to the parts. For the Vital Spirits are not excited in the Arterious Blood for their own sakes alone, neither are they distributed into the parts, and united to them, only for their own advantage; but chiefly, that they may enliven and dignify the inherent constitution of the solid Parts, and so actuate and promote their faculties. For as the heat of itself is only potentially visible, unless it be irradiated with light, so those inherent faculties of attracting, retaining, concocting, secreving, and forming, are dead as it were and merely potential, when they are deprived of the vivification and erogation of the Vital afflux, This is most clearly conspicuous in a lipothymy; for upon the defect of the Vital influx, all those faculties suddenly fail, decay, languish. But seeing all the faculties are established upon some constitution, which is both the cause and subject of them, it might be demanded in which Constitution of the parts it is grounded? We answer, in respect of the potential Nature they are radicated in the Natural Constitution which we have before described; but that in reference to the Actuated and Elivened Essence that they depend likewise upon the Vital influx. And we declare in general that the participative Vital Constitution, which we have already asserted to consist in Three things, conjoined with the Natural Constitution, is the total and adequate, both cause and subject of all those faculties. But it would be a tedious degression, and inconsistent with our purpose, to make enquiry how those Constitutions can produce this or that faculty determinate in its Species. For the present we will only run over those faults of the faculties aforesaid which occur in this affect. First, The fashioning virtue here erreth by an unequal purging out of the Vital Blood in divers parts, as we have discoursed above. Hereupon the Head and the Liver grow to an unmeasurable bigness; the first affected parts are extenuated, the ends of the Bones stick out, and sometimes the Bones themselves, which are otherwise strait, wax crooked. Secondly, The Concoctive faculty is weak in this Disease and in the first affected part by reason of the inherent cold distemper, the penury and benummedness of the Spirits, the brittle and slippery union of the Vital spirits with the Natural Constitution, and by reason of the feeble imprinted Vital heat. Thirdly, The Attractive, Retentive, and Expulsive Faculties, seem not to recede much from their Natural Condition; yet the Attractive is somewhat more slow than aught to be; the Retentive, by reason of the internal lubricity is somewhat weaker, and the Expulsive is more vehement for the same Cause. And thus at length we have dispatched the faithful examination of the faults of the Vital Constitution in this affect. The Animal Constitution should now undergo the next disquisition, but that some faults of the Natural Constitution; namely the Organical faults thereof, which have some dependence upon some of the recited faults of the Vital Constitution, do challenge this place, as most proper to themselves. CHAP. XIII. The Organical Faults of the Natural Constitution in this Affect. seeing that the Organical faults in this Disease belong to the Inherent Constitution of the parts, those indeed by the Law of just Method should be immediately after the similary vices of the same Constitution; but as we have noted above, the Reason and Caus of them must be derived from the faults of the Vital Constitution lately mentioned, and therefore we are constrained to premise the examination of these, and to reserv the consideration of the other for another place. The Organical faults in this affect are fitly reduced to these Heads. First, To the extenuation and leanness of certain parts namely, the parts first affected. Secondly, To the unreasonably augmented magnitude of some parts, as the Brain, the whole Head, and the Liver. Thirdly, To the tumours or launching out of certain Bones, as of the Bones to the Wrists, to the Ankles, and the ends of the ribs. Fourthly, To the bowing of certain Bones, as it frequently happeneth to the Bones of the Cubit, and the Shin Bone, sometimes to the Bone of the Thigh and Shoulder. Fifthly, To the pointed figure and narrowness of the breast. And these faults are reckoned beneath among the Symptoms and signs of the Disease, not because they are indeed mere Symptoms, but because they are obvious to the Senses, and so do fitly supply the place of signs, both in respect of the parts of the Essence of the Disease more deeply retired, and also in respect of the hidden causes thereof. For whatsoever is perceived by the sens, and besides itself representeth somewhat else to the understanding that is obscure, hath the formality of a sign. For indeed these faults are parts of the secondary Essence of the Disease, seeing that they are the vicious Constitutions of the Organs depraving the action, and have a dependence upon the other parts of the Essence of the Disease. The common cause almost of all these recited affects seems to be an uneven or disproportionate nourishment or Alogotrophy of the parts. Now this dependeth chiefly upon two causes in this affect. The first is, the unequal inherent Constitution of the parts irregularly nourished. The disparity between the inherent Constitutions of the first affected parts, and the Head and Bowels, cannot be so well collected by what hath been already said, but that it may deserve a further inculcation. The last ca us, which is indeed of equal moment, is the very unequal distribution of the Arterious Blood into the parts unevenly nourished. That the Blood is unequally distributed in this affect we have already showed, here we only infer that that must needs produce an unequal nutrition of the parts. All Creatures the more liberally they feed the more fat and fleshly they are unless some other impediment doth intervene; but if the du quantity of aliment be substracted, they grow lean, and are daily more and more extenuated. Why should we not suppose that the same thing happeneth in the Parts of Creatures? the Blood, or at least somewhat contained in the Blood, is acknowledged for the last aliment of all the parts, where therefore that is liberally dispensed to one part, and sparingly to another, certainly, it is no wonder if one part be excessively augmented, and another extremely extenuated. But these things may suffice in general. In particular, First, We assert, that the first affected parts in this Disease do daily wax lean and fall away. Proof of this assertion cannot be reasonably expected, seeing that daily experience yieldeth an ocular demonstration of it. But why those parts are so extenuated, that may require some reasons, and we offer these. The first is deduced from the primary essence of the Disease; namely, from a cold distemper, a penury, and inactivity of the inherent Spirits in the parts aforesaid, For by this means the attractive, retentive, and concoctive faculty, do execute their functions in those parts, unduly and ineffectually. The second is brought from the looseness, softness, and internal slipperiness of the same parts; for hereupon the expulsive faculty is too much irritated, the breathing is too easy and dissipative, the circulation of the Blood is to slippery, the retentive faculty through the weakness of it, parteth with the aliment too soon, and with too much facility: and this very thing almost happeneth here in these parts, which befalleth the Guts in a Lyentery. Howsoever it be, the expenses exceed the incoms, and by consequent those parts are extenuated. The third Reason ariseth from the unequal distribution, and indeed defective in the first affected parts, of which we have already superabundantly discoursed. Secondly, We affirm, that in this affect the greatness of the Head, and especially of the Liver, as also of the Brain is unreasonably increased. Sometimes the Palsy in the Head is conjoined, which nevertheless we suppose to be of a different Species, and no part of this Disease: although we grant, that this affect may sometimes give occasion to the supervening Hydrocephalus. Moreover, we have sometimes seen, the Consumption being superinduced upon this affect, and long continuing also, the Face, and the parts about the Head to be somewhat extenuate before death. But this was produced by the Consumption, not by this Disease we now treat of. But that we may give a reason of that greatness unmeasurably increased in the Parts aforesaid. We note, First, That the parts belonging to the Head and almost all the Bowels, do receive the Nerves from that part of the Spinal Marrow, which is included within the Skull, and therefore that these parts are not necessarily subject to that unhappy condition of the first affected parts. Wherefore no reason doth compel us to affirm, that these augmented parts are either affected with a cold distemper, or a penury and dulness of Spirtts, or that the attractive, retentive, or concoctive faculties are thereupon vitiated, and by consequence that those parts are totally exempted from the first cause of that extenuation which befalseth the parts first affected. Secondly, we observe that neither looseness, nor flaccidity, nor softness, nor internal slipperiness are predominant in those immeasurably augmented parts, and that these qualities (as it happeneth to the first affected parts) do not yield a more irritated expulsion then is requisite, so that the exportation should be feared to exceed the importation, which we have showed to befall the extenuated parts. Thirdly, We observe that the Blood in his circulation, by how much the more sparingly it is distributed to the first affected parts, the more liberally it doth water and nourish these parts. This we have already proved, and it is needless to insert more arguments to that purpose. These things therefore being observed, the Reason is plain, why the parts aforesaid are unmeasurably and irregularly augmented. For if the attractive retentitive and concoctive faculties be not weakened in them, according to our first annotation, and the expulsive be not immoderately irritated according to the second, and in the interim if sufficient aliment be dispensed to them according to the third, the bulk of them must needs increase beyond proportion. Thirdly, We affirm that the protuberancies or swellings of the Bones in the Wrists, Ankles, and the ends of the Ribs do vitiate the Organ in a twofold respect▪ namely, in respect of the greatness, and also of the figure. The parts vitiated in both respects are obvious to the Eyes, and therefore we shall supersede all further proof. But why are the Bones stretched out after that manner in those places? Truly it is very hard to render a Reason thereof, neither perhaps dare we engage ourselves by promise to give satisfaction in all respects herein to the curious. Therefore instead of an answer we dedicate to the Reader these subsequent observations as not altogether unprofitable. First, The Bones in many do agree with the substance of the Bowels. For first they consist of a certain similary matter severed from the preterfluent Blood, not needing any laborious assimilation, and seem to admit a most easy nutrition till they arrive at the exaltation and highest pitch of their increase; Moreover, they seem to be nourished until by age they are brought to an extreme dryness, and they seem not to be obnoxious to any considerable extenuation; so the substances of the Bowels are similary being joined together by the separation almost of the Blood alone, and they likewise easily encreas, and are difficultly and rarely extenuated. Secondly, The Bones are nourished almost after the same manner, as the Parenchymata or substances of the Bowels: Through the Arteries they receive the blood, through the Veins they amandate and convey away the superfluous portion of it, and instead of Vessels of the third kind whereby the excrements are expelled, they are furnished with Cells and Cavities. Some perhaps may doubt of the Arteries of the Bones, because so hard and rigid a part may seem unapt to admit any pulsation of the Arteries within it, we grant indeed that the Bones in regard of their hardness and stifness are less apt for the pulsation of the Arteries, and therefore we acknowledge that they admit not within them any notable ramification or branching of Arteries; but if any man will from thence infer that no Arteries are admitted into them, truly herein he must expect our absolute denial, for they are living Parts, they are nourished, they grow, and they exercise the Attractive, Retentive, Concoctive, and Expulsive faculties. Again, they receive the Blood, which they cannot do but by the conduit Pipes of the Arteries, and this is manifest by the bloodiness of them, when the Bones of Living Creatures are either broken or any other way divided. In young Creatures the spongy substance of the Bones, and the very Marrow is sensibly perfused with Blood, and the greatest part of their Cavities is filled more with Blood than Marrow. In elder and greater Creatures you may observe both Veins and Arteries through the Membranes enwrapping the Marrow; all which things do sufficiently prove that the Blood is distributed into the very Bones. But wise Nature (who in the conformation of all the parts doth most equisitely and aptly proportion all things) foreseeing here that the Veins and Arteries could not conveniently be extended by a longer carnification through the substance of the Bones by reason of their hardness, she casteth that vast number of them, some being as small as hairs, into almost inconspicuous little holes in the Bones. But if you sound boil the Bones of greater Creatures these Orifices of the insertion of the Vessels may very easily be perceived in the outward superficies if you remove the Skin enwrapping the Bones. But let this suffice concerning the Veins and Arteries of the Bones, seeing that this matter is somewhat incoherent with our scope. As for the Vessels of the third kind, seeing that the excrements of the Bones were not about to prove altogether improfitable, nor could commodiously be expelled out of the Body, Nature, instead of a Vessel of the third kind hath made certain Recepticles (namely Cavities and Cells) into which she would exno●rate and cast aside the excrements, namely that fat part which is altogether improfitable to furnish the Bones with nourishment. There are some who suppose the Marrow to be the principal nourishment of the Bones, but very inconsiderately, seeing that the Marrow, as we have said, is altogether unapt for the generation and nourishment of the Bones, for the bones are not only most hard and solid and naturally of a white colour, but they consist of a certain earthy and clammy substance, which conditions differ very much from Marrow. Again, Marrow cannot by any art be sublimated to the firmness of a Bone. Moreover, Marrow melteth, and is dissolved with a moderate heat of the fire; but the Bones endure the most ardent flames of fire without any melting. Besides, Boil the Bones as long as you please, they resolve into a jelly, not into the substance of, or like Marrow. Again, Bones may be worn to powder, so cannot Marrow. Certain therefore it is, that the marrow is not the Aliment of the Bones but a kind of excrement, or rather secrement of them, profitable indeed, and therefore to be preserved in those receptacles. For the Bones being otherwise dry, cold, and rough, would be unapt for motion, were they not moistened and made slippery by the exundations and exhalations of the Marrow, and cherished by their gentle heat. All these things are confirmed by this single experiment. In young Creatures the greatness of the Bones being considered, there is less Marrow in the Bones, and more Blood, than in greater Creatures. In the Embryo, there are scarce observed any signs or appearances of Marrow destinct from the Blood. But after the birth the medullary substance is daily augmented, and it is visibly perceived to be less and less intermingled with the Blood; again in the maturity of years the Bones are filled almost with pure and sincere Marrow, without any considerable commixture of Blood; but in the approaches of old age it is credible that the Bones are less and less watered with the circulation of the Blood; and perhaps the Marrow itself upon the suspension and cessation of the nourishment is rather augmented than diminished; in which respect the propounded experiment must be peradventure limited. Thirdly, the Bones (the Teeth perhaps excepted) cannot want their nervs, at least very little, neither are they supposed to be otherwise sensible, then by reason of the Periostium, or the Fibers thereof fastened into the Orifices of the Bones. In like manner the substances of the Bowels seem to obtain that dull sense, which they possess, rather by the Membranes and vessels, then from their own substance. From hence we collect, that the Bones in this affect are not much otherwise affected, than the substance of the Bowels in respect of nourishment. We have already showed that the Bones are not to be reckoned among the first affected parts, as likewise neither the Parenchymata: only we here further affirm that all the Bones universally considered, are not perhaps less sparingly nourished in this Disease, than they usually are in sound Bodies, for if they be nourished by way of coaugmentation, or joining together, as the Parenchymata are, and with such facility also, if they possess Arteries and Veins delated unto them, and Cells, and Cavities to receive the Blood, if they be not in the number and condition of the first affected parts, and if they receive not Nerves from the spinal Marrow; it is very credible that they do duly receive, laudably retain, and perfectly concoct their Aliment. Moreover, If you will consult experience, Children afflicted with this Disease, a regard being had to their age, and the magnitude of their parts, weigh heavier than others for the most part, as we have sometimes observed, which very thing seemeth partly to be ascribed to the greatness of the Bones. Although in this case we wish more frequent, certain, and accurate observations, which others who are befriended with opportunity may oblige the world withal: in the mean time we suppose in general that the Bones are not illiberally nourished in this Disease. Some may reply, That what hath hitherto been spoken doth concern the nourishment of the Bones in general, but that they yield not a reason of the protuberances in them. We deny it not, but seeing that these faults of the Bones depend upon their unequal nourishment, as we have already proved, we supposed it would not be unprofitable to purpose some reason of their nourishment in general: now we draw nearer to the aforesaid swellings of the Bones. And we observe, Secondly, That those tumours of the Bones are not of a different kind in respect of the other parts of the same Bone, but that they are parts altogether similary and of the like kind with the rest, and that they are not faulty in respect of the similary Constitution, but in respect only of their greatness and figure. From hence it followeth thirdly, that these swellings are not produced by any illegetimate matter of the Bones, or by any other virtue than the same by which and from which the other are generated. Fourthly, That the said swellings are produced by an unequal nourishment of the Bones, as by a more liberal nourishment of the swelling parts, and a sparing nourishment of the other parts of the same Bone. And these Three last observations we have already abundantly proved where we treated of the affected parts. Fifthly, We observe the Epiphyses of the Bones in the Wrists and Ankles, and perhaps in some other places, to be more soft and spongy than in the other parts of the same Bones. And peradventure they receive into themselves greater Arteries and Veins, although indeed we are not yet fully assured of this. The tops of the Ribs are also much more soft and spongy than the other parts of them. From whence we infer that those more soft and spongy parts of the Bones may more easily and freely admit the circulation of the Blood, and therefore be more plentifully nourished than the rest of the parts of them. You will say, That softness and sponginess of those parts is observed to be as well in healthful Children as in those affected with this Disease. We grant it, but yet it must needs be, that those parts which are of a more compacted substance, and with difficulty admit the circulation of the Blood, must be affected and obstructed upon lighter causes, than those parts that are more open, and more easily receive it. But the Blood in this affect is transmitted to the external parts somewhat more cold, viscous, and thick, than it ought to be; therefore those parts which are unapt to admit the circulation of it, those are more apt to be somewhat obstructed, and less liberally nourished. But, Why also are not those soft and spongy parts more liberally nourished in sound Bodies, seeing that they (as hath been said) do more plentifully receive the Blood? We answer, Because, as in health those parts do in a larger measure receive the Blood thorough the Arteries, so they remit the same more plentifully thorough the veins which certainly doth preserve them from that excessive augmentation unto which otherwise they would grow. But in this affect the same parts by reason of the coldness thickness, and viscosity of the Blood, do perhaps more sparingly and more slowly remit it, than it is poured in to them; and therefore from that abundance and excess of the Blood, those parts do somewhat increase; whilst the other parts of the Bones by reason of the narrowness of the cavity of the Artery, are not perhaps sufficiently nourished with Blood, whereby to obtain an equal nutrition and increase. And from hence (at least probably) we deduce the inequality of the nutrition of the Bones in this affect. But the condition of the Blood whereby in this Disease it is apt to obstruct an▪ parts thorough which it floweth, seems to have a peculiar respect to the quality of the Bones. For in the Bowels, the Lungs excepted, the Blood doth seldom Generate obstructions, as also ne ither in the first affected Parts: However it be the Bony substance, either because it is incapable of the internal slipperiness, or because the nutritive juice in the mass of Blood is peculiarly apt to congeal in the parts so vehemently fixed: or lastly, because it hath in its own nature some affinity with the Bones: we say, the Bony substance is easily infested with obstructions in this Disease, and thereupon it happeneth to be unequally nourished. The Faults of breeding Teeth are likewise to be referred hither, seeing that they also seem to depend upon this unequal nutrition of the Bones. For if the Teeth should be equally nourished, they would be of a uniform substance, and would not fall out by pieces, as it here frequently happeneth. For the similary parts, when they are equally nourished, acquire not such an interrupted and unequal consistence, as to be easily broken in pieces. Wherefore seeing the Teeth are parts naturally delighting in a similary substance, were they equally nourished, they should enjoy an equal and uniform consistence, and would either continue firm in their gums, or would fall out whole: And there can scarce any other reason be given, why they should be broken and fall out more on one side, or in one part then another. We grant indeed that their aptness to break, may hitherto conduce very much: but we conceive that even that aptness to break, doth in great part depend upon the unequal nutrition aforesaid. For otherwise the Teeth do usually obtain a very firm, solid, & coherent substance; and the truth is, they seem to consist especially in this viscous affect of a very matter. For the Blood for the most part is observed to be more viscous and thick then ordinary, so that this aptness to break off the Teeth, cannot be so easily ascribed to a defect of viscosity in the matter, as it may much more probably to the inequality of the nutrition. We conclude therefore that the standing out of the Bones, and likewise the faults of the Teeth, do proceed from the unequal nutrition of these parts, arising from a peculiar obstructive disposition of the Blood, having reference especially to the Bones. Now we proceed to the crookedness of the Bones in this affect. Fourthly, In this affect the Bones are frequently somewhat crooked, especially the Shin Bones, and the lesser Bones of the Legs; also the Bones of the Cubit, the lesser of the two long Bones of the Cubits, and the bigger Shankbone, sometimes the Bones of the Shoulder and Thigh: some Joints also become crooked, sometimes inward, sometimes outwards: the whole Spine is likewise many times bended, sometimes it is wreathed like the letter S; namely, partly forwards, partly backwards, and sometimes partly to the right Hand, partly to the left. Some ascribe this crookedness of the Bones, to the bending faculty of them; for say they, in the tender age of Children, the Bones themselves are not so stiff stubborn, and inflexible, as in their riper years; and therefore upon the invasion of this Disease, they are rendered in some degree easily flexible. Therefore they rebuke the Nurses, which too soon commit the children to their Feet, supposing, that the Bones are made crooked by the sustained burden of their Bodies. Others also tax the Nurses of imprudence in swaddling them. But we cannot yield our full assent in all respects to these Reasons. And first we flatly deny, that the Bones of Children afflicted with this Disease are more flexible, or less stiff and friable than the Bones of others. For we have already proved, that the Bones in this affect do not differ in respect of their similary substance from the Bones of sound persons. Besides, no man hitherto worthy of credit hath attested that he hath seen the Bones flexible in this Disease. Moreover, if we should grant that in this tenderness of years the Bones might perhaps be somewhat bended, yet they would not continu so bend like lead or wax, but being left to their liberty they would return again to the proper position and figure of the parts. For they consist not of any ductile matter, and therefore by being thus bend, they would either be broken or else doubtless they would endeavour to reobtain their former situation. As for the ignorance or negligence of Nurses, although we do not altogether excuse it, yet cannot we justly impute this crookedness of the Bones to their carelessness. We see the Children of Poor People are ordered and handled with less care, and sooner committed to their feet then the Children of the rich, yet the Children of Poor People are more rarely afflicted with this infirmity, than the Children of the rich. Besides, we have known Nurses use all manner of diligence as swaddling them, and every other way labouring to prevent this incurvation, yet all their pains, otherwise prais-worthy, hath in this respect been successless. Therefore we must endeavour to find out some other cause of this crookedness. A B C D E F G A B C D E F G A B Now that we may accommodate these things to the present business, if the Bones aforesaid be more plentifully nourished on one side, and therefore do grow out more on that then the opposite side, there is a necessity, that that must grow crooked: For here the overplentiful nutrition of that side, hath the same power after the same manner to bow the Bones, as the interposed wedg hath to bow the Pillar, save that the wedg is fastened only in some places of the side of the Pillar, and the over-plentiful nutrition of the side of the Bone, is commonly equally made, according to the whole length thereof. For the aliment received into the Bone, in what part it more liberally admitteth it, that part it obstructeth: and like the wedg thrust into the Pillar it extendeth it into an augmented length, whereupon the Bones must needs be bowed towards that side which is not lengthened in an equal degree with the other. Moreover, if the production of one side of the Pillar happen only in one or two places thereof and not in many, as in the third figure, than so much the nearer the inflexion of it approacheth to the figure of a part of a Circle, or a Bow. But if the said side according to the total longitude thereof should be equally lengthened beyond the opposite side, doubtless it would be bended towards the opposite side, & would exactly resemble a piece of a Circle or Bow without any Angles, just after the same manner, ariseth the bending of the Bones in this affect: namely, from the greater lengthening of the side most nourished; for seeing that that lengthening happeneth by the received aliment, according to all the parts of that side, an Angular figure cannot be expected, or one compounded of many strait ones angularly connexed, but a crooked one like a Bow, wherein the convex part is constituted by the side, plentifully nourished, & the concave or hollow part by the side, which is sparingly nourished. But when it happeneth that some part of the convex side of a crooked Bone is disproportionatly nourished, in respect of the opposite side, without all doubt the convex Bone will stick out more on that part then in the rest: and so from the inequality of the nutrition, we have given a reason of the crookedness of the Bones in this affect. We will add for a higher confirmation of this matter. An observation raised from the cure of this crookedness of the Bones. The Quacks of our Country are wont to rub daily the hollow, not the convex sides of the Bones, and that rubbing, say they, doth very much conduce to the cure, but this doth rather hinder it. But it is certain that rubbing doth powerfully summon the nutritive juice out of the Bloody mass into the part so rubbed, therefore if at any time you rub that hollow part which is insufficiently nourished, it is no wonder if it do good, seeing that thereby the aliment is more plentifully alured, and the heat of the part is also excited and augmented; neither on the other side is the Gibbous part of the Bone, being hurt by rubbing to be wondered at, because by that means the aliment is attracted to that part which was before superabundantly nourished: besides, the Ointments, which may cherish the inherent heat, and strengthen the nutritive faculties, after the rubbing, do most good, when they are applied to the hollow part of the Bone; but the convex part a straight ligature which may restrain the rising up of the Bones is usually fitted with desired success: chiefly indeed for this reason, because the capillary Arteries which convey the Blood, or nutritive juice, to that side of the Bone, are bound up by such a ligature, and thereupon the nutriment is lessened. And these things shall suffice concerning the crookedness of the Bones in this affect. Moreover, To this Article we opportunely add the inflexion of some of the Joints, as of the Knees, and Ankles, which happeneth very frequently in this Disease. sometimes being made inwardly, sometimes outwardly, And this bending also seemeth to be not unfitly referred to the inequality of nutrition. For if it happen by unequal nutrition, that one side of the Shankbone be so lengthened more than the other: suppose outwardly, that it doth somewhat lift up the outward part of the Epiphysis of the Shankbone above the inward part, the joint in the Knee must needs stand outwardly bend; and on the contrary, if the inward part be lifted up, and the outward depressed, the same Joint must needs stand inwardly bend: as may be easily perceived by the following Figures. C B A D C A D B C B A D A D C B In the Joint of the Knee, A B, that part of the appendance of the Shankbone B, in the two first Figures, is higher than the other part of the same appendance; whereupon the Bone of the Thigh (is inwardly bowed, and so likewise is the Shinbone D; but the Joint A B is thrust somewhat outwardly. But in the two last Figures all the contrary things may be observed. The Joint A B is inwardly, because that part of the Shinbone A, is higher than the other part of it B. Whereupon it must needs lift up the inner and lower top of the Thighbone, so that the Thighbone will be bend outwardly, and the Joint inwardly. The same thing likewise may happen in the Ankle-bones, and the turning Joints of the Back, if the Bones fastened to the Joint be higher on one side than on the other. But in the Ankles, because there, besides the Shinbone, the lesser Bone of the Leg is also fastened through the Joint, it may so fall out, that the lesser Bone below may stand out further than the Shinbone, and so bend outwardly the Joint of the Ankle; and on the contrary, if it happen that the Shinbone be longer than the lesser bone, the Joint must needs be inwardly bend. Although we confess that such an inequality of length between the Shinbone and the lesser Bone in the Leg doth not so often happen. Moreover, We suppose that the preternatural bending of the Spine doth rarely happen from the unequal altitude of the sides of the turning Joints of the Bones, but more often from another cause which we will now prosecute. We have already said that the Spine is somewhat weak in this affect, and that Children afflicted with this Disease are unapt not only to motion, but also to stand upon their feet, yea, and to raise their backs by reason of the weakness of the Spine. Therefore whensoever their Bodies are raised, they seek somewhat to rest upon, and they suffer their Spine to be bowed sometimes forwards, sometimes backwards, sometimes to the right hand, and sometimes to the left; whereby the burden of their Body may be rested upon something that stands near them. Hereupon it many times happens, that the Ligaments of the turning Joints of the Spine in that part which is most commonly bending out are loosened and lengthened, and on the opposite side they are contracted; so that intract of time the Spine cannot be erected according to the strait and natural Figure. And truly in this case we cannot excuse the Nurse's indiligence or negligence, because they do not observe with a sufficient attentiveness, to which part the Children which they suckle are most prone to bend their Bodies, that by that means they may endeavour to bend them to the opposite part: In like manner also when Nurses without due regard and care do too soon commit weak Children to the use of their feet, it may happen, that, when the regular motion of the Muscles is too weak to bear the Body, Children may suffer either their Knee or Ankle to be bowed to one side; whereupon the Ligaments of the Joint are extended either on the inner or the outward side, and by consequence the Ligaments on the contrary side are contracted, whereupon the joint must needs be bended either inwàrdly or outwardly, therefore although we have denied above that the crookedness of the Bones dependeth hereupon, yet we grant that the bending of the Joints may happen in weak Children by the negligence of the Nurses. We grant moreover that the Bones which would otherwise have been strait, may be crooked by an unskilful swaddling; yet that this cause doth happen exceeding rarely in this affect we are somewhat confident, as we have showed already more at large. Now we proceed to the pointedness and narrowness of the breast in this affect. A B C D A B C D Now it must be known that the opposite couples of the Ribs do express a certain rude kind of circular Figure, especially the uppermost which chiefly fashion the Breast, by the mediation of the Spine on the hinder part, and the Stern on the fore part. Nor should it trouble any man, because they will not make an exact and perfect Circle, seeing that our demonstration is as effectual in a circular Figure how imperfect soever, as in the most exquisite and perfect; provided that there be a coherence among all the parts, that they be not distorted, that they be flexible, but not easily extensible; which conditions are sufficiently conspicuous in the Figure of the Ribs even now proposed to view. Therefore if in this affect the Bone of the Stern be somewhat elevated forwards, that it may yield room to the augmented Bulk of the Liver, the Ribs towards the Spine must needs be drawn in nearer to one another, whereupon the Breast must unavoidably be laterally straightened, the latitude of it, being lessened. Some may say, If the rising of the Bone of the Stern did conduce any thing to the pointed Figure of the Breast, it would chiefly effect that about the inferior Ribs, seeing that this elevation of the Stern doth begin at the lower part; but it is manifestly known to fall out otherwise; for the narrowness of the Breast happeneth chiefly about the Armpits, and afterwards beneath the Channel Bones; but the lower Ribs seem to be enlarged about the sides rather than straightened. We answer, That the Five lower Ribs are not articulated with the Stern, neither do they make a perfect Circle; and therefore in no wise do they relate to the propounded demonstration; but the stretching of them dependeth upon another cause, namely, the fullness of the Hypocondriacal parts. Let it likewise be noted that we assign not this for the chief cause of the vitiated Figure, yea, we suppose that it conferreth very little towards it. And so we proceed to the second cause of this vitiated Figure, which we also conceive to be a very slight one. In this affect the Hypochondriacal parts is almost perpetually observed to be full and stretched, namely both in respect of the greatness of the Liver, and also because all the other Bowels almost which are contained in the bottom of the Belly are sufficiently large; seeing that as hath been said, the first essence of this Disease is not rooted in them. And lastly, Because the Guts and the Ventricle are usually more or less distended with wind. But now from that fullness and extension of the Hypochondriacal parts we may justly collect that in this affect the Ribs are drawn downwards a little more than is expedient. For the greatest extension is here observed in the oblick Muscles that are extended beneath the Hypochondriacal parts; Now the Muscle obliquely descending hath toothed heads fastened to the sixth, seventh, eighth & ninth Ribs, and the part of the broad tend on also oblickly ascending is adjoined to the grizles of the ninth, tenth, and eleventh Ribs. Wherefore seeing that the said Muscles are almost pertually too much extended in this affect, they must needs in some manner draw the said Ribs downwards, and seeing all the Ribs are firmly fastened together by the intercostal Muscles, it happened that in this affect all the Ribs are somewhat drawn downwards. But now that these Ribs so drawn down do somewhat straighten the Breast may be perceived by this following Figure. Fig. 1. A F C D E B Fig. 2 A F C D E B Fig. 3 A F C D E B Let A B be the Backbone. CD E the Rib. F the Bone of the Stern. We suppose that every one may see here in the Skeleton, that the Ribs are not conjoined with the Spine, according to the strait Angle, but that the Angle beneath the Rib is somewhat less than the strait Angle: So that if the Rib be drawn a little upwards, the Articulation of it approacheth nearer to a strait line. We suppose also, that the circulation of the Rib, whether with the Spine or with the Stern abideth firm, and doth not draw upwards (lest any man should o) save only the middle parts of the Rib between the said Articulations. We say, therefore on the contrary by how much the more downwards the Rib is drawn, so much the more acute is the Angle with the Spine, which it then maketh: Wherefore that part of the Rib furthest distant from the Backbone A BC; (namely, D in each of the Figures) as being thrown downwards, it constitutes a more acute Angle with the Spine, so is it also less distant from the Spine than it was before, and rendereth the broadness of the Breast more narrow. For the sides of the Breast were then indeed most broad, when the Ribs are most erected upon the Spine, according to a strait line. For that part of the Rib D will be then furthest distant from the Backbone A B, as you may soon perceive if you compare the first and second figure with the third. For in the third Figure, the Rib is expressed erect in a strait line, with the Backbone, and then that part of the Rib D is sensibly further distant from the Backbone A B, than it is in the first or second figure, as he that will examine them, shall quickly apprehend: but in the second Figure, the Rib with the Spine is supposed to make a more acute Angle, and in proportion that part of it D (as you may perceive) is less distant from the Spine than the same part D in the same Figure, whose Angle is supposed to be less acute; and yet that is much less distant from the Spine, then in the▪ third Figure, whose Articulation is erected to a strait Angle. We infer therefore, that the Ribs, when they are drawn upwards, do amplify the Breast sidewise, but when they are drawn downwards, than they straighten the Breast on the sides. This is further confirmed in that, because at such time when the Breast is dilated; namely, when the breathing is rightly performed, the Ribs are drawn a little upwards by the strength and force of the Intercostal Muscles; and when the expiration is performed; namely, when the Breast is contracted, the same Ribs are drawn back again downwards by the help of the oblique Muscles of the Abdomen. Any man may observe this in himself or in any other man especially in great inspirations and expirations. For in a vehement inspiration he shall plainly perceive at the same time to be lifted upwards, and withal to enlarge the breadth of the Breast; but in a vehement expiration he shall feel the Ribs as it were bowed downwards, and at the same time contracted inwards. Neither of these things could happen, unless the position of the Ribs were such, as that those beneath in respect of the Spine, should make an acute Angle, and being more depressed, should make it so much the more acute, and by consequence the Breast, should be then most straightened; and on the contrary being lifted upwards, they should appracch near to a strait Angle, with the Spine, and so extend the sides of the Breast. We conclude therefore that the Ribs in this affect are drawn somewhat downwaads, and that the Breast is contracted on the sides, by reason of the plenitude and tensity of Hypochondrical parts; although we grant as we have intimated above, that this cause is not so considerable, that we should attribute any great part of this Disease unto it. Be this therefore the third, The Caus of this vitiated Figure of the Breast, Is a lateral growing of the Lungs in the Pleura, in this Disease especially, being confirmed it is most frequently observed to happen. Doubtless such an adnascency doth restrain and interrupt the motion of the Ribs outwardly, whereby the Breast is laterally dilated. For if the Rib, under which this adnascency lieth, should endeavour forcibly to remove itself, from the centre of the Breast, there would be danger of pulling the Lungs that grow to it, or the Pleura itself from the ribs with intolerable pain. For although the Lungs upon the ingress of the air admit an easy extension, according to all the parts thereof, yet when they fall down, or are stuffed with thick humours (which most frequently happneth in this case) they scarce admit any notable distension, without dissolving the unity either of some Vessel, Membrane, or the substance of the Bowels themselves. Moreover, whilst we consider that in sound bodies the Lungs are very rarely laterally divided from the Pleura; and but in those parts only of the chest, which were to be exposed to motion at a considerable distance; namely, the Back, the Stern, the Mediastinum (that is the Membranes that divide the middle of the Belly) and perhaps the middle parts of the Diaphragma, etc. We conceive that wise nature did this deliberately and with design; namely, lest their connexion's should either offend the dilitations of the Breast, or render the Lungs themselves obnoxious to those kind of calamities. However it be, it is scarce conceivable, but that preternatural growing together of the Lungs, with the Pleura more or less must hinder and retard the free spreading of the Ribs towards the sides, and therefore it conduceth a little at least to occasion the narrowness of the Breast. A B E C F D E B F D A B F C E D A B C F D This bending of the Ribs here cannot be made either upwards or downwards, because the Ribs in regard of their latitude are unapt to be bowed either way. Admetus also because that they are firmly restrained by the Intercostal Muscles in their position; so that without offers of violence to these Muscles, they can scarce be bend, either upwards or downwards. That that elongation cannot, or indeed very scarcely can bow the Rib inwards may thus be proved; because, the greatness of the Liver is repugnant to such a motion. For we have proved before, that the greatness of that Bowel doth somewhat lift up the Bone of the Stern outwardly or forwardly. Then the very figure of a Circular Rib doth evidently contradict the inward making of any plication, or bending. Lastly, because that elongation doth not many ways bend the Ribs, it may from thence also be inferred, that such a bending would infer a compound Figure, and should necessarily contain some of the simple figures before rejected. Wherefore we conclude, that that unequal length of the Ribs on the forepart, must needs change their outward Figure, elevating the Bone of the Stern, and then pointing forwards the Figures of the Breast (otherwise almost even.) The following Schemes do lively express the manner of it. A C D B A C D B Let A be the Bone of the Stern, B the turning Joints of the Back. C and D the two opposite Ribs, which as we have said do make a kind of Ring. Therefore if the forepart of the Ribs; namely, between C and A and between D and A be lengthened, and yet the parts between C B and D B are no way answerable to this elongation, the figure of the Ring must needs be outwardly changed. Therefore seeing that the Rib is, (as we have already showed) unapt to be bend either upwards or downwards, or inwards, it must needs be outwardly bowed, as it is expressed in the second Figure, where the stern A by reason of the elongation of the part of the Rib CA and D A is represented, as if it were outwardly pointed, which is the very vitiated Figure of the Breast in this Disease. Beside the causes of the narrowness of the Breast hitherto commemorated, we can here add the small increase of the Ribs between C and B and also between B and D. For the Just Latitude of the breast doth chiefly depend upon a du augmentation of those parts of the Ribs. For if those parts of the Ribs do grow to a just length, they must necessarily dilate the Breast unto the Ribs almost in a just proportion, that little of the narrowness only being taken away, which the former causes alone were able to introduce. For by how much the more those parts of the Ribs are lengthened, by so much the more also the Lateral part of the Rib D and the part C will be distant from the Backbone B, and will make the Breast so much the broader. On the contrary when upon the increase of the other parts of the Body, those parts of the Ribs are but little, or not at all augmented, they must of necessity be laterally less distant from the centre of the Breast than is meet, and therefore the Breast must be straightened towards the sides. For the sides of the rib C and D are so much the less distant from the Backbone, and the centre of the Breast, as the parts of the Ribs between C B and D B are less lengthened. And let these things suffice to have been spoken concerning the narrowness and acumination of the Breast in this affect: With which we put at last an end to this disquisition of the Organical vices occurring in this Disease. CHAP. XIV. The Secondary Essence of this Disease in the Animal Constitution. HAving put an end to the examination of the Natural and Vital Constitution, vitiated in this affect, it now remaineth that we make enquiry into the Animal Constitution. And we have already affirmed, that no primary fault doth here occur, and that it is a part of the primary Essence of this Disease. But whether there lurk in it any secondary vice, that we shall now examine. But seeing that neither the Ancients nor the Modern Writers, who have written of the Animal Faculty, have made any mention of the Animal Constitution, nor indeed so much as once attempted a description of it: It may very justly be expected from us, who acknowledge such a Constitution. And seeing some wise men do descent from that description, which may be deduced from the opinion of Antiquity, and the common opinion concerning the Animal faculty, and otherwise expounding the matter do substitute a somewhat different description, we thought good to offer both to the Readers consideration. According to the former and vulgarly received opinion and description of the Animal faculty, the animal constitution is that affection of the Body which consisteth in the generation and due motion of the Animal Spirits. Now by the due motion of the Animal Spirits they understand the excursion of them from the Brain thorough the Nerves like lightning, and again their recourse back to the Brain, whereby they declare unto it what is perceived by the Organs of the outward Senses. Others (as we have said) do otherwise explicate this matter. They grant indeed that the Animal constitution doth include the generation and destribution of the Animal Spirits but they say that that swift motion of the Flux and Reflux of the Animal Spirits like lightning, is inconceivable in the Nerves, and if it be not unprofitable, yet certainly it is very little necessary to establish the animal faculty. But instead of this they substitute in time of waking a certain contractive motion, of a moving endeavour of the very substance of the Brain, of the Spinal Marrow, of the Nerves arising from thence, and of the parts into which they are distributed. And this motion or endeavour produceth (say they) a certain Tensity in the aforesaid parts, by whose force all the alterations imprinted in those parts by any objects, are communicated to the Brain. For as in a Harp when the strings are stretched to a just pitch, if they be stricken in the most gentle manner at either end, that motion in a moment, at least a Physical one, runneth to the other end; so they likewise affirm that any Nerve being moved which is duly stretched without the Skull, that motion is extended to the Brain itself by reason of the continuity and Tensity of the said parts, and there fixeth a certain impression conformable to the cause thereof. But in time of sleep they suppose the Brain, the Spinal marrow, and some of the Nerves to be somewhat loosened. And indeed they say perpetually and simply that the foremost connexion's of the Spinal Marrow with the Brain remain loose continually during sleep; but they grant that the hindermost connexion's with the Cerebethi are somewhat extended, as in Nightwalkers, and so by that means they do in some sort discern outward objects, but they judge not of them by common sense, but as it were reflected from the memory to the Fantasy. Neither do they suppose it necessary that all the inferior parts of the Spinal Marrow, and therefore the Nerves from thence proceeding should be perpetually loosened during sleep: seeing that most Birds sleep standing upon their feet; seeing that respiration in time of sleep doth presuppose the Tensity of some Nerves; and lastly, seeing where sleep first steals in, the uppermost Nerves are wholly loosened before the neathermost. As for Dreams they conceive that they proceed from a various and chanceable agitation and commixture of divers impressions treasured up in the memory, which are now again freshly perceived by reason of a retained Tensity in some parts of the Brain. But when in deep and profound sleeps no dreams are represented, than they say that the whole Brain is loosened. Now whether the former opinion or this latter be most agreeable to truth, for the present we do not much care; Neither do we here undertake to determine this Controversy, seeing that the Animal faculty doth exercise his function both ways, from the same causes, and that the secondary vice doth happen by this affect in the Animal Constitution almost after the same manner. For first, as for the generation of the Animal Spirits, whether the former or the latter opinion be true, it will be all one; because we find no fault in the Brain (unless perhaps some other Disease be conjoined) wherein each opinion supposeth the Animal Spirits to be generated. For we have showed above that the Head ought not to be numbered among the first affected Parts, and that the internal and proper actions thereof are not vitiated in this Disease. Then secondly, As for the destribution of the Animal Spirits, whether it be perfected backwards and forwards by that rapid and sudden motion like lightning, or by a motion only made forwards and that too gentle and slow, commonly the same fault occurreth in this Disease. For first, Seing that that supposed rapid motion of the Animal Spirits is caused by their passage into the first affected Parts, namely, through the Spinal Martow without the Skull, through the Nerves from thence proceeding, and through the parts into which those Nervs are distributed; and seeing that all these parts in this affect do labour with a cold distemper, with a paucity and dulness of inherent Spirits, the due swiftness of that motion must needs be somewhat retarded. For a cold distemper, as also a benummedness and penury of Spirits are repugnant to any motion, excepting a constrictive; some may say that the opinion propounded in the first place doth suppose a wonderful activity and subtlety of the Animal Spirits, whereby they can easily overcome this repugnance. But, however it may be, seeing that the parts react through which the Spirits have their passage, and labour to communicate their coldness and dulness to them, they must needs in some degree retard that activity of the Spirits, lessen their subtlety, and somewhat intercept that expedite transition. Wherefore this opinion being supposed as true, the Animal Constitution will be vitiated in this affect, in regard of the retundation of that motion of the Spirits. And that secondarily, seeing that this motion is not interrupted by the primary fault of the Animal Spirits, but by the fault of the first affected Parts, as hath been said in like manner in the Opinion last proposed, wherein the motion of the Spirits is supposed to be peaceable and gentle, they must needs whilst they are somewhat slowly transmitted through the first affected parts, contract some viciosity from the depraved inherent Constitution of those parts, for the same Reasons which we alleged in the Question immediately preceding. It will be therefore according to this Opinion also, a Secondary vice in the destribution of the Animal Spirits, Again, As for the Tensity of the very substance of the Brain, of the Spinal Marrow of the Nerves and the Nervous parts in time of waking, which is supposed in the latter Opinion before propounded, there must needs be some defect of a due Tensity in the Spinal Marrow without the Skull, in the Nerves arising from thence, and in the parts unto which they are distributed. For first, A cold and moist distemper is repugnant and advers to that due Tensitiy, so also is that dulness and penury of inherent Spirits; wherewith the Parts are without controversy rendered slothful, and less apt to perform the Animal Actions; the contrary whereof happeneth, when the aforesaid parts obtain their due Tensity. Secondly, It is manifest by what hath been said, that the Tone of these parts is somewhat vitiated in this affect, by reason of their exceeding looseness, slipperiness, softness, weakness and internal lubricity, which qualities do most evidently enfeeble the just Tensity of the said Parts. Although therefore that the Brain in this affect do for his part yield a due and just influx, yet it is scarce possible, nay it is altogether impossible, that it should communicate that Tensity in a sufficient degree to to the Spinal Marrow without the Skull, to the Nerves from thence proceeding &c. because of the distemper, benummedness and penury of the inherent Spirirs. Thirdly, The Symptoms in this Disease that relate to the Animal faculty do most clearly confirm the same thing. For Children afflicted with this Disease do from the very beginning thereof (if they be compared with others of the same age) move and exercise themselves very weakly, and are less delighted in manly sports: but upon the progress of the affect, they are avers from any vehement motion, as they stand upon their feet, they reel, wave, and stagger, seeking after somewhat to support them, and can scarce go upright; neither take they pleasure in any play unless sitting or lying along, or when they are carried in their Nurse's Arms: Finally the weak Spine is scarce strong enough to bear the burden of the Head, the Body being so extremely extenuated and pined away. All which things do abundantly demonstrate that the Tensity of the parts subservient to motion is less rigid in this affect than is justly requisite in time of waking. If therefore that due Tensity in time of waking be a part of the Animal Constitution, which we here suppose, that being vitiated must without all doubt necessarily constitute a Disease in the Animal Constitution; and seeing that this fault hath no primary dependence upon the Brain itself, but upon the inherent Constitution of the first affected parts, it ought in all Reason to be reputed a Secondary fault in respect of the Animal Constitution. Yet here we meet with a scruple. Some may demand, Why the sens as well as the faculty of motion is not vitiated in this affect? The reason is plain, a far greater tensity, strength and vigour of the Nervs is required to exercise the motive than the sensitive faculty. For almost the gentlest motion of the Nervs is sufficient for sense; but not for motion. So you may observe in the motion of any Joint, that the Muscles which move it are very hard and stiff, but that hardness being remitted, yet the sensation is easily performed. Nor doth that any way hinder, because that sometimes in the Palsy the sense is somewhat stupefied, and the motion remaineth: for the Palsy is an affect very different from this; for in that the primary fault resides in the very Animal Constitution, therefore it may so fall out, that both the sense and the motion may be equally affected. Besides, when perhaps one Nerve doth want the du influx of the Brain, and another which is extended to the muscles of that part doth enjoy it, it may be, that for this cause also the sense may be abolished, and yet the motion may continu; although this case is not so frequent, and that the motion is more usually taken away, the sense remaining. But we have said enough concerning this matter. And thus at length we have produced those things which we have meditated of the integral Essence, both primary and secondary of this Disease; and that with as much perspicuity as a matter so difficult and unsearched into, would bear: In the next place we shall address our selus to the examination of the causes of this Disease. CHAP. XV. The Causes of the Rachites. And first those things which concern the Parents. WE have largely explained above both the Primary and Secondary Essence of this Disease. And indeed we have sufficiently demonstrated in the same place, the dependence of the secondary upon the Primary Essence. It may not therefore be here expected, that we should again purposely and in particular discuss the causes of the secondary Essence, which we have handled before. It may suffice that we have found out the causes of the secondary Essence. Yet if any cause do occur which at once▪ hath an influx as well into the primary or secondary Essence of the Disease, we shall not refuse to take notice of it, by the way as we proceed. But omitting all diligent search into the several kinds of causes, we purpose to contract this our discourse chiefly to two heads. The former containeth the Infirmities and the diseased dispositions of the Parents, which perhaps have so great an influence upon the Children, that they suppeditate, at least a proness to this affect, and infer an aptitude to fall into it, if they have not actually fallen into it from their very birth. The latter comprehendeth the accessary causes of this Disease; namely, those which happen to children after their birth. Concerning the causes of the first kind we meet with a Question at the first entrance: How and whether this Disease may be said to be hereditary? That we may the more successfully proceed in the determination of this question, an hereditary Disease must be distinguished into that properly, and that improperly so called. And indeed an hereditary Disease properly so called, is ever supposed to be preexistent in both or one of the Parents, and from thence to be derived to the Progeny. But an hereditary Disease improperly so called, is not supposed to be preexistent in the same kind, either in both or one of the Parents; yet the same fault must always necessarily precede (perhaps altogether of a different kind) at least in one of them, by virtue whereof a certain disposedness is imprinted in the children, whereby they are made obnoxious to fall into this improperly hereditary Disease. Moreover, An hereditary Disease properly so called, is twofold; either in the conformation, as when a lame Person begets a lame; a deaf Father, a deaf Son, or a blind a blind; or in the similary Constitution: as when a Gouty Father begets a Gouty Child. It is to be noted, that in the first kind, there is an hereditary fault inherent in the first affected parts of the Conformation. But in the latter, there is no necessity that a Disease of the same kind with the Disease of the Parents, should be actually inherent in the Embryon, from the first formation. But such a disposition imprinted by one or both of the Parents is sufficient, which as the life is lengthened may be actuated into the same, by the concourse of other intervening causes. Again, an hereditary Disease improperly so called, may be likewise twofold; namely, either in the Conformation, or in the similary Constitution. In the formation, as when neither of the Parents is blind, purblind, lame, etc. yet have begotten a Son blind, purblind, or lame, by the very fault of the formation. For in these cases, that very fault which is sensible and conspicuous in the Issu, flowed from some fault in the Parents, although perhaps of a different kind, and so it may be called, though improperly an hereditary Disease. In like manner in the similary Constitution of the Issu, there may reside an hereditary Disease improperly so called, as when a Melancholy, sedentary, or an intemperate Parent, begetteth a Child subject to the gout, or the Cachexia, although perhaps the Parent was never troubled either with the one or the other. These things being thus premised, we approach nearer to the resolving of the Question. And first, we affirm that this Disease is not comprehended under the former species of an hereditary Disease, properly so called. For that consisteth in the formation: but this Disease according to its primary Essence, is a similary Disease, as we have before demonstrated, and very rarely bewrayeth itself from the very Birth, much less from the very conception and formation. And for the same Reasons, we also affirm this Disease belongeth not to the former kind of herditary Diseases improperly so called. Which after a like manner consist in the formation of the parts, and are begun presently after the first formation. Secondly, We say, that so it may come to pass, that this Disease may fall under the second species ptopounded, of an hereditary Disease properly so called; namely, that which consisteth in the similary Constitution. Yet we cannot affirm this as certain and undubitable, because the Children which we have hitherto known to be afflicted with this Disease, have not lived to such maturity of years as to beget Children: and therefore we cannot otherwise suppose, then by probable conjecture, whether or no their progeny should be infected with this affect, as it were by right of inheritance. Thirdly, We say, that in many Children this Disease doth directly fall under the second species of an hereditary Disease improperly so called. For according to the primary Essence of it is a similary Disease, and although it hath not yet been so long and sufficiently discovered unto us, that we can determine the effects of it, how they will operate in the Progeny, yet frequently in the present progeny we have observed certain Rudiments of this affect to have been derived to many from one or both of the Parents. So that although neither of the Parents were in their infancy or childhood afflicted with this Disease, yet some proness and disposedness to this Disease hath presently appeared in their little Infants, especially in those whose Parents before coition were predisposed by some vitiosity of body, or error of life, to transmit this pollution to their Issu; but those defilements of the Parents which dispose them to propagate Children obnoxious to this affect, we shall by and by reckon up, in their order; from whence also a higher confirmation of this assertion may be deduced. Fourthly, We say, although the affects of the Parents do frequently imprint a certain propension in the Issue, to fall into this Disease, so that this Disease may be therefore reputed in the second acception of an hereditary disease, improperly so called; yet it very rarely happeneth that this Disease doth actually break out before the birth of the child. One amongst us attesteth, that once, and only but once, he saw a Child new born invaded with this Disease. And in this Child the Backbone, and the neck were so weak, that they could not sustain the weight and greatness of the Head, within three months after it was born, the Child died. Whereby it is apparent that he was grievously affected. It seemeth conspicuous by what hath been said, that Infants, however they may frequently borrow from their Parents a disposedness to this affect, are most rarely and seldom troubled with it before they are born, but if at any time they are so prematurely afflicted, that then the affect is most vehement and grievous. Now a reason of the event of both these may be demanded. To the former therefore we say, that this Disease doth partly consist in a cold distemper of the first affected parts, and indeed an unequal one, as namely, being very cold in the said parts, respect being had to the temper of the Head, and the Bowels: and that hereupon that unequal coldness of those parts, is of great moment in this Disease, and that also in respect of the very inequality. For this contributeth much to that unequal and deficient distribution of the Vital Blood to the parts first affected. Seeing therefore at such time when the Embryon is carried in the womb, this inequality of the temperament of the first affected parts may be much corrected and averted by an equal heat, whereby the womb may on every side embrace, and cherish the body of the Embryon, it followeth that the gestation doth very much drive away this Disease, at least retard the invasion of it. For the body of the Womb being all about equally warmed with an even heat, and equally embracing and cherishing all the parts of the Embryon, doth not easily permit one part to wax colder than the rest, and by that means to be cherished with a defective and sparing afflux of the Vital Blood. Wherefore seeing that that very inequality of heat and comfort, are Essential parts of this Disease, and without which this Disease cannot consist, it is no wonder that the womb strongly resisting these parts of the Disease, and the invasion thereof, doth for the most part protract it, at least during the impregnation. As for the latter part of the question propounded, namely, Why Infants, who before their birth were infested with this Disease, are more grievously and dangerously afflicted? We say, according to that Aphorism of Hypocrates, that a Disease which holdeth the least congruity with the condition of the Diseased, is more dangerous than the contrary; as a Fever threateneth more danger to an old man, than to a young, and in the winter, than the summer. For a Disease that hath some correspondence & conformity with the condition of the Diseased, requireth a slighter cause for its introduction: but that which is contrary thereunto argueth the magnitude of the cause, which notwithstanding resistance, and opposition, will produce his effects. In the present Disease therefore if the equal and impartial heat of the womb cannot restrain the propensity of the Embryon to this affect, but it will fall into it, some vehement cause must needs be imprinted by the Parents, and the seminal Principals extremely weakened. Therefore there is little hope when the Embryon labouring with this Disease is born, neither will a prudent Physician attempt the cure without some Prognostic of imminent danger. Moreover, instead of a Corollary, we substitute another Rule, having some affinity with the former, although perhaps it be not yet certain and approved; namely, that Children by how much the sooner after their birth they are invaded with this Disease, so much the more difficulty (caeteris paribus) are they delivered from it. And let these things suffice concerning the Question propounded. We will now apply our selus to the division and reckoning up of those causes which on the Parent's parts may produce this Disease. Some of these faults in the Parents relate to the Generation of the seed, whereof the Embryon consisteth, others have reference to the Embryon now conceived, and yet born about in the Womb. The faults of the Generation of the seed proceed either from the man or the woman, or from the whole Body, or from those parts only which are dedicated by nature to Generation. The faults of the Parents depending upon the whole Body have the strongest influence into the Child, because it transmitteth such matter to the Generation of the Seed, as is unapt for those parts dedicated to that office. We purpose not here to particularise the several faults of the matter of the Seed, but to instance in those alone, which conspire to entitle the Progeny to this Disease. These we reduce to four Classes. The first Classis containeth a cold and moist distemper of the matter, whereof the Seed is Generated. This chiefly resulteth from a cold and moist distemper of the Parents, unto which we also refer a predominancy of i'll juice, especially that which is Phlegmatic and waterish also a Cachexia, and Dropsy, and perhaps the Green-Sickness, which some call the white Fever, not sufficiently subdued before conception; all which affects manifestly help to constitute a waterish matter, both cold and moist in the Genital Parts, which is not only in general less apt for the Generation of the Seed, but it particularly inclineth to a condition of this Disease; a part of whose primary Essence consisteth in that very cold and moist distemper, as we have already proved. Moreover, we may perhaps hither reduce the Scurvy, the French Pox, & the Jaundice, in which affects the Blood also is polluted with filthy excrementitious humours, and corrupt exulcerations, which cannot easily be changed into laudable and fruitful Seed. The second Classis containeth containeth the penury of Natural Spirits, whereby the good Seed should be Generated. For a Spirituous Seed cannot flow from such a kind of matter. The causes which suppeditate that impure matter to the Parts of Generation are the dried and extenuated Bodies of the Parents, wasted either by long abstinence, or by some vehement evacuation, as by vomits, lasks, Lienteries, Dysenteries, Hepatical Flures of long continuance; by an excessive Hemorrhage from any part, by violent sweatings, or any Chronical Diseases, which wasteth the strength and is not repaired before Coition especially, a Consumption, a Hectic Fever, an indigestion from any kind of Caus. Lastly, from a defective and imperfect Concoction of the last aliment, or the fault of any part. For in such cases the matter which is separated to the parts subservient to Generation, is destitute of a competent plenty of Natural Spirits, whereupon the Parts preparing and concocting the Seed cannot perfectly correct this defect, and ejaculate such Seed as is sufficiently abounding with Spirits. Seeing therefore that a considerable part of this Disease consisteth in the paucity of Natural Spirits, it cannot otherwise be, but that the issue propagated by such a crude and almost Spiritless Seed, should be tainted with a certain Natural Propension to this affect, even in their first rudiments, which afterwards upon the concurrence or other causes, is easily deduced into Act. The third Classis containeth the benummedness or stupour of the matter transmitted to the Generative Parts, whereof the Seed is produced. For not only the solid parts, but also the whole Mass of Blood, and the humours therein contained are obnoxious to that same stupour. And from hence it is that Physicians being to render the causes of Diseases, do use to say, that the humours and also the Blood are too fluid and movable and unduly vehement; sometimes on the contrary that they are unapt for motion, less fluxible, and unactive beneath a Mediocrity, & in respect of this thing also a certain Mene is most wholesome: but more things relating hither may be seen above. We will here only prosecute those faults of the Parents from whence this defect of vigour and activity in the matter of the Seed doth arise. These therefore are first the fost, loose, and effeminate Constitution of either or both the Parents, indisposed to strong and Masculine exercises. Secondly, an overmoist and full diet and epicurison, obnoxious to frequent crudities. Thirdly, A delicate kind of life abandoned to eas and voluptuousness, slothful, and rarely accustomed to labour, danger, and care. Hither you may also refer a total defect of manly Exercise immoderate sleep, especially soon after mate, and any kind of sleepings whatsoever, a sedentary, speculative life, intent upon soft and quaint Arts and Sciences, as Poetry, Music, and the like, to these may be further added a daily frequenting of Comedies and other Plays, an assiduous reading of Fables, and Romances, and instead of manly and laudable Recreations, a loose expense of time in Carding and Dicing. Hither also belong the neverfailing fruits of a lasting peace and plenty, such as security, indiligence and the like. All these enumerated faults do manifestly contribute a share to introduce a laziness and Effeminateness in the parts. Seeing therefore that the Blood, together with the humours contained in it, doth in its circulation wash all those stupefied parts, it cannot otherwise be, but that as it glideth along it must participate some such alteration; and seeing that some portion of the transient Blood affected with this stupefaction, is transmitted to the Generative Parts, with the very matter whereof the Seed is Generated, it is easy to infer that that Child which springeth from such principals must inwardly contract at least some propension conformable to the sluggishness, and stupour of its Native matter, and that that propension, afterbirth when the preservation is taken away by the equal cherishings of the Womb, is by divers causes without difficulty deduced into act, wherefore seeing that such a dulness is a part of the Primary Essence of this Disease, it followeth that in such vitiated principals there lurketh a propensity to this affect, derived from one or both of the Parents. The Fourth Classis containeth the vicious Dispositions (if any such occur) of the Parents, who in their Childhood were infected with this Disease. For these would transmit into the Children a continuation of an hereditary Disease properly so called. But because, as we have said, it is not yet manifest whether the Parent afflicted with this Disease in their infancy shall beget children therewith affected; besides, because the faults of the Parents may be conveniently referred to any one of these Classes aforesaid, or to many, or indeed to all of them, it will be fruitless to insist longer upon them. Therefore having reckoned up the faults of the Parents which depend upon the whole Body, in the next place we proceed to their faults which peculiarly reside in the Genital Parts. These faults are sometimes a cold distemper, sometimes a moist, when by reason of too much humidity they are loosened or weakened, whereupon they ejaculate either an unfruitful deed or such as is propense to this Disease, sometimes those parts are infested with a virulent, vicious or waterish Gonorrhoea, and they excern a Seed not sufficiently elaborated; the same must be said of the white and red Fluxes of Women. Again, some things outwardly applied to those parts have reference hither; as Ointments of Hemlock and other Narcotical things, especially if they be often anointed with them, in like manner Ointments that are incorporated with white or red Lead, Chalk of Lead, Litharge, Sugar of Saturn and the like, daily and for a long time adhibited to those parts. For such as these blunt the activity of the inherent Spirits in those Parts, and introduce a certain dulness in them, which being communicated to the Seed prepared in them disposeth the progeny to this affect. At length we have finished our intended enumeration, if not of all, yet at least of all the most principal causes which happen before Conception about the Generation of the prolificative Seed, and have any concurrence to produce this Disease, or to dispose to the production thereof. Now follow the faults and errors of the Mother in the time she beareth the Embryon in her Womb, which also must be reputed among the causes of this Disease before the Birth. First, There happeneth a cold and moist distemper of the Womb itself, which (as were we silent is easily manifest to every one) may most readily be communicated to the Embryon by the perpetual contact of the Womb. In the Second place, All those things offer themselves which suppeditate to the Embryon crude and impure Juices converted by excrementions and corrupt humours instead of laudable aliment. Hitherto principally belongeth the unwholesome and preposterous diet of Women with Child, especially inclining to moisture, coldness and the heaping together of crudities. The same things also happen by the imperfection and defect of the first or second Concoction, especially when they are not excerned by vomit or some other evacuation of the Crudities from thence proceeding, but are at length transmitted with the Mother's Blood for the aliment of the Embryon. Besides, if a moist and cold Disease, as a cold and moist distemper with the matter, an ill digestion, a Cachexia or Dropsy, etc. do invade a woman with Child after Conception, it may thereupon easily happen, that the impure aliment also, which nourisheth and cherisheth the Seeds of this Disease, be dispensed to the Embryon. In the third place are to be reckoned all those things that defraud the Embryon of du aliment, as any excessive evacuation, especially a lashing flux of Blood in any part; also a rash opening of a Vein, or Phlebotomy that exceeds in quantity. The suckling of another child may also divert the afflux of sufficient aliment from the Womb towards the Breasts. Hitherto likewise belongeth inordinate fasting, or any indigestion in the Mother, any inappetency after meat, or defect of concoction. Moreover, an acute Fever happening to a woman with Child, besides other inconveniences, may also defraud the Child of du aliment; so also an Hectic Fever. All these things do not only infer to the Embryon, a dejection of Vital Spirits, and a defective nourishment, but also they cause a want of natural Spirits. For the Natural Spirits are wasted and dissipated without due nourishment, and are also destitute and disappointed of necessary reparation. Seeing therefore that a part of the Essence of this Disease consisteth in the defect of Natural Spirits, some disposition to this affect must need be bequeathed to the offspring from the causes aforesaid. 4ly. & lastly, excessive sleepiness of women with child, slothfulness, eas, any vehement labour and exercise after Conception, do also contribute their share. For although violent motions and actions of any kind are forbidden to women in such causes; yet moderate labours, watchings and exercises which offer no violence to the womb, or provoke to abortiveness, do not only conduce to the health of the Mother, but in some degree they drive away that dulness from the Embryon, and augment the heat, vigour and activity of it. And thus we put an end to the first Chapter of the causes of this Disease before the Birth. Those which happen after the birth shall be the subject of our next examination. CHAP. XVI. The Causes of this Disease incident to Children after their birth. WE have noted in the precedent Chapter, that Infants from their first Origin are seldom afflicted with this Disease, but by reason of the Causes there rehearsed, that they are frequently affected with a natural disposedness, and propension to the same. We shall now prosecute those causes which are apt to actuate that Natural disposition after the birth, or newly and fully to produce this Disease. For it must be known that the same causes which may actuat that predisposedness to this Disease, may produce this Disease a new, if they be sufficiently intensive in their degree. And therefore we confess that those children which are prone to this Disease from their Nativity are easily affected; but that other which are free from all Natural corruption fall not into the same but upon more potent causes; and yet those causes are the same for their kind and differ only in the degree. We therefore thought it needless to speak of these things distinctly and apart: it may suffice that we have spoken of them indescriminately and together. At the very entrance a Question there is which importunes a Resolution; namely, Whether Contagion may be numbered among the causes of this Disease, and therefore whether this Disease in a proper and right understanding be a contagious Disease, indeed he that considereth this Disease unknown to the Ancients, how it first invaded the Western Parts of England, and in few years hath been since dispersed all England over, will at the first thought easily judge it to be contagious, and to have been spread so far and wide by the infection of it. But the matter will seem to be otherwise to him that will consider it more intentively, For although this Disease may in some manner endeavour to imprint an affection like unto itself in other Bodies, yet it scarce advanceth so far that it can totally produce a Disease of the same kind. For perhaps it may in one some slight inclination in another Body, yea, sometimes perhaps it may accelerate or hasten the invasion of an affect in a Body highly predisposed unto it, yet it cannot therefore deserve the Name of a Disease properly contagious. For all Diseases conspire to change and assimilate those Bodies which are nearest to themselves, yet that is not sufficient to denominate Diseases contagious. For to constitute a contagious Disease properly so called it is further required that out of itself it propagate a certain Seminal fermentation of itself, which secretly insinuating itself into other Bodies, may by degrees introduce into those Bodies a Disease of the same Species. But this Disease containeth no such fermentation in its essence, neither is it secretly propagated by a precedent emission of Seed from itself which may imprint a Disease of the same Species in the adjacent Bodies. For we have already often said, That the first essence of this Disease consisteth in a cold and moist distemper, and in a dulness and paucity of inherent Spirits, which affections if they endeavour to assimilate any Bodies that are near them, they attempt and undertake it by open violence, and not by snares and fraudulence or a preimmission of secret little fires. In like manner if you reflect upon the Secondary Essence thereof, neither the vitiated Tone, nor the depraved Vital nor Animal Function, nor the Organical faults are found apt and fit in this affect to insinuate themselves into other Bodies, and to propagate their own Species. Finally, if we will consult experience, the matter will quickly be vindicated from all doubt. For we frequently observe Children either of the same age, or very near to the same age, be brought up in the same House, whereof one or other of them is perhaps afflicted with this Disease, whilst a third or many amongst them do escape it. Yea, We have known Children not only educated under one common Roof, and delighting in the continual and mutual society of one another, but daily meeting at one Board and lying together in one Bed; whereof one who hath been ill affected with this Disease hath not infected any of his companions either by feeding or lying together. Which could scarce possibly happen in a Disease properly contagious. Wherefore Contagion being excluded from the Catalogue of this Disease, we will address ourselves to the finding out of such as are more true and unquestionable. We divide the causes which produce this Disease after Birth into two Classes. The first containeth the errors which procure it in the use of the six nonnatural things. The latter comprehendeth the precedent Diseases of divers kinds, which are wont very often to leave behind them some Inclination to this affect. As for the former Classis concerning the abuse of the six non-Natural things, so far as they relate to this Disease, seeing that children are seldom discomposed with any vehement passions of the mind, and can thereupon very difficultly fall into this Disease. Again, in regard that the use of Venery appertaineth not unto them; we will reduce and limit these cases to the five subsequent heads. To the Air, also to what things soever extrinsecally occur, or are applied to the body, to meat and drink, and such things as are inwardly received, to motion and rest, to the kind and manner of life, to actions and exercise, to sleep and watching; lastly, those things which are preternaturally retained in, or severed from the body. These several things we shall examine in the propounded order with all convenient brevity. Of the Air and such things, as happen outwardly. A cold and moist Air doth powerfully contribute to this Disease. For seeing that it doth more easily steal into the external and first affected parts in this Disease, then into the hidden and fenced bowels, it directly helpeth to imprint in those parts that unequal; namely, that cold and moist distemper. The constitution of this kind of Air, is chiefly predominant about the beginning of the Spring, at which time the Nurses ought to be cautious and circumspect. How they too confidently expose their children, which are subject to this affect, to the injuries of the Air; as also when the Air is cloudy, thick, rainy, and full of vaporous exhalations. Hereupon places near the Sea, great Marshes that are obnoxious to much rain and showers, and fed with a great number of Springs, are wont to be (caeteris paribus) very fruitful of this affect. In like manner houses near the banks of great Rivers and Ponds or Meers are for this purpose condemned. Moreover, frequent bathing and washings with sweet water, although they be applied actually hot, yet in regard that they are potentially cold and moist, they are also justly culpable; for they do in some sort communicate their distemper unto the parts whereunto they are adhibited, and more or less cause a softness and looseness in those parts, and make the circulation of the Blood too slippery. Hither we may also refer cold and moist liniments, as also such as are loose and slippery, being too often continued in that tender age, especially about the Spine or the Origin of the Nervs: lastly, soft linen clothes, if they be not well dried, they cherish the roots of this Disease. For this cause amongst others, it happeneth that the Children of poor people are the less obnoxious to this Disease, because namely, for the most part they are enwrapped in course clothes, and woolly integuments, each of which doth rub and tickle the parts thereby exciting and augmenting the inward heat, and irritating a more copious afflux of the Vital Blood unto the habit of the Body, and are therefore very effectual to banish this Disease. But the softened fine linen doth neither irritate the heat into the external parts, nor laudably cherish it. For if they chance to be for some short space of time removed from the touch of the parts, they presently lose their warmth, and at the next touch they convey a sense of coldness into the parts. Wherefore such linen clothes being in the number of those things which are dedicated only to extrinsical application, and seeing that they are hurtful by their sole coldness & softness, we have referred them to this first Classes of causes, & the first part thereof which containeth cold and moist things outwardly occurrent. In the second place the Air being infected with any particular infection, as noxious Metalline exhalations, which for the most part sight against the inherent Spirits of the parts, by a kind of venomous malignity, and do either extinguish them, or drive away and dissipate them; withal they dissolve the Bone of the parts, and the pulsificative force, especially in the parts external, where they first happen, they at least diminish, if they do not weaken it, and affect it with a languidness. These things are principally caused by exhalations from Lead, Antimony, Quicksilver, and the like. Moreover, ointments made of the same, are almost alike perilous, if the first affected parts be frequently and unseasonably anointed therewith; although perhaps these things do also belong to the fourth title of this Classis. Finally, we have observed some Children who have been anointed with Mercurial Unctions for the Scabs, to have fallen afterwards into this Disease. In the third place an Air vehemently hot and subtle, extremely attenuant and dissolvent, may likewise be numbered among the causes of this Disease, because it allureth forth, dissipateth and consumeth the inherent Spirits. In like manner hot liniments and especially discussive withal, Chemical oils distilled and not sufficiently corrected by the commixture of things temperate; for these in such a tender constitution of the parts do easily melt and resolve the Spirits into a volatile and Airy thinness, and by consequence infer a penury of Inherent Spirits. Hither also belong sharp, saltish, hot and discussive Baths, especially, if they be unseasonably and unmeasurably used, for these no less than the former do waste and consume the Spirits. Fourthly and lastly, An Air filled with Narotical vapours or exhalations, and baths, fomentations and Liniments made of Soporiferous and Narotical ingredients, as Hemlock, Henbane, Opium, Nightshade, and the like, and externally applied, are very fitly reducible, also to this Classis. For they easily introduce a benummedness into the first affected Parts, into which they first convey their force. Which benummedness is not only itself a part of the first Essence of this Disease, but it also easily dulleth and diminisheth the Vital influx in those parts, and consequently is also a cause of that part of the Secondary Essence of this Disease, which consisteth in the Vital Constitution, which thing we have already explained more at large. And thus much of things outwardly occurring. Secondly, Of Meat and Drink, and things inwardly taken. To this Title there belong first aliments of any kind which are too moist and cold, for these things manifestly cherish the distemper, wherein a part of the Essence of this consisteth. Hither therefore we refer most kind of Fish, and crude Meats which are not well prepared by Coition; also all those things whatsoever they be which cause a defect of concoction in the Ventricle. Therefore the feeding upon new Meat, before the former Aliment is concocted, is very hurtful for Children disposed to this affect; and in this respect, a plentiful Diet is altogether to be abandoned, and a thin spare Diet ought to be observed, for too liberal feeding doth overwhelm and choke the heat, and therefore must needs accumulate many crude and raw humours. And perhaps this one may be reputed among the especial causes, why this Disease doth more frequently invade the Cradles of the rich; then afflict poor men's Children. In like manner cold & moist Medicines taken inwardly, and also such as are laxative, and endued with an internal slipperiness, do manifestly relate hither. For these things do not only infer a like distemper, but they produce a Relaxation in the Tone of the parts, and affect them with an internal slipperiness, and in a word they render the current of the Blood through the first affected parts over slippery and easy. Secondly, Nourishments that are too thick, viscous and obstructive belong hither, especially because they interrupt the equal distribution of the Blood. Hither we refer flesh hardened with smoke, and seasoned with much Salt; in like manner Salt Fish, and Cheese almost of any kind plentifully fed on. Bread newly taken out of the Oven, and not yet cold; also almost all sweet things condited with Sugar, unless they are withal tempered with Wine, or cutting, or attenuant. Obstructive Medicines likewise of any kind belong hither, unto which we may further add such as are Partotical, and whatsoever being drank induce a benummedness into the parts. Thirdly, Nourishments that are of an extreme hot and biting quality, sharp, & corrosive, as old & strong Wines, especially being drank upon an empty Stomach, Meats also that are seasoned with much Pepper and aromatical Sauces, must be connumerated among the reputed causes of this affect, For these things in such a tender consistence of the Parts, do easily feed upon and devour the inherent Spirits. The same thing is also affective by Medicines that are immoderately hot and discussive, yea, these are far more powerful to hurt, because they more quickly and forcibly spoil the inherent Spirits, than the prementioned Nourishments. Thirdly, Of Motion, Rest, Exercises, and Actions. Motion and Exercises, if they exceed a mean, they dissolve the Body of a little Child into a profuse Sweat, and withal they somewhat dissipate the inherent Spirits of the Parts, and therefore for that reason they may conspire the introducing of this Disease▪ although we conceive it falleth out exceeding rarely, that Boys are infested with this Disease, whereof we discourse. But a defect of Motion and want of Exercise doth most frequently, yea and most effectually concur to the production of this affect. For the Spinal Marrow, and the Nerves from thence arising, and the other first affected parts, serve chiefly for Motion and Exercises. A stupidity therefore and sluggishness of those parts, is a cause that neither their inherent heat is sufficiently cherished, nor that heat extenuated, nor the cold distemper stealing in banished, nor the excrementitious, and superfluous moistures expelled by a due transpiration, but it permitteth them to be affected with a certain softness, looseness, and internal lubricity, whereupon the Arteries also distributed unto them are faintly irritated, yield a dull and slothful Pulse, neither do they render the parts somewhat turgid or swelled, but leave them lank and subsiding. By which means the circulation of the Blood becomes slow and lessened, and more slippery than is meet, the production also of the vital heat must thereupon be necessarily be feeble and weak, all which considerations do sufficiently evince that this is an efficacious cause of this Disease. Fourthly, Of Sleeping and Watching. We grant that Children should sleep oftener and longer than Men; yet if it be excessive even in Childhood the matter is the same as in defect of exercise and motion. For sleep is a certain rest and privation of watchings or of the exercise of the senses. But watchings consist in the very exercise of the senses, according to Aristotle in his Book de Som. & Vigil. Wherefore the evils that we have described to arise from the defect of motion and exercises, the same also must needs happen from immoderate sleep. On the contrary, in that tender age, inordinate watchings are no less noxious. For they do not only retard the concoction of the aliment, but they likewise taint the Blood with a kind of acrimony, and consequently dissipate the Principals of the Natural Constitution of the first affected parts, and without difficulty introduce a defect of inherent Spirits. Fiftly. Of things preternaturally cast out and retained. All the internal causes of Diseases might be perhaps not incommodiously reduced to this title. For any thing whatsoever contained in the Body, and preternaturally altered, as they are preternatural, they indicate their ablation, and may so far forth be reputed among things to be cast out, which are nevertheless preternaturally retained. But we more rightly grant, that all internal causes may be distinguished into two kinds: one whereof containeth those things which are preternaturally retained and cast out: the other, such things as are contained in the Body being preternaturally altered. For these latter are not only taken away by casting out, but also by Alteration, they may be reduced to an agreeable proportion of Nature. However it be, there is a great affinity between the Humours vitiated by Alteration, and the excrementitious Humours which are retained. For there are so many and such various ways of casting out in the Body, that scarce any humour can be imaginably produced by Alteration, which doth not properly relate to the secretive and excretive faculty of some Bowel, or some other partt and is destinated to be severed and evacuated from it; and therefore though the errors of the first concoction are scarce corrected in the second or third, by Alteration, yet they may be mended by local motion, or excretion, made from some part of the Body, the unprofitable parts being separated and rejected. In like manner the mass of blood being any ways preternaturally altered, or infected with some Humour, the peccant matter which cannot be otherwise subdued by Alteration, is quickly exterminated perhaps by excression made from some part or Bowel (unless withal the secretive or expulsive faculty thereof be hindered) therefore it must needs be of great moment for a Physician to know what Humours are particularly predominant in any Disease, and by what determinate ways they may be most properly spied out according to the intent and purpose of Nature. For there are as many subordinate species of things spied out, as there are distinct substances of the Bowels and other parts destinated to that office in the Body. For it is credible that the Liver doth cast out one thing, the Kidneys another, the Sweetbread another, the Spleen another, the Stomach and Guts another, the Lungs another, the Brain another, the Stones, the Matrix, the Kidneys, the Kernel under the Canel Bone, the glandulous parts of the Larynxes, the Throat and Jaws another, the scarf Skin and the Skin another. For it seemeth scarce admittable, that Nature should build and prepare for herself Organs of different kinds, and yet should make use of divers of them for the performance of one and the same action. Therefore when the excretion of any of the said parts happeneth to be restrained, a certain peculiar filth will flow out from thence into the mass of Blood, and so there will be so many differences of things preternaturally retained, as there are kinds of parts inservient to particular casting out: and in like manner there will be as many kinds of vicious excretion, either by excess, defect or depravation, as there are divers ways thorough which the excretion may be made. If any man demand, Whether the several kinds of things excerned be sufficiently discovered and understood by us: We answer, that an exact knowledge is desired of that particular humour which is to be cast out thorough the new Vessel of the Sweetbread, then in the next place, what is cast out by the Kidneys, the Kernel under the Canel Bone, and the glandulous parts of the Larynx: yea, perhaps it is yet scare sufficiently known, what is rejected by the Spleen. For this cause therefore amongst others, it seemed good unto us to supersede in this place any high and accurate disquisition of things secerned and retained, either in relation to the parts and ways whereunto they belong, or in order to the present affect, and rather to insist on that fourfold division of Humours made by Galen; namely, into Choler, Phlegm, Blood, Melancholy, adding only undue transpiration and sweeting. For although we may doubt, whether this division can deduce the humours to the subordinate Species, (as we have noted above) more than four parts distinct in the species are evidently dedicated to the casting out of the humours; yet seeing that this division of the Humours is not only approved by all Classical Physicians, but that it is likewise profitable in itself, and at least reduceth the Humours to certain Heads or Kind's, (however perhaps every kind may comprehend under it several species) we are resolved for the present to insist upon it, and so much the rather, because under a general notion it very fitly conjoineth and containeth both things altered and preternaturally contained within, and also things to be spied out which are not yet excerned, and in that respect it will eas our burden and contract our work. For whilst we make our proceedings in this manner, it will be needless to institute any other peculiar Chapter of the Causes of this Disease, namely of this altered which are preternaturally contained, seeing that they are comprehended, as we have said, under this Title. We reduce therefore the internal Causes of this Disease (whether they be excrementitious humours retained, or vitiated by alteration) either to Choler, or to Melancholy, or to Elegm and a Waterish humour, or an undue Transpiration and sweeting, for the Blood properly so called is in this affect scarce observed to be faulty. You may object, That Practical Physicians do in this Disease commonly prescribe the opening of a Vein in the hollow of the Ear, observing that Evacuation to be very profitable, which Reason could hardly admit, unless the Blood were in some degree peccant? We answer, That this Remedy is available, not in respect of the universal plenitude of the Blood, but by reason of a peculiar plenitude of the Head itself. For we have already showed how that the Blood is uneqally dispensed to the parts of the Body▪ and indeed illiberally to the first affected parts, but to the Head superabundantly. Therefore although there be not an universal redundancy of the Blood in this Disease, yet in respect of the particular Plenitude of the Head itself, such a particular emptiness, is perhaps profitably instituted those outward and small Veins of the Ears being cut. You may reply that we by this Answer do indeed decline the universal Plethora, but that we grant a particular one of the Head, which ought no less to be esteemed a cause of sickness, We answer, That we have at large explained this fault of the Blood, when we discoursed of the unequal distribution of it, unto which place it properly belongeth, seeing that it is a cause of the Secondary, not of the Primary Essence of this Disease; and therefore a vain and superfluous repetition thereof ought not in this place to be expected, We will now therefore proceed to our purposed disquisition of the Humours, and likewise the Transpiration aforesaid. First Choler (whether by this word you understand that excrementitious humour in the little Bladder, and the Choleric poor, or a hot, dry, sharp, and bitter part of the Mass of Blood, or that unsavoury humour that tasteth like stinking Oil, begotten and flowing in the Stomach by some corrupt aliment, especially, that which is fat, addust, or salt; or certain sharp and corrosive Excrescences produced in the Body by corrupt Blood) if it abound and luxuriate in the Body, very probably be a cause of this affect. For although it may rather seem to impugn that cold and moist distemper, which is a part of the first Essence of this Disease; yet in regard that it is apt in some sort to hinder the nourishment of the Parts, either by a vehement irritation of the expulsive faculty, or by attenuation of the aliment, and to extenuate and waste the very inherent constitution of the Parts, and by consequence to consume and dissipate the Natural Spirits, it may not unjustly be numbered among the causes of this Disease. For every one knows that Persons of a Choleric Constitution are lean, and of an extenuated habit because of the Reasons aforesaid. Secondly, A Melancholy humour (whether you understand the Earthy Portion of the Blood, or that saltish or tartar like matter excreted in and with the Urinal, and when the Urinal groweth cold, incorporating into little Sands; or that sour humour poured into the Ventricle perhaps by the Spleen (though not through that short Veiny Vessel, as the Ancients believed) or those terrene Parts of the assumed Aliment, which are evacuated by siege with the other Excrements) understand either or any of them, if this humour aboundeth and be not purged out after a due manner, may be blamed as a cause of this Disease. For first, that humour which is the more Earthy part of the Blood, if it exceed a just proportion in the Mass of Blood, it rendereth it unapt to nourish the Parts, especially those that are first affected; for the first affected parts are of a more noble texture than the substances of the Bowels, or the bony parts; and therefore we have already noted how the Parenchymata of the Bowels and the Bones do easily admit nutrition, and by a way like unto digestion; but those former parts do require a far more exquisite secretion & elaborated assimilation. And this is the Reason that the fleshy parts of the Bowels are rightly imputed among the impure and grosser aliments, namely, Because they are nourished with a course Blood, and not accurately elaborated before the Union. Secondly, Any great accumulation of Saltish, and Tartar like matter is an Enemy to Nutrition, and is rather dissipative and devouring than favouring augmentation. Thirdly, The sour Humour of the Ventricle is totally ravenous, and as it were hungerstarved, and perhaps where it aboundeth it easily communicateth to the Blood such another Depredatory quality; Fourthly and lastly, The Terrene Dregs of the Belly may if they be inordinately retained, taint and infect the Chylus, and render it unapt for the nourishment of the part. Finally we grant, that every propounded kind of Melancholy superfluously coagumented or preternaturally retained, doth not primarily, properly, and directly concur to the production of this evil; but nevertheless we are of opinion that indirectly, and after the manner propounded it may contribute something to the generation of it, Thirdly, Phlegm (whether it be taken for the moister and colder part of the Mass of Blood, or for the wheyish part thereof, or for the slow humour of the Stomach and Guts, or for the Spittle, or for the Snot of the Nostrils or Jaws, or for that peculiar humour, which perhaps the new Vessel of the Sweetbread doth use to evacuate) however you take it, if it be retained or abound in the Body, it hath a direct reference to this Disease, and properly deserveth to be called the cause thereof. For this humour is cold, most, slow, thick, benumbed, little spiritous, lost, and affected with an internal slipperiness; all which things do exactly comply with the primary and secondary Essence of this Disease as they have been propounded. Wherefore upon a superfluous accumulation of this humour, seeing that there succeedeth a conspiracy to the production of this affect, it ought justly to be esteemed a proper cause and a Primary Agent. Besides these humours undue Transpiration, as also immoderate or defective sweeting may be sometimes numbered among the causes of this affect. For excessive Sweeting, as also immoderate Transpiration, doth dissipate the Spirits, and withal dissolveth the parts, especially the external which in this Disease are the first affected, and the inherent Spirits being consumed it easily leaveth a cold distemper behind it. For to a just excitation and conservation of the heat of the parts there is required a certain due and regular strife of the exhalations between breathing, which if it prove deficient, the actual heat also (because it partly consisteth in this strife) becomes very feeble and languid, and the parts are easily exposed to a cold distemper. But we have already spoken of this matter at large. On the contrary, Sweat preternaturally restrained, as also a very small or lessened Transpiration, doth easily kindle a Feverish heat, and therefore it likewise injureth the Spirits and dissolveth the parts, and rendereth them afterwards easily obnoxious to a cold distemper. Finally, That we may comprehend all in a word, Any humour excerned above Reason or Measure doth easily introduce a colliquation of the parts and a dissipation of the inherent Spirits, and consequently disposeth the Body to this affect. And let this suffice to have been spoken of non-Natural things, and the causes of this Disease thence arising. CHAP. XVII. Precedent Diseases which may be the Cause of this Disease. THese Diseases, in respect of their proper Essence, ought only to be called by the name of Diseases, but in respect of this Disease they may rightly pass under the notion of causes of Diseases, because they leave it behind them as one of their Effects. Yet although many of them (as they relate to the Parents and so imprint a Natural pollution in the Offspring) are rehearsed above, nevertheless, by right they here deserve their consideration, yet in a different respect and order. These Diseases we reduce to three Kind's or general Heads. First, To Diseases that have some affinity with this affect. Secondly, To Diseases that extenuate the Body. Thirdly, To Diseases inducing a stupor and dulness in the first affected parts. Of the First Kind. Diseases having an Affinity or holding Congruity with this we call those who at least in part consist in the same with the Essence of this Disease: of this kind are any cold distemper, or any moist distemper, also any cold and moist distemper. For a part of the first Essence of this Disease includeth a cold and moist distemper, and so those distempers do partly agree with this Affect. Hither also belong a Phlegmatic Cachocymy, a Melancholy and a mixed; an obstruction proceeding from such like humours, a Cachexia and a Dropsy. Yea, we may likewise refer hither in regard of their affinity, those Diseases wherein the inherent Spirits are somewhat consumed; for a part of the Essence of this Disease consisteth in a scarcity▪ of those Spirits, but otherwise they are more aptly referred to the second kind. In like manner the Diseases wherein the first affected parts are benumbed, & stupefied; may likewise in respect of their affinity, be hitherto referred, although they belong more properly to the third kind of Diseases. Moreover, those Diseases wherein the Tone of the parts is enfeebled and loosened must here be listed, for they include a part of this Disease; namely, that which consisteth in the looseness, litherness, internal slipperiness and softness of the Tone, as they are above described. The Philosophers say, that the Elements which agree in like qualities, are easily changed one into another; by the same reason that these Diseases which partly agree in the same Essence do easily admit a reciprocal change from one to the other. So we see a quotidian Ague, which agreeth with a putrid Fever in a preternatural heat, upon every slight Cause degenerate into it. Yet it must here be noted, That great Diseases are not so easily changed into small, as small ones into great. Besides, not all Diseases which perhaps participate alike of the same Essence, are with an equal facility reciprocally changed. For some Diseases are more subject to change into others, with whom in part they have some agreement, than others: And that for other Reasons beside the said agreement, however it be, if a cold and dry distemper should happen to a Child, that would easily change into a cold and moist; both in respect of the congruity of each Disease to cold, and also a peculiar inclination of that tender age to moisture. For by reason of the coldness, the digestion becomes imperfect, and hereupon crudities or crude humidities are engendered, which a cold distemper in so tender an age would easily and immediately follow. Moreover, a cold and moist distemper in regard of the coldness would make a slow Pulse, and in regard of the moisture would make it the more slippery, and the less viscous, whereupon the Vital heat being diminished, a benummedness and dulness by little and little would steal upon the Vital Spirits. Finally, in respect of that slipperish retention arising from the internal slipperiness of the parts, and by reason of the weak concoction, the inherent Spirits of the first affected parts, would also by degrees be diminished, and so by little and little after this manner the perfect Essence of this Disease will be introduced. Of the second kind. Most Diseases making lean, or any ways extenuating the Body, although perhaps they no way participate of of the Essence of this Disease (like the Diseases of the first kind) yet they do dispose the Body to the invasion of this affect, and may also leave it after them. For all great quotidian Diseases, in process of time do extenuate the Body, wast the inherent Spirits, and dissolve the Tone of the parts; and this attrition and attenuation of the parts doth chiefly refer to the first affected parts in this Disease. For as we have already asserted, the substance of the Bowels are not so easily subjected to dissolution or dissipation. But in the dissected Carcases of those who have died of Chronical Affects, the Bowels are observed to be no less; yea, many times much bigger when the external parts (which in this Disease are first affected) are for the most part made lean with the vehemency of the affect. And therefore seeing that extenuating Diseases, do chiefly communicate their force into the first affected parts, it easily falleth out that in Children they help to introduce this Disease. For the inherent Spirits of the first affected parts being very much wasted, a cold distemper must needs follow, which by reason of the crudity is (as we have said above) received by a moist one and a benummedness; because the heat, activity, and vigour of the parts do chiefly depend upon the plenty of Spirits. And thus we have exhibited the manner whereby this Disease doth follow and as it were tread in the footsteps of other foregoing affects of this kind, which we now further subdistinguish into three Classes. The first comprehendeth Diseases extenuating and consuming the habit of the body, by ways insensible; hither are referred almost all Fevers, especially the Hectic and Consuming, an Ulcer of Lungs with a putrid Fever. Also any continual Fever that is violent, as a burning, malignant, pestilential Fever, a Pleurisy, and an inflammation of the Lungs, also the small Pox, and the Meazels when they grievously afflict the Patient. In like manner intermitting Chronical Fevers. Lastly, all Chronical Fevers that torment with vehemence do the same. The second Classis containeth Diseases consuming by manifest passages, and evacuating the solid substance of the parts. Hither you may refer immoderate vomiting, a Lyentery, Dysentery, Lask, the Hepatical Flux, the Diabetes, any profuse Hemorrhage or Bloody Issue, any excessive sweeting, any great Ulcer in any part, eating deep, and daily casting out much matter. For all these Affects do evidently extenuate the habit of the body, and cause the introduction of this affect. The third containeth the Diseases which are said to extenuate the substance of the parts not directly, but by consequence: as all Diseases interrupitng concoction or the distribution of the Blood. For these prohibit the reparation of the parts continually fed upon by the Vital heat. Hereupon several Diseases of the Ventricle, Guts, Mesentery, Sweetbread, Spleen, Liver; Yea, Diseases in the Mouth, Jaws or Throat, which hinder only the assumption or swallowing of the Meat, may in this respect be numbered among the causes of this Disease. As a distemper, a tumour, a nauseating, a feeble appetite of the ventricle, a distemper, a tumour an obstruction & Skirrhus of the Mesentery, & Sweetbread, or the Liver, Spleen, and the like effects of any of the said parts, which by any means frustrate the due concoction and distribution of the nourishment, and thereupon extenuate the parts by defect of nutrition. Of the third kind. Diseases that induce an astonishment to the first affected parts, do also by a peculiar propriety conspire the production of this Affect. For the Natural heat of those parts is somewhat dulled by them, and is rendered less effectual: whereupon a cold distemper stealeth in by degrees, which is also (as hath been said) easily waited on with a moist distemper, a softness, and internal slipperiness. Moreover, the Pulls of the Arteries reaching to those parts is secretly, and by little and little weakened, the distribution of the Blood, and the Vital Heat is diminished, the parts themselves are sparingly nourished, and at length there comes a defect of Natural Spirits. So that from this Root also, for some time persevering the Essence of this Disease may at last bud forth. The Apoplexy, Palsy, Lethargy, and the like effects do chiefly belong hither. Yet Children do exceeding rarely fall into this affect from these sleepy Causes, and so rarely, that we have not yet observed this Disease to own its beginning to such affects. If any demand a Reason of this rarity; we say, that the Bodies of Children by reason of their permeability and thinness, are seldom subjected to those affects; but if at any time they are invaded by them the Disease doth not first assault the Natural or Vital, but the Animal Constitution, and consequently procureth for the most part a deprivation of the Animal Faculty, before it interrupteth either the Natural or the Vital. But the benummedness whereof we now speak, belongeth to the Natural Constitution, into which it cannot be presently transferred. Moreover, they are easily and speedily driven out, by reason of the facility of transpiration in the Bodies of Children, if peradventure those affects do gently invade them: but if they rage and tyrannize, they easily and speedily dispatch and kill, as being in their own Nature most terrible and grievous Diseases; and the sooner, because of the weakness of their Constitutions over whom they prevail. But which way soever they happen, they scarce continue so long, as with sufficient efficacy to imprint this benummedness in the Natural Constitution of the parts. Yet we grant that these affects may, if perhaps, they persist longer with life, affect the Natural Constitution with that benummedness so that this Disease may follow thereupon, although we can neither justify, nor assert it upon the credit of a single observation. But the Diseases which do most frequently introduce an astonishment in the Natural Constitution of the first affected parts, are those very same, which hinder Children any way from ordinary actions and due exercises, especially from the use of their feet, as the luxation fracture, or some wound of a foot, or thigh, or the leg, or the Backbone: also tumours and pains, or the like affects, whether they afflict the parts aforesaid or others, provided that they hinder the Children, so that they cannot walk, or play standing upon their legs, or use any Masculine Exercises. For hereupon by degrees the rigour and heat of the external parts waxeth dull, which in this evil are the parts first affected, and from thence the other parts of the Essence of this affect, follow by an uninterrupted and linked succession, as whosoever will may see above. We have now run over the Causes of this Affect, and should in the next place proceed to the differences thereof, but that two difficulties do here interpose themselves, which properly result from a higher consideration of the Causes propounded. For all those Causes now alleged seem as well common to Boys of big growth, as to Children, whereupon it may very pertinently be enquired, How it comes to pass, that they which are grown to man's Estate are not infested with this evil, as well as Children? Then again, Seing that the Causes propounded are all of them almost common, both to England and many other Countries, & some of them to all Climates of the Earth, It may be demanded in the second place, Why this disease is more frequent and rife in England, than in other Country's? These Questions we shall examine in order, and shall freely deliver our judgement concerning them. CHAP. XVIII. The Former Question. WHy they which are elder in years are not equally obnoxious to this Disease as Children? The terms of the Question seem to insinuate, that this Affect may happen, though very rarely to those of big age. But we reserve the solution of this doubt till the close of the present determination. Therefore in the mean time the Constitutions or dispositions both of Children that are chiefly obnoxious to this Disease, and also of bigger Boys which are rarely subject unto it, must be opposed and every way considered and thought on: also of Youths, Men, and Old Men, and that in order and relation to this Affect. For the Question is not absolute, but comparative, therefore the first and best way of determining it, will be by a mutual comparison between the different dispositions of the said Subjects, how they admit the impressions of the propounded causes either with case or difficulty. Then certain accidental and peculiar conditions of Young Children, under such an age must be likewise considered in respect of which they are under one age rendered more, under another less obnoxious to this Disease. That we may the more successfully declare the former comparison, we will distinguish the ages of men. Here we comprehend Children of six months of age, a year old, two, three, four years old; there we understand those of five years of age or more, Youths, Men, and old men, and those we call by the general name of Juniors and these by the name of Seniors, unless p●●●●ps the matter may require a subdistinction of the g●●●●er sort: these things being premised we add 〈◊〉 our s●lvs to the collation. First, The younger Children are of a colder temperament than the Elder. For the heat of the temperament is augmented from the time of the birth to man's estate, at which time it standeth at a stay being far more intensive than that of Children, but afterwards it declineth by degrees unto extreme old age, and a little before that extreme age, it falleth into the same degree as it held in the time of Childhood; but before the approach of this term of extreme old age the temperament of aged men is more hot than that of Children, for although young Children may enjoy a greater plenty of Natural heat, and abound with Natural Spirits, yet there is no necessity that they therefore must be of a hutter temperament, for there is required a concurrence of many things to constitute a hot temperament, beside the inherent Spirits, and the inherent heat; as for example a large portion of Choleric humours, and withal or chiefly a strong endeavour of the Vital faculty, namely in the pulses, and the Vital Spirits in their circulation. Seeing therefore that the younger Children are more cold, it is no wonder, if they be more subject to cold Diseases than others, such as this is. As for old men, especially such as are inclining to extreme old age, we grant that they also are more cold, and upon every light occasion obnoxious to cold Diseases. Wherefore from hence, namely, from the coldness of the temperament, we infer no difference between younger Children & these old men, in respect of an aptitude to fall into this affect. Secondly, The younger Children are more moist than the elder; for to wax old, if it be taken in a sound sense, is to wax dry. For although old men after their manner may be likewise obnoxious to moist affects, as Cathars, Obstructions, a Cachexy, a Dropsy, a Palsy, a Lethargy, a looseness and trembling of the Nervs, and the like evils, yet really there is some difference between a moist distemper which happeneth to Boys, and that which befalleth aged Persons. For in Children an adventitious humidity constituting the distemper doth not only penetrate the most retired substance of the solid parts, but they are totally incorporated with the same: But in old Men the solid parts, even then when it is endued with a moist distemper, doth not seem to part with its earthiness, but to be in some sort compounded of that Earthy Nature, and a certain adventitious crude and moist Juice, or else an excrementitious drunk into the pores, or into the substance of the parts, yet it is not sufficiently incorporated or united. For as sand, being drenched in much water, retaineth all its Earthy substance, however it be somewhat moist; So also the Bodies of old Men, however they may be moistened with crude and excrementitious humours, yet do they not deposit that terrene substance, or that part which by the Chemics is designed by the name of a dead Head, which they daily accumilate unto themselves from their first beginning. This distemper therefore of old Persons is spurious not genuine, crude and not perfectly digested into the substance of the parts. And therefore although we grant that old men may in their way, labour with a moist distemper, yet it is manifest withal by what hath been said, how great a difference there is between this of aged persons, & that of Young children. Morover, that this moist distemper of old men, is less Homogeneal to the present affect, then that of children, appears plainly from hence, because it produceth not that softness and tenderness of parts in old men, as we see it doth in Children, neither doth it equally dispose them to a dissipation or colliquation of the inherent Spirits, or any slippery passage either of the Blood or Exhalations, which are supposed in this Affect: But on the other side, it rather rendereth them obnoxious to obstructions, and the other evils recited before a comparison, therefore being made between the cold and moist distemper incident to Younger Children, and that which is wont to affect old men, there resulteth a pregnant reason, why aged people are not so subject to this Disease as Children. Thirdly, Young Children, although they Naturally abound with inherent Spirits, yet by reason of the easy transpiration of their Bodies, & because of the laxity, tenderness and incoherence of the parts, they are much more prone than Elder persons to dissipation and colliquation of the Inherent Spirits, and by consequence upon less and slighter causes they fall into a want of them. Fourthly, Younger Children by reason of that very same weak consistence of the parts, are also rendered more obnoxious to an astonishment than the Elder. For to the vigour and activity of the parts, there is required besides a just plenty of Spirits, a strength of their coherence and consistence. Fiftly, it is not needful for us to add any thing concerning the Tone of the parts, seeing we have so often insinuated the weakness of it in Younger Children in respect of the Elder, and any man may observe that upon the increase of years the Tone is more and more confirmed. Sixthly, As for the diminute distribution of the blood to the first affected parts, (which we have already proved to be a considerable part of the secondary Essence of this Disease) We say, that the Elder Children do use more strong and frequent exercises then the Younger, and therefore that the pulses of the outward parts are more strongly stirred up in them, and that a greater heat is raised and cherished in them, and by consequence a cold distemper is more potentially driven out of them. Seventhly, as for the Organical faults, namely, the augmented magnitude of the Liver Head, and their Vessels, it is a known thing that the proportion of the parts is more stable and confirmed in the bigger Children, and on the contrary that in the Younger they are easily moved and altered, but the augmentation ceasing they are not any more afterwards altered, without some unusual and weighty causes. So that even in this respect the Younger Children are most subject to this Disease. Let us therefore conclude the parts of the Question, That Young Children, in respect of their Natural Constitutions and dispositions are more obnoxious to this evil than those that are Elder, and so much the more, the Younger they are. But we must not wave an Objection, that here we meet with, which also doth very fitly convey an occasion of passing to the other comparison; namely, of Young Children amongst themselves. For if Young Children (as is manifest by what hath been said) are more prone to this Disease by their Natural Constitution and disposition, and the Younger they are, the more subject they are: How comes it to pass, that Children rarely fall into this affect, before they are six months old and somewhat more? For according to the Opinion delivered, Children should seem to be principally subject to this Disease immediately after their birth, which yet experience disappointeth; yea, rather indeed it witnesseth the contrary; namely, that Children before they are nine months old are seldom or scarce ever afflicted with this Disease. Here therefore it will be needful for us to declare that other comparison of Young Children among themselves. For it cannot be, that this Affect should so constantly spare Children, chiefly disposed unto it, and frequently invade those that are less disposed, unless some difference did intervene, which did in a divers manner relate to those ages, and which notwithstanding the propensity of Nature doth retard the invasion of the Disease, before the first twelve months were completely expired, and yet afterwards, either doth not at all or not so potently defend Children from this Disease. Here therefore we must find the very reason of the difference between these ages: which that we may the sooner do, it will not perhaps be impertinent to take special notice by the way of those ages, which upon the authority of experience are observed to be more frequently affected with this Disease, and likewise those ages which are least afflicted with it. We affirm therefore, that this Disease doth very rarely invade Children presently after their birth, or before they are six months old; (yea, perhaps before the ninth month) but after that time it beginneth by little and little daily to rage more and more to the period of eighteen months, than it attaineth its pitch and exaltation, and as it were resteth in it, till the Child be two years and six months old: So that the time of the thickest invasion is that whole year, which bears date from the eighteenth month, two years and a half being expired the Disease falleth into its declination, and seldom invadeth the Child, for the reasons already alleged. But the reasons Why Infants newly born are rarely affected, and why from the ninth to the eighteenth month they are frequently affected, and why after the first eighteen months they are most frequently affected shall now all of them in their order be produced. The First Reasons why Children newly born are very seldom invaded with this affect may be these. The First is, Because the Embryon in the Womb is by the equal heat and embracement of the Matrix strongly fortified against this Disease, as we have declared above, and by consequence the same being brought to light doth for a time retain some of that, muniment & defence which it contracted from that equal warmth of the Womb, and therefore presently after the Birth it doth not so easily fall into it. The Second is, Because the Midwives and Nurses do handle them so artificially when they are new born, that their condition is not considerably different from that which they possessed in the Womb. For they enwrap the whole Body, excepting the Head, in one continual Covering; whereupon the exterior and first affected parts of the Body in this Disease are fortified against the injuries of the outward cold, and the hot exhalations breaking out from any part of the Body are duly and equally retained by reason of that Covering which is two or three times double, and bound about with swathing Bands, and equally communicated to all the parts of the Body, so that they are cherished with an even heat as it were in a common Hypocaust or hot House. Seeing therefore that the first part of the Essence of this Disease consisteth in an unequal cold distemper, it is no wonder if these Defences and Fortifications of the Body do avert it at least for some short time. The Third Reason may perhaps be the wholsomness of the Diet, for Breast-Milk is the most solubrious and agreeable nourishment that tender age, especially when it is sucked from the Breasts: for it is a simple and uniform Meat, full of nourishment, easy to concoct, and friendly and farmiliar to the constitution of Infants. Therefore so long as they are conveniently nourished with it, they incur the fewer errors of diet, and are rendered the less obnoxious to this Disease. Yet it must be noted, that if the Nurse's milk be not laudable and good in itself, or otherwise disagreeable to the Constitution of the Infant, than this reason is of no force. Therefore if the Nurse be big with Child, or immoderately addicted to Venery, or any ways sickly, or given to drunkenness and inordinate feeding, it is safer to hasten the weaning of the Infant, unless you are provided of a better Nurse. The fourth and last reason is the slowness of the motion of this Disease in his first invasions. For it stealeth on so slowly, that it scarce bewrayeth any preparations to an assault till some months are expired, unless the progress of it be advanced by some extraordinary and most vehement Causes, as by some more violent Affect preceding or coming upon it. Seeing therefore that this Disease doth so slowly take Root, and seeing that Children, as we have formerly showed, are commonly born free from it, it seldom happeneth to break out evidently into act till the sixth, yea, indeed till the ninth month. And thus we have given the reasons, why Infants newly born, notwithstanding the weakness of their Constitution, are for many months privileged from this Disease. Secondly, The causes why Children from the ninth to the eighteenth Month are every day more frequently infested with this affect, are these, First, Because the first Caus even now propounded, driving away this Disease in those that are new born, doth daily remit, and before the ninth Month doth totally vanish. Secondly, In like manner the second propulsive Caus before alleged till that age doth every day grow more effectual. For the hands of Infants, after some Months, if not before, are usually set at liberty from the prison of their Blankets, and perhaps their Feet also before they are six months old, although at night they are swaddled up again. In the day time therefore at the least these outward Members are destitute of that common and comfortable warmth. The Nurses likewise do many times er, when they cloth the weak and feeble Infants too soon. For they idly define the time of clothing them by the number of the Months, seeing that they should rather give an estimation of it by the strength and activity of the motion of their Hands and Feet. For when the motion and exercise of those parts doth avail more to excite and cherish their heat, and to irritate their Pulses, than the warmth of their swaddling clothes, without all controversy that is the time to divest Infants from their swaddling clothes. Moreover thirdly, After the ninth Month Children usually are fed with other aliment besides Breast-Milk or other Milk, and from that variety in feeding there easily resulteth some errors in point of Diet. Fourthly, The slowness of the Motion of this Disease doth not hinder, but that it may break forth into act after the ninth Month. For the motion, by reason of the unperceivable slowness of it, at the end of certain months, doth exhibit some effects and impressions. Lastly the evils of breeding teeth do likewise contribute very much to the same purpose. For the Teeth begin to breed commonly about the seventh Month, and come accompanied with divers Symptoms, which easily dispose tender Bodies to this affect. Thirdly, The Causes why this Disease most frequently rageth when the Child is eighteen Months old, are; First, Because the Causes before cited hastening this Disease in the younger Children, are upon the approach of this age taken away, or at least they operate with weak and ineffectual powers. Secondly, The evils of breeding Teeth, although in respect of the immediate Symptoms which they produce perhaps before this time, they nourish; yet for the most part they leave behind them in the first affected parts a certain disposition, which privily hiding itself within them, after the term of some months produceth this Disease. But the breaking out of the Dog-teeths chiefly hath reference to this place; seeing that these break out a little before the Child is a year and an half old, and their coming forth likewise is of all other the most painful. Thirdly, Hitherto belong also those accidents which happen by reason of ablactation or weaning of the Child, and at that time a great alteration befalleth Children in matter of Diet, which they endure not without palpable molestation. For herupon they are angry, they cry, the commotions of their minds makes them forsake the nourishment of their Bodies, they are hard to be pleased, neither do they sleep quietly. All which things do easily imprint in the parts first affected at least a foregoing disposition (although perhaps not till a long time after) to this affect. And so at length we have also run through this second Comparison, namely of young Children among themselves, and we have briefly explained the Causes why those Children at one age are more, and at another age are less exposed to this evil. The Third part of the Question still remaineth, which as we said we would reserve to be examined at the close of this Disputation; namely, Whether those that are of a greater age do sometimes fall (though exceeding rarely into this Disease.) We say first, For so much as concerneth that part of the Essence of this Disease, which consisteth in a moist distemper, that some difference must be expected to be between that distemper in younger Children, and those that are bigger, in young Men, Men, and especially in old Men, for the same difference which we put before between the moist distemper of young Children and old Men, may according to quantity as more or less, be observed between the middle Ages, and therefore the humidity of the younger Children will be better concocted and more genuine than that of the elder, as it is obvious to collect, mutatis mutandis, from the same reasoning. Secondly, As for the organical faults, we affirm that necessarily there concurreth a vast difference between Diseases of this kind incident to Children, and perhaps to those of greater age, for the tumours of the Bones in the Wrists and Ankles, as also that narrowness of the Breast, likewise that disproportionatly augmented bigness of the Head and Liver, are either less conspicuous or altogether undescernable, especially in those that are grown to full age. For as the years encreas the Figure and proportion of the Parts becomes more compact, firm, and stable; neither doth it easily come to pass that one part doth much grow out more than another by true augmentation. Thirdly, We say that excepting the two premised conditions, and that in that manner as they are propounded, this affect according to the other parts of the Essence thereof (although indeed very rarely and upon the highest causes only) may happen to Boys, Young Men, Men, and old Men. For first a cold distemper without all controversy may befall them, though not so easily as Children. Secondly, A moist distemper may also invade them, but yet only by the limitation propounded. Thirdly, A want of inherent Spirits, may also befall them, but than it must proceed from the most potent causes. For Chronical Diseases and such as consume the habit of the parts, or dissipate it into air, or waste it by long fasting and an Atrophy, do necessarily leave behind them a paucity of Natural Spirits. We see the outward parts even in those that are grown to full age, when they are extenuated and consumed by such like causes, to wax feeble, to languish, whither, and become destitute of all sufficient Spirituosity. Yet we grant that in those that are grown to full age, the evil which causeth leanness being overcome, the wasted Spirits may soon be repaired by the vigour of the Pulses, and that the rudiments and impressions of this Disease may be rooted out within one or two weeks, and by consequence, that they are seldom affected with it. In the interim, if it should so fall out, that upon that consuming of the Inherent Spirits some impediment should intervene that might retard their reparation, it is possible that this disease may grow from thence in that manner as hath been said. But a numbness of the Inherent Spirits must necessarily follow upon a fewness of them. Fourthly, The parts of the Secondary Essence, seeing that they have a strong dependence upon the Primary faults, where these persevere long (the Organical faults being excepted) they may supervene in their order. So that we do not doubt but this Disease may happen to any age after childhood; the restrictions which we have now propounded being granted, and upon the urgency and perseverance of great and weighty causes. One amongst us affirmeth, that he had a Gentleman in cure about thirty years of age, who by daily immoderare use of Wine and Tobacco, continued for some whole years, having neglected the due receiving of his meat, fell into such a weakness of Stomach, that continually every morning he vomited, and loathed all kind of Meat, and if at any time he swallowed any with unwillingness, he presently vomited it up again: to appease this queziness of Stomach, he was at last compelled to a continual use of ordinary Aqua vitae, but afterwards his custom was to mingle it with stale Beer, and a quantity of Sugar; and with this drink alone he preserved himself alive for many months. In the mean time all those parts which in this Disease we call the first affected, were extremely lean, and became soft, loose, languid and withered, so that he could neither turn himself in his bed, nor rise, nor walk, nor stand upright, yet he felt no pain, neither was there any privation of sens and motion, no cough, no uneasy respiration, his face was well coloured, and all the parts about his Head were in a good condition, and well habited, so that had you judged of him by his countenance only, you could scarce have suspected that he was sick. As he lay in his bed he would chat with his Companions, take Tobacco by turns, and drink that mixture of Beer and Aqua vitae aforesaid. The event of the Disease doth not indeed belong to this place, yet we shall set it down to gratify them who are desirous to know it. The Physician being sent for, he strictly forbade all intemperance, and amongst other remedies having given him one grain & a half of Laudanum Londinensis, he appeased the nauseous infirmity, and tumult of his Stomach, which part he likewise strengthened with internal and external applications, and prescribed him such a diet as was most easy of concoction. Instead of exercise he solicited the heat unto the outward parts with rubbing them every morning: having first given a small quantity of strengthening and opening Electuary, made up with a little portion of Steel, which he drank in two ounces of Wine, composed of Wormwood and Mint, a little Saffron being hung in it, to give it a tincture; three ounces of small Beer, being tempered with it, and a quantity of Sugar to make the taste of it more pleasant. Moreover, he purged him by fits with gentle Medicines, and in the evening comforted him with cordials. Within twenty days he grew to such a degree of amendment, that he could walk abroad, for the space of an hour, and could without any striving or much weariness climb ladders without any help. But afterwards by a relapse into the like intemperance, he died in the absence of his Physician. But let us return from this degression into the way, & direct our speech to our intended scope. The Affect being now confirmed, as it was upon the first coming of the Doctor; Besides the faults of the Stomach, it seemed to include a great part of the Essence of this Disease, we now treat of. For in the parts subservient to motion; namely, those that are first affected in this Disease, there was a cold distemper, either through defect of motion, or by reason of the immunite afflux and dispensation of the Vital Blood. Again, the softness, slipperiness, laxity, and litherness of those parts showed that there was a moist distemper in them. Also the extreme leanness of those parts did sufficiently demonstrate a fewness of inherent Spirits, and the unfitness to motion, and affectation of rest and eas did strongly witness a numbness in those parts. The full and flourishing habit of the parts about the Head, when the other parts were extenuated, was a forcible reason to prove the unequal distribution of the Blood. But the peculiar cause of this inequality in this sick man, might be his frequent vomiting, whereby a more plentiful afflux of the Blood was driven to the parts about the Head the other being almost destitute of it. Any man may perceive by what hath been said, that at least the greatest part of the Essence of this Disease was comprehended in this mentioned Affect. From whence at length we may▪ probably infer, that it is possible for this Disease to happen to those of full growth, being considered according to the propounded limitations; although it very seldom comes to pass, because great causes and length of time are required to the production of it. And thus at last we have put an end to the search upon the former Question. CHAP. XIX. The latter Question. Why this Disease happeneth more frequently in England, then in other Country's? And whether it be Natural to Englishmen? IT is acknowledged by the common consent of Physicians that there are certain Country Diseases; namely, which more frequently infest the Inhabitants of some one Region, than of another, by reason of some Common Caus. But seeing the relation of the Country to the Diseases usually raging in it, may be observed to be of a divers kind; and seeing wise men have improperly denominated some Diseases from certain Country's: Finally, seeing that they who have hitherto written of Country Diseases have without difference, called all Diseases which are most rife in any Region by the name of National or Country Diseases as if they did equally participate of the Nature of a Country Disease; we have judged it to be a profitable enterprise to premise some things in this present disquisition, concerning the differences of these Diseases among themselves. First, Therefore those affects which have the denomination of Country Diseases, from the Region, are properly, or less properly, and abusively so called. There are four conditions required to denominate a Country Disease properly so called. The first condition is, That the Disease be more frequent in that Region, unto which it is attributed, as Natural and common, then in any other Region, unto which it is not attributed as such. For a common or Country Disease, is always supposed to have an unequal reference to divers Regions, and to infest one more (namely, that unto which it is ascribed) and another less. The Second Condition is, That the Disease depends upon some kind of inclemency of the place. For a Disease properly common imputeth a certain crime or faultiness to the very place; therefore when a place is not guilty of some peculiar fault, such an imputation is improperly, falsely and unjustly ascribed unto it. The Third Condition is, That the inclemency and sharpness of the Region be so great, as to affect the more wary, and such as observe a du Regiment of health, and such an one as is apropriated to the place. For in the Regiment of health some peculiar Caution is due to certain Countries. Therefore when a People neglecting such a peculiar Observation of the place, shall fall into some Epidemical Disease by an erroneous use of the non-natural things, that it is not to be reputed a common disease, but to be imputed to the error, want of wit, incogitancy and negligence of the Inhabitants. For this disease, which we suppose might have been prevented, had the Regiment of health apropriated to the place been rightly observed. The Fourth Condition is, That that vicious constitution of the Country do either continue long, or return often. For the fault of a place that is fugitive, not permanent nor often returning, must be accounted as somewhat forregn and merely accidental in respect of the Region, and cannot properly denominate a common Disease. As for example, If a pernicious and unusual Air should chance to be blown hither from other countries, and should produce a common disease, which should not prevail beyond some months; that disease ought not properly to be called common, but rather casual and chanceable. Wherefore the Fever of Hungary, and the Sweating-sickness of England, although they obtained their Names chiefly from those Regions, yet are they abusively termed common, because they want a durable fomentation from those places, and because they either cease altogether, or at least are not for the present more predominent in this or that place than in another. Diseases improperly common do indeed include the first propounded condition of such as are properly so called, namely, because they more frequently occur in that Region whereunto they are attributed, then in another, (for otherwise they would not deserve the apellation of Diseases improperly common) yet they want the second third, and fourth. For they either lack that fomentation that is rooted in the Region, or that fomentation which they have is very weak and in considerable, which also may be overcome by a Regiment of diet appropriated to the place; or finally the fomentation is not permanent nor durable, nor frequently returning. Now by fomentation we understand somewhat that is faulty in respect of health, founded likewise in the condition of the Country. Therefore when some common and frequent Disease ariseth from the abuse of some commodity of the Region, as if some Nation by reason of the great plenty of fruit, and the like fruitfulness of the place, or by reason of a long and secure peace should abuse themselves to intemperance, sloth or the like vices and thereby incur some common Disease, that Disease is not properly to be called common. For the occasion of that Disease, which the Country did supply with, was laudable in itself, and therefore what event soever succeeded, the abuse thereof aught to be imputed to the error of the inhabitants, not to any unkindness or discourtesy of the Region. In like manner if the fomention of a Disease be culpable, yet shall not that be founded in the very constitution of the Country, but in some action of men, as when after the desolations of War the unburied Carcases pollute the Air with their putrefaction, and thereupon introduce an Epidemical Disease, this ought not to be called a common or Country Disease, because it dependeth upon the liberty of man's will, and was not procured by any proper fault of the place. Sometimes also a Disease is ascribed to a Nation or Place by calumny, and abusively through the malevolent and corrupt intentions of some People to traduce the Fame of their neighbour Nations. After this manner the Neopolitans call the Venereous Evil, the French Pox, as if it were Natural and Common to the French. And on the contrary, the French to requite the Slander, term it the Neapolitan Scab. But of this enough. A Disease properly called Common, is either Original and Ancient, or Adventitious and New. The Original is that which from the first Inhabitation of the place hath infested the Inhabitants: of this kind perhaps is the Disease in the Throat called Branchocele among those that dwell about the Alps; that burning Fever which they call a Calenture, under the torrid Zone: the mortification of the parts under the cold Zones towards the Poles by extremity of cold. A Country Disease that is new and adventitious, is that which is brought into a Country by some common Caus. This is threefold, for either it proceedeth from some Original fault of the Region, prevailing by the advantage of time against the health of the inhabitants, or from some alteration or innovation happening to the Region itself. Or from some incongruity between the Place and the complexion of the Natives. First, A new common Disease invadeth a Country by some Original fault in process of time prevailing more and more. For 'tis possible, that the firm and strong Bodies of the first Inhabitants of any place may powerfully resist the unwholesome influence of the Region, and for many Ages may repel the invasion of the evil, although their posterity afterwards, in length of time, being by degrees changed in that peculiar Reason of the complexion whereby they maintained the former resistance, may fall at last into some common Disease. For the Plica of Poland, and the Scurvy, are common Diseases to the Sarmatians, Polanders, and the Inhabitants of the Baltic Ocean, and they are likewise new Diseases, and (as all men confess) totally unknown to the Ancients. But to this day it is not known that any notable or remarkable Change or Innovation hath happened to those Regions before the breaking out of those Diseases, to which you might probably ascribe the beginning of a new Disease. Wherefore we ought rather to say that those new Diseases did proceed from some ancient and original fault of the places: and yet that they did not bewray themselves at first by reason of a peculiar resistance made by the Natural strength of the Inhabitants. For to this very day some Families in those places are free from those Diseases, and very credible it is that they may so persevere, not yielding to the injuries or threatenings of the Region. Secondly, A new common Disease may result from the altered or innovated constitution of the place. Such kind of innovations happen in Countries, either by Earthquakes, or Inundations of Water, or the bursting forth of some new pernicious Springs, or perhaps of some new Mineral Exhalations from the Caveous of the Earth, or from some malignant Aspect of the Stars and the like Causes. Thirdly, A new common Disease may proceed from the incongruity of the Place with the complexion of the Natives. Such kind of Diseases chiefly happen to Nations, when they transplant themselves from one Region to another: especially when the Constitutions of those Countries which they go to possess, are very different from those they forsook. So the English who first inhabited Virginia were frequently afflicted with a swelling of the Abdomen, and the Hypochondriacal parts; who upon their return to England were cured without any difficulty, but they who continued in Virginia were not so easily restored to health. Moreover, National and common Diseases differ among themselves. Because some of them totally depend upon the inclemency of the Region, and others in part only. The mortification of the parts seemeth to be of the first kind which befalleth men in the Northern Tracts near the Poles. For the whole Essence of the Disease may be ascribed to the cold and sharpness of the Place. Of the second kind the Venereous Pox among the West-Indians seemeth to be. For there it is conceived to be partly gotten by impure Copulation, and partly to be contracted from the Insalubrity of the place. In like manner the Bloody Flux is predominent in Ireland, depending partly upon the constitution of the place, partly upon an erroneous and preposterous diet. And thus much in general be spoken of the differences of common Diseases. In the next place we must inquire why this Disease is more rife in England than in other Regions? And by the way it must be observed, Whether, and how far forth this Disease may be said to be Natural to English men? First, it must be observed, that England is an Island which borroweth some humidity from the adjacency of the Sea, and some frigidity from the distance from the Equator, then that it aboundeth with innumerable fountains, discovering their Springs almost in all places. Lastly, That it is watered with many and frequent showers of rain more than other Regions. All which things do sufficiently attest the frigidity and humidity of the place. Seeing therefore that a cold and moist distemper is a part of the Essence of this Disease, we may easily infer that the bodies of the Inhabitants are here more inclined to those distempers then in other hot and dry Countries. If therefore you demand, Whether this Disease, at least considered in this part of it, may rightly be said to be natural to English men? We answer, That in some sort it may (although perhaps not properly) namely, so far forth as the same is attributed as natural to other Regions, alike cold and moist (although perhaps it may not yet be observed in them.) For those Countries are as readily disposed to imprint a cold and moist distemper as England itself. Yet it must be observed, that a cold and moist distemper is a common part of the Essence of this Disease, and that it alone doth not manifest the Affect, for every cold and moist distemper doth not introduce this evil. Wherefore although we grant, that an excess of cold and moisture may be imputed as a fault to England, yet we deny that from thence it can be rightly inferred that the whole Disease is common and Natural to English men. Moreover, Some Countries may perhaps be found out far exceeding England both in cold and moisture, as Scotland, Holland, Zealand, Ireland, and Denmark, and the like; wherein notwithstanding this Disease hath not been observed to appear much. Therefore if this Disease be not rightly imputed to these Regions, wherein that common cause is predominant; namely, the excess of cold and moisture. Certainly neither can it justly be imputed to England, by reason of that common Cause, which is here less prevalent. Again, The coldness and moistness of this Kingdom doth not so far transcend a a mediocrity, but that by outward and inwaad applications, exercises and the like; namely, a right use of the six things not Natural, they may be sufficiently corrected to the cashiering of that imputation, Wherefore if these things be so, namely, if a cold and moist distemper be only a common cause of the Disease, if other Regions wherein this Affect hath not yet been observed to make any impression, are at least equally obnoxious to cold and moisture: Finally, if those distempers may be prevented by a Regiment of diet appropriated to the place; certainly the reason drawn from the coldness and moisture of the Climate, which even now we produced to show why English men should be more frequently invaded with this Disease than others, will be very weak and insufficient, so that we can by no means place our content in that alone, and therefore we intended nothing more by that assignation, than that England doth more dispose the Bodies of the Inhabitants to this Affect than hotter and drier Regions do the Bodies of their Inhabitants. And ●o we proceed to the search of the other causes of the rifeness and frequency of this Affect. In the second place we can note that England is very ruitful and Child-breeding being sufficiently favourable both to Conception and Childbearing, and not ubject to cause abortions. Now from hence it comes to pass, that not only strong and able bodied men, and such as are endued with perfect health, but the weak and sickly persons do also generate; weak & unsound women likewise, and such as are prone to a consumption, do conceive, carry their children nine months, and bring them forth in a decent and laudable manner. But it is no wonder if the Issue begotten by such matter, and which oweth its life almost to the clemency of the place alone, should be feeble and languid, and very subject to this Disease. For as much as the very benignity of the Region may in this respect be the occasion of some infirmity in the Issue. For as barbarous People in time passed by an inhuman experiment upon their new born infants; namely, by dipping their naked bodies in the coldest water, destroyed the weak ones with the extremity of the cold, and gave education only to the strong ones, whose vigorous Constitutions overcame the injury of their cruel policies, purposing by that inhumanity to have an universal race of strong & lusty people. So on the contrary the very clemency of the place promiscously preserving the languishing and weak Children together with the strong & healthful, doth minister an occasion of bringing forth a mixed kind of people some strong and some weak and sickly. Yet lest any should mistake, we do not mean that all the Children in this Kingdom which are born of weak and sickly Parents are subject to this Affect. For although if one or both of the Parents be infirm, the Children will be infirm; yet it is often seen that when the Parents have been very strong and healthful, yet their Children have been very subject to this Disease. Wherefore neither do we rest in this second cause, but another must yet be enquired out, from whence we may derive a sufficient reason of the frequency of this evil. We affirm therefore in the third place, That the rifeness of this Disease in England hath been much promoted, by that long and secure peace, which we enjoyed before the first breaking of it. For by this the more wealthy families, which were first invaded by this evil, and which doth still infest them more than others, had addicted themselves to idleness and a loose and effeminate life, and thereupon they fell into a moister, softer, and degenerate Constitution, and such as was less purged and cleansed from excrementitious humours, and by consequence their Children were even procreated obnoxious to this Affect. You will say, that Scotland and the Northern parts of England, although they enjoyed peace and security, yet they are seldom observed to fall under this Affliction. We answer, True it is that Scotland and the Northern parts of England are less affected with this Disease than the Southern and the Western. In the mean time peradventure the first impressions and rudiments of it are far more frequent in those places; yea, and in some foreign Countries, then is commonly believed. For although this evil be very familiar in the South and West parts of this Kingdom, and very well known among the Vulgar sort, yet we have many times seen Children afflicted with it in a slight manner, of whom neither the Parents nor others of the same family did suspect the least evil: Yea, we have known many, whom none of their friends thought to be affected, to be healed without any help of Physic by the sole benefit of the increased heat, or by the increase of age or exercises. How much easier therefore may the first rudiments of this Disease be concealed from them, to whom it is less familiar, and among whom it seldom ascendeth to that degree, that they need to implore the Physicians help. We conjecture therefore that this Disease is more frequent than is commonly believed both in Scotland and the Northern parts of England; yea, and in some Countries wherein the people are ignorant of it to this day: but in those places they are so gently tormented with it, that they are seldom condemned to the hands of the Physician. For that is the custom of the Vulgar sort, not to send for the Doctor (especially to Infants and young Children) unless the vehemency of the Disease constrain them. However the matter is, we seem not yet to have given satisfaction to the objection propounded, Why the South and West Country men of England are more grievously & frequently conflicted with this Disease, than the Northern People and the Scots, although both Kingdoms equally shared the blessing of the lasting peace and security. Therefore we grant that a higher reason yet must be given for this difference. Fourthly, therefore and lastly, we say, That the cause of this difference is the affluence of all good things in these Southern and Western Countries of England. For this part of the Kingdom is much the more fruitful, rich and flourishing, and abounding with all manner of allurements to pleasure. Therefore it is no marvel if the customs of men do first generate here, their Spirits decay, and the strength of their Bodies begin to dissolve now, that this degenerate and delicate manner of living doth weaken families, is a truth so solidly and constantly attested by Historians, that it were an impertinence to offer any proof of it. For you may observe that the most Noble and Gallant Families have been very much reproached for these very causes; yea, and sooner or latter sometimes totally extinguished, and so much the sooner as they have the more refused to undergo labours, and to innure themselves to masculine exercises. Neither are families ever plunged in a greater danger of degeneration, then when they abound with all good things, and lying open to plenty and security they are most powerfully invited to delicateness, idleness and effeminateness, without any labour, care, and solicitude. Who was more rich, secure, and effeminate, than Solomon? He left Rehoboam a degenerate Son behind him. And perhaps the family of Henry the 8th. is extinct for the like cause. We could heap up almost innumerable examples to prove this, if it were needful. However it be, we see plainly, that this Disease doth more frequently and vehemently invade the families of the wealthy, than the cottages of poor men, and therefore it ought not to seem strange that it likewise infested the richer and more pleasanter parts of the Kingdom; namely, the South and West, before the North parts. But these things shall suffice to have been spoken concerning this matter. It remaineth only that we inquire, Whether and how far the three last assigned causes relate to the denomination of a Common Disease, and whether in respect of them, this Disease may be ascribed to England as common and Natural? You must know then that these three causes in as much as they depend upon the Region, are not properly causes, neither by their own nature do they produce this affect, but that they are only an occasion whereby this Disease may accidentally arise. For in themselves they denote the laudable conditions of a Country, at least they infer not what is culpable in it. For who can accuse his Country, because it favoreth the procreation of Children, much less make outcries against it, because it enjoyed long and secure peace. Finally least of all calumniate the pleasantness, fruitfulness, and affluence of all good things: For all these things are in themselves blessings, and conditions to be wished for in a Country. Seeing therefore as we have showed above, that a Disease properly common doth imprint some mark of a vicious Constitution to the place to which it is ascribed; It is impossible that any Disease can be attributed unto it as properly Common, by reason of the commodity of the Region. Wherefore (that we may comprehend all in a word) although this Disease in respect of the coldness and moistness thereof have a fomentation in the very Constitution of the Country▪ Although also that it borrow three other occasions of invading from the Country; Yet seeing that those distempers may be prevented by a due observation of the Regiment of Health appropriated to the place; and seeing that the three other occasional causes, are not properly blamable, but desirable, we must affirm that this Disease is not properly Common to England. And so we have put an end to the search of the causes of this Disease. CHAP. XX. The differences of the Disease, called the Rachites. THere are many differences of the Rachites in regard of the concourse of several evils, and more than any man would easily imagine; some whereof are of great importance, and others less considerable we have resolved here briefly to propound the chiefest. For the knowledge of them is not only profitable to define the prognostical causes, whereby the various events of a Disease are distinctly foretold according to those differences; but it also much conduceth both to the prevention and the cure of a Disease; namely, that by a consideration of them apt and fit remedies may be chosen. Now these differences arise either from the Essence of the Disease, or from the causes thereof: or lastly, from Diseases conjoined with it. The Essence of a Disease may vary many ways: First, By reason of the parts of the Secondary Essence either present or absent. Secondly, In regard of the magnitude of it. Thirdly, In respect of the vehemence. Fourthly, in regard of the Spirits; And five in respect of the times. We grant indeed, That there is a certain agreement between some differences comprehended under these titles; yet seeing that the formal conceptions of them are distinct, it must be confessed that they deserve distinct considerations. For although a Disease, even in that very respect may be called greater, because it containeth many parts of the Secondary Essence in the same Patient yet this is a different & distinct consideration from that of the magnitude of that Affect. For the magnitude properly hath respect unto the degree of recess from the Natural State, and not to the Nature of the part of the Essence either present or absent, for hereupon resulteth more than a gradual difference. In like manner some of the other differences do perhaps signify the same thing, in ● concrete and restrained acception, which notwithstanding in an abstracted and formal consideration denote a diversity. But let us proceed. The first difference of this Disease is that which ariseth from the presence of few or many of the parts of the Secondary Essence thereof. For although all the parts of the Primary Essence are perpetuàlly present with the Disease itself, yet there is no necessity that all the parts of the Secondary Essence should be always present. For these are after-comers to the first Essence, and do by degrees come upon it: Yea, some of them may be so highly intercepted by the intervention of resisting causes that they may not at all appear. Hither you may refer that difference, which we propounded at the foot of the precedent disputation, and which we showed might possibly▪ though indeed very rarely, befall those that were grown to full age. But because our purpose here is only to handle the Disease as it is incident to Children, we shall be content to pass by that difference thus noted by the way. But even in Children themselves there sometimes happen some parts of the Secondary Essence, which have a most strict conjunction with the Primary Essence, at least they succeed them in the order of Nature. For the Primary Essence hath the efficacy of a cause, which in Nature doth ever go before the effect. But in order of time some parts of the Secondary Essence do conspire as it were, and concur with the Primary Essence in the invasion; and others again do come afterwards, these we must here distinguish. For the former sort are absolutely inseparable, the latter sort separable from this Affect. The inseparable parts of the Secondary Essence may be reduced to these Heads. First to the afflicted Tone of the first affected parts. Secondly, to the unequal and imperfect distribution of the Vital Blood. Thirdly, to the too small participation of the Vital influx in the first affected parts. Fourthly, to the Secondary faults of the Animal Constitution. These faults are sufficiently unfolded above in our discourse of the Secondary Essence of this Disease; where likewise because of their strict carriage with the Primary Essence, any man may perceive with eas (though they have a casual dependence upon the Primary Essence) that they begin together at the same time. But all the Organical faults which we have also already recited, are found to be separable, and sometimes actually separate from this Disease. For the magnitude of the Head, and the leanness of the Joints, the crookedness of the Shankbone, or the Elbow, the inflexions of the Joints, the sharpness of the Breast, do not necessarily accompany this Disease presently from the beginning, but in process of time they bewray themselves by degrees and supervene upon the Affect. And although the Consumption of the parts, which in some sort hath an influence into the said faults, may be said to be present in some slight degree from the beginning of the Disease, yet is it indeed only a Symptom, and not a Disease; neither is it able presently to produce those Diseases of magnitude, Figure and Place. Moreover it is not necessary, that these Organical faults should equally and at the same time invade one that hath the Rachites, we grant indeed that the extenuation of the first affected parts, when the Disease is of some continuance, doth always and necessarily succeed it, neither can it afterwards upon the perseverence of the Disease be removed, that it is likewise a principal part of the separable parts of the secondary Essence; yea that the extenuation whilst it is making doth immediately follow the smallness of nourishment of the first affected parts, almost no otherwise than the smallness of nourishment immediately followeth the primary Essence of the Disease in the said parts; but withal we affirm that the extenuation being made which is itself a secondary part of the Disease whereof we discourse, doth necessarily presuppose the motion and time of the Disease, and that it cannot be in the first moment of the existence of the Disease. We say moreover that Physicians do not acknowledge any change made in the parts exposed to the sens, which doth not yet appear to the sense, and by consequence they affirm that extenuation befalleth the first affected parts, till it be made obvious to the senses which certainly doth necessarily prerequire some duration of the Disease. But the improportionat magnitude of the Head, doth begin almost at the same time with that extenuation of the first affected parts, but it may so fall out, if a consuming Phtisick be joined together with this Disease, that that magnitude of the Head may vanish before death, as we have already proved by one example in our Anatomical Observations. The Magnitude of the Head therefore is more separable from this affect than the extenuation of the first affected parts, for this cannot be removed without the Disease be cured. The sticking out of the Bones appear sometimes sooner, sometimes later, and they sometimes grow out more, sometimes less, but upon any long continuance of the Disease they are seldom (if ever) seen to be absent. The narrowness of the Breast doth not appear, but after a long time when the Disease is confirmed, and for the most part is the forerunner of a Ptysick. Again, the crookedness of the Bone in the Arm, and the Shankbone, as also the inflexion of the Joints may be absent through the whole course of the Disease, and may be more or less present, and indeed is the most chanceable among those things which follow this affect. We conclude therefore that these Organical parts of the Secondary Essence are separable after that manner as we have said, and as a more or fewer of them are present, so the Difference of the Disease is constituted, as being more or less compounded. The Second Difference of this Disease resulteth from the magnitude thereof. And the magnitude is estimated from the greater or lesser recess from the natural condition of it. There is a vast difference in this Disease in respect of the magnitude. For some are so gently affected with it that you would scarce suppose them to be sick. They complain of nothing, they eat, they drink, they sleep like those that are sound in health; only they play with more unchearfulness, and show forth some other very slight signs of sickness, By the only benefit of Nature likewise without any assistances of Art they perfectly recover, neither their Parents, Nurses, nor the Bystanders so much as once suspecting that they are affected with this evil. On the contrary, Others are so vehemently afflicted that they cannot be rescued from death or the danger of imunient death by the most approved remedies. The Third Difference is from the vehemence of the affect. Now this is valued by the violent motion of the Disease and the resistance of Nature, and also by the sharpness of the conflict of these things among themselves. This Disease, although it be otherwise very great, yet is it slow in motion unless some fewer, or some other urgent affect be conjoined with it, and stir up the Nature of it to a fiercer opposition, yet is the motion thereof sometimes more vehement, and sometimes very dull, and thereupon it happeneth to be differenced. The Fourth Difference, is from the strength of the sick Child or Infant. This is estimated by the greater or lesser presence of those things which are according to Nature. Hither belongeth the condition of the temperament, the plenty of inherent Spirits, the activity and strength of the Tone, the vigour of the Vital and Animal Constitution, and the structure of the Organs. For as these are more or less obedient to the prescriptions of Nature, so their Spirits ought to be judged more or less strong, and according to them the evil must be determined the more or less dangerous. For this cause the younger Children caeteris paribus are more dangerously affected than the elder. The Fifth Difference, is from the times of the Disease. And this difference in a qualified and limited acception includeth almost all the precedent; for what difference soever happeneth to any Disease, must necessarily happen at some time of the Disease. Physicians reckon up four times of a Disease: The Beginning, the Augmentation, the Consistence, and the Declination. But it must be noted that Physicians are not so exact in distinguishing the seasons of things as the Philosophers, for they do not restrain the beginning of a Disease to that point of time wherein the Disease beginneth; but so far they extend it, till there appear so great an alteration of the Disease, that it may be known by certain and sensible evidences. For the indivisible beginning is not the time, wherein the Physicians help is perfected, and why should that distinction of a Disease be profitable which could not be grounded upon any alteration of it known to us? Galen therefore hath rightly deduced the times of Fevers and Inflammations from the understandible alteration of them: that is, The beginning from the crudity of the matter causing the disease, the augmentation from the manifest coction thereof; the state from the Excretion, and the Declination he computes from the Reduction of the Relics to the Natural state; and indeed these times do sweetly agree in the general, and differ in particular from the crudity and coction of Fevers and Inflammations. But the truth is, That this distinction of times hath not the like success in many other diseases: For in these Nature doth not so regularly proceed from crudity to coction, so to expulsion, and at last to reduction; neither by thes can we truly and safely know the progress of the disease. Other alterations therefore of these Diseases, such as are more clear and easily known must be weighed. Yet we grant that even thes diseases when they are directed to health, do run thorough those four seasons, the beginning, the augmentation, the state or consistence, and the declination. But when they tend to the destruction of the Patent, they scarce attain to the consistence, but are daily more and more augmented even to the least period of life. Wherefore in thes the augmentation admitteth the greatest latitude, neither doth it deserv a higher difference, or a lower subdivision: but when an indifferent state of a disease of the same kind is made the Middle term between the beginning and the end of such an augmentation, than we can conveniently distinguish. The encreas into an augmentation on this side, or beyond, or beneath, or above the consistence. An encreas of the first kind about the consistence we may call a simple encreas, in regard that it differeth not from the thing itself commonly received by that name, an encreas beyond or above the state, we call an encreas excrescent, excessive, transcendent and desperate. Moreover, Two kinds of declination may be observed in a Disease. The first is legitamate when the Disease simply declineth towards health and recovery. The later is spurious, when a disease remitting changeth into another of a different kind. And so although there are in those that recover health, only four times of a disease, yet in others two more differences may be discerned: Yet it must be noted, that thes six times are never to be found in the same disease, or the same patient, but where there is the same disease in the Species in divers subjects. Let us now apply these things to the present affect. We affirm therefore that six differences of this disease do occur in respect of the times thereof. For it hath a beginning, and may be called incipient: it hath an encreas, and may be said to be confirmed; it hath a state, and then it it may be termed consistant; it hath an increase beyond the state, and may be called desperate: it hath a true declination, and may be said to be an affect remiting or simply declining; and it hath a spurious declination, and may be called a change, as when it chancheth into some other disease. Of all which we will speak in their order. First, The Rachites is called a Disease beginning, when the first Rudiments and impressions thereof are, though very obscurely, first observed, and before there happeneth any manifest extenuation of the first affected parts. Secondly, This disease is said to be confirmed, when an evident and manifest extenuation of the first affected parts becomes obvious to the Senses. And here the Reader perceiveth we do not distinguish thes two times from crudity and coction, but from another alteration of the Body, namely, The Extenuation made in the parts first affected; for the beginning of this disease can no ways be discerned from the encreas thereof by crudity and coction: But otherwise, so far as the nature of the thing is capable of it, we shall willingly follow the example of Galen, and as he distinguisheth the encreas from the beginning by the manifest coction, so we also put a different between thes times in this affect from a manifest alteration, namely, the extenuation made in the said parts. Thirdly, This disease advanced to its consistence, is that, which having attained the highest vigour and exaltation, is arrested, and for a time is neither sensibly increased, or lessened, but continueth at a stand. Fourthly, This disease exceeding the Mediocrity of the consistence is called desperate, namely, Because in magnitude and vehemence it surpasseth the very state of the same disease in another Patient indifferently affected, and withal is continually increased, neither is there any hope but that it will daily encreas till it hath altogether subdued and dissolved the Patient For which cause this condition of a disease is termed desperate. Fifthly, This disease is said to be truly remitting or declining, when the Essence thereof is by little and little diminished, and when the Signs and Symptoms of it are daily mitigated. Sixthly, This disease is said to be illegitimatly declining, or passing into another disease of a divers species, when the Essence, Signs and Symptoms thereof are so lessened, that new ones of a different kind, and perhaps more outrageous appear in their stead. Thus the Rachites frequently degenerate into a Consumption, a Hectic, and sometimes perhaps into a slow putrid Fever; yet for the most part the same disease doth accompany thes supervening affects to the dissolution of the Patient. And let this suffice concerning the differences of this disease deduced from the Essence. This disease in like manner in respect of the Causes is as it were taken into pieces, or divided into parts, namely into a natural affect, and into an after-coming or newly contracted malady. Again, This disease may be termed natural in a twofold sens▪ In the first properly, As when the Sick is born actually affected with this disease. In the later improperly, when the Patient at his birth is not actually affected with it, but strongly disposed by his native principles to fall into it. If it pleas the Reader to summon those things to his memory which were said above concerning the causes of this Effect on the Parent's parts, he will easily conceive the reason and foundations of this difference, and consequently that will excuse us from any further explication: Only we add, that this difference is of great use in the judicial part of cure, which consisteth in applications antidotal and preventive, but it is not of so great moment in the Method of Cure. In like manner this Affect is merely coming after, when being fomented by no Natural disposition, it is newly contracted after the birth▪ & here also it is twofold. For it either succeedeth some foregoing Disease; or it is immediately produced by an erroneous use of the six non-Natural things: We have sufficiently discoursed of both, where we hammered out the causes of this Disease after the birth, and thither we direct the Reader. Again, this Disease admitteth some differences by reason of other Diseases wherewith it is conjoined in the same subject. It must not be expected that we should give in a Catalogue of all Diseases, wherewith this Affect may possibly be conjoined, we shall only reckon up those which ate the usual Companions of this Malady▪ Some whereof have a certain dependence upon this Disease and the causes of it; others have not any, or at least not any worthy of a distinct consideration. Of the former kind are a Hydrocephalus, the faults of breeding Teeth, an Asthma, the Ptysick, an Hectik fever, a slow, and erratical Fever, and the Ascites, which is that kind of Dropsy when water hath gotten between the flesh and the Skin. The Hydrocephalus hath a great correspondence with this Affect, seeing that this Affect also doth for the most part suppose an increase of the Head preternaturally increased, and an overplentiful afflux of the Blood unto the Brain by reason of the largeness of the Arteries thither extended. And hereupon it easily comes to pass that the Brain being oppressed with the abundance of the Blood, must sometimes needs suffer the more serous portion thereof (as being the most permeable) to evaporate or sweat out into the Ventricles and cavities within the meanings, and by consequence to produce the Dropsy of the Brain. But this, as we have already noted, doth always appear. The faults of breeding of Teeth also are sometimes justly ascribed to this Disease going before. For it is well known that they who are affected with this Disease do commonly breed Teeth with extreme pain, and many times the Teeth themselves fall out by pieces. But we have above reduced this fault to the unequal nourishment of the parts, and there the Reader may find further satisfaction. In the mean time it must be observed, that a painful breeding of Teeth may likewise precede this Disease, and sustain the force of a cause in reference to this subsequent evil, as we have likewise showed above. Moreover, An Asthma or difficulty of breathing doth familiarly follow upon this Affect, because the Blood is somewhat cooled in his circulation thorough the first affected parts, and is rendered more thick, viscous, and sluggish in motion, neither is it always perfectly corrected before its return to the right Ventricle of the Heart. Whereupon being unapt for passage, it is poured back from the right Ventricle thorough the Arterious Vein into the substance of the Lungs, and for that Reason doth easily introduce obstructions, hard tumours, difficulty of breathing, sometimes inflammations, impostumes, Ulcers, the Ptysick, the Dropsy of the Lungs, a Hectic Fever, or else a slow erratical Fever. An Ascites is also sometimes consociated with this Affect. But whether it proceeds from a copious flowing of the Blood to the Bowels of the Abdomen, we dare not yet attest for an undoubted truth. Yet certain it is that the flowing of the Blood to this Belly is very copious and sufficiently active in this Disease. For the Liver is great, and the other Bowels are observed to be rather more full than ordinary, than pined away. Whereupon it may happen, that that watery moisture from the Bowels which are oppressed with a fullness may be carried into the hollowness of the Abdomen, but we affirm this with a distrustful confidence, because we have not yet given our selus full satisfaction in this matter. Nevertheless these recited Diseases may happen to Children although the Rachites have not preceded, and may be the cause to introduce it. Yea, they may likewise come upon this Disease from other causes; as for example, by some errors in the Regiment of health; although in this case also this Affect may be partly guilty, if it went before: And thus much of complicated Diseases of the former kind. But of the latter kind, namely, such as have little or no nependance upon this Affect, are a malignant Fever, the French Pox, the Scurvy, and the Strumaticall Affect. First it is certain, That a Malignant Fever may come upon this Affect, because for the most part it is produced by infection, from which this present Affect leaveth not Children free, we add only, that this Fever doth seldom or never owe his Origin to this Disease. Secondly, If the French Pox chance to be complicated with this Disease, it is either derived from the Nurse's infection, or from the Parents by Inheritance. For it is a Disease altogether Distinct from this, and hath scarce any affinity with it. Thirdly, The Scurvy is sometimes conjoined with this Affect. It is either hereditary, or perhaps in so tender a Constitution contracted by infection, or lastly, it is produced from the indiscreet and erroneous Regiment of the Infant, and chiefly from the inclemency of the Air and Climate where the Child is educated. For it scarce holdeth any greater commerce with this Disease, then with other Diseases of longer continuance, wherein after the same manner the Blood in time contracteth for the most part this peculiar infection, yet it must be granted, that this Affect doth somewhat the more dispose to the Scurvy in regard of the want of motion and exercise. Fourthly, and lastly, The Strumatical Affect doth sometimes associate this evil. But it is credible that it oweth more to other causes proper unto it, then to this precedent Disease. Although we deny not, but this may minister some occasion of invading, in as much as it rendereth the humours more viscous and gross. Some other Diseases are peradventure sometimes complicated with this, but because they happen exceeding rarely, and have yet scarce fallen under our observation, we pass them by, for the present and proceed to the signs of the Disease, and the difference of the signs. CHAP. XXI. The Signs of the Rachites, and first the Diagnostical Signs. WE distinguish the Signs of the Disease into three Chapters. The first containeth those Signs which demonstrate the presence of the Affect, and are called Diagnostical. The second containeth those that distinguish among themselves the differences of the Disease, and these are called, Diacritical, or Discrepant. The third comprehendeth those Signs which presage the event of the Disease, and they are termed Prognostical. In this Chapter we shall not treat of the first kind. We divide the Diagnostical Signs into Pathognomonical and Synedreontal. And here the Physical Authors seem to be more strict in the definition of the word Pathognomonical, than the necessity of the nature of the matter doth require. For they will have it to be Inseparable and (as Logicians speak) Proprium quarto modo, that is, to agree, omni, soli, & semper. Indeed it must be granted, that such an Inseparable Sign, or, Proprium quarto modo, must be according to the most proper since a Pathognomonical Sign. For whether it be present, or whether it be absent, it is ever demonstratively significant: When it is present it certainly witnesseth the species of the present malady, and being absent it showeth that that species of the Disease is not present. But when we truly and seriously consider how seldom such Signs as these occur and of what useless consideration they will prove, the knowledge of them being thus restrained; we are induced to think of the amplifying of the usual signification of the word. For although the Ancients to supply this defect, did substitute 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in the place of one true Pathognomonicol Sign strictly taken, and we our selus do most willingly accept of, and approve this very same 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉; yet seeing that this 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 doth seldom appear from the beginning of the Disease, and by consequence seldom obtaineth the reputation of an Inseparable Sign, it necessarily followeth, that it also can but seldom perform the office of a Sign, quarto modo propriè, and therefore also that this notion is reduced to an extreme narrow use. We are compelled therefore that we may fully prevent, or avoid this inconvenience to extend somewhat higher the signification of a Pathognomonical Sign; yet so, as that we will abate nothing of the Nature and certitude of the signification. Therefore we define a Pathognomonical Sign to be somewhat appearing about the Patient, which certainly and infallibly demonstrates the Species of the Disease, And in this extended since it may be divided into a Sign Inseparable, or, proprium quarto modo, and a Sign Separable; namely, as being proper only, Modo secundo; to wit, because it is compatible only to one kind of Diseases, although not always. In like manner the Paththognomonical Syndrome, or Concourse of Symptoms may be divided into two kinds, respectively Analogical to those aforesaid. For sometimes it beginneth with the Disease itself, and doth inseparably associate to the very last period. So the pricking pain of the side, and acute Fever, the difficulty of breathing, and the cough, if they be taken collectively, they are indeed a Syndrome, but such an one as is always equivalent to one simple Pathognomonical Sign of the first kind, and doth inseparably accompany a Pleurisy from the first beginning to the very end. But sometimes the Syndrome or concourse of Symptoms is not complete and perfect from the beginning of the Disease, yet afterwards it is made perfect by the intervention of the other Signs, and doth infallibly denote, the species of the Disease. For example, in the small Pox upon the first beginning of the Disease, the Syndrome, is so incomplete, that it doth not yet certainly determine the species of the Disease; but afterwards the Pox breaking out of the Skin very thick, and tending to maturation, than the Syndrome is finished, and the species of the Disease is put out of all doubt. But that a Sign proper to one Disease alone (although not in the fourth manner) whether it be simple and solitary, or compounded of a concourse of many together, may suffice, when it is present to make a Sign truly Pathognomonical: It is manifest from hence, because, when it is present, it doth as certainly and infallibly denote the species of the Affect, as a Sign doth, which is proper in the fourth manner. For that which agreeth to one species only, when it is present, doth necessarily infer the presence of that species also. Although therefore that a Sign proper in the second manner, be not Inseparable, and where it is absent, doth not determine the absence of the Disease, as a Sign doth proper in the fourth manner; yet when it is present, it is as we have said of the same valu and certainty. For Physicians do esteem the dignity of the Sign by the certainty of the signification. For to that purpose they inquire out the signs of a Disease, that they may attain to a certain knowledge thereof. Therefore seeing that Signs proper in the second manner are equivalent in respect of their certainty, when they present to Signs proper in the fourth manner: we shall here comprehend them under the extended signification of Pathognomonical Signs. You may say after this manner many after appearing Signs may be reduced to the Pathognomonical and are confounded with them. Be it so, provided that they do infallibly denote the species of the Disease. For in this respect they are worthy to be severed from the other after appearing Signs, neither will any confusion follow hereupon in the method of the semeiotical art, but rather the valu and dignity of the Signs will by that means be more plainly and easily observed. Of the Synedremontal or assident Signs we have nothing of moment to say, but will directly proceed to the Signs themselves as they are to be reduced into order. Yet no exact method must be expected from us, because for the most part the Signs flow from so many several fountains, that they will scarce suffer themselves to be marshaled into any accurate order. Wherefore, that they may be constituted which have some affinity among themselves, we have reduced the signs of this Affect to the subsequent Method. We shall propound therefore First, The Signs which relate to the Animal actions. Secondly, Those which have reference to the irregular Nutrition. Thirdly, Those that concern the Respiration. Fourthly, Those that appertain to the Vital Influx. Fifthly, Certain vagabond and fugitive Signs reducible to no Classis. Under each of which we shall subjoin the valu of the Signs. First the Diagnostical Signs relating to the Animal Actions, are these. The looseness and softness of the parts. The debility and languidness. And finally, the slothfulness and stupefaction. First, A certain laxity and softness, if not a flaccidity of all the first affected parts is usually observed in this Affect. The Skin also is soft and smooth to the touch, the musculous flesh is less rigid and firm; the joints are easily flexible, and many times unable to sustain the body. Whereupon the Body being erected it is bend forwards or backwards, or to the right side or to the left. Secondly, A certain debility, weakness, and enervation befalleth all the parts subservient to motion. This weakness dependeth much upon the laxity, softness, and litherness of the parts aforesaid: for which reason we have placed those Signs before this, as also this before the slothfulness and stupefaction in the next place to be enumerated, which owe much both to the looseness and softness. Moreover, this debility beginneth from the very first rudiments of the Disease. For if Children be infested within the first year of their age or thereabouts, they go upon their feet later by reason of that weakness, and for the most part they speak before they walk, which amongst us English men, is vulgarly held to be a bad Omen▪ But if they be afflicted with this Disease, after they have begun to walk, by degrees they stand more and more feebly upon their legs, and they often stagger as they are going, and stumble upon every slight occasion: neither are they able to sustain themselves long upon their legs without sitting, or to move and play up and down with an usual alacrity, till they have rested. Lastly, upon a vehement increase of the Disease they totally lose the use of their feet; yea, they can scarce sit with an erected posture, and the weak and feeble Neck doth scarcely, or not at all sustain the burden of the Head. Thirdly, A kind of slothfulness and numbness doth invade the Joints presently after the beginning of the Disease, and by little and little is increased, so that daily they are more and more averse from motion. The Younger Children who are carried about in their Nurse's arms, when they are delighted and pleased with any thing do not laugh so heartily, neither do they stir themselves with so much vigour, and shake and brandish their little Joints, as if they were desirous to leap out of of their Nurse's hands, also when they are angered they do not kick so fiercely, neither do they cry with so much fierceness as those who are in health. Being grown greater, and committed to their feet, they run up and down with a wayward unchearfulness, they are soon weary, and they love to play rather sitting then standing, neither when they sit, do they erect their body with vigour, but they bend it sometimes forwards, sometimes backwards, and sometimes on either side, seeking some props to lean upon that may gratify their slothfulness. They are not delighted like other Children with the agitation of their bodies, or any violent motion; yea, when the Disease prevaileth they are avers from all motion of their limbs: crying as they are at any play that is never so little vehement; and being pleased again with gentle usage and quiet rest. In the interim, unless some other Disease, Symptom, or cause of sickness doth come between, they are moderate in sleeping and waking, they are ingenious, not stupid, but for the most part of forward wits, unless some other in impediments arise, their countenances are much more composed and severe than their age requireth, as if they were intent and ruminating upon some serious matter. These Signs being taken together, unless they result from some evident wariness, or proceed from some primary affect of the Brain (which indeed happeneth very seldom in this tenderness of age) do constitute a sufficient Pothognomonical Syndrom of the first kind, & where they are present together, they certainly witness the presence of the Disease, & when they are absent together they infallibly attest the Essence of this Disease. But if at any time a wearisomeness do bewray any Feverish, or any other like Signs, they may easily be distinguished from these, both because the reasons of the weariness have gone before, and also because the Signs from thence arising do suddenly break out, and assoon vanish. But in this affect the signs do invade by degrees, and persevere, or else they are daily more increased. Now the primary Diseases of the Brain are distinguished by their proper Signs. And thus much of the Signs which relate to the Animal Actions. The Signs which belong to the disproportioned Nourishment of the Parts. Of how great moment the Alogotrophy, or unequal Nourishment of the Parts is in this affect, we have already showed; we shall here therefore prosecute those signs which in some great measure depend upon it, and we shall present them as if they were to be beheld at one View. First, there appeareth the unusual bigness of the Head, and the fullness and lively complexion of the Face, compared with the other parts of the Body. But although this Sign may presuppose some motion of the Disease before it shine out, yet is the Disease so obscure before the appearance of it, that it is accounted in a manner unperceivable: Therefore commonly this Sign showeth itself more or less from the first beginning, and continueth till the departure of the affect, unless (as we have noted before) the pining of those parts supervene from some other cause. Secondly, The Fleshy parts, especially those which are full of Muscles beneath the Head which we have listed among the first affected, in the progress of the Disease are daily more and more worn away, made thin and lean. This Sign doth not presently show itself from the beginning of the Disease, because it pre-requireth some notable motion of the Disease before it evidently appeareth; yet in time it most certainly is exposed to the senses, and accompanieth the Disease to the last step be it either to life or death; excellently demonstrating the motion and degree of the Disease by its encreas. Moreover this Sign being conjoined with the former doth at least constitute a Pathognomonical Sign of the second kind, that is such an one as is proper to this Disease alone; and where they are present together they infallibly denote the presence of this Disease, although upon their absence they do not equally signify the absence of the Disease. Thirdly, Certain swellings and knotty excrescences, about some of the joints are observed in this affect; these are chiefly conspicuous in the Wrists, and somewhat less in the Ankles. The like Tumours also are in the tops of the Ribs where they are conjoined with grizles in the Breast. We have noted abov in our Anatomical Observations that these tumours are not situated in the Parts, but in the very Bones; although this consideration doth scarce belong to them as Signs, seeing that of themselves they are searce conspicuous. This Sign doth also suppose some kind of motion of the Disease, neither is it emergent a Principio principiante, as the Philosophers phrase it, yet it offers itself as an object to the senses sooner than any considerable extenuation of the parts. But where it is present, it constitutes a Pathognomical Sign of the Second kind, and without dispute witnesseth the Species of the Disease. Fourthly, Some Bones wax crooked, especially the Bones called the Shankbone, and the Fibula or the small Bone in the Leg, than afterwards the greater Shankbone, and the undermost and lesser of the two long Bones of the Elbow, but not so much altogether nor so often; sometimes also the Thighbone and the Shoulder-bone. Again, there is sometimes observed a certain shortening of the Bones and a defective growth of them in respect of their longitude. This by chance was omitted above, where we gave the Reason of the Organical faults. Yet this affect doth seem to depend upon the same irregular nourishment; namely so far forth as the nourishment taken in encrcaseth the Bones according to breadth and thickness more than length. From hence it comes to pass that some Children long afflicted with this Disease become Dwarves. Hither perhaps may be referred that folding in the Wrists, the Skin it may be having better nourishment and more growth than the Bones of those parts, whereupon it must needs be contracted in the Wrists into a folding or wrinkledness. Finally, to this place also may belong a certain sticking out of the Bones of the Head, especially of the Bone of the forehead forwards. For it concerneth the common kind of vitiated Figure and the Alogotrophy of the Bones. Yet this in the Bone of the Forehead doth evidently seem to depend upon the free nourishment of that Bone in his circumference, wherewith it is coupled to the Bones of the fore part of the Head, and constitutes that seam called S●tura Coronalis, which lieth in the foremost parts thereof. For herupon it must needs be thrust forwards. And indeed in that place it is plentifully nourished without any difficulty, because this Bone in Children is cartilagineous towards that Seam. And this also was pretermitted above where we discoursed of the Organical faultiness, because we have but lately observed it. Fifthly, The Teeth come forth both slowly and with trouble, they grow loose upon every slight occasion, sometimes they wax black, and even fall out by pieces. In their stead new ones come again though late and with much pain. This kind of Sign, as also that which we noted in the former Article, may be referred to the Synedremontal Signs, because neither of these is either perpetually present, or if it be present, it doth not undoubtedly confirm the presence of Disease. Some have imagined that the Bones in this Disease are transfigurable like wax; But we have never seen it, neither have we received it from any eye witness who was not of suspected credit. Wherefore we reject this Sign as altogether Fabulous. Sixthly, The Breast in the higher progression of the Disease, becomes narrow on the sides, and sticking up foreright, so that it may not be unaptly compared to the Keel of a Ship inverted, or the the Breast of a Hen or Capon. For on each side of the middle it riseth up into a point, the sides being as it were pressed down. If any demand whether this Sign be solely apropriated and peculiar to this affect; We answer, That the Breast may be a little increased in an Atrophy or Phtisick, and less than the other parts of the Body, and so by consequence it may be narrower: but it can scarce so fall out according to the change of the Figure without an Alogotrophy, namely that which is proper to this Disease. Wherefore this Sign also when it is present, although the invasion of it be tardy must be reputed a Pathognomonical Sign of the second kind, because when it is present, it certainly denoteth the Species of the Disease, though not on the contrary. And thus much of the Signs which have reference to the unequal nourishment. The Signs which belong to Respiration. First, The narrowness and sticking up of the Breast already mentioned must be hither referred, whereof we then discoursed at large. Secondly, A swelling of the Abdomen, and an extension of the Hypochondriacal parts, which hindereth the free motion of the Diaphragma downwards, and by consequence doth somewhat interrupt the breathing. Yet it must be noted that the Abdomen and the Hypochondries also in respect of their outward parts appear very lean and extenuated, but inwardly, namely in those parts which are contained in the Cavity of the Abdomen, they swell, from whence ariseth this fullness. This swelling proceedeth partly from the windiness of the Stomach and Guts, and partly from the bigness of the Liver and other Bowels. Sometimes also a watery moisture into the Cavity of the Abdomen, introducing an Ascites, joineth in this conspiracy. This Sign is seldom absent, and yet it must be numbered among the Pathognomonical Signs, because it is common to many other Diseases. Thirdly, A Cough is frequently present in this Affect, as also a difficulty of breathing, and many other faults of the Lungs, as Stops, hard Tumours, Imposthums, Inflammations, a Coalesence of them, with the Plura, and the like; Yet these scarce deserve to be reckoned among Signs, because of themselves (whilst the Patient liveth) they are not sufficiently conspicuous. Fourthly, Children afflicted with this Disease are ofavers from lying upon their Sides either the right or the left, or at least it is troublsom to them; namely, either because of the Coalesence of the Lungs with the Plura, or by reason of some Tumour on the contrary side, but to lie with their Faces upwards they are very much delighted. And thes signs also being taken together will not amount to pathognomonical signs of either kind, but syndreciontal only and are common to other Diseases. Signs belonging to the Vital Influx. First, The Veins and the Arteries are more slender than ordinary in the first affected parts, and less conspicuous than you would expect in a lean Body. But in the Face (respect being had to the gracility aforesaid in the other part) they exceed the just proportion. This perhaps is a pathognomonical sign, although it be difficult to be observed, and indeed not yet sufficiently sifted by us. Secondly, The Pulls in the Wrists, and the other affected parts is small & weak, otherwise perhaps it is moderate, unless when a Fever is present. Thirdly, A moderate Ligature cast about the Elbow or the Knee, doth not so soon swell and colour the part beneath and above the Ligature with Blood, as it doth in other sound Children of the same age. Centain vagabond and wand'ring Signs. First, An appetite to Meat and Deink that is either moderate, or unduly weak, unless where a Fever is conjoined. Secondly, The Excrements of the Belly and Bladder do commonly resemble theirs that are in health, unless some other Disease do interdict it. Thirdly, It is observed, that those which are sick of this disease do abominat sweet things, as Syrups, and Junkets condited with much Sugar or Honey▪ Perhaps also such things as these are hurtful for them, as also for those which are troubled with the Scurvy, because they thicken the humours. Fourthly, Some have observed, That they have seen some Children affected with the Rachites, to weigh heavior than others of the same age and stature. If this be so, it must be attributed partly to the facility, and partly to the inequality of the Nutrition of the bony substance in this Affect. For when this weight can scarce be ascribed to the Flesh, which are here extenuated, it seemeth plain that this must be attributed to the bony substance: And seeing that the Bones in this Disease are not yet observed to encreas beyond measure in respect of their longitude, it followeth plainly, that it must be imputed to the thickness of them which is superfluously augmented. These are also common signs, neither do they merit a more worthy estimation. And thus much for the Diagnostical Signs, the Diacritical now follow. CHAP. XXII. The Signs of the differences of the Rachites, or the Diacritical Signs thereof. WE shall insist in the same Method we propounded above, where we discoursed of the differences, whose Signs we now inquire after. We have above deduced five differences from the very Essence of the Disease. The first was separable from the parts of the Secondary Essence, whether they were present or absent. But no other Signs must be expected besides the very pars present or absent, which of themselves are subjected to the senses, and therefore they are numbered among the Diagnostical Signs in the second Classis in in the precedent Chapter. The second difference was from the magnitude of the Disease; 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 showed the way to judge of the strength above: But the difference of a Disease arising from hence hath respect unto the danger, and therefore we refer the Signs thereof to the Prognostics. The fifth difference was deduced from the times of the Disease. In which respect we have above reckoned up six divers apparitions of this Disease: to wit, The beginning, the encreas, the state or consistence, the encreas beyond the State, the true declination, the superious declination, or the passing into another affect. It must be known that the beginning of this Disease, besides the signs that difference this time from the increase, doth likewise require some peculiar Signs of the presence of this Disease: for it is a time of the greatest obscurity, wherein the Disease doth as it were lurk and hide itself, neither can an unattentive and in expert Physician easily distinguish it from the Diagnostical Signs above rehearsed. For by this time most of the Diagnostical Signs aforesaid do not yet openly break forth; and such as make a discovery of themselves, present only some obscure impressions to the Physician's Observation. Therefore the indication of this time requires an accurate and peculiar collection of the first appearing Signs, and a diligent consideration of them; but the other times, besides the Diagnostical Signs above granted, want only a difference among themselves, which is performed by an easy industry. Wherefore in the first place we will declare the Signs of the presence of this Disease, being newly begun or rather beginning, and then the difference between that and the encreas. The Signs of the present Disease of the Rachites newly begun. First, Diligent Observation must be employed about the three kinds of Signs ascribed above to the Animal Actions; namely, the looseness and softness of the parts, the weakness and languidness, the slothfulness and numbness. For these do in a remiss degree, and subobscurely yield advantage to circumspection and heedfulness presently a principio principiante, as they phrase it. Secondly, The colour must be considered, and the habit of the Head and Face in relation to the Joints. For if the colour or the habit be more fresh and lively in those than in these, it presenteth a strong suspicion that this Disease hath taken root. For although the Bulk of the Head which is evidently increased, and also the extenuation of the parts affected do pre-require some considerable motion and duration of the Disease before they appear, yet from the beginning a certain difference may be observed by an accurate attention or intuition in respect of the heat and the habit of these parts compared one with another. Thirdly, The Wrists and the extremities of the Ribs must be noted. For before the end of the beginning certain rudiments of knurls or knots begin to appear in the Wrists, and Excrescencies also in the tops of the Ribs. Fourthly, A kind of swollen fullness and stretching the Belly is conspicuous immediately after the beginning especially in the Hypochondriacal parts. For the magnitude of the Belly compared with the magnitude of the Breast exceeds the just and due proportion. Now these Signs collectively taken do assuredly demonstrate the presence of the Disease even from the very beginning. But if no sensible and manifest extenuation of the first affected parts do appear at the same time, in that very respect it is clearly distinguished from the encreas thereof. The Signs of the other times are with eas differenced from one another by the descriptions of those times already laid down; yet because 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 become more intense and evident in the encreas of the Disease, and many other and more grievous are daily accumulated. 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 Disease the Signs and Symptoms are most outrageous and conspicuous. But so long as this time lasteth it neither manifestly increaseth or decreaseth. In the encreas beyond the State, the Signs and Symptoms 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 daily 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 restauration of health begins to discover itself; no other Signs of the invasion of any other Disease appearing. On the contrary, in a spurious and illegitimate declination, Other Signs of a new and succeeding affect are involved and complicated with the Signs and Symptoms of this Disease: and these are distinguished according to the various condition thereof, 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 Disease, they must be reserved among the Prognostics; and thus much of the Signs of the Differences of this affect deduced from the Essence thereof. The Differences of the Causes distinguish the Disease into Natural and Accidental, and the Natural again into that which is properly so called, and that which is so termed improperly. A Natural Disease properly so called, because it is supposed to be actually present from the very Birth, requireth no other Signs than the Diagnostical recited in the former Chapter. For upon their appearance presently after the Birth the Disease is certainly known to be Natural. But if those Signs appear not presently after their Birth, yet a Natural disposedness to this Disease may be inherent from the Birth, which afterwards actually breaketh out, and the Disease produced by it, may (though with some impropriety) be termed Natural, in regard of that dependence upon the Native faultiness. A Natural Disease in this since, requireth other Signs than those which we have recited above, to distinguish it from the same Disease when it is altogether and plainly Accidental. The Signs of a Natural Disease improperly so called. First, A weak and sickly Constitution, and the Diseases of both or either of the Parents: As a cold and moist distemper, a Cacochymy, especially the Phlegmatical, a Cachexy, a Dropsy, an Atrophy, the Phtisick, the Gonorrhoea, the Whites, the Venereous Pox, the Scurvy, and the like affects. Secondly, The Slothfulness, Effeminacy, and Sedentary 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 Disease in relation to the Parents. Fourthly, The Debility of the new born Infant when it proceedeth not from the difficulty and labour of the Birth. Fifthly, The invasion of the Disease before he is exactly a year old; for this argueth some Natural disposition to the same. Sixthly, If the elder Brothers or Sisters were before affected with the same Disease; for than 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 invasion of the present Disease. Of which we have spoken above 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 Disease newly and totally contracted after the Birth, are in a manner contrary to these, and therefore we shall only run them over. First, If the Disease 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 Disease began when the Child was above eighteen months old. Fourthly, If the Brothers and Sisters were free from the Disease. Fifthly, If any notorious errors were committed about the Child after the Birth. Sixthly, If any Disease went before which might occasion a suspicion that this followed it. If there be a confluence 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 Irregularities. And thus much of the differences of this Disease in respect of the Causes. Lastly, Some differences happen to this Disease by reason of other Diseases, wherewith they are peradventure complicated; in which case, besides the Diagnostical signs already reckoned, some other may be desired as peculiarly proper to the complicated Disease. Nevertheless an accurate Description of them cannot be here expected, because for the most part they are the same which are every where artributed to those Diseases by practical Writers. But because some Diseases do more frequently accompany this than others, we will briefly look into their Signs. First therefore a Hydrocephalus or Dropsy in the Head being complicated with this Affect needeth sometimes no signs to make it known, but is sufficiently, yea abundantly manifest of itself: namely, either by the exceeding magnitude of the Head, or by the water that is outwardly contained under the Pericranium (which notwithstanding we suppose doth very rarely happen) or by some extreme 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 tumour is outwardly perceivable by the touch in the spaces between the Bones. Many times the Hydrocephalus is somewhat obscure and requireth signs to discover it. First, Therefore all the inward and outward senses are more dull than otherwise they use to be in this effect. Secondly, The magnitude of the Head is sometimes greater than at other times. Thirdly, 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 bunchings out of an unusual bigness. Secondly, The conjoined evils of breeding Teeth are thus known. 1. If the accustomed time of breeding Teeth be either approaching, or now at hand; for from hence ariseth some suspicion of pain from thence proceeding. This time ordinarily beginneth in the seventh month after the birth, and continueth till the Child be a year and six months old, and longer, if the Teeth come slowly; which happeneth very commonly in this affect; and it endeth when the number of the Teeth is complete. 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 somewhat hot in the touch. 4. The Teeth that come forth sometimes wax black or are loose, or fall out by pieces. 5. To these you may add watchings, the looseness of the Belly, Fevers and Convulsions, which notwithstanding are chanceable Symptoms. Thirdly, An Asthma is perceived by the very difficulty of breathing, when it doth not proceed from the stretching and fullness of the lowest Belly. But if withal 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, than they desire to lie erect or with their Faces upwards. The same thing for the most part happeneth in an Inflammation, with a growing together of the Lungs with the Pleura, as also in a Pleurisy, but then there are added, an acute Fever, a Cough and spitting of Blood, moreover in a Pleurisy a pricking pain in the Side. The Phtisick is known by a diuturnal Cough, and a roundish and sometimes a purulent spittle (although indeed Children do seldom spit out, because that matter which the Cough fetches up into the Mouth they swallow by the oesphagus) also by a putrid Fever conjoined, and by a sudden Colliquation in the parts. An Ascites is discovered by the unreasonable bigness of the Abdomen. Fourthly, A Hectic Fever bewrayeth itself by a continual heat, being somewhat more vehement than that in a Quotidian Ague, especially about the Arteries, and still increaseth after the receiving of meat; also by the swift and speedy consumption of the parts: a putrid fever is known by the urine being at the beginning cude, afterwards more concocted, then also from the extreme high colour of it. Moreovor, if it be an intermitting Ague, it is discernible by the inequality of the heat, the external parts being at the beginning extreme cold, & afterwards excessive hot; also from the fits either constant or erratical; again, by the contraction of the Pulls upon the approach of the fit, afterwards unduly increased. A continual Fever is known by an intensive and un-intermitting heat, also by thirst, roughness of the Mouth, and the altered colour of the Tongue, and the like. Fifthly, The Venereous Pox is supposed to meet in complication, if either of the Parents or the Nurse 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 Medicines cannot subdue▪ if hard tumours grow conspicuous, or knots defiling the Bones in the Fingers with rottenness, or any other parts; if unquietness and bitter pains in the nighttime alarm the sick; or if Buboes break out in the Groin. Sixthly, The Scurvy complicated with this affect hath these signs: 1. They that labour under this affect do impatiently endure Purgations; but they who are only affected 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, there 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 conjoined with the Rachites. 3. upon any concitated and vehement motion they draw not breath without much difficulty, they are vexed with divers pains running through their Joints, and these they give warning of by their crying, the motion of the Pulls is frequent and unequal, and sometimes they are troubled with a Falpitation of the Heart, or threatened with a Lypothymie, which Affects are for the most part soon mitigated, or altogether appeased by laying them down to the rest. 4. Tumours do very commonly appear in the Gums. 5. The urine upon the absence of the accustomed Fever is much more intens and increased. Seventhly, The Strumatical Affect, if extremely complicated with the Rachites, is sufficiently conspicuous by Swellings obvious to the senses; yea, where many knotty Excrescences do outwardly occur, it may be justly suspected that the like Tumours do lurk in the Bowels. But if the knots grow inwardly only, they are scarce discernible by any certain sign; for that Rule which some have observed, namely, That those who have short Necks, low and narrow Foreheads, with compressed Temples, and wide Cheek-bones, are subject to these strumatical Tumours 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 sometimes only, and not always true. Thus much of the signs of the differences. CHAP. XXIII. The Prognostical Signs in the Disease of the Rachites. THis Disease in its kind is not mortal, yea sometimes it is so light and gentle, as the Children affected therewith have been restored to health by the sole benefit of Age, the Vital heat being increased and summoned forth to the external parts by the force of frequent Exercises. Yet it sometimes so vehemently prevaileth, that the imminent danger of life can scarce, yea sometimes cannot be prevented by the best and most prudent applications. Wherefore it is very necessary that a Physician should first diligently contemplate the Prognostical signs of a disease, that hemay be the better instructed to foresee the several events of it. But in general those things which abet the Disease, that is, all such things as war against Nature, require a contrary consideration, and as thes are the stronger and they the weaker, so much the more grievous and pernicious is the Disease. But because it is not obvious to every one to give an accurate Judgement of Particulars from this General Admonition, it will not be impertinent or unprofitable to insert some particular and special Rules and Observations hitherto belonging. First, This Disease properly Natural, or that which invadeth before the birth, is the most dangerous, and seldom, if ever, end in health. For it argueth a deprivation of the Seminary principles, and by consequence that the Spirits are very infirm; besides it insinuateth a vehemency in the causes. Secondly, The more early the invasion is after the Birth, the more dangerous (caeteris paribus) the Disease is: for the Spirits are so much the weaker. In like manner, The Elder Children, and such as go up and down, are more easily cured then young Infants that cannot use their legs. Thirdly, A Disease improperly so called; namely, that which in part dependeth upon the Natural Inclination, is more dangerous than that Which is contracted by the mere error of the Nurse or Mother. Fourthly, This Disease proceeding from some other foregoing Affects, is more dangerous than that which is introduced by an erroneous Regiment of health; For it implieth a precedent dejection of the Spirits. Fifthly, Some have observed, That Infants who have had red Haired women to their Nurses, have been most obnoxious to this Affect. Yet we indeed suspect this rule of some fallability. Sixthly, Some affirm, That Girls are more frequently infested with this Disease than Boys, and more easily cured. The truth is, we have not yet had any unsuspected experience of this. Yet we grant that Girls are of a more cold and moist temperament, which holdeth the greatest correspondency with this Disease, and for that reason probable it is that the Female Sex may be affected with the lighter causes, and for the same reason also be the sooner restored. Seventhly, This Disease doth chiefly invade the Cradles of the Gentry, especially, of those who live at eas, and fare deliciously; then of the poorer sort, by reason of the manifold and various errors which necessity introduceth as well in the diet of the Parents, as the Regiment of their Children; but it findeth the most difficult access unto those who are privileged from such assaults by a mediocrity of fortune, and accustomed to undergo some painstaking and labour, and are not destitute of necessary means to sustain life and a healthful competency to prevent indisposition. Eighthly, By how much the more the first affected parts are extenuated, so much the more difficult caeteris paribus is the cure of the Disease. Ninthly, The greater the Head is, the longer and the harder is the Cure. When therefore the Bone of the Forehead sticks much out forwards, it portendeth at least a long continuance of the Disease; the same also do the other irregular stickings out of the other Bones of the Head. Tenthly, The weaker the Backbone, the greater and more dangerous is the Affect. Wherefore they which are unwilling to sit upright, much more they which are not able to sit upright, but most of all they whose feeble Necks cannot underprop the burden of the Head, are in hazard of their lives. Moreover, by the Diuturnal weakness and bending of the Backbone, Children become Crook-backed, or some other ways incuruated, and the trunk of the Body is afterwards scarce reducible to its Native Figure. Eleventhly, Great Swellings in the Bones of the Wrists and the ends of the Ribs presage the continuance of the Disease. Moreover, The crookedness of the Shankbone, Shoulder-bone, or the Bone in the Arm, prognosticate no less. Again, The greater that the inflexion of the Joints is, the more difficult and retarded will the restauration be. Twelfthly, They whose Thigh and Shank-bones are much increased, rather according to latitude and thickness, then according to longitude, for the most part become dwarves. 13ly. They who draw their Knees upwards and unwillingly, suffer them to be extended, recover not without some difficulty. 14ly. When the Teeth wax black or fall out by pieces, there is some danger, and so much the more, the later they come again, that is, others in their room. 15ly. Al they who attain to the consistence of the Disease, escape the danger of it, being carefully looked unto, unless perhaps some other Disease be conjoined with it, or do accidentally come after, and disturb the Patient with a higher encreas. In like manner the declination of the Symptoms doth assuredly promise a restitution of health. 16ly. If an Hydrocephalus be complicated with the Rachites it ever importeth great danger. But if it prevail far, as that the Sutures of the Brain pan do gape, and that some water gotten into the middle Spaces doth swell the Dura mater into a waterish and soft Tumour, it is mortal. 17ly. A painful and laborious breeding of Teeth comes sometimes accompanied with most vehement Symptoms, and even threateneth death. But commonly it is violent and ceaseth in a short time; however, so long as it is conjoined, it much accelerates the motion of the Disease. But the Dog-teeths come forth with more vexation, than the rest and portend more danger. 18ly. An Asthma (especially the Orthopny, when the Patient cannot draw breath, but with an erected neck, and that difficulty of breathing when he cannot lie on either side) is very dangerous. For that prompteth to a suspicion of some Tumour, Imposthum, Pleurisy, or Inflammation of the Lungs, or some growing too of the Lungs with the Pleura, all which affects want not their danger. 19ly. If the Ptisick be complicated with this Affect, it is for the most part mortal, especially if one and the same ulcer of the Lungs continu above forty days. 20. We affirm that if this Disease be of any long continuance it easily changeth into the Ptysick, or a Consumption, or at least commonly brings a Consumption to the destruction of the Sick, unless some other affect per adventure, or grievous symptom do intervene, and prevent the Consumption by hastening death; as a Convulsion, the loud Cough, the swelling of the Lungs, (vulgarly called, THE RISING OF THE LIGHTS) a continual Fever, a Pleurisy, etc. In the next place, We assert, That if a Dropsy of the Lungs, or an Ascites be complicated with the Rachites, it portends a desperate and deplorable condition. Again, An Hectic, slow, putrid, and especially a continual Fever, consuming the first affected parts doth vehemently hasten the motion of this Disease, and render it the more dangerous. Also, If the Venereous Pox be consociated with the Rachites, b e it hereditary or contracted by infection, it is almost uncapable of remedy. The Scurvy likewise conjoined doth very much retard the cure, though less than the Pox. In like manner Strumatical tumours either internal or external do not very much suspend the hopes of cure, though otherwise of themselves they are not easily subdued in this tender age. For the external parts are exulcerated, or inflamed with insupportable pain, and do vehemently irritate Nature, and waste the Spirits, but the internal much more, especially, if they invade the more noble parts, or bring molestation to the adjacent members with their weight and bulk. Moreover, Whosoever are not perfectly cured before the first five years of their age be spun out out, they afterwards for the most part live miserable and sickly, and being either Astematical or Cachectical or Physical they die before they arrive to the consistence of their age, or else they grow deformed, crooked, and dwarfish. If Scabs, wheals, pimples, or the itch come after this Affect, it doth hopefully expedite the cure. Finally, They which easily endure any kind of agitation of the Body, caeteris paribus, are cured without difficulty. Thus at length we have finished the History of the three kinds of Signs, according to the best faith of our observations hitherto. In the next place we shall proceed to the Method of practice, which comprehendeth the prevention and cure of this Disease. CHAP. XXV. The Method to practice and Indications in general. THE Method to practice is divided into the Therapeutical and the Prophylactical part, or the Curative and the Preservative. We shall discourse of the former in this Chapter, although perhaps we shall here also propound some things which are common both to the Prophylactical part, and the Eugieihal. But the Prophylactical in particular and uncommunicated we reserve for the close of this Tractate. The Curative part is usually called the Meth odd of Cure, whereof, as of every other art, there are two general instruments, namely, Reason and Experience, the uniting whereof comprehendeth the whole skill of the Artist. Now by experience we understand not only the History of one or more Diseases, and the success of Medicines, but also the observation; that is, the application of the Histories unto those things, which reason dictates in the same affect, and that by way of comprobation or disallowance. In like manner, by reason we mean every operation of the mind, so as we do not only comprehend the third; namely, ratiocination either demonstrative, or probable and Analogal, but also the first and second, that is, a simple apprehension, comprehension and division. For this part of Medicine includeth or rather presupposeth the Physiology, Patholog y and Semeiotical part, which certainly require a manifold exercise of every operation of the understanding. Again, no man can understand any proposition, who doth not first apprehend the simple terms thereof, nor any Syllogism, who is ignorant of the Propositions of which it consisteth; so that it is manifest that every operation of the mind doth meet with an employment. Indication, That noble instrument of the Method of Cure (by the use whereof the Dogmatical Physicians do principally glory to discriminate their Sect from the Empirics) doth likewise vindicate a station among the parts of reason. But because some things both difficult and obscure do occur concerning this instrument which have not received an unfolding and full illustration, from the Neotericks themselves, we judge it expedient here briefly to unveil them by an examination. We will inquire therefore. First, What is Indication? Secondly, Unto which operation of the understanding it relateth? Thirdly, Into what kinds and differences it is distributed? As for the first, although perhaps many significations of this word may be found among Authors, yet that is the best and most proper which is delivered by Galen, in his book the Method. Meden. Indication (saith he) is an insinuation or declaration of the consequence, that is of something to be done. In this sens Indication may be defined and described to be an objective action of the Indicant relatively considered, which representeth to the understanding the thing Indicated, that is, what may be helpful what hurtful, and by consequence what must be elected and applied, what forsaken and avoided, that this Description or Definition may be the better understood, let us further examine what is here signified by the Indicant? what by the thing indicated? what the action of the Indicant is? of what use distinction is of the thing indicated into helpful or hurtful, into that which must be chosen, and that which must be refused? First, Although those terms Indication, Indicant, Indicatum, or the thing Indicated may peradventure be extended to other Arts and Sciences, yet because it hath hitherto been only apropriated by the Industry of Physicians (especially of Galen) to the Method of Practice, their definitions which we shall here declare, shall have respect only to this Method, all other use of them being pretermitted. The General Definition therefore of the Indicant must be derived from the most general Nature which doth indicate in our Art. The Indicant therefore may be defined in general to be a state of the Body as it is fluxible or movable, or rather, as it is actually influx or motion, relatively considered, namely, as it intimateth what is to be done in that particular. First, We affirm that the Indicant doth perpetually imply some state or condition of the Body; wherefore because that which is without the Body, and doth not yet affect it, is no state or condition of the Body, it can scarce rightly be said to indicate. The external cause therefore, which doth not yet affect the Body, is not the Indicant, although the aversion of it may possibly be the thing indicated. Secondly, the state of the Body as it is frail, or movable, or rather as it is actually in motion, is required to the Essence of the Indicant. For as Galen most luculently proveth to Thrasyb. If our Body were immutable and perpetual, there were no need of Medicine, but because the heat doth continually feed upon the moisture, and because health itself in the most perfect state is frail and fluxible, yea actually fluitant, and in some measure is already flowed away, manifest it is that the Physician's Art and the Practical Duty of the Physician are both exceeding requisite. For if the state of the Body and the alteration thereof be only considered absolutely, a bare and naked speculation only resulteth from thence: but if it be considered in order to that which is to be done whereby the Physician may rightly execute his duty concerning that state, presently it meriteth the denomination of a Practical Instrument, and is invested with the nature of an Indicant. For such a state doth indicate, as it is frail and in motion that care must be every way had of the health, and that that care must be exercised and practised with all diligence and circumspection. And consequently this very general Indicant doth point out, that which the general scope of the Physicians sought after, but it must not be expected that the consideration of the most general Indicant can represent any other thing than a most general action correspondant to the general scope. For if the Physician desireth a higher prosecution of the particular scope, he ought to descend to more particular Indicants. Secondly, The thing Indicated is a Medical Action required on the part of the Indicant. For the Indicant primarily and formally denoteth the action, but secondarily and by consequence the instrument wherewith the action is perfected. Therefore by way of an appendix let us add to the proposed Definition, that secondarily, by consequence, and in a concrete acception, it includeth the Instrument wherewith that action is accomplished. First, We say, that the thing indicated is an action For the Physician useth Indication to that end, that from thence he may collect what is to be done: you will say perhaps, that when the crisis is at hand or legitimatly proceedeth, the thing indicated is an abstinence from, or a suspension of the action, and not the action itself. We answer, That this abstinence in that very regard that it is enjoined advisedly and according to art, is evidently contained under some kind of notion of a Medical Action; and the same is to be said of any kind of prohibition of any action in our Art. Secondly, We say that the thing indicated is a Medical Action, that is directing the Action to health. For the end of Medicine is health, and therefore that Action which doth aim at health is rightly termed a Medical Action. Thirdly, We say, That the thing Indicated is an Action requisite and importing at least in respect of the Indicant. For every indicated action ought not presently to be reduced to Practice, neither can it be simply said to be requisite, but only in reference to the Indicant: wherefore it must be exposed to a further examination before the exercise of it can be resolved on; and if neither the Spirits do dissuade, nor no other contra-Indicant doth more potently resist, than it is simply requisite, and must be put in practice in its due time, with all possible convenience. And herupon the thing indicated is rightly distinguished into profitable and unprofitable. The thing indicated becomes unprofitable either by defect of Medical matter, wherewith it should be accomplished, or by the presence of a stronger Prohibent, or contra-Indicant. Again, A thing indicated and profitable is rightly subdivided into an Indicate, Circumstantiate, and non-Circumstantiate. The first by which is meant an Action rightly clothed with circumstances must be prosecuted without any delay. The second must be deferred until it have perfectly acquired due circumstances. We say fourthly, That a thing indicated in a concrete and secondary sens doth also include the Instrument, whereby the Indicated Action is perfected. As for example, the state of health doth primarily and formally indicate an act of conservation, but secondarily and by consequence it doth withal indicate the Instrument, whereby we conserve it. This passage of an Indication from the Action to the Instrument doth not seem to depend upon the sole virtue of the Indicant, but in part also upon some general certain and commonly received principles, as like things are conserved by the like, things contrary are cured by their contraries, and therefore we industriously said that such an Instrument is the Indication or thing Indicated in a Secondary sens, and by consequence inferred, and because it includeth the Action together with the Istrument, we termed it so likewise in a concrete signification. Moreover, Seing that the Practical duty of a Physician hath great affinity with the Indicated action; we shall here consider wherein they unite in some agreement, and wherein they differ among themselves. The general Duty of a Physician is to attain (as much as in him lies) the end of his Art, namely Health. And that same obtaining of Health is in a manner the most general Indicated Action, yet this is distinguished from the general Duty of a Physician, because the Purchase, and restauration of Health is not always attainable. Therefore although the obtaining of Health be perpetually Indicated; yet when that is impossible, the Physician is disobliged, seeing that no man is bound to impossibilities, and so consequently, it is no part of his Duty. In like manner an Indicated Action is sometimes unprofitable for the reasons before alleged, in which case it appertaineth not to the Duty of the Physician. Again, An Indicated action, though when it is profitable it must be performed in its place, yet so long as it continues an apparelled and devested of due circumstances, it presseth not the Duty of a Physician. For it is the part of a Physician not only to prescribe things profitable in the Species, but they must be such, regard being had to time, order, and other conditions of a just and regular administration. Finally a profitable Indicated Action being robbed in all its due circumstances doth truly exact the duty of a Physician. For a Physician is obliged to execute such actions, and only such, at least when they are conspicuous. Besides; The scope and intentions of the Physician having a divers respect to the Indicated Actions and the Duties of the Physician, and holding some commerce with each of them, we shall likewise here consider in what respect this falleth out. But in the very entrance into this Discourse these scopes seem sometimes to be properly distinguishable into little notions or forms of enquiry after every Duty of a Physician, and the things themselves to be enquired after. The forms of enquiry are nothing else but apt Questions or Interogations, which subdivide every Duty of a Physician into so many parts, as it containeth to be distinctly sifted and examined. Argenterius reckons up nine Forms of this kind: First, Whether? Secondly, What? Thirdly, With what matter? Fourthly, How much? Fifthly? Of what kind? Sixthly, After what manner? Seventhly, When? Eighthly, Where? Ninthly, In what order a thing must be done? Others contract these to fewer Heads, but for further satisfaction the understanding Reader may consult with the Books. The real Scopes or things themselves to be enquired are those very parts, into which each Duty of a Physician may be aptly distinguished. They are therefore so many in number as there are found parts in that duty to be examined. These Scopes thus found out differ not really, but only in reason from those that are yet to be found out, namely in respect of the divers relation to the intellect seeking, and actually understanding. From hence it appeareth what affinity there is between these Scopes and the Duty of a Physician, and also the indicated actions. For the notional Scopes or forms of Scopes, and the things themselves to be enquired after under those forms do both aim at the same mark, namely the distinct invention of all the parts of a Physician's Duty. But the things to be sought out are the parts themselves of the Duty aptly separated and disjoined from one another the better to facilitate the invention and examination. Moreover, Those parts of this Duty, in as much as they are found out by the force of Indication, are the very indicated Actions; so that the Scopes invented by the Indication, and the Indicated Actions do really signify the same things. We say really, because the Scopes even when found out differ in reason from them as they are Scopes, seeing that besides the Indicated Actions they seem to note together an intention of prosecuting the same Actions, as the Scopes not yet found out do intimate an intention of enquiring into them. Thus much of indicateth or things Indicated. Thirdly, The action of an Indicant is Objective and Indicant, as an Object besides itself, doth in some sort insinuate another thing to the understanding. Perhaps some may wonder, how an Object can represent any other thing besides itself. We answer, Such is the Nature of relatives, that (as such) they cannot be conceived without an implication of their correlatives. For one relative in his proper consideration doth at least obliquely involve the consideration of another, and by that means it easily ushereth the understanding to the knowledge of the other. Some may reply, If the force of the Indication be built upon the mere relation of the Indicant to the Indicatum, How comes it to pass that the use thereof is restrained solely to the Art of Medicine? To this we answer, We deny not, but this instrument may be extended to other Arts and Sciences, as we have before insinuated. For in moral Philosophy it is lawful to say, that Virtue doth Indicate the protection of herself, and Vice the suppression of itself. But neither doth this kind of relation consist only between the States of things, and the Actions thereunto belonging, but also between the terms merely speculative; as twice two are four, a man is not a horse. But here we consider the Indication and the efficacy of the Indicant only in order to the Method of Physic, so as it will not be here needful to extend the use of this instrument further, neither indeed did Galen, because it would contribute little to the scope thereof. Yet we affirm, that every relation is not a sufficient basis of an Indication, but it must be such, as hath either an evident conformity and agreement between the Indicant and Indicatum, whereby they may be fitly marshaled into a proposition of undoubted truth; or a disparity and repugnance of them among themselves that so they may aptly be divided from one another; that is, they may be disposed into a negative proposition equally certain. Now because the propositions elected by this indication are certain and evident, not needing any higher proof: from thence it is manifest that every understanding that is Master of itself, not clouded with a vail of prejudice, nor wittingly ensnared with sceptical Sophisms and fallacies, must necessarily pay an assent unto them so soon as he understandeth the terms. Moreover, the Sceptics themselves, though in their disputations they will lie in wait to traverse any verity, how manifest soever it be, and busy themselves to equal the most certain principles with things extremely doubtful, yet in performing the necessaries of life, seeing that they relieve hunger by food, hoard up money, avoid stripes, and do these and the like things constantly and without any distemper of mind, they plainly discover that they are led by some bad disposition of mind, or governed by a desire of glory, or tickled with a hope of victory in the contention, rather that they doubt really of the truth of such Propositions. In the interim, it must be observed, that the very Indication is fallible and deceitful, where the absolute nature of the Indicant or the Indicatum hath not been exactly understood before. For in this art of Indications, we do not presuppose only that a Physician should always have learned before, and duly known what all those things are, which we call according to Nature, as also in what the Essence of a Disease, and all the parts thereof consist, and to have an exact knowledge of all the causes of an Affect. Yea, it is necessary that he understand all Medical actions, and upon occasion be able to render a ready account what alteration is, what heating, what cooling, etc. what evacuation, purgation, and the section of a vein, etc. what conservation, and the like. For the Indication doth not make manifest the absolute nature either of the Indicant or the Indicatum; but presupposing this as already known, it representeth only a mutual relation; namely, either a strict connexion and conformity which they retain among themselves, or a disparity and opposition, whereby they may be form into an undoubted proposition: but the certainty of the indicated proposition cannot exceed the certainty of the knowledge of the Indicant. Therefore if at any time we scruple the certain knowledge of the Nature of the Indicant, it is not safe to trust to the Indication alone, till it shall better be confirmed by some other Reason or experience. But this doubting must not be imputed to the Nature of the Indication, but to the ignorance of the Indicant. Moreover, it must be considered that the relation of the Indicant in the Method of practice, doth demonstrate besides the evidence somewhat of duty in respect of the Indicated action, and that the propositions form from the Indication do either explicitly, or at least▪ implicitly insinuate that duty. As in this Proposition, a Disease doth Indicate the ablation of itself, the ablation is decreed and resolved upon, as a requisite action on the part of the Indicant, that is a Disease: as if one should say, a Disease requireth or importuneth the removal of itself. Yet this duty of the action is more frequently and indeed much more elegantly expressed by the Participle in dus, as a Disease is to be taken away: which Proposition in the fullness of its signification hath a manifest coincidence with the former. There remaineth still an objection to be answered concerning the action of the Indicant; and this it is, If the Indication be the very action of the Indicant, how can it be called an operation of the understanding? For all writers refer the Indication to some generation of the understanding. We answer, The Indication is indeed an action of the Indicant, but yet an objective action, and that it is united to the intellective faculty, and abideth in it as in its subject: Moreover, that the understanding a power, both actuated, and as it were informed by its subject. Wherefore although the action of Indication be objectively attributed to the Indicant, yet subjectively it is ascribed to the Soul, and especially to the intellective part thereof, which is as it were the act and form of it. And from hence it will be most easy to reconcile Galen with himself, who sometimes defineth Indication to be an Emphasis, sometimes a Catalepsis. Fourthly, It must be examined whether that distinction of an Indicated action, into an action helpful and hurtful may tend. For some may urge, that Galen doth perpetually affirm, that one Indicatum only can be insinuated from one Indicant; and that in his Method. Med. he doth affirm, That they vainly attempt the Method of cure, who are ignorant that one thing is Indicated from one Indicant, and that all who have written of this matter do seem to attest the same thing, We answer, That Galen must be understood of the three distinct▪ kinds of Indicants, which must by no means be confounded, nor their indicateth, that is, the things indicated by them. For that which a Disease doth properly Indicate, must not be attributed to the causes or the Spirits: In like manner that which the causes Indicate must not be applied to the Spirits or the Disease itself. Finally, that which the Spirits Indicate must neither be ascribed to the Disease nor the causes. For in this respect one Indicate answereth to one Indicant, and he that observes not this, must avoidable confound all things, and in the employments of art makes an unsuccesful use of this instrument, according to the judgement of Galen. But it must be considered, that in each of these kinds, the Indicatum may be divided into two parts, one whereof is an advantageous action, and to be prosecuted; the other is noxious and to be avoided▪ yet each of them belongeth to one and the same kind amongst the aforesaid three, and is as it were a middle part of the whole Indicate: For the Spirits direct to an election of such things as may cherish and protect them, and to an avoidance of such things as may in a further degree empair them: and both these actions concur to advance and ascertain the complete and final conservation of them. In like manner, both in cure and restauration, and also in caution and prevention, there is found an action as well to be embraced, as abandoned; yet whether of them exceedeth the bounds of its kind, so that no confusion can from thence be feared. For whilst we cure, we make choice of those things that will demolish the Disease, and we deliver the application of such things as will augment it. In like manner, when we preserve, we take away the causes, and withal we eat the use of those things that may conspire either the continuation, or future breeding of them. And for this Reason in the definition which we have presented above of an Indication, we distinguished the action indicated into that which ought to be prosecuted, and that which ought to be waved: which very thing also we were about to do, in the enumeration of the particular Indications to this Disease. It is now time for us to proceed to the second enquiry propounded at the beginning, namely, Unto which operation of the Intellective faculty the Indication belongeth. We say, first, That the Indication doth in some sort include the simple apprehension of each term, both of the Indicant and the Indicate. For he can never understand a Proposition who is ignorant of the Terms thereof. Yet this knowledge is only preparatory and presupposed in the art of Indications, as we have already noted. We affirm secondly, That composition and division is an explicit operation of the Intellective faculty in the perception of an Indication. For the Indicant by force of his relation doth represent the Indicate to be aptly continued together into a relative proposition. Now that a Proposition thus constituted may in its own nature be so manifest and evident, that no man can reasonably doubt of the truth thereof, or need any clearer proof, is expressly taught by Galen— 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉; and again in another place— 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉. Here some calumniate Galen, as if he had devised an art separated from all experience, and quarrelling with Reason; but because Galen intended nothing else, than that Propositions framed by Indication are of self credit, and need not any comprobation from Reason or Experience, thes Critics may perceiv their own rashness and retract the scandal. Senertus indeed objecteth, that the Indication cannot belong to the second operation of the mind, because the Indicate is neither affirmed nor denied of the Indicant. But that learned man was herein mistaken. For although peradventure that the Indicate be neither affirmed nor denied of the Indicant directly, and by the bare Verb Substantive or Copulative (est.) Yet indirectly and obliquely it is manifestly predicated of the same, and after the same manner as it useth to be in relative Propositions. As for example, A sound State is the Indicant of its own conservation; a sickly condition is the Indicant of some remedy, etc. And if any man will express the Indicate with his relation to the Indicant by the participle in dus, than the Predication will be direct. As a sound State is to be preserved; a diseased State is to be cured, a Disease must be removed, etc. If the Learned Senertus can deny these to be Propositions, he may with the like facility deny that an Indication belongeth to this Operation of the Understanding; but if he must needs confess that, there is no room left for the denial of this. Now we have said that the Indication doth belong to the second Operation of the Mind, because the Understanding, in reference to the order of time, doth withal comprehend the mutual relation between the Indicant and the Indicate, and thereupon frameth a Proposition, which formation and contexture of the Proposition is the very Indication; and explicitly a second Operation of the Understanding. Now that the Understanding doth together at one time comprehend the Indicant and the Indicate in the Indication, is elegantly expressed by Galen in a decompounded word which he useth in the definition thereof, 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉: also in another definition, 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉. We say Thirdly, That Indication may likewise implicitly be referred to the third operation of the Understanding; Because in the order of Nature the Understanding seemeth first to perceive the evident relation of the Indicant to the Indicate before it can conclude of the certainty of the Proposition from thence resulting. Although in the order of time the Mind (as hath been said) comprehendeth them together; neither is it necessary to form an explicit Syllogism, for the truth is, The Understanding can comprehend those things together at one time, which by the Institution of Nature are termed Successive, as the Sun and Light, Fire and Heat, etc. But in regard that this simultaneous comprehension of an Indication doth include a certain dependence of the knowledge of the Indicate from the perceived relation of the Indicant, it supposeth also that the said relation is sooner perceived at least in the order of Nature, and that the Indicate is later understood and by an implicit bringing in, for a kind of transition, in respect of the order of Nature doth seem to be here implied from the relation of the Indicant, as the Medius terminus, to the Proposition constituted of the Indicant and the Indicate as to the conclusion; and this may be called an implicit reasoning. We say Fourthly, That by circumlocution and circumstances of speech, an Indication may be reduced to an explicit reasoning or syllogism, or rather, that the same thing which we pursue & argue at by Indication is to be found out and proved by way of Syllogism. For the Reason of the evidance of an Indicated Proposition may explicitly be applied, as the Medius terminus, to infer that proposition. In the interim a Syllogism so pieced together will be either absolutely frivolous and childish, or at the best only explicatory. As if any one who would prove that a Disease were to be removed, should thus proceed: That which is contrary to Nature is to be removed; A Disease is contrary to Nature, therefore a Disease is to be removed. The Medius terminus (that is against Nature) is not the reason of the Relation of a Disease to the Ablation thereof, but it is only an Exposition of the general Nature of a Disease. For whosoever understandeth what a Disease is, doth at the same instant presently conceive something not natural. And therefore such a syllogism is only expository. Yet we do not suppose it to be always unprofitable, because it may sometimes be serviceable to the conviction of a stubborn, or the information an ignorant Distemper. Hither also we may refer the translation of an Indication from the Action to the Instruments by virtue of general Rules: Likes are preserved by their likes, Contraries cured by their contraries. We say Fifthly, That a Collation of the Indications among themselves, whereby we may guide our choice by the consent and descent of the Indicants to what simply and absolutely aught to be done, doth necessarily involve the third Operation of the Understanding. For the limitation of any Indication supposeth a middle term extraneous to that Indication, which being first understood, the limitation is inferred as a conclusion. For he that findeth out an external for a middle term (thereby to assert the verity of any proposition) doubtless he manifestly argues and disputes. Seeing therefore that besides the Indicant and the Indicate a third term, and the affirmation or negation thereof is required to the limitation of an Indication, evident it is that the third Operation of the Understanding is requisite to the Invention thereof. Therefore although simple Indications may subminister the first rudiments of Method to Practice, yet to the compliment and perfection of disputing the Art must likewise be joined with it. We affirm Sixthly, That the election of the Physical Matter in particular, and the apt and prudent administration thereof, doth not only employ every Operation of the Understanding, but that it also requireth experience; for without this, who can sufficiently understand to administer a dose of Scamony or of any other purging Medicament, or know what humours such and such a Plant draweth away by a peculiar propriety? Again, in Medicines alterant there may perhaps lurk some hidden quality, which may be hurtful to the Patient, and this without experience cannot be discerned. We conclude therefore (the proper force and use of Indications being continued) that to a complete method of Medicine all the dictates of Reason, and the contributions of Experience are pre-required. We now proceed to the Third Title propounded at first, namely, Into what kinds and differences Indication is distributed. Some differences may easily be observed by what hath already been spoken, which therefore we shall here omit. Now here we distinguish Indication into general, succeeding, and specifical. The general is derived from the general Indicant, the succeeding from the intermediat kinds of Indicants, and the specifical from the lowest Species of them. We have already noted that the general Indicant is the very state of the Body considered in general, as it is frail and in motion; this state indicateth that health must be intended, which is the most general physical action, and the most general Indicate; yet this action is in some sort concrete, and equally includeth two general actions in the abstract, namely Conservation and Correction. For the general state aforesaid is also concrete, and comprehendeth two like Considerations in the abstract, namely, one of the parts yet qualified according to the prescript of Nature, which require a pure Conservation: The second of the parts somewhat degenerated from their integrity, which in like manner require a pure correction. These two actions are perpetually conjoined in every work of Art. For he that conserveth, withal correcteth, that is, he rectifieth some irregularities; and he which correcteth, hath at the same time conservation for the object of his Undertake. The complication of these actions is so subtle, that it seemeth to have posed that most acute Physician Argenterius, who in his Book Off. Med▪ affirmeth Conservation to be that very Correction, which is exercised in the art of maintaining health. But his Error is twofold. First, because he supposeth Correction and Conservation in 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to be one and the same action, when indeed they are two distinct actions, however they are complicated in the Exercises of Art. For they are indicated (as we said before) from the several Considerations of the Indicant, and Conservation hath respect to those things which are according to Nature; but Correction reflecteth upon preternatural faultiness. Moreover, They are perfected by instruments formally distinct, yea opposite: For Correction even in the very art of defending health, is accomplished by Contraries, but Conservation by Homogeneals; as in this Art we help Emptiness by taking Nourishment, contrary indeed to the Emptiness, but homogeneal to the Parts which are to be nourished: Therefore although these Actions be complicated in the Execution, yet indeed they are formally distinct, and ought distinctly to be entertained by the Understanding. The Second Error of Argenterius is, because he granteth the correction of Errors only to be the General Action of all Medicine, when as Conservation is equally universal and alike exercised in all the works of Art. No man doubteth but we conserve in the Hygienal part, and that we correct. Also Galen demonstrats in his Book, whether the matters of preserving health belong to a Physician. You will say, That Galen in that place doth prove every Medicinal Action to be correction, and that conservation is comprehended under the latitude of correction. But Galen must not be so understood, as if he intended correction to be a kind of conservation, seeing that (as we have showed before) conservation and correction even in this art of preserving health are actions formally different and differently distinguished: for Galen's meaning is, that every Medical action when it is actually administered, doth imply and comprehend correction, and in that respect may be called Correction, and so by consequence Correction will be the general Action of all Medicine; yet Galen confesseth Conservation to be equally general. For what hinders but there may be two general abstracted Actions in Physic? That doth not destroy, if any man have such conceptions, the unity of the Art, it rather indeed confirms it. For the unity of an Art consisteth in some community, which may be attributed to all the parts thereof; and this union is to be esteemed so much the more firm, as all the parts of art are reciprocally conjoined among themselves by more communities. If therefore there are two general Actions, and those common to all the parts of Medicine, so much the more firmly will those parts conspire the advancement of the Art. Wherefore he contradicts not Galen, that affirms conservation also to be a general Action of all Medicine; seeing that the scope of Galen was only to show the unity of the Medical art by the community of that general Action, namely Correction; now he might as easily have showed it, if the nature of the thing had required it, by the community of Conservation. For in the Hygienal part of the most noble circumstance is the Conservation of the whole concrete action, and thereupon the whole action is denominated from the more principal part, and the Art itself an Art conservative. Although otherwise (as hath been said) it also includes Correction. But in the Prophylactical part the principal scope of the Medical Action is preservation, namely the correction of the cause of the imminent Disease: yet this is so performed, and by such means which the present spirits can allow, but in no wise by such things as may destroy them. And therefore also in the Prophylactical part regard is had to the Spirits, and their conservation is Indicated. Now after the same manner the whole concrete Action (although as hath been said, it also includeth Conservation) is called Preservation and Precaution from the more Noble part. Finally, In the Therapeutical part, although in like manner the whole concrete action be called Curation, and the art itself a Curative Science from the principal part of the action, yet to speak properly and truly all this action of cure may be divided into three abstracted parts, and evidently distinct; namely, into the Cure of the cause, the Cure of the Disease, and the conservation of the Spirits. For the Vital or Conservative Indication doth evidently, and by the unanimous grant of all Physicians belong also to this part of Medicine, and must be consulted of in every curative action before it be undertaken. From whence it is manifest that this part likewise of Medicine doth perpetutually conserve, that is, provide and foresee in every Cure, lest the Spirits should receive more detriment than profit from the prescribed remedies. All these things therefore being thoroughly weighed, we conclude, That a general Indicate is a certain concrete thing, and may be properly distinguished into two general abstracted actions which are exercised in every part of Medicine, and that in the work of art they pertually make one complete or complicated action. Moreover, The general Indicant, namely the State of the Body, as frail and in motion may be divided, besides the parts or obstracted considerations already proposed, into three kinds, or rather three succeeding kinds equally and alike concrete: namely, into a sound state, a diseased state and a neutrality. These three Species are the subjects of the three kinds of Method to Practice; namely the sound state of the Hygienal part, the diseased state of the Therapeutical, and the Neutral of the Prophylactical part. These three states are also concrete Indicants, and respectively Indicate what is particularly to be done, or what the Physician's Duty is in all those Arts: namely a sound state indicateth the conservation of health; a diseased state the removal of some affect, and the Neutral state that the cause of an imminent malady ought to be corrected lest it break out into a Disease. Now these three indicateth are alike concrete, and each of them as we have proved above, abstractively includeth both Conservation and Correction. Finally, In a Diseased state the action of correcting is dissolved into two Species; into the correction of Caus, and the correction of the Disease, and so here may be discovered three kinds of abstracted actions. For a diseased state brancheth itself into three Species evidently abstracted, into the Essence of a Disease, the causes of a Disease, and the Spirits or those things which remain in this state according to Nature. For those things which are preternatural and indicate correction in general, are here separated (as hath been said) into two parts, namely into the Essence of a Disease, and the Causes of a Disease; and therefore there are three parts of this state, each of which do formally and distinctly Indicate. Three kinds therefore (that we may put an end to this matter) of Indications are to be considered in this state; namely, from the Essence of the Disease, the Curative; from the Causes the Preservative, and from the Spirits the Vital or Conservative. To the Causes we refer all impediments of cure, as also vehement Symptoms, and such as divert the Progress of the Cure to themselves, for in this respect they are invested with the Nature of Causes. And thus much of Indications in general. CHAP. XXV. Indications Curative. WE have already affirmed that these Indications are deduced from the Essence of the Disease, we shall therefore in this place slightly run over all the parts of the Essence of this Disease, that the Reader may perceive, what every one insinuates to be done. First, Therefore the Essence of this Disease partly consisteth in a cold and moist distemper, this Disease therefore in respect of this part of its Essence Indicateth, not only that all those things are to be avoided, which are in any wise endued with a faculty to cherish and augment that distemper; but also that the aid of such things ought to be implored, which may subdue the same; namely, hot and dry. Secondly, This Disease partly also consisteth in the want of inherent Spirits, therefore not only all those things are to be avoided, which can any further scatter, and consume the Spirits; but such things must be elected which are virtuous to restore, cherish, and multiply them. Strong discussing remedies are therefore in this case to be declined, because withal they consume the Spirits: in like manner such as are extremely hot, for they cause them to evaporate and vanish into air; but much more such as have power to dissolve the parts, as violent cathartics. But the best nourishment must be chosen, and Medicines that are easy of Concoction, as much as may be, and amicable and benign to the Spirits. Thirdly, The Essence of this Disease consisteth partly in a numbness or astonishment of the Spirits: this numbness insinuates a prohibition and abstinence from all such things as vehemently make thick and fix the Spirits or any other ways stupefy them, as narotical remidies, and many Minerals, which participate of the nature of Lead, as Cerus, lethargy, Sinople or Vermilion; and all such things as have power to excite the Spirits, to expel their stupefaction, and to render them active and agile, are to be made choice of, as exercises, motions, Frictions. Fourthly, The Tone being over soft, loose, flavid, and withered, indicateth an avoidance of such things as are wont to mollify, loosen and weaken the parts; and that such Medicines are to be outwardly applied and inwardly given, as may render them more firm and solid. The same Tone as it is internally too brittle brings a suspicion upon all such things as abound much with an inward slipperiness, and seemeth to desire some roughness, or indeed astriction in those things applied or taken. Fifthly, The corrupted Vital Constitution on the part of the Generation of the Vital Spirits is not so considerable; but on the part of the distribution of the Vital Spirits, the inequality thereof is of great importance, and indicateth a caution to be had of those things which promove the flux of the Blood towards the Head, as also of such things as retard the passage thereof to the first affected parts, but that choice must be made of such things as stir the Pulses of the Arteries in the parts first affected, and temper those that are in the Head. A slow and diminute current of the Blood through the first affected parts indicateth the same things, namely an evocation of the Pulls to those parts. But an over facile and slippery passage of the Blood through the habit of the parts, is coincident in its indication with the slipperiness of the Tone lately recited. A defect of the Vital Constitution on the part of the union sufficiently vigorous and pleasant between the Vital and the Natural Spirits, indicateth an election of such things as can both nourish and cherish the Spirits, and also excite them to a greater activity, and that their contraries ought to be avoided. The Vital heat, as deficient indicateth almost the same thing as a cold distemper, provided that regard be had withal to the strength of the Heart and Arteries, and to the vigour of the Vital Spirits. Sixthly, The unequal Nutrition Indicateth those things which promove the even and impartial distribution of the Aliment and Heat. Or indeed that which is too liberal to the parts that are nourished beyond a due measure; the extenuation of the parts requireth a fuller Nourishment. The irregular magnitude of the Head, chiefly things extenuant and such as are of the flux from the Head. The Tumours of the Bones indicate the same thing; the crookedness of the Bones require such things as attract the Aliment to the hollow side, as moderate rubbings; but things repressing chiefly on the gibbous and bunched side, as strong bindings. The bending of the Joints, insinuateth an Artificial erection of them, as much as is possible. The narrowness of the Breast pointeth to Pectorals, and such things as have a faculty to dilate the Breast; but the sharpness thereof indicateth such things as have a dilative Virtue. Sevently, The imperfect distribution of Animal Spirits, and somewhat defective in the first affected parts indicateth Cephalicals, and such things as facilitate the distribution, as exercises, rubbings, and the like. A defect of due stretching in the Nerves, or Nervous and Fibrous parts, indicateth those things as Corroborate the Nerves and strengthen the parts. Thus much of Indications Curative, the Preservative follow. CHAP. XXVI. Indications preservative. THese Indications are deduced either from the Antecedent or the present causes of a Disease. Those which flow from the former kind of causes concern the Prophylactical Part: here we only propound those which proceed from causes that are present and contained in the Body; namely, from common causes, or such as are proper to this Disease. Now although that common causes do not seem immediately to attain to the production of the Essence of a Disease; yet even in this respect that they are esteemed an impediment, and may retard the cure, they Indicate their taking away. These causes are either impurities, or excrementitious humours collected and impacted in the first passages, which unless they be taken away, do not only infect the nourishment inward, but they somewhat dull, or otherwise hinder the appropriate Medicines. They indicate therefore an evacuation either by a gentle vomit, or by a lenitive purgation, as occasion shall rather persuade to this or that: or they are common causes deeper imbited into the Parts of the Body, and these also require an evacuation. But seeing that according to this kind of common causes it is at the same time driven away and almost with the same Medicaments, as are the causes which are proper to this Disease, we shall conjoin both the kinds of them in this present consideration. The causes therefore which are proper to this Disease, as also the Common causes which have a deeper penetration into the Body, may be divided into Blood and Cacochymical humours. The Blood indeed, although it be rather deficient than redundant in the first Affected parts, yet in the Head for the most part it requires a particular evacuation, which usually is performed by scarification of the Veins in the hollow of the Ear. Hither likewise we may partly refer blisters raised between the first and second turning Joint of the Neck, although these perhaps may relate over and above in part to the Cacochymical humours. Cachochymical humours are divided into those which still flow in the channel of the Veins, and into those which are impacted in certain parts of the Body. The causes or humours flowing in the Veins do (primarily and intentionally) Indicate their evacuation. But if they be unapt for motion (as to the execution) than they require some previous preparation. But because it happens for the most part, that not all the humours are equally unapt, but that some are sufficiently flexible, and others not so, but resist the Medecines, in this case they indicate a less evacuation and then a preparation. Moreover, These humours in the channel of the Veins may be subdivided into Feverish (namely, if there be a putrid Fever) and not Feverish. The Feverish humours are either swelling, or not swelling. The swelling, that is, those which are unquiet, or impetuously agitated, do Indicate a sudden evacuation, at least a lesser, unless perhaps they are carried of their accord to the external and more ignoble parts, as it happens in the small Pox, the Meazels, and the like Affects. But if a Fever be present, and that acute, and yet the humours are not swelling, they chiefly Indicate that peculiar preparation which they call coction, that by this means they may be obedient to the Medicine to be aftergiven, and than evacution, but if the Fever not be acute but Chronical, although the matter be not irritated, and yet some part of it be sufficiently flexible; in this case, a lesser evacuation is first indicated at any time of the Disease, and afterwards the coction of the relics, that they also in their time may be evacuated. The humours contained in the Veins which are not Feverish, if they are fluxible, they first indicate evacuation: but because in this Affect slow, gross, and clammy humours are almost perpetually present, preparation (at least where a lesser evacuation hath gone before) is first Indicated; and indeed the viscous humours Indicate incident, and the thick attenuant remedies. Again, when the Disease is very Chronical and extended to many months; yea, perhaps to a year and upwards, it is not to be supposed that the whole matter causing the Disease can at once be prepared or evacuated; wherefore in this rerespect it Indicateth, that we insist upon things preparatory and evacuant by turns. Besides we must know that Choleric humours require one preparation and evacuation, and Melancholy humours another, phlegm another, and watery humours another. And that the preparation and purgation is Indicated variously according to the diversity of the humours commixed with the Blood. The humours that are impacted in certain parts of the Body do much more require preparation before they are evacuated; according to that of Hypocrates, When you would purge a Body, you must first make it fluxible. Neitherdoth a certain general purgation suffice to subdu thes humours, but such a preparation is required, that hath a peculiar reference to that part, in which they are inherent, and therefore the humours in the Liver require one kind of preparation, those in the Lungs another, etc. Finally, Seing that the propounded kinds of all humours, after they are evacuated, may grow and breed again; they Indicate an avoiding of such things which may dispose the Body to an easy generation of such humours: And thus much of Indications Preservative, it remaineth now that we consider the Vital and Conservative. CHAP. XXVII. Indications Conservative, or Vital. THis Indication ariseth from those things which are according to Nature. For Life in itself consisteth in these things; namely, in a triple Constitution of the Body, the Natural, Vital, and Animal above rehearsed. The Natural comprehendeth under it First, The Temperament. Secondly, The Inherent Spirits with their plenty and vigour. Thirdly, The Tone of the Parts. Fourthly, The Structure of the Organs. Fifthly, The Continuity. The Vital containeth First, The Generation Secondly, The Distribution of the Vital Spirits. Thirdly, Their participation with those parts, unto which they are distributed; namely, from the union of them with the said parts, and the communicated heat. The Animal comprehendeth First, The Generation Secondly, The Distribution of the Animal Spirits. Thirdly, The due Stretching of the Parts depending upon the Influx of the Brain. All these things because life consisteth in them, are called Vital Indications. But among Authors for the most part they are known by the common name of the Spirits, but this name is somewhat to gross, seeing that in propriety of speech, the Spirits are radicated in the said Constitutions, and are faculties of them. Yet we have no design to innovate the custom of speech, provided that the things may be understood as it is. These Indicants so long as they continue firm and sound, they require only a general and ordinary conservation by the right use of the six non-Natural things▪ but when they are all alike vitiated or obnoxious to imminent hurt, they require not only a general conservation, but such an one likewise, as is mixed with cure and preservation. Again, Where some one Constitution, or some one part thereof is depraved more than the rest or subject to such depravation, besides the general preservation, it requireth in like manner an especial one to be associated to the peculiar Curation. Lastly, When a Constitution Subject to error, or actually erroneous is fixed to some certain part, it doth higher specify that conservation; namely, that respect may be also had of the part so labouring more than the rest. But because some say, That the Vital Indication is the only, and that Conservation is the simple end, and that they cannot be further subdivided, because that all things, which are according to Nature are comprehended in the word Spirits, and that they Indicate one Action; namely, the preservation of themselves. We grant indeed that the Spirits, if (as we have already noted) they be improperly taken for their causes; namely, the three Constitutions aforesaid, may in one word comprehend all things which are according to Nature, but then this word must be Generical, and divisible into three species; namely, the three Constitutions, as Spirits Natural, Vital, and Animal. We grant also that the end, or that the Indicated action is one; namely, Conservation, but by the unity of the Genus, not of the ultimate species. For those very things which are according to Nature, however they agree in the Genus, yet in the species they may differ among themselves, and require a different conservation; yea, it is possible that those things which conserv the Spirits on one part may impugn them on the other; as for example: Wine given may in one respect cherish and strengthen the Vital Spirits, or rather the Vital Constitution, but in the interim it may offend and debilitate the Animal Spirits, or the Animal Constitution. In like manner the Temperament requireth one preservation, the Structure of the Organs another, and the Continuity another. Yea, the very different Constitution of the parts indicateth a various conservation, neither do we after one and the same manner or by the same actions provide for the special conservation of the Liver, Lungs, Brain, etc. Wherefore when some one Constitution is more infirm than another, or when some one part is weaker than another, it indicateth a proper conservation peculiar and special to itself, and therefore both Conservation and Conservants may be divided into their Species. For the Conservation & the Conservants appropriated to the Animal constitution, differ from those which are destinated to the Vital or Natural: And from hence the three first kinds of Conservation are to be deducted, namely, the Conservation of the Animal, the Vital, and the Natural constitution. In like manner the Conservation of the Liver is accomplished by the use of the Hepaticals, and of the Lungs by Pectorals, etc. Yea, all parts of an eminent diversity do subdivide the conservation into so many more species. Thus much of the division of Conservation into its species. Moreover, The same Conservation seemeth to be further divisible unto its parts. For this Conservation is somewhat complicated, and doth not only relate to simples, but in some sort to contraries, to wit, indicateth both Curative and Preservative, and either permitteth or disalloweth those same things being estimated with the Spirits. It seemeth therefore to be branched into three parts, into an election of like matters, into an election of contraries under a certain condition, and into a prohibition of the same under a divers condition. The election of like things is the most appropriated Action to Conservation, and seems withal to have reference to two kinds of things alike; namely, such as are easily assimilated, and are properly nourishments, and such which although they cannot be assimilated in respect of their substance, yet they contain within the same qualities like unto the constitution of certain parts, in respect whereof they are reputed amicable and familiar to Nature, and do cherish and strengthen certain parts. You will say, These are indeed Alterants and do belong to the kind of contraries. We answer, That in a divers respect they may be referred to each kind, but in as much as they obtain qualities like unto the du Nature of the parts, although otherwise they alter some small matter, yet they are to be referred to the similaries. For the very nourishments do in some degree alter, and are directly contrary to emptiness, and conservation itself doth implicitly include a certain correction, as we have showed above. Now these indeed in regard of a middle nature, which they have between similaries and Alterants, are not called Medicaments, but Strengthens, Conservants, and Cordials; Again, these are Indicated as Conservants by the peculiar debility of the Spirits, and as to be elected, and not only permitted, and so they are esteemed in the Books of Practical Authors. The Permission of a remedy somewhat contrary to Nature doth likewise belong to this Indication. For such is the dignity and valu of this Indication, as it summons both the Curative and Preservative indicateth to an examination before they are reduced into practice, and doth not only moderate and limit the quality and quantity of the remedy, but also the very time of repeating it, yea, whatsoever appertaineth to the use thereof, or the manner of using it, and all this least in any wise it should exceed the Spirits of the Patient, or be injurious to them: nor is the excellency of it thus circumscribed, but it requireth more; namely, that more profit and advantage may accrue to the things, according to Nature by impugnation of the Disease, then hurt or detriment by any violence offered to Nature. And under this Law and Condition. Vital Indication permitteth many things to be done, which of themselves are contrary to the Spirits, yet always in favour of health, never to the prejudice of Life. A prohibition of a contrary is altogether a commanding Action of this Indication, and by a kind of Authority dictates this or that thing not to be done, (although it were otherwise Indicated) because perhaps it endangers life itself, or brings more disadvantage than benefit of health to the parts. And this is the third and last force and use of this Indication. We shall now in one word apply these things to the present Disease. All Constitutions in this Affect are very weak and infirm; and this is manifest from the bare consideration of this tender age. But the Natural doth yet further suffer by the force of the first Essence of the Disease; and from hence also the Vital is somewhat weakened, and indeed neither doth the Animal escape wholly free, as was showed above. Wherefore both a general and also a particular regard must be had to these Constitutions, as well in the Election of Similaries, as in the permission or prohibition of contraries. First, Therefore in this Affect you must make choice of the best nourishments, such as are easy of concoction, and as near as you can agreeable to the custom and age of the Patient, to the time of the year, etc. the contraries must be abandoned, namely, such things as nourish little, are difficult of digestion, and incongruous to the custom, age, and season. Secondly, Those things must be chosen which cherish and strengthen the weaker Constitutions, and the parts that are most Affected, and these must be either exhibited severally, or they must be mingled with nourishments or Medicines; but such things as are neither serviceable to this scope, nor otherwise Indicated, must be totally avoided. Thirdly, Benign and gentle evacuants, or othertherwise sufficiently corrected, must be allowed in a moderate quantity, just and du interval of time being observed. But the contrary things; namely, violent and fierce purgers, especially such as are apt to dissolve the parts, or are exhibited in an undu quantity, or too often repeated, are forbidden. Fourthly, Remedies alterant, or such as prepare the humours, or correct the Disease must be permitted; such also as are friendly and familiar to Nature, or such as may be made such by good company, that is, by composition or sufficient correction. Remedies violently alterant, extreme hot, and vehemently discutient, or any other which in any wise resolve and dissipate the parts. CHAP. XXVIII. The use and right administrations of the Indications aforesaid. HAving propounded the three kinds of simple Indications, and deduced them into their lowest species, we shall in the next place consider the right use & administration of them. The exact knowledge whereof seems impossible to be obtained without road and experience. For it descendeth unto Individuals, and comprehends not only the Election of a thing among so many indicateth simply to be done in the Species, but also the invention of quantity, place, form, time, order, and matter of the remedy to be exhibited. The Consent and Dissent of Indications do contribute much to this invention. Now the Consent may be twofold: 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 granted without hurt; must never be allowed without the greatest circumspection, and so much the greater, as the damage may be the more to him that permitteth. For although the Permittent may part with somewhat of his private right to advance the public good, yet in respect that he is a member of the whole he is supposed to be a gainer. The Dissent of Indicants is twofold; namely, 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 which in this respect we must always yield obedience. The Contrary is called Contra-indication, and this doth not simply forbid, but so far forth as it undergoeth the Nature of an impediment, or some more urgent Indicate. First, Where Indicants consent, either by Coindication or Permission, satisfaction if it be feasible must be given to all the indicateth: 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, than you must institute an apt composition of divers simples one with another. The Essential parts of this Disease, although they are very various, yet is there not any considerable disagreement among them, and nothing hindereth but in a great part they may be considered together. For Medicines temperately hot and dry, may at once cherish the Inherent Spirits, and perhaps conduce to the scattering of the numbness in them, and withal somewhat 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 vigour in the Vital and Animal Spirits, proritate the Arteries in the first affected parts, and strengthen the Nervs: unto which Heads almost all the indicateth of the Essence of a Disease may not unaptly be referred. Moreover, the Spirits also, although they prohibit all extreme hot things, yet they allow of these as monderat, and very congruous to Nature. In like manner there is little or no particular repugnance between these causes and the indicateth, albeit in respect of time and the order of administration some dissent may be observed, as we shall see afterwards in due place. Wherefore in what respect and how far these agree together whilst we intent a cure, we do at once respect not only the Spirits, but in some 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 employed either in preservation, or in the rooting out of causes, we make choice of such evacuants, or else we compound them with such remedies, as are also partly contrary to the Disease. 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 requisite in the Species, in the next place we shall inquire out their du circumstances. 1. In regard that this is a great Disease it requireth a great quantity of the Remedy, in respect of itself. For a Remedy unequal to the Disease cannot extirpate it. It is necessary therefore that the dose of the Medicine be equally to the magnitude of the Affect. But in this Disease the Spirits permit not so great a quantity of Remedies to be given at once. Wherefore that quantity must be divided & given by turns. For this is a Chronical Disease, and of slow motion, neither doth it necessarily require an hasty Cure, and although the Spirits cannot well endure either vehement Remedies or such as are given in a large dose, yet they permit the use of Evacuant Medicines by an Epicrasis. Wherefore by turns, we must sometimes make use of Remedies Preparatory, sometimes Evacuant, sometimes Alterant, and sometimes strengthing. Secondly, For so much as belongeth to the place of administration, the general Rule is, that the remedy ought to arrive at the seat, and penetrate to the very Cause of the Disease. If therefore 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 injected by the Fundament. If the humours be naturally ready to move upwards, expel them by vomit; if downwards evacuat them by siege. In like manner you must humour the inclination of Nature, and root out the causes by spitting, by Urinal, or by sweeting. Particular evacuations must be instituted in the very affected parts, or in the parts adjacent. For so the force of the Remedy doth the more surely make way to the seat of the Disease 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 some parts, in which case the remedies are frequently administered to the part, wherewith that consent intercedeth, and neither to the affected nor the adjacent part. Thirdly, The form of the Medicament doth partly depend upon the Rule last propounded. For if the scope be to lenify the Jaws or the Windpipe, we choose a licking 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 Pills, Powders or Electuaries, that they may the longer abide in the Stomach. To the Kidneys 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 some part depend upon the very nature of the Disease, as in burning Fevers liquid 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 Powder; in like manner bitter things, such as beget a vomiting, and stinking things are concealed in the form of Pills; sometimes also they are guilded, or else they are enwrapped 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 easy 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 loath to take Physic, that form is to be preferred before the rest, which shall be observed to be least distasteful to them. Fourthly, As for the time of action, you must so endeavour 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 stomach; 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. Strengthening and astringent Medicines, and such as provoke sleep, are to be taken rather in the evening than in the morning; but perhaps some of these are most agreeable after meals. Medicines that are mingled with the nourishment, aught to be gratful to the palate, lest they subvert the stomach and hinder concoction, or cause a loathing of the meat, or else empair the Spirits. As for the order of proceeding, there occur two general Rules. The former is, That that must first be done, which being premised makes way for the following Remedies, and therefore 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 some impediment intervene. If the Question therefore be, Whether the Disease, or the Caus of the Disease doth first require the help of Physic? The answer will 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 Disease; for they cherish it, and infringe the virtue▪ of the Medicines. Wherefore, before that we are intent upon the vanquishing of the Disease, we premise all possible endeavours 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 Disease. Yet in the interim whilst we are busy in the removal of the Causes, the Essence of the Disease 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 overcome and cast out) the more diligently and earnestly attempt the resisting of the affect; yet with this condition, That if the Causes revert and become new impediments, that then we are obliged presently to undertake the subduing and evacuation of them: so that in this Chronical Affect, sometimes the Causes, sometimes the Disease must be resisted by turns: and the Spirits do better undergo this change of action, than if we should continually make our battery against the Causes, till they were absolutely rooted out. Moreover, When the Causes of the Disease in this Affect are unapt for motion by reason of their toughness, grossness, and perhaps setledness; they must first be freed from this impediment and prepared before they are evacuated. For according to the Rule of the great Dictator, Quae movenda sunt, fluida prius facere oportet. In like manner, that thickness, toughness and setledness of matter, if it be present, indicate Remedies attenuant, incident and opening. But these things are not safely taken the impurities still flowing back▪ into the first Passages, for then perhaps they are carried along with the Medicines into the Veins, and more defile the Blood, or at least hinder the efficacy of the Remedies. These therefore 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 surrogated 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 impacted. Wherefore 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 relieve the more urgent and weighty Indicant first, unless there be an interruption of some impediment. That is termed an urgent Indicant which threateneth the most danger. Now every such Indicant is supposed to induce great afflictions into the Body, and not without manifest danger to waste the Spirits. Therefore in this respect, we must sometimes first help the Disease, the Caus being neglected: Sometimes also we must neglect both the Disease and the Causes, and address our endeavours to the pacification of the Symptoms, as in a vehement Flux of the Belly, long Watchings, profuse and immoderate Sweeting, and the like. But even in these cases, we must have a prudent regard both to the Disease and the Causes, and when the urgent Symptom is corrected, or the violence of the Disease repressed, than 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 Indications, there is required an exact and accurate knowledge of the Medical Matter whereof we shall discourse in the subsequent Chapters. CHAP. XXIX. The Medical Matter answering to the Indications proposed, and first the Chyrurgical. 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 absolutely excluded. It is vulgarly and not unaptly distributed into 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 shall see anon) shall be extended to many more, namely of Cuppinglasses, Leeches, Blisters, Ligatures, and Swathing-bands: But the opening of a Vein the Spirits cannot brook, as every one knows, who but observes the frailty of the age, the extenuation of the habit of the parts, and the smallness of the Veins. The Scarification of the Ears shall lead our discourse. The Empirics who undertake the cure of this Disease, make more of it than one would imagine. For in their practice they celerate it with great vaporing, and without it scarce hope for a happy cure. But we, although we disallow not this kind of remedy, have seen many Children successfully recovered without the use thereof. 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 endure this remedy, and obtain most profit by the use of it, which are of a Sanguine complexion and well habited, and who are affected with an Alogotrophy, rather than an Atrophy or a Consumption, or any other remarkable 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 Penknife, 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 whole circumference. No man hitherto as we know have attempted the Scarification of the hinder side of the Ear, although indeed it is not easy to give a reason, why it should conduce less being administered 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 Chirurgeon Fubricius Hildanus hath written in his Observe. 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 supposed, Scarification in the hollow of the Ear may very conveniently both free that Nerve from any kind of oppression, and likewise shake off the numbness, and give it vigour. For the hollow of the Ear is the next place unto it which we can come at with an instrument. Wherefore evacuation being here made may immediately drive away the matter which commonly oppresseth the very beginning of that Nerve, and withal causing pain and increasing the heat, and may drive out all stupidness from within it, and ad vigour unto it. If this Nerve therefore (as that famous Chirurgeon affirmeth) or a part thereof 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 obstruction, thus excited and having gotten vigour, may likewise in some manner excite the Marrow of the Back itself, and all the Nerves from thence arising, which by that opinion it doth accompany to the very end of the Body, and imprint some vigour in them. Wherefore Scarification being made in that place must needs be of greater efficacy, 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 Physicians 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 vigour of the Nerve of the Fifth Pair. But omitting this Conjecture we will propound some other Considerations, in respect whereof this Scarification 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 fullness. Secondly, By the very evacuation of the Blood we somewhat correct the thickness and toughness thereof, and by consequence we promove the more equal distribution of it, and a more regular and equal 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 performeth 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 busy about when they administer this Scarification; whilst they fasten the Blood of the right Ear sucked up into Wool to the left Hypochondry, and the Blood of the left to the right. Thus much of Scarification. Issues in this Disease 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 against the Hydrocephalus, both Curative and Preservative, and very much conduceth to lessen the unusual magnitude of the Head, and to evacuate the superfluous watriness thereof. And lastly, to repress the inordinate 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 astonishment. Now because this kind of remedy is properly a little Ulcer▪ and causeth some small pain to the Child that hath it, and bringeth daily some trouble to the Nurse, it ought not to be prescribed, unless the greatness of the Disease be such that we despair to conquer it by other remedies without the concurrence of this. This little Fountain must be made between the Second and Third turning Joint 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, because all Caustics are advers to the Nature of an Infant, insinuating some venomous quality, and at least do too much dissipate the Spirits, and weaken the parts. Therefore we allow rather of an Issue made by Simple incision with a sharp Penknife. Some make use of Iron tongues contrived for this purpose, wherewith they take hold of the Skin, the place of incision being first marked with ink, and by a moderate compression they dull the since of the part, and then they thrust in the Penknife 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 Plaster: upon this they wrap a Paper or a linen clothe 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 examine some other kind of Chyrurgical Operations. And first Leeches offer themselves. Truly we have not yet sufficiently tried how beneficial the application of them may be in this Affect. But if we consult Reason, 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 sucking they would easily cause 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 ministered 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 troublesomeness of the administration. Cuppin Glasses without Scarification, as we began to say, seem not refusable either by the Spirits, or the Disease, or the causes of the Disease. But these are very little effectual, and we leave it to be prepended, whether the profit arising from the use of them, whatsoever it be, can recompense the trouble of the application. Nevertheless it may happen by reason of the complication of some other Disease, that the use of them may be of some moment, as in a Pleurisy, a Frenzy, and where some dangerous Flux is imminent against some principal part; in which case, those perhaps that are adhibited with Scarification, may be admitted in great and strong Children. But than you must apply them to the turning Joints of the Neck, the Shoulders, the Haunches, to the inner parts of the Thighs, to the sols of the Feet, and to other places as the peculiar complicated affect shall require. In the mean time it must be noted, that in an age so tender, you must make use of very small Cuppinglasses, and that they must be applied with a less flame than they are wont to be in others of man's estate, and that the scarification, if at all it be admitted, must be done with a gentle hand. Thirdly, As for Blisters, although hitherto we have not had sufficient trial of them, and although we banish from this Disease both septical applications, because they dissolve the parts, and also caustical, because they penetrate deeper and produce a crusted substance, yet we conjecture that those Pyrotical remedies which only raise Blisters in the Skin may be sometimes profitably admitted. You will say that Cantharideses wherewith they are commonly made are extreme hot, and besides suspected to be of a venomous quality. We answer, That we may not here insert any thing of the qualities of Cantharideses, we grant that which is asserted. But because they are administered only to the outward little Skin, and only to a little part thereof not much extended, and because as soon as the blisters are raised they are removed, the excess of their heat and their poison scarce penetrates deeper into the Body, than the bottom of the Epidermis, and therefore this remedy may be applied without any notable harm or danger. But than 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; all which things are of no small moment in the cure of this Disease. 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 Fever, and grown almost frantic. Hereupon the Child found present and manifest eas, and after a few days was delivered from his Fever. Afterwards having purged him twice or thrice with an infusion of Rhubarb, etc. Beyond the expectation 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 all inconveniences. For it is unpleasing, full of pain and molestation to Children: Moreover, for a time it interrupteth their exercise and pastime, in respect of which things, unless perhaps some other complicated affect do point at an interdiction of exercise, it may do much more prejudice than advantage. Again, the force of it suddenly wasteth, and afterwards by degrees is consumed, which doth not in all respects keep touch with a Chronical Disease. Finally, an Issu which is proper to Chronical Diseases, may very well supply its place in this affect. Wherefore we scarce admit the application of blisters in the cure of this malady, unless some acute Disease be complicated, which may require this kind of Remedy, as it falls out in the Cause propounded. Now where this administration is requisite, it is most commodiously performed upon the turning Joints of the Neck, unless some 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 Disease. Fourthly, Ligatures also may be referred to this Title, and indeed we grant, that sometimes they are not altogether unuseful in this affect; namely, if they be very moderate, and adhibited by just distances, and unto convenient places; but you must beware that they hinder not the growth of that part, whereunto they are applied; which is done if they be sufficiently loose, and made of soft wool, if in the Day time, or for some part of the Day they are tied 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 fastened 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 applied. Fifthly, Hitherto also belong the Fasciation or swathing of certain parts, for this hath an affinity with Ligatures. For some use to enwrap the weak parts in woollen blankets, thereby to strengthen them, and to cherish their heat; namely, the Feet, the Legs, the Knees, and the adjacent parts of the Thighs. But you must be careful that the overstraightness of them hinder not their growth. F C B A C D D G A B C D A B Two Iron rings. C D The Diameter of the Joints of the Splents. F G The two Splents. Instead of the Splents you may more commodiously use thin plates of Iron, and the whole Instrument may be made of Iron. The two Axel trees or Diameters C D upon which the Shingles or Splents are bended F G be fastened with two rings or hoops. But the hoops themselves A B C are made of plates of Iron of an exquisite thinness, that they may not be burdensome, and withal they ought to be well smoothed, and polished that they hinder not the motion of the Splents. These rings must be of an equal Latitude, suppose about two fingers a cross, and they must be so fitted together, that on every side they may be parallels; only let there be so much distance between them, that they may fitly receive the tops of the Splents. Moreover, Those hoops must not only be coupled with a double Axel C and D, but also with five small Iron Nails. Lastly, The whole composition of the Instrument 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 ordinary bending of it, but let it restrain the deflexion of it to either side, especially to the part sticking out. Which is the cause why the Axels are fastened with a double Hoop, namely lest the Joints should be loose, 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, than 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 strait, they use to make Breastplates of Whale-bone put into two woollen clothes and Sewed together, which they so fit to the Bodies of the Children, that they may keep the Backbone upright, repress the sticking out of the Bones, and defend the crookedness of them from a further compression. But you must be careful that they be not troublesome to the Children that wear them, and therefore the best way is to fasten them to the Spine of the Back with a handsome string fitted to that use. CHAP. XXX. Of the Pharmacentical matter, and first of such things as cleanse the first Passages. THis matter is of manifold and most noble use, and satisfieth very many Indications. For it comprehendeth all Medicaments, those only accepted which concern the Chirurgeon, which have a primary relation either to the causes of the Disease, or the Disease itself, or the Symptoms. It is divided into remedies Internal or External, and each of them into Simple and Compound. Again the Internal may be subdivided into such as clens the first passagsses, as Medicines Preparatory. Into Electively evacuant, and such as are Specifically alterant and Evacuant, and finally into those that correct the Symptoms. Among these the Internal obtain the precedency, and of those again such as wash away the impurities of the first passages, because these (as hath been already observed) are justly accounted an impediment in respect of the following remedies, and simply ought first to be removed. But in all the Titles (as far as the Nature of the thing will licens or warrant us) we will place the Simple before the Compound. Moreover, these washing remedies comprehend these three kinds, namely, Clysters, Vomits, and Lenitive Purgations. The use of Clysters, and some forms of them. The Injection of Clyster-pipes, before we more exactly and earnestly attempt the Cure, is then chiefly pre-required, when the Belly is costive, and the Excrements are hardened; or when some windy humours torment the Guts, or some vehement pain in the Bowels afflict the Patient. In which cases they may not only be injected before any preparation, but also before a Vomit, yea or a Lenitive Purgation. These are frequently compounded of benign and gentle Purgers, sometimes also of such as have only a faculty to make the ways slippery, and to expel wind, but never of Cathartical ingredients that are violent they are to be injected warm or lukewarm, and after a long abstinence from meat. We shall present some forms. Take Cow's new-Milk, warmed, four or five ounces; Anis Seeds beaten to Powder ten grains; Cours Sugar, one ounce, one ounce and an half, or two ounces; The Yolk of one Egg: mingle them and make a Clyster; to these may be added half an ounce of new Butter. Take a sufficient quantity of an emollient Decoction. An Electuary lenitive half an ounce; Syrup of Roses Solutive, and Syrup of Violets, of each six drachms; Oil of Chamomel one ounce; mingle them, make your Clyster and let it be injected lukewarm. Take the Roots of Marsh Mallows beaten together, half an ounce, or in lieu thereof, the leaves or Flowers of Mallows half a handful; Flowers of Chamomel one pugil; Hemp Seeds two drachms: boil them in a sufficient quantity of Whey mingled with Beer: To four or five ounces of the Decoction ad of Diacassia, or Electuarium Passulatum half an ounce, Syrup of Roses Solutive, and Kitchen Sugar, of each one ounce; new Butter six drachms, you may if you see occasion add the yolk of one Egg. Take Stone-Horsdung that is new, one ounce and an half; The Seeds of Annis, Fennel, Mallows, beaten together, of each one drachm and an half; Flowers of Chamomel one pugil. Boyl them in a sufficient quantity of posset drink: In four or five ounces of the Decoction, dissolve ten drachms of Syrup of Violets, common Sugar, and Oil of Roses, of each half an ounce: Mingle them and make your Clyster. The use of vomiting remedies, and some examples of them. Emedical Remedies or Vomits, do chiefly perform three things. First they evacuate crude or corrupt humours and all manner of impurities contained in the Stomach, and that by a shorter and more expedite way, than if they were conveyed through the involutions and labyrinths of the Guts. Secondly, By an agitation and commotion raised in all the parts, especially the Bowels, they loosen the gross and viscous humours adhering unto them, or impacted in them, and frequently expel them, especially those which are collected in the Stomach and Guts; in which respect they are profitable against torments of the Colic and very conducible to unlock Obstructions. Thirdly, They most effectually irritate the expulsive faculty of all the parts of the Body, and especially of the Bowels, and by this means many times upon a single application they compel forth the hidden and unappearing causes and fomentations of Diseases, and especially of intermitting Fevers. For by the very straining to vomit, the Guts are also instimulated to cast out by siege. The Liver poureth away the Choler by the Biliary Poor; the sweetbread voideth his peculiar excrement by the new Vessel into the Guts; the Spleen also perhaps unburdens in a plentiful manner his excrement into the Stomach by Vessels not yet throughly known: The Kidneys exern through the Ureters, the Lungs by a strong Cough eject their Phlegm through the Windpipe: The Brain emptieth itself of salt, waterish Rheums, and matter by the Palate, the Nostrils and the Eyes. Finally the whole Body for the most part is rendered more prone to a Diaphoresis either by a manifest sweeting, or else by an occult and insensible Transpiration. In the mean time it must be noted that not all gentle Vomits, nor indeed the more vehement, if they be given in too small a dose will presently and fully perform all these things, yet in their operations they effect more or less according to the strength or quantity of the Medicine, and indeed if the stronger be administered in a full dose they effectually attain to the three marks propounded. It is obvious, by what hath been said, to the consideration of any Reader, that strong Vomits prescribed in a full quantity are not compatible to Children affected with this Disease, neither can their tender strength overcome and subdue so great tumults in the Body, and such an Universal evacuation so suddenly wrought, Wherefore this kind of remedy ought not to be prescribed to Children without diligent precaution and circumspection, and both the strength, quantity, and efficacy of the Medicine are duly to be prepondred. To this end therefore we shall set down some Cautious in favour of unexperienced Practisers. First, A Vomit is not to be provoked in this Disease, unless the humours tend upwards of their own accord, but then indeed they may be expelled by vomiting remedies without difficulty. Seeondly, Not unless Children are naturally or customarily apt to vomit, and do easily endure it. Thirdly, In Bloud-spitting, the Ptisick and Consumption, in any flowing of Blood at the Nose, or any internal opening of the Veins, and the like cases, abstinence must he enjoined from this remedy. Fourthly, Vehement vomits exhibited in a larger dose are here forbidden. For the fear is just and prudent that they may depopulate the Natural Spirits, and further consume the very solid parts which before were overmuch extenuated. It is necessary therefore that the Vomits here prescribed, be either in their own nature gentle, or corrected if they be vehement and administered in a lessened dose. You will say, If they be of a mild and lenitive faculty, or exhibited in a diminute quantity, they cannot compel the humours with any efficacy. To this we answer, Indeed where Nature contributeth little or no assistance, it cannot be denied; but in such cases we totally prohibit the administration of vomiting remedies; but presupposing both a fitness of the Body and Humours to this evacuation (as is required in the first and second Caution) even gentle vomits may expel such humours as are seated in the first passages. The thing must be said of the strong being prudently corrected and sparingly applied. For by reason of the correction and diminute quantity they do not much shake and discompose the Body, or provoke Nature; and again, through the proclivity of the Stomach and Humours they are sufficient to reward this Scope with a laudable success. We will now subjoin some few Examples. Take the tops of Groundsel half an handful, Raisins one ounce; boil them in a pound of Ale to the consumption of one half. To three ounces of Colature, ad half an ounce of Syr. Acetoes. simple. Mingle them & drink them lukewarm. Or Take the Infusion of Crocus-metallorum in Spanish Wine, made in a cold place and well purified, by subsidence one dram, a dram and an half, or two drams (according to the age and strength of the sick) half a dram of Syr. Acetoes. simp. Posset-drink an ounce and an half. Cinnamon Water ten drops: or instead thereof if there be any fear of Convulsions, one scruple of Aq. Antepilept. Lang. Mingle them and drink it warm. Take the Juice of the Leaves of Asarabacca half a dram, two scruples or a dram. Syrup. Acetoes. simp. two drams. Mingle them with a sufficient quantity of Posset-drink. Take Salt of Vitriol from five to ten grains, Give it in Posset drink. Lenitive cathartics. These Evacuant Medicines produce their Effects without tumult, and therefore they requir not so great circumspection as Vomiting Compositions, or such as are electively Purgant. Yet three things must be considered in the Use of them. 1. That they do not nausiat the Ventricle with such an ingrateful taste and favour as may render an abhorrence from all future Medicaments. 2. That they oppress not the Stomach by an immoderate quantity. 3. That the potion drunk be not presently vomited up. To prevent this last danger it will be a good way presently to bedew and moisten the Mouth with some pleasant and agreeable Liquor, or with candid Cherries, or preserved Barberries 3 or to temper the juice of Oranges, or the like. These Lenitives may be divided into Simple & Compound: and these again into such as are sold in the Shops, and such as are newly made and accommodated to the present scope of the Physician. There are found very few Simples that of themselves will satisfy this scope; as Manna, Cassia fistula, Aloe soccatrina, Tamarinds, Polypodium of the Oak. But very ineffectually, unless they be compounded with other Purgative Ingredients (more follow) as Jujubes, Sebestens, sweet Prunes and Damascens, Figs, Dates, the Pap or Pulp of roasted Apples, the Flowers of Mallows, Violets, Pellatory of the wall, Mercury, the Roots of Marshmallous, Liquoris, the four greater cold Seeds, the Seeds of Mallows, sweet Almonds, rare Eggs, Fatty substances, Butter, Oil of Olives, Oil of Almonds, Whey, and the like. These although of themselves they are of small efficacy, yet by the commixture of other cathartics they require a gentle purgative quality, not to be contemned. The Lenitive compound cathartics which are sold in Shops, are these: Cassia extracted with, or without Senna, Diacassia, Electuarium Lenitivum, Diaprunum lenitivum, Electuarium passulatum, A common Decoction for a Medicine, A Decoction of Flowers & Fruits, Syrup and Honey of Violets, Syrup of Roses solutive, Honey of Mercury, Honey of Raisins, Conserve of damask Roses, Of the Flowers of Mallows, of Violets. To these may be subjoined some extempore forms. As Take of the best Portuguese Manna six drams, Cremor of Tartar seven grains, Posset-Ale in which a few Aniseeds have been boiled an ounce and an half. Mingle and give them in the morning. Take of Polypodium of the Oak two ounces, White Tartar prepared two drams, sweet Apples twelve handfuls, Raisins of the Sun stoned one ounce: Boyl them in a sufficient quantity of Water to a pound. In the Decoction infuse all night long Choice Senna an ounce and an half, Rhubarb two drams, Pulp of Cassia new drawn half an ounce, Tamarinds an ounce, Liquoris, the Seeds of Annis and Coriander of each a dram and an half: The next morning strain it through a linen Cloth, and to eight ounces of the Decoction ad White Sugar six ounces; Boyl it a little; and when you have done so, ad to it Manna dissolved in Syrup of Roses, of each two ounces; Syrup of Violets one ounce: Make of them a Lenitive Syrup. Let the diseased Child take an ounce either in Succory Water, or Water of Pellitory of the wall, with a dram of the Juice of Lemmons. Take of Lenitive Electuary one dram and an half, or two drams; Syrup of Roses solutive two drams and an half; Cremor of Tartar ten grains; Posset-ale a sufficient quantity▪ Mingle and administer them early in the morning. Take of Aloes washed, or Aromatical Pills seven grains; Make two Pills with Syrup of Roses solutive, put them into two Candid Cherries the skius being pulled off, and let them be swallowed whole lest the taste be offensive, about sleeping time in the evening. In the morning give to drink after them, one ounce of Syrup of Roses solutive in Posset Ale. Or Take of Syrup of Roses solutive six drams; Violets half an ounce; Juice of Lemons one dram; Electuarium Passulatum one dram: Mingle them with Succory or Pellitory Water, and give them in the morning fasting. Thus much of those Medicines as clear the first passages. CHAP. XXXI. Remedies Preparatory, and their Use. THese Remedies partly relate to the preparation of the Humours, partly to the ways thorough which they are to be expelled, and partly to the passages themselves, wherein they are contained. Now it must be known, That the Evacuation which is perfected by Vomits, doth least of any pre-requir any preparation; but that which is accomplished by cathartics or Medicines Purging, doth most of all exact it. First, The Humours in general to be prepared are either Phlegmatic, namely cold, which must be qualified and tempered with hot, thick, and must be attenuated; viscous, and must be cut and opened; or Choleric, namely sharp, bitter, burning, corrosive, which are to be mitigated with lenifying and aswaging Medicines; or Melancholy, namely earthy, feculent, tartarous, which by a benignity of application must be rendered fluxible; or lastly serous and waterish, which must be disposed and as it were manuducted either to the Urinary passages, as by pissing, or to the Belly as by siege, or to the parts near the Skin that they may with the more facility evaporate by Sweeting. Secondly, The ways, thorough which the Evacuation must be effected, aught also to be made fit and prepared, and not only the common, but also the special, by which the peccant matter in particular is conveyed to those common Channels. For there is one preparation of the Vessels of the Kidneys (which is chiefly expedited by Medicines of a slippery and loosning faculty) another of the Vessels of the Liver, which is done by opening, cleansing, and somewhat astringent Medicaments: A third of the Vessels of the Lungs, which is most successfully wrought by Lenient and Maturant Remedies, sometimes perhaps according to the nature of the matter Medicines incident or atenuant being administered, or on the contrary, Administrations making thick, and such as have a virtue to arrest and avert the flux. Thirdly, Those parts wherein the vicious humours principally flow or are lodged, require the admixture of Medicaments peculiarly apropriated unto them. And as this or that part is more or less affected, sometimes choice must be made of Cephalicals, sometimes Hepaticals, and sometimes Pectoral Preparations. Moreover, (that we may comprehend together most if not all of the qualities of Preparatory Remedies required in this Affect) we say, That these Remedies prescribed by Art ought to be moderately hot (unless there be a Fever present) also attenuant, incident and opening; in like manner, that by a peculiar right they must have respect to the Liver, the Lungs and the Head, which parts for the most part are commonly in this Affect oppressed with a plenitude of humours: Again, That there are some things specifically apropriated to this Affect▪ and if such things are not in Readiness which are registered in the number of things preparatory, and dedicated to the Disease, than at least other specificals ought to be mingled with the Preparatory Medicines. These things being premised, we judged it expedient to set down such Simple and Compound Medicines as are usually sold in the Shops, and also some examples of decompounded Preparatory Remedies. Yet we forbid the expectation of all Simples, or perhaps of any one, that should comprehend all the qualities, which even now we attributed to those exquisite and apropriate Remedies; for then there would be no need of any Composition, and we shall reckon up such and so many that a prudent Physician may select and contemper them among themselves, which being discreetly intermingled they may be correspondent to all the fore recited qualities. The Simples and Compounds prepared in the Shops in readiness are these. All the Capillary Herbs, especially Tricumanes, Rhue of the Wall. Spica Roots of Os●●●ed royal; the Buds of the male Fernbrake newly sprung up, Polipodium of the wall; Hartstongue, Liverword, Ce●●●ach, Agrimony, Doddar, Scabious, Betony▪ the Leaves and Bark of Tamarisk, the Bark of the Root of the Caper tree; the Roots of Succory, Endive, Grass, Sparagus, Myrobalans; Liquoris, Raisins, Primes, Damsens; the Seeds of Annis, sweet Fennel▪ Coriander, Caraway, Dill; Syrup of Maidenhair, and Botany, Simple and Compound, Syrupus Bizantinus, Syrup of Succery, Eupatory the five Roots, S●aechadis, and Horstongue. Out of these according to present Emergencies divers others may be Decompounded. As take the little Buds or Gems of the Roots of the male Fernbrake five in number; boil them in half a pound of Milk to three ounes; let him drink the Decoction in a morning upon an empty Stomach. This is most agreeable to young Children that are tied to Milk. Or, Take of the Buds of male Fernbrake newly budded out of the Earth, one handful; male Betony, Hartstongue, Liverwort, of each half an handful; Flowers of Tamaris one pugil; Raisins one ounce and an half; One Chicken the Guts pulled out, and with a sufficient quantity of Oatmeal, make your Broth according to art. Let the Child take three or four ounces in the morning, and at four of the Clock in the afternoon, adding (if you pleas) ten grains of the Cremor of Tartar. Or Take Maidenhair, Liverwort, Agrimony, Doddor, of each half a handful; the Roots of male Fernbrake, Grass, Sparagus, of each half an ounce; Flowers of Tamaris, one pugil; Raisins one ounce; White Tartar prepared one dram; Liquoris half a dram; Mace one scruple: Boyl them in two pints of Fountain water. To one pound of the Decoction ad 3 ounces of white or Rhenish Wine; Syrup of Hartstongue one ounce and an half: Mingle them and make your Decoction, whereof let the Child take a draught every morning, and at four of the Clock in the afternoon. This is most prevalent and effectual against pertinacious obstructions in the Mesentery, Liver, etc. Or Take of Coltsfoot, Maidenhair, Hartstongue, Liverwort, of each half an handful; the Roots of sweet Chervil and Sparagus, of each half an ounce; Spanish Liquoris two drams; Mace a scruple; Raisins of the Sun stoned, an ounce; Jujubes by number six, Sebestens eight, two Figs cut in pieces: boil them in a sufficient quantity of Barleywater, and to a pound of the Decoction, ad Syrup of Maidenhair, an ounce and an half: Mingle them together; and this is a very good Drink for such as are troubled with an obstruction in the Lungs. Take of sweet Wort two pound; Liver-wort, Maidenhair, Hartstongue, Scabious, Coltsfoot, Featherfew, of each an handful; blue Figs cut in pieces, Raisins of the Sun, of each half a pound; Liquoris, Anniseeds, of each two drams: boil them over a gentle fire nine hours, strain it, and keep it for your use. It's good for that the former was. Take Salsaperilla cut and well beaten three ounces; the Roots of China, Hartshorn shave, Ivory, of each one ounce; the Leaves of male Betony, Liverwort, Scabious, of each three handfuls; the Buds of the Root called Royal Osmond, and Fernbrake, of each two ounces: Boyl them in four gallons and a pottle of new Ale four or five hours over a gentle fire: Then after some hours respite strain it thorough an Hair-Sieve: afterwards put in of the Juices of Scurvigrass and Brook-lime, of each half a pound; a sufficient quantity of Barm or Yeast: Let it work according to the usual manner, put it into a little vessel and drawn out for the ordinary drink. This is most conducible, where there is any suspicion of the Scurvy or Venereous Pox, being complicated with the Rachites. CHAP. XXXII. Remedies Electively evacuant. THe matter of the Disease being prepared, and the passages opened to facilitate the evacuation, the next thing is, To consider what remedies will electively expel the peccant humours in particular. Now these Medicines do partly concern the humours, and partly the parts wherein they are lodged; but in each of them a du regard must be had to the Spirits. The violent must be either totally prohibited, or else exhibited after a du correction or a circumspect diminution of the dose; and for younger Children, and such as are weak, they must be the less in quantity, and the more gentle in quality; for great and lusty Children you may prepare stronger remedies and in a larger dose (provided that they exceed not the strength of the Child. In both causes it is safer to favour and go less than the strength will bear, than to transcend it in the least degree: and in this affect it is altogether better to proceed by an Epichrasis, than together and at once to attempt the full evacuation of the peccant humours. Moreover the predominant humours in the Body require proper and peculiar remedies; as Choler, Medicines purging Choler: Phlegm, Medicines purging phlegm: Melancholy Medicines purging Melancholy: and waterish humours such as purge water. Again, If the Liver be oppressed with humours more than the other parts, such cathartics must be chosen as peculiarly belong to the Liver. In like manner the Lungs being vehemently infested, or the Brain, and the other parts, such remedies must be chosen as are appropriated to those parts. But if there be not a ready supply of purging Simples peculiarly dedicated to those parts, that defect must be made good by a prudent commixture of such ingredients as are familiar to those parts. Lastly, You must endeavour (as much as possibly you can) to make choice of such purgers as are directly opposite to the Essence of the Disease. In this respect we commend Rhubarb above all other simples. For it is a Medicament moderately hot and dry, very familiar to the inherent Spirits of all the parts, it gently dispelleth the stupefaction of the parts, and strengtheneth the softness & looseness of the parts, somewhat correcteth the internal slipperiness, summons the Pulls to the Arteries, and increaseth the heat of the outward parts, and finally it cherisheth the vigour and activity of the inner parts, and especially of those which are subservient to nourishment. Ad in a word, That it exceeding rarely (provided that you give it in a just dose) causeth superpurgation, for it is a Medicament safe for all ages, and every Complexion. These things being premised, we shall propound some simple purgative Medicines, and some examples of the Compound. For nothing hindereth, but that many of the prerecited lenitives, may be commodiously referred hither, though in a different respect. For there they are considered as quickners of the lenitives which of themselves are somewhat dull: But here rather as they qualify and attemper the violence of the strong. Simple and Compound purging Medicines which are sold in the shops. Manna, Cassia fistula, Tamarinds, all the sorts of Myrobalans, Rhubarb, Aloes, Syr. of Roses solut. syr. of Cichory with a double quantity of Rhubarb, syrup▪ Augustanus, Scammony, Agarick, the seeds of bastard Saffron, Mechoacan, Jalap, Turbith, sweet Mercury, syrup of Roses solutive with Agarick, Epythymum, Polypody of the oak, Senna, Syrup Magistralis against Melancholy, syr. of Apples of King Sapor, Diabalzemer, Electar lenitivum de prunis. solut. Electar passidat Diacatholicon, Confectio Hamech, Benedicta Lexativa. Some Examples of extemporary Compounds. Take syrup Augustan one ounce, syrup of Roses solutive two drams. Succhory water half an ounce to dissolve the syrrups, make a potion to be administered in the morning upon an empty stomach. Take the best Rhubarb beaten to powder eighteen grains syrup of Succhory with a double quantity of Rhubarb six drams, syr. ros. solutive two drams, water of the leavs of Fernbrake six drams, mingle them for a potion, this agreeth best with Choleric Constitutions, and such whose Livers are distempered. Take the leavs of Senna, Polypody of the Oak, Epithymum of each a dram, Rhubarb one scruple, Crystal of Tartar, Fennel seeds of each a scrupel, make an infusion in a sufficient quantity of fumitory water, to the strained infusion, ad syrrup Magistralis six drams, Cinnamon-Water, seven drops; else Langius his Antipeleptical Water half a scruple: mingle them for a potion accommodated to Melancholy Constitutions. Take the leavs of Senna two drams, the pulp of Tamarinds six drams, the seeds of Aniss, Liquorice of each half a dram, cremor of Tartar half a scruple, make an infusion in a sufficient quantity of fountain water for the space of a night, with three ounces of the strained infusion make an emulsion according to art with sweet Almonds blanched, half an ounce. The four greater cold seeds of each two scruples, for two doses, adding to each dose syrup of succhory with a fourfold quantity of Rhubarb, and the best Manna of each three drams. This qualifieth and evacuateth sharp and adust humours. Take lenitive electuary three drams, Rhubarb a scruple, Cremor Tartar and Anniseeds of each half a scruple, the flower of Borage and Rosemary of each half a Pugil, Fumatory water as much as is sufficient: after you have infused them, certain hours strain it through a thick Cloth. And to an ounce and half of the infusion ad syrup of Apples of King Sapor, half an ounce: mix them together for a potion. Take Elder flowers a pugil, Rhubarb two scruples, Jalap, Mechoacan of each a scruple, Cremor Tartar half a scruple, Nutmegs fifteen grains, first infuse them, then boil them gently in the water of broom flowers, & Rhennish Wine, of each so much as is sufficient, strain it. And to an ounce and an half of the decoction ad syrup of Roses solutive half an ounce or six drams: mix them together and make of them a potion which will be very agreeable for such Bodies as are troubled with phlegmatic or dropsical humours, or a Cachexia. Take of the leavs of senna a dram and an half, Rhubarb two scruples, Agrick trochiscated one scruple, Tamarinds two drams, Anniseeds, Cremor Tartar, of each a scruple, Rosemary flowers a pugil, make an infusion in a sufficient quantity of fountain water, and after a very gentle boiling to an ounce & an half of the decoction, ad syrup of Roses solutive with Agrick, Magisterial syrup against Melancholy, of each three drams mix them together for a potion to cleanse the Body of mixed humours. Take the leavs of senna one dram and an half, or two drams, Agaric trochisc. half a dram, Fennel seeds half a dram, flowers of Chamomel ten in number. Boil them in a sufficient quantity of fountain water, and to ten drams or an ounce and an half of the decoction, ad half an ounce or six drams of syrup of Roses solutive with Agarick, Manna three drams, mingle them for a Potton dedicated to evacuate thick and Phlegmatic Humours. Take sweet Mercury fifteen grains, conserv of violets one dram, powder of Gum Dragon▪ one grain. Mingle them; and make them into a Bolus, with syrups of violets to be given in the morning drinking after it an ounce of syrup of Roses solutive, dissolving a draught of posset drink. This is most proper for such Children as are troubled as well with the Rachites as the worms, and on the contrary; also for such as have the French Pox, complicate with the Rachites: also to such as are troubled with a Struma. Take sweet Mercury twelve grains, Jalap eleven grains, Nutmegs half a grain, the pulp of Raisins a dram. Mingle them, and with syrup of Violets make a Bolus to be taken in the morning. Instead of Jalap you may make use of Diagrydium, to three or four grains: This is proper for Children that are afflicted with Strumatical Affects, and such as are suspected to have the French Pox, and such as are difficultly purged, and are averse from Remedies of an ungrateful taste. Take of sweet Mercury a dram, gummy Jallop half a scruple, white sugar dissolved in Betony water three drams or half an ounce, make them into Lozenges according to art of a dram or two scruples and an half weight of which let the diseased take one at a time. Take the best Rhubarb one dram and an half, Raisins of of the Sun, the stones being picked out, one handful, a pint of ordinary Ale, infuse them for twelve hours, strain it and give it to Children that are greedy of drink in the night season. Take Aloes succotrine seven grains, Rhubarb in powder eleven grains, with syrup of Roses solutive, so much as is sufficient to make it into pebbles which must be given in preserved Cherries, the stones being taken away, or else you may gild them for the more easy swallowing. CHAP. XXXIII. Specifical alterant Medicines. THe causes of the Disease being now prepared and in part evacuated, or at least so subdued, that for the present they cannot retard the cure, you must proceed to these Medicines specifically alterant, which as it were fly at the very throat of the Disease, and in regard whereof the premised Medicines both preparatory and evacuant took place. Now these specificals may be defined to be, Remedies diametrically contrary to the Nature of the Disease, and such as directly impugn it. These are either Simple or Compound, the Simple which hitherto we have had knowledge of, are these that follow: the root of Osmund the Royal, or rather the spike of the root, the middle being thrown away, the root of the male Fernbrake, or rather, the little buds before their peeping forth out of the earth; the roots of Grass, Succhory, Asparagus, Madder, Eringo, all the Maiden hairs, Ceterach, Harts tongue, Liverwort, Betony, the flowers and leavs of dead Nettles, Borage, sage Rosemary, Tamarisk, Southernwood, Pontik Wormwood, The greater Sulendine, Saffron, Turmerick, the roots of Sarsaperilla, Salsaphras, China, the three sorts of Sanders, the wood of Guiacum, and its Bark, flower of brimstone, steel prepared, Crocus Martis, salt of steel, wine steelified, syrup of steel, white and Rhennish wine Sperma Ceti, Musk, Ambergris, Castoreum, Earthworms, the Livers of Frogs and young Ravens, Woodlice, washed in white Wine, baked inan Oven, and beaten to powder, and such like things. But if any demand, After what manner, or by what action these Medicaments do especially overrule the Essence of this affect? We answer, That perhaps it is not necessary, that we presently fly to occult qualities, which for the most part is but the Sanctuary and refuge of ignorance: but that the primary and secondary parts of the Essence of this Disease above described aught to be reduced to Memory: for by making a comparison between those parts, and these Medicaments, we shall plainly discern an obscure contrariety and repugnance between them. For this Disease consisteth in a cold and moist distemper inherent in the Spirits together with want and astonishment of the Spirit and weakness of the parts afflicted: on the contrary these remedies heat and dry, cherish the Natural Spirits, dissipate that numbness which is in them and strengthen the parts. Moreover, In regard that these remedies with their heat and dryness obtain withal a manifest friability and thinness of parts, it comes to pass, that they cut through all viscous matter, they attenuate all gross and thick humours, and procure a certain equality of all the juices that have their circulation in the Sanguinary Mass, and an even distribution (consideration being had of the distance from the fountain of heat) both of heat and Blood. Herupon the external parts which before were lean enjoy a more liberal heat and nourishment, and the Parenchimata of the Bowels which were irregularly increased, are delivered from thick and viscous alimentary juices, and thereupon are somewhat lessened: by this means that Alogotrophy or irrational Nourishment of the parts, from whence so great a series of organical faults resulteth, is corrected. Finally, These remedies do also strengthen and cherish the sinewy parts, and likewise the extreme weakness of the Bone of the Back. You will say, That all the Simples above recited by us, do not fully perform all these things. For the several kinds of Sanders, though they may by their dryness, friability and thinness of parts strongly impugn this Disease, yet by their coldness they seem rather to come near to the parts of the Disease; we say therefore that Simples of this Nature ought not to be given alone, but being commixed with some other, which may prevalently correct the noxious quality; in like manner some Simples extremely hot, as Saffron, Castoreum, Flower of Brimstone, etc. are very repugnant to this Disease, yet you must refrain the administration of them unless they be duly attempered. Moreover Sarsaparilla, Sassaphras, Osmund the royal, the kinds of Fernbrake, all the Maidenhairs, Hartstongue, Ceterach, and the like, their heat and dryness being conjoined with a notable friability and thinness of the parts they contribute very much to the equal distribution of the Blood, as also to subdue many other parts of the Disease. But they scarce lend a sufficient strength to the sinewy and fibrous parts; wherefore they seem to crave an admixture of Cephalical Remedies. Again, Lignum Vitae, by its heat, dryness and friability, and by its Balsamical and Rosinish substance, doth very much strengthen the Tone of the parts, and is contrariant to some other parts of the Disease; yet because it helps very little the contemperation of the Juices contained in the Sanguinary Mass, but on the contrary is rather an hindrance thereunto, it ought not without great caution to be prescribed, and that in a small quantity and well corrected. Lastly, Among the Simples here recited, some are received to strengthen all the Spirits rather than to subdue the Essence of the Disease, as Sage, Musk, Ambergrees, and the like▪ which come not into use but when they are mingled with other effectual and more apropriate ingredients. If any shall further demand, Which among all these propounded Simples are to be valued as the most noble and effectual; we comprehend our Answer in these Rules. First, They are the most noble Medicines, which jointly make the strongest opposition against most parts of the Essence of the Disease. Secondly, Those Caeteris paribus, are to be esteemed the more noble, which directly affront the Essence of the Disease, especially if at the same time they advance the equal distribution of the Blood and Vital Spirit, whereby so many organical faults are corrected. Thirdly, Such things as oppose the Disease most eminently by an essential contrariety, provided they be not as well too strong for Nature as the Disease. Fourthly, Those which are both repugnant to the Disease, and yet withal, grateful to Nature, in no wise offering any violence to her. Fifthly, Those which be most grateful & pleasing to the sick Child, & such as administered trouble not its palate. These things being premised we shall now subjoin some examples of compound Medicines. Decoctions, and Physical Drinks. Take the Spikes of the Roots of Osmund the royal, six in number; Paul's Betony, Hartstongue, Ceterach, Liverwort, Maidenhair, of each one handful; Sage, and Rosemary Flowers, of each half a handful: small Raisins three ounces; Spanish Liquoris half an ounce; Mace two scruples; Boyl them in six pound of Fountain Water; take three pound of the Decoction and ad unto it three ounces of the Syrup of Maidenhair, mingle them and make your Apozem. Let the Child take a draught of it every morning, another at four a clock in the afternoon, and a third in the night if he than call for Drink; yea if it pleas him, let him take it for his ordinary Drink. This is most proper for those who are sadly afflicted with the Rachites, complicated with a cough and an obstruction of the Lungs. Take the Leaves of Royal Osmond, Hartstongue, Liverwort, Ceterach, the Flowers of Tamerisk, the Roots of the Male Fernbrake, of each a handful; Raisins two ounces; white and red Sanders, Sassafras Wood, of each two drachms; Coriander Seeds one drachm; Mace one scruple; Sage Leaves, half a handful; boil them in a sufficient quantity of Fountain Water according to art, to three pound; Let the Decoction be sweetened with Sugar or Honey, for ordinary Drink. This is best for such whose Liver is most afflicted. Take Sasaperilla cut and beaten, three ounces; the Roots of China cut into little pieces, two ounces: Infuse and boil them according to art, in seven pound of fountain water, to four and a half: then add two drams of Sassafras roots, the roots of Osmond royal, the leaves of Hartstongue, Ceterach, Maidenhair, Archangel, of each half an handful; Spanish Liquoris two drams; Mace a dram: boil them to three pound. To the Decoction ad Honey or Sugar three ounces. Mingle them for ordinary drink. This is most conducible where there is suspicion of the French Pox, as also in Strumatical Affects. Take the Flowers of Tamaris one handful; the male Paul's Betony half an handful: bruis them gently, and infuse them in two pound of common Beer cold, in a stone or glass Flagon, well stopped with Cork for the ordinary drink. Take Sarsaperilla eight ounces; China two ounces▪ Sassafras half an ounce; Ivory an ounce; Osmond royal, Palus Betony, Hartstongue, Ceterach, Maidenhair, Liverwort, tops of dead Nettles, of each two handfuls: cut them and bruis according to art, and boil them in four gallons of new Ale till one be consumed; then when you have taken it from the fire, ad another gallon of the same Ale to it, and when you have added it, stir it up and down with a stick, and when you have done so, strain it, and when you have strained it, put the Ingredients in a Boulting-bag, and put a piece of Iron into them, and add a bit of Leaven to it, and hang it into the Ale with a string, and let the Child drink it for its ordinary Drink; so soon as it hath drunk half of it, draw out the rest, and stop it close in stone Bottles for the Child's use. Take Wine of S●●ll half an ounce; Syrup of Succory with Rhubarb two drams: let the sick drink of it every morning for five or seven days or longer, unless some looseness of the Bowels or debility of the Stomach do advise a prohibition: in which case, instead of Syrup of Succory with Rhubarb, take Syrup of dried Roses. Broths and Panadaes. Take Hartstongue and Cetrach, Liverwort, Maidenhair, Sage, of each half an handful; the Bark of Tamaris, red Sanders, of each two drams: Put them into the Belly of a Cock-Chicken or Hen, or an old Cock. Sew up the Belly, and boil it with two ounces of Malaga Raisins in a sufficient quantity of Fountain water, adding also a sufficient quantity of pure Oatmeal flower: Make your Broth, and let it be sound boiled. Take the roots of China cut into small bits, two ounces; white and medulous Sarsaperilla sliced and well beaten, three ounces▪ Infuse them for a night in ten pound of fountain water: In the morning after a gentle bubbling, strain it, and to the Decoction ad Harts-tongue and Paul's Betony, of each an handful; Mace half a dram; Currants an ounce; and with Mutton, Veal, or a Capon, adding Oatmeal: make your Broth according to art. But if thinner Broths be more desired, you may boil a crust of Bread instead of the Oatmeal; and if you would have it thicker, you may mingle with it the yolks of Eggs and grated Bread: Moreover, to help a weak concoction, you may sometimes add a few spoonfuls of Wine. Panadaes' also may be made of the same Broth strained, and boiled again with grated Bread, adding at length a little Butter and Sugar. The same likewise may be made of the Decoctions even now prescribed, unless peradventure they contain some bitter and unpleasing mixture. Morrover, the Panadaes and ordinary Broths may be altered with these ensuing Powders, and by consequence apropriated to the cure of this Affect; if the Child desire Milk most, let them be made in Milk; if the Child desire it thick, you may make it thick either with Flower, or Oatmeal; and if you mix a little Saffron with it, it will be the better. But if any thing in the Powders do nausiate and offend the taste, let them be omitted, and substitute some other things that may be more acceptable to the Palat. Powders and Electuaries. Take the Roots, but rather the Buds of the male Fernbrake scarce sprung out of the Earth, and dried in a shady place; the spike of Royal Osmond, of each two drams; Mace, Anniseeds, of each half a scruple; Saffron half a grain: make a Powder. The dose from half a scruple to a scruple, in Milk, or Posset drink, some Decoction, Broth or Panadaes'. Take the medulous part of the Root of Sarsaperilla two drams; the Roots of China one dram; the Root of Sassafras one scruple; the seeds of Caraway and Coriander of each half a scruple; the Roots of the male Fernbrake, Osmond royal, of each two scruples: Mingle them and make a Powder to be used as the former. Take Wood-lice, or as some Countries call them, Sows washed, first in water, and then in White-Wine, afterwards calcined in a Crucible; Bread dried as much as you pleas: make them into a Powder. The dose is from half a scruple to a scruple, either in Broth, or any thing else: In the same manner you may if you pleas prepare the Livers either of Frogs or young Ravens: We gave you the manner before. Take of Flower of Brimstone two drams; Diarrhodon Abbatis, Diatrion santalon, of each half a scruple; Saffron half a grain; refined Sugar three ounces: All of them being made into very fine Powder, make them into a Past with a sufficient quantity of Rose water: Dry them, and when you pleas you may beat them into Powder, and give a dram of them at a time. Take Conserv of Red Roses one ounce and an half; Conserv of the flowers of Borage, Archangel, Sage, Rosemary, of each half an ounce; Steel prepared one dram; Cinnamon, Spanish Liquoris, of each half a dram: Saffron half a scruple; Red Sanders a scruple: beat such things (as are reducible) to powder; make an Electuary according to art, with syrup of Succory with Rhubarb a sufficient quantity. Let the Sick take half a dram, two scruples or a dram every morning, either by itself, or in a spoonful of Posset-Ale, or some appropriated Syrup, or else in Wine. Take Conserv of Archangel flowers one ounce; the flowers of Sage, Clove-Gilliflowers, Rosemary-flowers, Myrobalans candied in India, Citron Pills candied, of each half an ounce; red Sanders, Cinnamon, Spanish Liquoris, of each half a dram; Salt of Steel, or else Saffron, half a scruple; with a sufficient quantity of syrup of Wormwood, make your Electuary. The dose and manner of using it is the same with the former. CHAP. XXXIV. Remedies that correct the Symptoms. SOme Symptoms supervening upon this Affect, do sometimes anticipate the legitamat Method of Cure, and require a particular manner of proceeding. Of this sort are the flux of the Belly, the Lask, wherewith somewhat of a Lientery is frequently joined; profuse Sweats, laborious and painful breeding Teeth, and the Toothache. The flux of the Belly doth very much follow this Affect; which if it persevere for any long time, it is either very violent, and easily watereth the Spirits, consumeth the solid parts, manifestly puts on the nature of a cause, and as a cause indicateth it's own correction. A Bloodyflux rarely happeneth with this Disease. But a Lask with exulcerations in the Guts, or complicated with a Lientery is very useful. For in respect of the debility to the parts subservient to digestion, a Lask, or a Lyentery may easily supervene, but not a Bloudyflux. Yet there is a frequent concurrence of other causes; as of the indigested nourishment vicious either in quantity or quality; some fever, watchings, worms, painful breeding Teeth, etc. all which things do likewise easily occasion a Lask, or Lyentery rather than a Bloudyflux. As for the Cure, it is partly perfected by Purgations, partly by astringent Remedies; partly by such as open, and partly by such as strengthen the parts. These Purgers are most proper which leave behind an evident binding after evacuation; as Rhubarb, Senna, Tamarinds, Myrobalans, etc. out of which for the most part we frame a Bolus or Potions, because they are most easily swallowed under those forms. As, Take Conserv of Red Roses half an ounce; Rhubarb in Powder twelve grains; with a sufficient quantity of syrup of Coral make a Bolus to be given in the morning. Take of the Pulp of Tamarinds one dram; Rhubarb in Powder seven grains; Sugar of Roses half a dram, with a sufficient quantity of syrup of Quinces, make your Bolus. Instead of this Syrup you may use syrup of Coral, or syrup of Mint, or syrup of Myrtles, or syrup of Pomgranats. Take Senna half a dram; Rhubarb one scruple; Tamarinds a dram and an half; Anniseeds bruised ten grains: Infuse them in a sufficient quantity of fountain water: boil them very gently: and to an ounce and an half of the Decoction, ad syrup of dried Roses half an ounce: mingle them together for a Potion. Take Plantain or Succory water, or Saxifrage water, one ounce; Rhubarb in powder ten grains; syrup. Augustan. syrup of dried Roses of each two drams: Mingle them and make your Potion. It must be observed, That a more full evacuation is sometimes requisite, namely, when the flux hath not been immoderate, or of long continuance, and in the mean time the matter offending hath been copiously collected in the Body. In which case, in lieu of the Syrup of dried Roses, you may take some drams of syrup of Roses solutive, syr. Augustan. or of Succory with Rhubarb or Manna: But commonly the safest way is, to augment the dose of Rhubarb, or else of Senna, not omitting the syrup of dried Roses. In the evening after the Purgation, you may administer ten grains of Diascordium boiled in Wine, with Cloves, and a little Cinnamon, and mixed with a third part of Erratic Poppy water, and some cordial Syrups, as Syrup of Clove-Gilliflowers to strengthen the Spirits and to stay the Flux; or if the Flux be stubborn, you may mingle two drams of Diacodium for a dose instead of the Syrup aforesaid. Or Take of Posset-drink made with white-Wine, the Curd being taken off (aromatize it with a little Saffron tied up in a rag, crushing it gently between your Fingers) Confectio Alkermes one scruple; Pomegranate Pills in powder seven grains; Diacodium two drams: mix them together to be taken when the Child is minded to sleep. Or Take Laudanum according to the London Dispensatory, half a grain; Magister▪ of Coral twelve grains; Conserve of Clove-Gilliflowers, or Red Roses, one scruple, with a sufficient quantity of Syrup of Quinces, make a Bolus to be taken at bedtime. If there be obstructions, you may prescribe Crocus M●rtis, or Salt of Steel, to be taken in the morning. As, Take Conserve of Roses one ounce: the Roots of Succory preserved, Myrobalans preserved in India, of each half an ounce: Salt of Steel half a scruple, or Crocus Martis one scruple: Cinnamon, Liquoris, red Coral, of each eighteen grains: Saffron a grain and a half: Syrup of Succory without Rhubarb a sufficient quantity: make your Electuary according to art, whereof let the Child take half a dram each morning. Red hot Iron may be quenched to the same purpose in its ordinary drink. If the Child be troubled with a violent flux, you may give it some binding Conserves, imagine Conserve of Sloes, and mix it with such things as the Child delights to eat, but in so doing be sure you pleas its Palat. Sometimes a profuse and excessive sweeting find a peculiar business for the Physician in this affect: for it very much wastes the Spirits and retards the cure of the disease. Yet caution must be used not to restrain it rashly, if perhaps there be a Fever, or if any feverish fit, or immoderate heat hath gone before: For in these cases it may be upon a critical time, or at least it may bring more advantage to the Body by the mitigation of the Fever, than damage by the loss of the Spirits. For we know not whether any thing doth more potently or indeed more sweetly expel the feverish heat than sweeting. In the interim when it floweth inordinately and causelessly, it argueth that the Body is oppressed with obstructions, with crude juices and unprofitable superfluities, which whilst Nature striveth to master, and to subdu, by that very labour, (the openness of the pores withal concurring) it is evaporated by sweat, and indeed an unprofitable one, very laborious and such as wasteth the Spirits, which therefore as soon as possible must be corrected This Hypocrates meant, where he adviseth, That that sweat which floweth away without cause, requireth purgation. For what can more commodiously diminish and dissipate these superfluities? Again, this motion is contrary to sweeting, wherefore it meriteth the pre-eminence among the remedies opposed to this Sympton, and seeing that it clears the way for Medicines aperient, and such as strengthen the skin, and move forward concoction, (which perfect the last part of the cure) it ought in all right to be premised before them. Purgative Medicines hitherto belonging, are those that are observed to be friendly, and agreeable to Nature, and withal such as open obstructions, and strengthen the Bowels: all which things whither any Simple can perform so well as Rhubarb, we very much doubt. Yet all those Simple and Compound Medicaments proposed above in the Chapter of Remedies Electively evacuant, may, according to the Condition of the Patient, and the Prudence of the Physician, be transplanted hither. Some very much commend Beer in this case medicated with Rhubarb. Take Rhubarb cut into any small pieces, two Drams; Raisins stoned and slit, one ounce; small Bear, two pound; put them into a Glass or stone flagon stopped with the best Cork; set it in a very cold place, and stir it very often, but before you use it let it settle again, a whole day, then draw out the liquor for your ordinary drink. When the flagon is empty fill it again with beer but put not in a new quantity of Rhubarb. Moreover, The most noble Aperients which both help concoction, and repress unprofitable sweeting, are French Wine, and Rhennish Wine. But if there be any fear of their heat in this tender age, they may be tempered with roasted Apples, Borage, or red Rose-water, adding a little Sugar and grated Nutmeg, let them be also taken in a lesser quantity and only at meals. They are likewise the most effectual Aperients, which do not only help concoction, but also strengthen the Tone of all the parts, especially of the Bowels. Among which we chiefly commend things made with steel, as wine made with steel, and the Electuary before named, and the like. Now although steel doth indeed effectually perform those things which we have said; yet because it doth not in all respects answer to some other scopes of great moment in this affect, but doth more hurt sometimes in one particular, than it doth good in another; we thought it expedient to subjoin these following Cautions concerning the use thereof. First, Seing that Steel is an enemy to the Lungs, and doth easily stir a cruel flux of phlegmatic matter in tender Bodies, therefore you must totally abstain from the use thereof, where there is any Catarrh, Cough, obstruction of the Lungs, and much more, if there be any Inflammation, Pleurisy, Blood-spitting, or a proness of disposition to any of these affects. Secondly, Because Steel contributes little or nothing to the operation of the Blood: but on the contrary (however it may attenuat the tough and phlegmatic part thereof) doth rather expedit the separation thereof from the other mass of Blood by reason of the tart quality that is predominent in it, it cannot be admitted but with circumspection, especially that inequality of the Blood being so importunate and urgent. Thirdly, Seing that the attenuating, cutting and opening faculty in Steel is conjoined with an apparent and extreme dryness and binding, and therefore perhaps doth more compact those humours, than dissolve and scatter them; the use thereof aught to be refrained, at least suspected in any considerable Alogotrophy of the parts. For the fear is lest it should bind too close and consolidate the short parts of the Bones & those that are too scantily nourished; whereby afterwards they may become less prompt and apt to grow in length: but the parts sticking out (as also the convex sides of the Bones) which are liberally nourished it cannot dissolve, and then there may be a jealousy that it will too much confirm them and make them stubborn; namely by an extreme thickening and hardening of them. Fourthly, In all acute Fevers the use of Steel is hurtful, because it over-dryeth and bindeth the Parts, yea, for that very regard that it restraineth Sweeting, and makes the humours more fierce and sharp. These Cautions being rightly observed, we admit the use of Steel in this Affect, but because Mountebanks and Quacks cannot distinguish between the use and the abuse, we would not persuade any to make trial of this noble Medicine without the advice and counsel of some prudent and knowing Physician, because if it be not circumspectly administered, the danger is very great. Some other Aperients of less note may serve this scope; as the Roots of Succhory or borage, or Conserve of their Flowers; the Roots of Grass, Sparagus, Fernbrake, Madder; the Leaves of Ceterach, Spleenwort, Maidenhair, etc. Among the Compounds Species, Diatr. santal. Diarrhod. abbot. etc. Or Take of the best Sugar three ounces, dissolve it in Rose Water and boil it a little beyond the consistence of a Syrup, then add Conserv of Barberies one ounce; Diatri. Santal. and Diarrhod. Abbot. of each one dram; powder of Saffron, one grain; mingle them and make your Electuary. The painful breeding and the aching of the Teeth are the familiar Symptoms of the Rachites; and because they breed Fevers, unquietness, watchings, and other evils, they also deserve a peculiar mitigation; if the Tooth therefore as it is working through the Gum puts the Child to very much pain, you must without delay (unless it were done before) appoint some universal evacuation: as a Vomit, which is thought to be a potent remedy against the Toothache. Now that may be moved by the only tickling of the Throat, putting in a Feather, or the Nurse's Finger into the Child's mouth; or else with rubbing the Tooth that is breaking forth with a Tobacco Leaf wrapped about the Nurse's Finger, and a little moistened with Beer; or lastly, by giving some vomiting draught above described. But this remedy is forbidden reiteration in regard that it too much may weaken the Stomach. The day following (the pain persisting or returning) some Cathartick Potion or Bolus among those above rehearsed, or like unto those must be administered. After this universal Evacuation you must descend to Topical Remidies. Nurse's are wont to rub the Gums with Coral polished for that purpose. But the Physicians do rather commend the Root of Marsh Mallows, which do mollify and loosen the Gums that they may obtain the more easy passage. Others report it for a great secret to rub the aching Tooth with the Root of the sharpest Sorrel. Others very much commend the rubbing of that Gum where the Tooth is coming out with a Cocks Comb newley cut off, or with the hot Blood distilling from that Wound. We have had no experience of those things which they use to instill into the Ears; in like manner, neither the Plasters of Mastic, Olibanum, or red Lead, which in those of full growth are observed to stop the Rhewm. Others apply small Epispastick Plasters behind the Ears, which perhaps compel back the matter that breeds the pain in the Teeth. But neither do we interpose our judgement concerning these things. Only when Universals are unavailable, we have recours to Hypnotical Remedies, which indeed by outward application profit little, but being taken inwards they are very helpful, especially being rightly prepared and duly corrected. Therefore when want of rest and watchings beget molestation, thus we proceed. Take Diascordium seven grains; Syr. de Meconio, one dram and an half, or two drams; Posset Drink made of Milk and white Wine, with a little Saffron, one ounce, or ten drams; mingle them and give it at Bedtime the next night following after the Purgation. Take Laudanum, according to the London Dispensatory, half a grain; the Cordial Powder of the Claws of Crabs ten grains; Conserve of Clove-gilliflowers one scruple; with a sufficient quantity of Syrup of Balm make a Bolus to be swallowed in the evening at sleeping time. Thus much of such things as correct the Symptoms. CHAP. XXXV. External Remedies. HAving finished the Disquisition of the matter and kinds of internal Remedies, we shall now direct our Discourse to external Remedies. Which indeed we have reserved for the last place, not because they must perpetually be last put in execution, but because they are altogether of a different kind from the internal: now Universals be to be administered immediately after Evacuants, or at least after those that are electively Purgant, and withal with the Specifical Alterants, unto which kind they belong, although indeed as they are external, they differ from them. Now we desire that we may here be understood by external Remedies to signify and intend every kind of Medicament which cannot properly be referred to Chirurgery, or those things that are inwardly taken, provided that they have their use in the Cure of this Affect. Therefore we divide it into two Kind's, namely, The manner of Exercise, and things externally Applicable. The Manner, or Kind's of Exercise. All kinds of Exercise, unto which Children are accustomed, may be useful in their time and season. But because Children who are molested with the Rachites are somewhat 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; therefore they must begin perpetually with gentle Exercises, and afterwards proceed 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 therefore 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 Nurse's Arms. Fourthly, To sedentary pastimes. First, Lying upon the Back among all the postures of the Body doth chiefly recede from Exercise, and is almost only allowable in the extreme weakness of the Spirits, as in acute Fevers when the Spirits are spent, likewise in many cases of the Chest and Hypochondriacal parts, as frequently in an inflammation of the Liver, Spleen, Lungs, in a Pleurisy, in the growing of the Lungs with the Pleura, and an Imposthume, etc. The lying upon one side either right or left cometh nearest to the Supine Position, and participates very little of the Nature of Exercise. Wherefore it is also allowable in any great weakness of the Spirits, at least in regard of altering the posture of the Body, as also when a profound sleep is not expected. Moreover, it is somewhat 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 agreeable unto, nor beneficial for them, especially when the Body is fully refreshed with sleep. For then that posture is best which draweth nearest to the Nature of Exercise. The Simple Lateral Position containeth somewhat 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 themselves 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 troublesome, 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 because it easeth the pains in the Head, helpeth the Concoction of the Stomach, mitigateth the pains of the Colic, and loosneth a costive Body, it may be sometimes useful when Nature is throughly satisfied with sleep, and in this affect it may supply the place of Exercise. For it sometimes happeneth in this Disease, 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 Joints; 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 Disease. Thirdly, Lying down, in regard of the common Cover of the whole 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 Backbone and the whole 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 whole Body, and so they may be compelled as it were to straightness. But when Children roll 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 conform himself to a strait 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 somewhat 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 sometimes intended, and sometimes remitted. It is most profitable for weak Infants that can scarce stand upon their Feet, or are otherwise hindered from waking. Thirdly, The bearing them about in the Nurse's Arms is almost agreeable to the same Children; and under the same conditions: in like manner the rejoicing of the Child whilst the Nurse 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 whole Body may hang down. Also the drawing of the Children backward and forward 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 somewhat to the erection of the crooked or bended Backbone, 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 other 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 unto 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 whole Body is inverted. Hitherto also may be referred that rolling of the Child, which some use, upon a Bed or Table, the Body being laterally declined: which we more approve if it be not rolled quite round about, but only backwards and forwards, laying a little hard Cushion underneath, whereon 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 will 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 crooked, such sports must be invented as may allure him to move his Body to the contrary side. When therefore one Shoulder is higher than another hold up some Gugaw 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 Nurse's industry. The Masculine Exercises of greater note we reduce to these three Titles. 1 To Going. 2 To an Artificial hanging of the Body. 3 To Friction, rubbing, and contrectation of the Hypocondries and the Abdomen. First, Ostentation or waking may be numbered 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 Disease. But this kind of Exercise must be refused unto them whose Joints 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 comes to pass, that they suffer those Joints to be bended either inwards or outwards, backwards or forwards, and consequently they are the occasion of that deformity which befalleth the Bodies of most men and women. Moreover, those Children which have already contracted such a bending in their joints, either by the natural weakness and looseness 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 Joints 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 Spectators. This kind of Exercise is thought to be many ways conducible in this Affect, for it helpeth to restore the crooked Bones, to erect the bended Joints, 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 Shoes 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 indeed in respect of any active motion in the Child requisite to the administration thereof (for it is performed by an action of the Nurse 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 applied, for which cause 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 Linen clothes dried and heated; others with woollen clothes; and others again with a little Brush, and indeed some do most commend the Brush, and prefer it before the other ways, but because there seemeth to be so little difference in all the ways, we approve them all, and leave the choice to the Nurse's 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 upwards, now downwards, now on each side, then to the Thighs, Hips, Legs, Ankles, the Sols 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 continued beyond a moderate ruddiness raised in the parts, lest the Natural heat should be scattered, rather than cherished. This kind of exercise is most agreeable to weak Children; and such as are scarce able to stand or go. For it supplieth the defect of running up and down, exciteth the Natural heat, summoneth the Vital, and attracteth 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, although 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 Friction also belongeth that contrectation of the Belly, or of the Abdomen and the Hypochondries, sometimes lifting up the Bowels, sometimes depressing them, sometimes removing them towards the right, sometimes towards the left hand, and sometimes thrusting in the tops of the Fingers under the Bastard Ribs. And Physicians hope, and not without reason, that by this action they may deliver the Liver from any preternatural growing 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, whereupon the Peritoneum and the Membrane of the Liver are are most nearly and strictly conjoined, and being conjoined 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 Disease, namely, to the organical parts vitiated, among which it deserves to be reckoned, although above we chanced to omit it in its proper place, and therefore we thought good to mention it here. Thus much of Exercises, now follow the External Applications. CHAP. XXXVI. Things to be Externally Applied. THese remedies (as we have said) do not only prerequire Friction, but for the most part they are administered with a gentle Friction. Now they are either General, or Universal, respecting all parts alike, or Particular, and dedicated to certain Regions of the Body. The matter of the Universals is almost the same with that which we have propounded above in the Chapterof Specifical Alterant Remedies: but the matter of the particulars must be distinguished according to the variety of the Regions of the Body unto which they are applied. The forms of either kind seem to be common, and they are five in number, Liquors, Oils, Liniments, Ointments, Plasters: although Plasters are dedicated rather to certain parts, and never are at once applied to the whole Body. Liquors that have been commended by long experience in this Affect are almost all kinds of Wine; but especially Muskadine. But some do prefer the Pruisian Beer, which indeed may help much to strengthen and consolidate the Parts, but very little or nothing at all to effect the equation of the Blood, or an equal distribution of it. The same judgement is also to be made of Aligant, as also of red Wine. Some instead of Wine use ordinary Aqua vitae, which is believed to be nothing inferior to Wine, Decoctions also may be prepared for the same use. As, Take the Roots of Royal Osmond, the Leaves of Sage, the Flowers of Marigolds, the Leaves of Bay-tree, Paul's Betony, Hartstongue, of each half an handful; Rosemary, red Roses dried, of each one pugil; boil them in Fountain Water, and ordinary Aqua vitae, of each a pound, to the consumption of the third part; strain it and keep for your use. Or Take the roots of the male Fernbrake one ounce, the leaves of royal Osmond, Clary, Bay tree, Sage, Paul's Betony, of each half a handful, infuse them in some Wine, and keep the strained liquor for your use. But these Liquors are seldom or never administered alone, but must be mixed with equal parts of Oils, Liniments, or Ointments; and indeed they must be used before a warm fire, and rubbed on with a hot hand till they be dry. Compound Oils such as are approved in this Affect are very few, and those ineffectual: but there are many Simple Oils, as Oil of Earthworms, Chamamile, S flowers, Paul's Betony, Neats-foot Oil, unto which you may also add Oil of Foxes, Oil of Whelps, Oil of Swallows, provided that these last be prepared Simply by themselves without any commixture of extreme hot ingredients. Oil of Exeter, although some Practitioners use it, and though it be a little hotter than is fit to be used alone to so tender an age as is troubled with this Disease, and so are other things which are vulgarly used, as Oil of Castoreum, or Jacobi de Manliis, and Ung. Antiparalyticis, and other Ointments, as, de Nervino, Martiato, Aregon, and the like. And the reason is, because such a numbness afflicts not these as it doth such as are Paralitical, nor the same Defect of Vital Spirits, nor the same unequal distribution of nourishment. But because this is a new Disease, if any desire Oils, Ointments, or Liniments proper to the Evil, let him make use of a right Method, an able Physician, a specifical way either of Oils or Ointments as we shall show you by these examples: Take the leaves of red Sage, Betony, Pimpernel, Marygold flowers, of each two handfuls: the roots of royal Osmund six ounces, May Butter three pound, white Wine half a pound: cut the Herbs, bruise the Roots, and boil them according to art till the Wine be consumed: Afterwards strain them being yet hot, and put to them oil of Nutmegs drawn by expression one ounce and an half, mingl them diligently, and after settling, casting away the dregs, make your Ointment, which you may reserve in a glass Vessel for your use. Or, Take the leaves of Brooklime, Chamomile, Watercresses, garden Scurvygrass, Paul's Betony, Motherwort, Maidenhair, Hartstongue, Ceterach, Bayleaus, the tops of Mint, red Sage, Rosemary, Ivy-berries, of each half a handful: the Roots of royal Osmund four ounces, Muscadale half a pound, May Butuer three pound: cut the Leaves, bruis the Berries, and boil them all to the consumption of the Wine, strain it whilst it is hot, and separating the pure substance from the settle, make an Ointment according to art. Or, Take the leavs of red Sage, Paul's Betony, Hartstongue, stinking Gladon, of each two handfuls: the roots of royal Osmond six ounces: the tops of Lavender, Rosemary, Bay-leaus, of each a handful: common Aquae vilae, one pound: Oil of Neats-feets, and Foxes, of each half a pound: Deers-suet, or the suet of an Ox, Oil of Worms, of each one pound, boil them to the consumption of the Aquae vitae: strain out the Ointment whilst it is hot, and making a separation of the dregs, keep it for your use. Fourthly, Take the green leavs of royal Osmond, six handfuls: Pimpernels, Morigold-flowrs, the leavs of red Sage, Clary, Mother-wort, Brook-lime, Watercresses, of each a handful: the leavs of Rosemary, Bay, of each half a handful: chop them together very small, and beat them diligently in a Marble or Wooden Mortar, with a wooden Pestle, with six pound of unsalted Butter, and so let them stand fourteen days, then melt them gently in a Bath, and as soon as they begin to be hot, strain them, and then put in a new quantity of Herbs as before: at length strain and purify your Ointment, and keep it for occasions. To these general external Remedies some particular ones relating to some certain parts of the Body may be subjoined: as if the region of the Abdomen, especially the Hypocondria, be stretched, hard and swelled, and this stretching hardness, and swelling would not yield to a Purgation though rightly administered, than you must proceed to Local Remedies: As, Take Oil of Capers, Wormwood, Elder, of each one ounce: of the general Ointment first described, one ounce and an half: mingle them and make a Lineament. Or, Take Ointment of the opening juices Foesius three ounces, the first general Ointment two ounces, mix them together and make them one Ointment: also Oil of Saxifrage made of a manifold infusion, and boiling of the bruised Herb in common Oil is much to be commended to be mixed with it. In the time of using it, this and the like Liniments or Unguents may be mingled for penetration sake with some appropriate liquor: As, Take the flowers of Elder, the flowers of red Sage, Bay-berries bruised, white Sanders slightly beaten to powder, of each two drams, white Wine two pound, steep them for three days in a cold place in a glass vessel accuratly stopped with Cork, and shake it twice a day: when you use it, strain as much as will serve your present occasion, then stop your vessel again. Or, if you desire a stronger, Take the roots of white Bryony well dried and sliced, Bay-berries, Goose-dung, of each two drams: Cumin-seeds one dram: the leavs of red Sage, the flowers of Elder, of each one pugil; boil them in one pound and a half of Rhenish-wine to a pound: keep the Decoction in a cold place diligently stopped. These and the like Liquors mingled with the Ointment, and heated at the fire, must be rubbed upon the Abdomen, and especially the Hypochondries, even to dryness. Let the Nurse also having well warmed her hands, handle those parts gently, sometimes pressing the Bowels upwards, sometimes downwards, sometimes to the right hand, and sometimes to the left, according to our former Directions. The most galent thing of all is the Balsam of Tolu mixed with any Ointment or Plaster, and so applied to the Region of the Back either in form of an Ointment or Plaster. Plasters also seem to contribute something. As Take three ounces of Ceratum santalinum; Gum Ammoniacum dissolved in Rhennish Wine, or in some other medicated wine above described, purified and boiled again to a thickness, one ounce: make your Plaster according to art. Spread part of this upon Leather and lay it upon the right Hypochondry, or else the left, if the hardness be there most sensible, which indeed is very seldom. Or Take the Juices of Brooklime, Watercresses, Garden-Scurvygrass, Wormwood, the bark of Elder, the roots of the male Fernbrake, of each one ounce: Let the Juices be purified with a gentle heat, and being extracted reduce them to a thick body, then add one dram & an half of Mace, and two drams of yellow Sanders in powder. Take of this Mixture one ounce and an half: Gum Ammoniac. dissolved in Wine and boiled to a body four ounces. Mingle them bot, and stir them continually till they begin to wax cool and hard, and make a Plaster to be applied as the former. Moreover, when the Lungs are il affected many times a peculiar pectoral Plaster is very useful. As Take Oil of Violets, white Lilies, and the Ointment of Orange flowers, of each one ounce: Mingle them and make a Lineament to be rubbed with a hot hand upon the Breast, laying a Lawn Paper over it lined with Wool or linen cloth. To this Lineament you may add a small quantity of Natural Balsam. Or Take two ounces Unguent. Pectorale; an ounce and an half of simple Ointment of Liquoris: one ounce of Oil of Violets. Mingle them and make a Lineament to be used after the same manner. The Ointment of Liquoris is thus made. Take new and juicy Liquoris four ounces: new unsalted Butter washed in Rose water one pound: slice the Liquoris and beat it well with the Butter in a stone Morter, afterwards fry them, than strain and squeeze them, and repeat the same labour thrice with a new quantity of Liquoris. Again, Some Plasters may be prepared proper against the weakness of the Back, which very frequently happeneth in this Affect. In the Shops you may have the Plaster of Betony, and Diachalcitheos', unto which nevertheless when you use them, you must add Mastic and Olibanum in powder of each half a dram: the Plaster also which is called Flos Unguentum may hither be referred, provided that you omit the Camphire, in like manner also Emplastrum Nervinum. Or Take two ounces of the first general Ointment; five of the Herbs that are contained in that Composition, cut and chopped very small; Yellow Wax four ounces; the purest Rosin eight ounces: the Ointment, Rosin, and Wax, being melted add the Herbs and according to art make a Plaistrr. Or Take fifteen ounces of the third general Ointment; Litharge of Gold beaten small and sifted nine ounces; boil them together continually stirring them to the consistence of a Plaster; then add Wax, Burgundy Pitch, of each three ounces; Oil of Nutmegs by▪ expression three drams; Mastic, Olibanum, Myrrh, of each one dram and an half; Costorium half a dram; white Vitriol in powder half an ounce; make your Plaster according to art. In like manner some commend a Lineament for the weakness of the Backbone which consisteth of Jelly of Hartshorn, made with such things as strengthen the Sinews, adding the Flowers of Sage, and the Roots of our Lady's Seal. In the time of anointing mingle therewith a little Oil of Nutmegs by expression, or Oil of Worms, or Man's Grass. And thus much of external Remedies. FINIS. A Table of the Chapters contained in this Treatise. CHAP. I. THE Antiquity and first Origin of this Disease, the Name of it, and the Derivation of the Name. Pag. 1 CHAP. II. Anotomical Observations collected from the Dissection and Inspection of Bodies subdued and killed by this Disease. p. 8 CHAP. III. Certain Suppositions are proposed for the easier finding out the Essence of the Disease. First of the Essence of Health. Secondly, of the Essence of a Disease. Thirdly, of a threefold Division of Health and Diseases. The Explication of the third Division, and the Use of the same. The Description of a Natural Constitution, and the Exaltation of it. The Fourth Supposition of the Combination of three Constitutions in the same parts. p. 17 CHAP. IV. That the Essence of this Disease consists not in the Animal or Vital, but in the Natural Constitution; not as Organical, but as Similar: Three Limitations are propounded. p. 26 CHAP. V. The proposed Opinion is examined by Parts. First, That this Disease is a cold Distemper. An Objection, and the Answer thereunto; That it is moist: that it consisteth in the penury or paucity of the Spirits. An Objection, with the Answer. Finally, That this Disease consisteth in the stupefaction of the Spirits. p. 36 CHAP. VI Of the Part first affected in this Disease. p. 45 CHAP. VII. Of the secondary Essence of this Disease. p. 57 CHAP. VIII. The secondary Essence of this Disease in the Vital Constitution. p. 72 CHAP. IX. The vitiated Generation of the Vital spirits in this Affect, and whether that fault be a part of the secondary Essence? p. 75 CHAP. X. The vitiated Distribution of the Vital Spirits in this Affect, and whether it be a part of the secondary Essence thereof? p. 80 CHAP. XI. The Inequality of the Distribution of the Blood in this Affect? p. 94 CHAP. XII. The faults of the Vital Participativ Constitution in this Affect. p. 99 CHAP. XIII. The Organical faults of the Natural Constitution in this Affect. p. 108 CHAP. XIV. The secondary Essence of this Disease in the Animal Constitution. p. 144 CHAP. XV. The Causes of the Rachites. And first those things which concern the Parents. p. 151 CHAP. XVI. The Causes of this Disease incident to Children after their birth. p. 163 CHAP. XVII. Precedent Diseases which may be the Cause of this Disease. p. 180 CHAP. XVIII. The former Question. p. 187 CHAP. XIX. The latter Question. Why this Disease happeneth more frequently in England, than in other Countries? And whether it be Natural to Englishmen? p. 202 CHAP. XX. The Differences of the Disease, called the Rachites. p. 215 CHAP. XXI. The Signs of the Rachites, and first the Diagnostical Signs. p. 228 CHAP. XXII. The Signs of the Differences of the Rachites, or the Diacritical Signs thereof. p. 241 CHAP. XXIII. The Prognostical Signs in the Disease of the Rachites. p. 251 CHAP. XXIV. The Method to Practice and Indications in general. p. 257 CHAP. XXV. Indications Curative. p. 279 CHAP. XXVI. Indications Preservative. p. 282 CHAP. XXVII. Indications Conservative, or Vital. p. 284 CHAP. XXVIII. The Use and right Administrations of the Indications aforesaid. p 302 CHAP. XXIX. The Meddical matter answering to the Indications proposed, and first the Chyrurgical. p. 310 CHAP. XXX. Of the Pharmacental matter, and first of such things as cleanse the first Passages. p. 322 CHAP. XXXI. Remedies Preparatory, and their Use. p. 330 CHAP. XXXII. Remedies Electively Evacuant. p. 335 CHAP. XXXIII. Specifical Alterent Medicines. p. 340 CHAP. XXXIV. Remedies that correct the Symptoms. p. 349 CHAP. XXXV. External Remedies. p. 357 CHAP. XXXVI. Things to be Externally Applied. p. 366 FINIS.