REMARKS On the Giving Vomits IN FEVERS. In a Letter to a Friend. BY H: C: M. R. Car: II.  
EDINBURGH, ●●●nted by James Watson, for Thomas Carruthers in the Parliament-Closs. 1700.   

SIR,  
I was scarce entered the Limits of Scotland, when I was by a young Nobleman entertained with the Relation of a Printed Controversy about Vomiting in Fevers, betwixt two Physicians of Edinburgh, (which being a Practice I have always approved, as having been transmitted to me, both by the Instructions and constant Example of my Father and Grandfather, who were Men deservedly Eminent in their Profession, and could have no design to deceive me; and since confirmed by my own Experience in near 50 Years plentiful Employment) I was not a little Curious to peruse; and accordingly I no sooner arrived there, than I procured their Papers. I Confess, I have not the good Fortune to be known to either of the Gentlemen, as I remember: But that did not Discourage me from putting Pen to Paper, since my Opinion may therefore pass for the more Impartial, at least with respect to their Persons; and since I am not accustomed to consider so much, who Writes, as what is Written; For Amicus Hypocrates, Amicus Galenus, sed magis Amica Veritas: And this being a Subject of no small Moment to Men's Lives and Healths, the best of Worldly Enjoyments: I conceive myself Obliged not to pass it over in Silence, but to Communicate my Thoughts, with Submission to better Judgements.  
The occasion of this Paper Warr, seems to be a Scandalous Report, supposed at least to be industriously spread through Town and Country by the Ordinary or his Abetters, That Dr. Oliphant had Killed a Patient with a Vomit; And that giving Vomits in Fevers was an Innovation in Medecin never heard of before. Now, lest this should affect the Drs. Reputation, he thought it necessary to Vindicat the Truth and Himself, and to mantain his said Practice by Reason and Authoritys, as well as by a Faithful Relation of the Fact: And in order thereto he Prints a short Discourse to prove the Usefulness of Vomiting in Fevers etc. which his Adversary endeavours to Refute with his Melius Inquirendum, or an Answer to Dr. Oliphant's Discourse, etc. in which it does not plainly appear, that he denys the greatest part of the Relation, but only quarrels at some Trifling Omissions, which he therefore supplies in his Melius Inquirendum, (viz. the frightful consequences of the Operation of the Vomit, with the number of his Vomits of Lukewarm Water, etc. and of his Bleeding, Purging, and Clystering the Seven days before: And then proceeds to refute the Dr's. Reasons, and to show his mistaking, misunderstanding and misapplying the several Authoritys, he quotes, all which is loaded with a few Quibles and Reflections; and then concludes.  
Now with the Ordinaries leave, I'll begin with the consideration of the question, on which he seems to lay the greatest Stress. Which is this,  
Whether the giving an Ounce of Emetic Wine, mixed with Three Drams of Syrup of Buckthorn, on the the 9 th'. day of a Fever, to one who had been Blooded twice Vomited thrice, Clystered several times, all in Seven Days time, which Vomit wrought so violently 8 or 10 Hours together, that the Patient was reduced to the last Extremity, his Hands and Feet cold, his pulse quite gone, Spasmodick contractions through the Body, be a Practice agreeable to right reason, the rules of Art, and the Practice of the best Physicians both Ancient and Modern.  
The first thing herein, which offers itself, is the Dose of the Emetic Wine, which cannot well be adjudged, unless the Preparation or Pharmacopaeia, by which it was dispensed, were known: For I remember, there were two Eminent Apothecaries Shops in London, of which both the Masters are since Graduated Doctors, and of no small Esteem, and in the one of them half an Ounce was a large Dose, and in the other two Ounces was but a moderate one, though generally, according to the common Preparation of the Infusion of Crocus Metallorum in London, an Ounce and half or two Ounces, is a fit Vomit for a Man, to be by a fourth or fifth part increased or lessened, according to the Strength or other Circumstances of the Patient,  
The next Remark is, Whether it was proper on the 9th. day of a Fever? I confess, times in Fevers, before they were better understood, used to be Religiously observed: But of late the proper Season to give Vomits is, whenever there is an Indication for them, whether the First, Ninth, or Fifteenth Day, sooner or later, provided there is no material Contra-indication. Of this I had a late instance in this Country upon my Lord Tullibardine's Page, who had languished with a Fever about 40 days, most of which time he had faint Sweats, with burning Heats, little Sleep, great Rave: The Nerves of his Tongue and of many parts of the Body frequently affected, in so much that he often lost his Speech, and had no use of his Limbs, for Weakness and Trembling, besides other Symptoms, as Coughs, etc. He was reduced to a Skeleton. This Gentleman in this deplorable state, took about 10 or 12 Drams of Infusion of Crocus Mettallorum, which wrought very kindly, and from that Minute recovered plainly to all men's sense, and in less than 24 hours all the Symptoms vanished: Afterwards he took 3 or 4 times the Decoetum amarum cum senna, and in a Weeks time he was able to walk abroad, and in few days enjoyed his perfect Health.  
Thirdly, The Patients having been twice Blooded, Purged, and thrice Vomited with Whey or warm Water, etc. was not a sufficient Argument against giving of Emetic Wine, if there yet remained a proper Indication for a Vomit; because if the first, 2 d. & 3d. Exhibition were reasonable, because there was an Indication for Vomiting, I am humbly of opinion, that as long as the same continued, the same measures ought to be pursued, and perhaps with more vigour than before.  
Fourthly, Tho all this was done in seven days, yet, if the Nature of an acute Disease require it, not only Evacuation ought to be repeated the eight Day; but probably it was a great Omission, that more had not been done in Number, Power, or both, within the first seven Days.  
Fifthly, The Operation as related deserves a place here also, being a Material part of the Question, which says, that the Patient was reduced to the last extremity (though by the sequel it did but seem to be so, for the Patient is very well) that the Medicine wrought by Stool 8 or 10 Hours together, which appears to be no more than necessary, to expel such a quantity of pernicious Humours, and to save his Life: But how are we certain it was the Medicine, and not a concurrent Crisis, made so large an Evacuation? For I have known, that a medicine has been blamed for the like, when it would naturally have rather hindered, then provoked it. Next the Patient's Hands and Feet were Cold, his Pulse quite gone, and Spasmadick Contradictions affected his whole Body: These truly seem Frightful, but yet are never Dangerous in the Operation of a Vomit: And beside, the Dr, in p. 5. or his Defence, denies, they followed the Operation of the Vomit; but, in case they had, it must have been very difficult to distinguish, whether they were the Effect of the Vomit, or of the Distemper; they frequently attending Distempers, and but rarely Vomits: And I pray how can it be known, whether these Symptoms might not have been much worse, if no Vomit had been taken, and whether the Patient might not then have died in earnest, who now only to the Ordinary seemed to be a dying? And here the Question comes to be summed up: Whether this be a Practice agreeable to right Reason, the Rules of Art, and the Practice of the best Physicians both Ancient and Modern?  
This indeed deserves a serious Consideration, though, if it should but agree with right Reason and the Rules of true Art, it is no great Matter, whether it has the Concurrence of the best Ancient and Modern Physicians; Reason and Art being very sufficient, tho' Authorities were wanting.  
A few Reasons may therefore be here added to the Consideration of the Impartial, as  
First, May we not reasonably believe, that neither the Dose, nor time it was administered, did any ways prejudice the Patient, since not only he recovered after, but thousands have taken larger Doses at that, and all other times of a Fever, both without Injury and with wonderful Advantage; and possibly it will be no easy Task for the Ordinary, to produce an Instance of any Patient, that certainly suffered only by the like Dose or time.  
Secondly, May we not rationally suppose, that, if the previous Evacuations, being proper, had not effected the Cure, they ought to be rejected: Or that, if improper and too weak, more proper and powerful should be applied, and continued, till the Indication ceased.  
Thirdly, May we not fairly presume, that the Continuance of the Operation 8 or 10 Hours, and the terrible Symptoms mentioned, if there were any such, were rather caused by the Violence of the Sickness, then by the Vomit, because so small a Dose rarely, if ever, works above 4 Hours, and because such like Symptoms frequently occur, where no Vomit has been given: And because 'tis probable nothing, but the remaining Vicious Humours, put in Agitation, could produce such new Symptoms, and keep the Patient ill so many days after; Non Causa pro Causa makes most Mistakes.  
Fourthly, May it seem unreasonable to conclude, that ill Humours are the only Cause of all Fevers, as well as they are of other Distempers: And that, so long as they continue moving in any Quantity, so long the Patient must be disordered, if not in Danger: And therefore, that they ought, by all proper and speedy Methods to be expelled, till when there can be but small Hopes the Fever should be extinguished.  
Fifthly, May it not be consonant to right Reason to think, that, if Vomits and other Evacuations are given to expel the offending Humour, being the only true end of all Medicaments, they could neither prejudice nor weaken the Patient near so much, as the Disease, either let alone, or trifled with.  
These Particulars, 'tis hoped, may serve to show, Reason is not so much a Stranger to this Sort of Practice: Let it now appear, how much some Rules of Art may support the same, by the following approved Maxims. As  
Ablata causa tollitur affectus. Ubi ad animi defectionem educere expedit, faciendum id quoque, si aeger par esse possit. Obsta principiis, sero medicina paratur. Extremis morbis extrema remedia conveniunt. Purgandum in valde acutis, si turgeat materia, eodem ipso die, differre enim in talibus malum. Praestat anceps remedium quam nullum dum natura movet, move; quo natura tendit, tend, etc.  
I must now go to the next Paragraph, where the ordinary Censures the Dr. for Labouring in Vain, since it was never denied, that Vomits in Fevers is no Novelty: but then its strange, he had not sooner ordered one more effectual, than Whey and Lukewarm Water, which scarce deserves the Name of Vomits, bringing seldom much more off the Stomach than themselves, and rarely if ever the peccant Matter. Then he implys, that Antimonial Vomits murder Men, Women and Children, and that the Practitioner deserves to be accordingly punished. Truly unless the Ordinary hath murdered any with such Vomits, I must be so uncivil, as to disbelieve his Suggestion; for I have given, and known given some Hundred Thousands, and do not remember, that ever one of them could be justly taxed for having in the least caused, or hastened the Death of one Pateint, that must not certainly have died without. But this is the Misfortune, that when a Patient dies under the Cure, though by the Ignorance or Neglect of a pretended cautious Physician, who prescribes plentifully comfortable Cordials, he shall seldom, if ever, be blamed, but extolled for a safe tender Hearted Doctor, cujus contrarium; etc. But on the other side, if it happens, that a Patient die in the hands of an honest Skilful Physician, who follows effectual Remedies, though plainly off the Distemper, or for his being called too late, 'tis Odds, but the Wise and tattling Gossips damns him for a rash and dangerous Physician, because he directed few or no Cordials, but only Powerful Medicines, fit to combat and expel the Disease, which indeed are more uneasy to the Patient, and frightful to the Ignorant bystanders in their Operation, and less grateful to the palate, though much more safe and effectual than the pleasant comfortable Cordials, so much applauded by persons of slender Understanding in such Matters.  
In the 6 and 7 Pages, the Ordinary says, the Patient had been purged more, had not the Dr. by his Rashness prevented it, and brought the Patient to so low a Pass, that no Place was left for any thing, but Cordials and gentle Opiates. I am glad to find here, he could have continued Evacuations longer, and hope, for the future he'll proportion them in Number, Quantity and Power to the Discase, or else, though never so proper, he'll certainly fail of Success, as the Sequel proved, his Vomits of Whey did. But further, if the Disease be still rampant, though the Patient was very low, yet was there more room for Evacuation, than Opiates and Cordials, to expel the Cause of the Disease, and whenever that shall be removed, a little Milk Pottage or Gruel would have procured rest and Strength sooner, than either Opiates or Cordials: For that being taken away, which obstructed Sleep and Strength, Nature without other help, will very well perform her own Duty.  
Reasons are not wanting to prove every Assertion, but that it would swell this Letter beyond the due Limits, and it's hoped, that what is not proved, is so self evident, that 'twould be superfluous to add any further.  
In the same 7 th' Page, after an Exception at a triple Dose in stead of a quadruple, he affirms that every Physician, acquainted with Emetics, knows, that two Drams with a little Oxymell will evacuat considerably: If he means five or six Ounces of Oxymel by that little, I believe it may, but otherways I never heard of less than an Ounce of the said Wine, was ever given to a grown Man, and seldom so little, except in the Shop abovementioned.  
It is a probability next a Proof, that, if so much of the peccant Matter had not been carried off with the Dr's Antimonial Vomit, the Patient, who was after so bad with the Remainder of the Disease, could never have subsisted under the Burden of the whole, therefore the Dr's Conjecture does not seem to be so Groundless: The Reason offered by the Ordinary, can never support his Assertion: For, where Nature proves too strong for the Fever, and throws all the vicious Humours out by Vomit, Sweat, or otherways: The Patient certainly recovers, not only without Vomits but without Physician, or Medicines; And of this there are Multitudes of Instances in all Ages: But yet, even in these cases where Nature is thus Victorious; The Skilful Assistance, according to Nature's indication of an Honest Physician may be very Convenient to render the Cure more certain and speedy, though his principal Duty be to rescue those out of the Jaws of Death, for whose Nature, the Disease would else have been too powerful.  
In Page 8, he allows Vomits in Fevers, if administered by wary and skilful Physicians, to which I readily consent, for no other ought to be admitted to Practise, and in such hands edge Tools are better than blunt ones; Fools and Knaves ought not to profane so sacred a profession. But what provision is made for a fair Trial of Physicians abilities: The University seems not the most fit; for they rather prepare them to be made, than make them Physicians. Physician's Colleges wherever they be constituted, are Parties; and Apothecaries are too much biased by their interests to such Drs. as Write longest Bills, and can Spin out a Cure from a Week to above a Month, and the Vulgar tho most concerned, are the least capable common fame, for the most part a Liar▪ and their own Passions and Affections always blinding their judgements, if they have any.  
In the same Paragraph the Ordinary promises, what I do not find he hath yet performed, and what I would gladly see, viz. that the taking the Vomit had almost killed the Patient, when it seems rather to have been the Disease, that had almost killed him, and in all probability certainly would have done it, had he not taken the Vomit, But non causa pro causa makes all or most mistakes in the World.  
In the last Paragraph of the same Page, the Ordinary gives an account, that at first the Vomit wrought pretty well both Upwards and Downwards, and then the Dr. goes off, but a little after the Patient began to purge so violently. etc. Now a good Homeward person might have thence concluded, and it may be more truly that after the Operation of the Vomit was quite finished, Nature, being in part thereby relieved, rallyed her scattered Spirits to make a Critical Evacuation of the remainder; for, he says, the Patient began again to purge: And that all the Symptoms then appearing were no other, but what every experienced Physician knows to be very usual in such Evacuations of like Matter, where only the Crisis, without any Medicine whatsoever, proves Naturam Medica●ricem.  
What the Doctor prescribed, in concert with an other Physician, to help to Compose, and to Suppress Vapours, was not amiss; since Nature, without some Intervals of Rest, is unable to bear the Fatigue of discharging all the preternatural Humours at once.  
Page 9th. It is a little wonderful, the Ordinary at his Return should be surprised at so great a Change in 48 Hours, when in acute Distempers all Practitioners, how mean soever, cannot but know, there may be much greater in 12 Hours time: And the Abatement of the Fever, till all the Morbific Matter was spent, he ought not to have expected; for oftimes the last Fit of an Intermitting Fever, when most of the Saburra is expelled, seems to be the most violent: Therefore there was more reason for him to be pleased, that it continued in order to expel by the Pores, what still remained, which seemed to be their joint Opinion: For, if they had not thought, there had still remained some ill Humours, it had been a great cruelty to have tormented a weak Patient with blistering Plasters, in order to draw them out.  
In Page 10 th', The Ordinary takes notice, That on Saturday, being the 6 th' day after he had taken the Vomit, the Symptoms began gradually to decline, which was reasonable to be expected, Nature having then finished the Expulsion of such peccant Matter, as still remained after the Operation of the Vomit.  
In Page 11 th'. there is this Passage: Whose Temper and Constitution he was not in the least acquainted with, and who had undergone so many Evacuations before, since there could be no hazard of giving a less Dose: As if forsooth, in an acute Disease, which requires the speedy Assistance of the Physician, nothing should be done by him, under Pretence of not being acquainted with the Constitution of the Patient, and so let slip the Opportunity of saving his Life: Neither do I agree to his Opinion, that there is no hazard in giving a less Dose, for every Cure, which comes short of the Disease must be very hazardous, by subjecting the Patient to its Power with such small Assistance; Diseases being ever dangerous, when Remedies are rarely so, unless very unskilfully administered.  
Page 12 th'. he is pleased to call Weakness a Contra-Indication to Evacuation, which is certainly true, where there is no Diseased Matter to be Evacuated: But, where there is, nothing can strengthen such weak Patients so much, as the removing that Matter, which at first caused it, and, if continued, will certainly increase it.  
I can as little approve his Commendation of such a wary Physician, who is backward to prescribe strong Evacuations, especially by Vomit; for, when strong Medicines are necessary, it is as great a Fault to omit them, as to give them, where they are certainly not wanted: But, if he means such strong Medicines, or large Doses, as no Man of Sense ever gave, I must agree with him, that its a dangerous Practice to blow up a House to dislodge an Enemy, which, though it be a frequent Military Practice, seems here but an improper Simile. To proportion justly the Strength and Dose of a Medicine to the Power of a Disease, and to trifle away no time with too gentle Methods, is not only the Duty of a Physician, but an evident Demonstration of his great Skill and Judgement; as the contrary would be of his Weakness.  
The difficult Problem left undetermined in the 13 th'. Page, whether these Evacuations should precede or follow Blooding, I think may be solved by common Sense and frequent Practice, without the help of Euclid's Elements; for every Housewife can tell, that, when an inner and outer Room are to be made clean, it's best beginning with the inner; for, if you should first clean the outer Room, you cannot avoid fouling it again, when you go about cleaning the inner.  
Now, If Vomits and Purges cleanse the Primae viae, whence the Blood is supplied, as none denys, its fit to begin there, lest, after the Blood is lessened in quantity, it should be again defiled by the Supplies it must receive from the Primae viae.  
Page 14, The Ordinary affirms, that the Dr: would not have failed to have killed outright, if either the Dose had been a little stronger, or the Patiented a little weaker, which was to sail too near the Wind. Suchlike Supposals may be made in all Cases, where Malice or Friendship is concerned, which may be as easily answered, that the Dr. judging exactly his Patient's Strength, so proportioned the Dose of the Emetic as to be neither too strong for his Patient, nor too weak for his Fever: And thus by sailing so near the Wind, a Prize may be taken, which might else escape.  
Tho I had resolved not to meddle with the Authorities, yet I could not let them slip without this remark, that, if these Authors had never seen, or had like Occasion to make such Reflections, as our modern Practitioners may have had, Posterity must be condemned never to grow Wiser: Whatever was well said or observed by these Authors, was only so far so, as consisted with right Reason and Experience: And, if both the same be the Guides of this present Age, I know not, why a wise and true Saying or Observation of this present Generation, may not be as authentic as of any of the former.  
Page 17 and 18, The ordinary drawing towards a Conclusion affirms, that not only Physicians, but all Men in their right Wits, must condemn a Practice, that reduceth Men to the last Extremity, and brings them to the brink of the Grave, especially when there is no necessity: This surely may be granted by all Men, but hath little regard to the Case in hand: Where its manifest, it was not the Dr's Practice, but the Disease reduced the Patient to this Extremity, and it was so far from being unnecessary, that without it, in all Probability, the Patient must most certainly have died; but there is the Mischief of non Causa pro Causa.  
In Page 19, The Ordinary seems to grant all that is desired, (viz.) That Fevers both with and without Vomits and other Evacuations may be cured, restraining Antimonial Vomits only to greater circumspection, and this he supports with Riverius his Opinion; but, if none but skilful and circumspect Persons were permitted to practice, as no other aught, then sharp Knives and Swords ought not to be neglected, Skilful Persons knowing full well how to use them to the best purpose.  
This in brief is faithfully my Opinion, a● it naturally arises from the several Tracts published in this Case; And if any person whatsoever, perusing this Letter, wil● please to show me the mistakes by right Reason and fair Experiments: I shall be so far from being offended, that I will both confess my Error, and acknowledge my Obligation to him: For I can neve● think myself too Old, nor too Wise, t● learn, though I presume I shall never, jurare i● verba Magistri, Authorities unless agreeable to common Sense and Matter of Fac● though never so highly applauded by other● have but a very slender Influence on m● Mind, which notwithstanding is ever readily submitted to right Reason, though without any Authority.  
I fear by this time I may have tyreed your Patience with my long Scroll; ● shall therefore conclude, leaving the f●●● Consideration of the Authorities to such ●● have leisure, and a mind to compare bo●● sides.  
FINIS.