A Short Discourse, To Prove the USEFULNESS OF Vomiting IN FEVERS, BY PLAIN REASONING And the Authority of the Best Physicians, ANCIENT and MODERN.  
By CHARLES OLIPHANT, Doctor of Medicine.  
EDINBURGH, Printed for Thomas, Carruthers, and Sold at hi● Shop in the Parliament Closs. M. DC.XC.IX.   

THE PREFACE.  
IT is but too remarkable, That Physic as it hath advanced in Age, so it hath decayed in Reputation. Physicians, who among the Learned Grecians were held in the highest Esteem, are now rather employed out of Custom and Fashion, as necessary Implements of Deathbed Sickness and Funeral Charges, than for any great Performance expected from them, either by the Patients themselves, or their Relations. And the Truth is, at the rate a great many Practice, we cannot say the World it altogether in the wrong: An affected starched Gravity with a saucy Assurance, and a parasitical Cunning to get into the Acquaintance and good Opinion of People, is almost all that does entitle some Men to their Employment. It is to such mostly we are obliged to, for the Discredit the Practice of Medicine is fallen under of late, who contenting themselves with studying the mean and crafty Politics of the Trade, and having neglected every thing else to qualify them for it, do by their Puny Feats make a great many judge it to be more the fault of the Art than of the Practisers. And indeed it is no wonder that the World is more imposed upon by the Pretenders to this Science than to any other whatsoever, so far is is out of the ordinary Road of these, who do not make it their Study: When a Lawyer, appears at the Bar, or a Minister in the Pulpit, every Body that has but little more than common Sense may be almost a Judge of either the one or the others Performance, but the Generality of the World does not so much as pretend to understand the first Elements of Physic, and consequently can be but a very ill Judge of the Sufficiency of those who profess it. What Applauses have we seen a Formal Pretender, when he has spruced himself up with a little forced Rhetoric draw from his listening Admirers, who commonly have not Line enough to Fathom him; that he is an Ingenious Man, is a Character they cannot in justice deny him, and make no question but he is as good at Curing a Disease, as he is at telling a Stolen Jest, or an Antiquated Story; but whenever they have occasion to use this Talking Machine, and find how ill suited his Dwarfish Performances are to his Gigantic Wit, then presently they throw Dirt on the whole Faculty, & proclaim Physic to be nothing else but Conjectural ill grounded Notions wrapped up in difficult and hard Terms.  
I am not ignorant how much Physicians have lessened their Esteem by the Indecent Scuffles amongst themselves, and that by Inveighing one against another, they rather fasten an Imputation on the whole Profession, than there where they design it: however this has been mostly the fault of those who know, that it is much easier to establish themselves by Decrying what another Man does, than to acquit themselves as they ought to do, when their own Skill is required. It was such an Inhuman and Malicious Treatment I met with from one of my own Employment, that gave occasion to this Discourse, which otherwise may be of use to such as may hazard their Lives by their Prepossession in the Affair discoursed of. The Story in short is, That I was very lately called to a Gentleman of Consequence and Merit, who had been in a Fever several days before; from the beginning it had been attended with such Symptoms, as were evident Signs of Repletion, his Stomach being overcharged with Choler and other Humours, which of its own accord it threw up frequently, with a great Bitterness in his Mouth, and other undoubted Evidences of Redounding Gall: Blooding and Clistering with Milk and Sugar had been the Achillean Cures his ordinary Physician had plied him with before I came; When first I saw him, I found him labouring under the greatest Oppression imaginable, his Pulse low and oppressed, his Breathing uneasy, and his Spirits overwhelmed with the continuing Disorder of his Stomach which he had from the beginning; in a word, he was in such a Case, that I could not venture to give him that which I was sure aught to have been done at first, and which as yet was the only thing could be done to purpose, until I had procured a Remission by Injecting a Sharp Clyster, which had the desired Effect, so that next day I ordered a Vomit of an Ounce of Emetic Wine, and three Drachms of the Syrup of Buck-thorn: This, by the by, was not only aggravated with the Frightful Name of an Antimonial Vomit, but also called a Triple Dose, which I leave to be judged of by those, who have the Courage to give more than a Single Drop or two of the Spirit of Hartshorn at a time. The Evacuation of Gall that followed the taking of the Vomit, both upwards and downwards, was so Surprising, that in all Probability imaginable, it must have been of Fatal Consequence, if it had been left to the Course of the Fever, to have been carried off by a Crise, After that the Fever went on, but without any thing near that Oppression I at first found him under, so that both that Gentleman, whom I alled to my Assistance, and whose Judgement and Knowledge are equal to his Years and Experience, and myself gave good Hopes of his Recovery; but his Physician, who, it seems, is equally good at the Cure and the Prognostic, not only told, that he was gone past Recovery, but that I had Killed him, and that the giving of Vomits in Fevers, was an Innovation in the Practice of Medicine, never before heard of. So for my own Vindication I have shown, that both by plain Reason, and the General Rules and Maxims of Physic, that Vomiting is not only to be done in most of our Fevers, but also, that if is so far from being a Novelty to any, to whom the whole Art is not such, that we have it Confirmed by the Authority of the best Physicians, both Ancient and Modern. But nothing can be Surprising from the Impudent Ignorance of that Spark after his Elaborat Work, I mean Apollo the Mathematician, as one merrily called it, wher● he attacks as ignorantly as dully the Useful, Ingenious, and Demonstrative Discoveries of a most Learned Physician, who had given him no occasion for it, that I know, and where he overturns whole Mathematical Demonstrations by such Witty Turns, as calling an Effatum an Effartum, etc. I shall say no more, but only tell him, that if he find his Choler moved,  

Et si  
— Turgescit vitrea bilis.   
he'd even best take one of his own Topping Prescriptions, an easy Parable Medicine made up of Domestic and Safe Ingredients, no Edgetools, an Injection of Milk and Sugar to bring it downwards.   

A Short Discourse, etc.  
IT is beyond my Design to Discourse of the several Causes and Natures of Fevers, or of their several Names and Divisions. I confine myself only to speak of those Continued Fevers, which most usualy reign amongst us, and of the Use, or rather Necessity of giving Vomits in such: And I think I need scarcely be put to prove a Matter of Fact so well known, to wit, That most of our Fevers, from the very first Invasion of them, are attended with a Squeamishness, Vomiting of Gall, bitterness of the Mouth, and such other evident signs of overflowing Choler in the Cavity of the Stomach and Intestines. I am not now to inquire what are the Antecedent Causes of producing this quantity of Bile in the Body, neither shall I Dispute, whether it be Generated immediately in the Stomach by a depraved Digestion, or whether it is separated from the Blood by the Liver, and poured into the Stomach by the passage of the Gall, that is inserted near the lower end of it; But I suppose it to be actually there now, where it cannot stay long, without undergoing a great Alteration by its Stagnating in the Stomach, and consequently not so fit to be mixed again with the Blood as it was before it was separated from it. Now the Question is, Whether we shall Assist or Stimulat Nature, to Dislodge so dangerous a Guest, or shall we suffer it to mix with the Chyle in the Stomach and Guts, and be carried again to the Blood, from which it must be separated again, otherwise the Patient Dies.  
I think after stating the Question, I need make no answer, only I would advise these Gentlemen who Practise with that Caution they pretend to, not to think so lightly of neglecting these necessary Evacuations in the beginning, the doing of which must at best prolong the Disease; and with all, I would have them take some better notice whether Bleeding aught to precede them or not, This may be Discussed by a very plain Calculation.  
I suppose the Fever beginning, and the quantity of Gall and other Humours actually fluctuating in the Stomach; which cannot be carried off by any Medicine, but part of it will mix with the Blood. Now, Supposing the Humours in the Stomach to be to the whole Mass of Blood, as one to Twenty; if you let a Twentieth part of the Blood, than it is but as one to Ninteen; that is, the proportion of the Blood is diminished in respect of that Matter, which gives Fuel to the Fever, and consequently not so able to Digest or throw it off by a Crise. On the contrary, if we evacuat (for Example) one half of the Humours before they mix with the Blood, they are but as one to Forty; which must make a vast difference in the event of the Cure. This Calculation is so plain, that I shall not quot the Fifth Book of Euclid to prove it, and by it I would have these wary Gentlemen take notice, that seeing they do little more than look on and see fair Play between the Patient and the Disease, that at least they would not cast the Balance on the lasts Part, and leave the Patient to manage his Strength the best way he can, against both Disease and Physician. I do not pretend by this, but there may be some Cases that Require Bleeding before any thing else; but to do it of Course without any urgent Indication, at the Rate as is commonly practised, must certainly be of fatal Consequence to a great many.  
But now the Fever is gone on for several days before a Physician be called. Well says Master Dolittle, Here can be no place for evacuation, because the Course of the Disease has wasted the Strength and Spirits, and the Patient shall never be able to endure it; & further, it will put the Blood into a great Commotion, and Increase the Fever.  
I do indeed Confess the Patient had run a great deal less hazard if these Evacuations had been made in the beginning; But yet as we are still to make best of an ill Bargain; and if the Patient be not reduced to extreme weakness, I say it is yet to be done. As for wasting the Strength and Spirits, it is evident, that these Humours mixing with the Blood, to be at last subdued by a tedious Crise, must infallibly at the long run, exhaust and weaken them a great deal more than the short Operation of a Vomit; which doth but lend a hand to Nature; and I appeal to any man who ever took an ordinary Vomit, if he has not found himself more weakened, and his Strength more exhausted by a few Hours of tossing and anxiety from a disordered Stomach, than from the effect of the Vomitive Potion. As for the other Objection of increasing the Fever, every body knows, that hath the least studied the Operation of Medicaments, that a Vomit works only in primis viis, the suddenness of its effect too, shows that it has no time to mix with the Blood, to put it into any great Commotion. That the heaving of the Breast, and the Extraordinary motion of the Muscles of the lower Belly, and Diaphragm will quicken the Pulse, and make the Blood move faster during its working, is without all Question, but even that will Contribute more to the Cominution and digestion of the Feverish Matter in the Blood, than do any harm to the Patient, seeing that ceaseth so soon as the Vomit hath done Operating.  
To call this an innovation in the practice of Medicine, is to speak against the current of the Physicians or all Ages, as well as against the General Maxims of Physic. It is true the Ancients knew no other Vomits, but what were of the Vegetable kind; and these were either too weak, such as the Decoction of Hyssop, Oil and Water, common Oxymel, etc. and consequently had either little or no effect, or these which had a deleterious and poisoning Quality, and therefore over violent and unsafe, which makes them speak mostly of Purgatives. But even these they used, notwithstanding of the vast Commotion they make in the whole Juices of the Body, beyond Vomitive and Laxative Medicines, such was the force of the Indication. It were endless to give all the Quotations which can be adduced to prove this, and would far exceed the bounds I laid down to myself.  
I shall begin with Hypocrates, who Aph 21. Sect. 1. says, Such Humours as are to be carried off, let it be done that way that Nature affects most; if it be a convenient way. Now, I judge no Physician ever pretended that Redundant Choler in the Stomach should not be carried off, neither that the way of Vomiting is not lege natura commoda; so Heurnius translates it. In the 10 Aph. Sect. 4. he says, In very acute diseases Purging is to be used if the Humour be turgid, for it is dangerous to delay. Now, what way we are to evacuat the first cited Aphorism shows, and this shows we are to do it even in the most acute Diseases.  
Celsus, Cap. 13. de Vomitu, says, Vomiting as in perfect Health it is often necessary for such as are Choleric, so it is also in those Diseases which are occasioned by Choler, only he adds, That in Fevers and Acute Diseases, we need not use the harsher Medicaments, such as White Hellebor, which was the only effectual Vomitive he knew, & which they were almost always in a dread to give, and by its Violence now quite out of Use. It is not possible to Quote the Innumerable Passages from Galen, and the other Principes Medici to prove my Assertion, besides, that what they writ concerning Fevers, cannot so exactly jump with the Case in hand, it being certain, that mod of their Fevers were either of the Inflammatory or the Pestilential kinds, and that the Difference of the Climates, and of our Way of Living from theirs, must of necessity alter the Type of the Diseases very much. So I shall not longer insist on their Authority, but now come to the Moderns, of whom I shall only take the most Famous, and whose Practice has most obtained.  
I shall begin with the great Fernelius, Cap. XI. de Curate. Febr. When (says he) there happens an Evacuation of Bile of its own accord, the Fever may end without any Medicine, but when that is either none at all, or too little Medicaments are to be given, lest the Fever, by being neglected, change its Species, and become worse, and of longer Continuance. And a little afterwards he adds, for seeing the Stomach and Intestines, (which is what he means by the Prima Corporis Regio) in which the Noxious Humour fluctuats, are most unclean, some of it is to be timeously evacuated in the beginning, especially if there be Bitterness in the Mouth, Oppression of the Heart, or Squeamishness, or want of Appetit, etc. And, Cap. V. Which treats of these things which are to be observed in the Methodical Cure of Fevers, he says, Not only therefore in very Acute Diseases, whose Matter is Turgid (after Hypocrates 's Way, to whom only Violent Medicines were known) but also in all Acute Diseases, Purging is proper in the beginning. And a little after, If in the first days of the Fever the Evacuation be omitted, whatever time you are sent for, you shall order Remedies as if the Disease were beginning. When there is an Inclination to Vomit, what he gives is Oxymel or Hydreleum, the Use of Antimonial Vomits not being known in his time, or if they were, being first introduced by rash ignorant Quacks, they were cried down by the Dogmatical Physicians for a while, until their safe and easy Operation brought them in, in spite of Humour and Prepossession.  
Platerus who lived about fifty years after him, and whom Silvius, who was hot over prodigal pf good Names to any Man, calls Magnus Platerus, says in bis Treatise de Febribus, Pag. m. 77. Vomiting to these who are accustomed, and Nature pushing on to it, is allowed, and if in a continued Fever, the Gall doth work up in the Stomach, and be troublesome, it will extremely help. And afterward, Pag. 87. If there be crude Humours in the Stomach, and the Gall be carried into it, Nature is to be helped to throw out that by Vomiting which does molest it. I shall Quote no move of the Moderns of that Age, these two being looked on by all to be the most Learned, awl best Practitioners amongst them.  
I come now to the later Physicians, and shall omit the Crowd of Germane Authors, whom I take to be all on my side, Ludovicus in that excellent Book he calls Pharmacia Moderno Seculo Applicanda. I remember somewhere says, That he's sure, wherever one was killed by giving a Vomit or Opium, a hundred have died for want of them. Etmullerus de Febr. asserts, That Vomiting is proper in all Fevers, even in these which are Malignant. And withal tells us, He had often observed, that to whomsoever he gave a Vomit in the beginning of Malignant Fevers, that whether the Event was good or bad, through the whole Course of the Disease they lay quiet and easy. He does also prefer the Antimonial Vomits to all other, because of its Sulphur which resists Malignity. It were tedious to give you many more Quotations, so I shall end with the Testimonies of the three greatest Physicians of this Age, that is Willis, Silvius, and Sydenham.  
Willis in his Treatise of Fevers not only approves of Vomiting in continued Fevers, but shows by some Observations that it was his common Practice, For Example, the first he gives is, Of a Noble Matron of Fifty years of Age, of a slender habit of Body, a low Stature, who by shifting her  in the Month of June, was ill towards Night, after that she was taken with a Squeamishness and oppression of her Stomach, felt flying pains without any excessive heat. The Second and Third day she was much the same, on the Fourth day after she had taken a Vomit, which was an Ounce of Emetic Wine, she Four times vomited up yellow Gall, and Purged thrice: And so he gives an account of the Progress of the Fever afterwards, too tedious to insert: However, she Recovered. He has several others to the same purpose, which may be seen in his Works.  
Silvius Prax. Med. lib. 1. Cap. XXXL after, he tells that the Primary Cause of these continued Fevers is the Bile which is faulty either by its Acrimony, or inflammability, Sums up the Method of curing them all in the last Paragraph of the Chapter, thus. Blooding indeed is then chief conducible, when there is an extraordinary heat, the provoking of Sweat, when there are Signs of a troublesome acidity, and lastly purging by Stool and Vomiting when the Gall works up and is too Plentiful. Now, what sort of Vomit he is for, may be seen the next Chapter but one, in which he treats of Malignant Fevers, where he says, that in those when Vomiting is necessary, he prefers Antimonial Vomits to all others, because of their Admirable Sulphur, which doth wonderfully mitigate every thing that is Acrimonious. But he tells Positively, Cap XXIII. I prefer, says he, Antimonial Vomits to all other, both because they promiscuously evacuat all Humours, and also because they are most Friendly to Human Nature; reducing by a peculiar way, all the juices in the Body to a Laudable State; which Power I Question, is to be found in other things, but I know it to be in Antimony, whatever either Learned or Ignorant Men may Prate to the Contrary.  
I shall Conclude with the Opinion of the Judicious and Ingenuous Dr. Sydenham, who in the Fourth Chapter of his Works, treating of such continued Fevers, as are every whit the same we commonly have amongst us, says,  
After Blooding (if it should be found necessary after the fore mentioned Cautions) I carefully inquire whether Vomiting or any Inclination to it, did trouble the Patient towards the beginning of the Fever. If that happened, I certainly order a Vomitive Medicine, except either tender Age, or some extraordinary weakness of the Patient do persuade me to abstain from it. And indeed the giving a Vomit where such an Inclination to Vomiting has preceded, is so necessary, that unless that Humour be expelled, it will turn to a Sink of Evils, which shall torture the Physician during the whole Course of his Medicating, and throw the Patient into no small danger. The most usual and Chief is a Diarrhea or Flux, which for the most part follows in the Declination of the Fever as often as Vomiting, when there was an Indication for it, was neglected, etc. Now, says he, The Danger of that Diarrhea lies here, that when the Patient is sufficiently weakened by his Disease, he is by it further Enervated, and besides, (which is yet of greater Moment) in the Declining of the Fever, at which time the Blood ought to Contract itself, and Exert its Power to throw off by Despumation the Morbific Matter, is now entirely hindered by that Evacuation.  
Now lest you should doubt that this Humour that Nestles in the Stomach, except it be carried off by Vomiting, will sometime thereafter make this Tragedy; if you'll inquire, you shall almost always find, that if a Flux do accompany the Fever, that the Patient had in the beginning of the Disease been Squeamish, and that no Vomit had been given him. And further you shall find, that altho' that Inclination to Vomiting be over, yet nevertheless the Diarrhea shall cease so soon as you give the Vomit, provided the Strength of the Patient be able to endure it: I have also frequently observed, that when the Diarrhea once began, that adstringent Medicines, either taken inwardly, or outwardly applied, did little or nothing contribute to the stopping of it.  
Then he tells the common Vomitive Potion he to uses in such Cases, which is six Drachms of Emetic Wine, with Oxymel of Squills and Syrup of Scabions. Afterwards he goes on.  
If any Man ask me, What time of the Fever I would have a Vomit givens.  
I Answer.  If I could have my Wish, I would do it in the very beginning: for by that I shall preserve my Patient from these dreadful Symptoms, which are occasioned by that Heap of Humours in the Stomach, and Neighbouring Places; and even perhaps crush the Disease in the Bud, which otherwise would grow to the danger of the Patient, being nourished by these Humours, etc. 
But, (says he, the next Paragraph) If, as it often happens, by our being too late sent for, we cannot Consult the Safety of our Patients towards the beginning of the Fever; Nevertheless I am certainly of Opinion, that it ought to be done whatever time of the Disease it be, provided the Strength be not so far wasted, that it cannot endure the Force of a Vomit. And indeed for my own part, I have made no Scruple to give a Vomit on the twelfth day of the Fever, even when the Patient had left off to be Squeamish, and not without Success: And afterwards, Neither would I in the least doubt to do it later, except the Consideration of the exhausted Strength of the Patient should stop me.  
These Quotations which I have Translated, do faithfully speak the Sense and meaning of the Authors I took them from; and I think they are so decisive, that there is not any need for more: I shall only add, that as Vomiting in Fevers has been the way of the best Physicians of all Ages; so it is at this time all Europe over, the Practice of such who understand any thing of their Business, and is daily Confirmed (not to mention the good event of that Gentleman's Fever, which gave occasion to this Discourse) by the recovery of these who are so treated.  
Neither shall the Reader take this on my bare assertion for that it is at this time the practice of the French Physicians, who had used to be the greatest opposer of Antimonial Medicines, they shall have the word of a very Honest man for it; I mean Doctor Tournefort. whose admirable Genie and Learning, procured him the Profession of Botany in the King's Garden at Paris, and made him worthy to be a Member of that Illustrious Society, The Royal Academy of Sciences. He in a late Book entitled, Histoire des plantes qui naissent aux environs de Paris. In the Preface, speaking of the great use of Vomits, and of their way of Operating, adds, That France is Obliged to the Diligence of its Skilful Physicians, for it's being free from the? Plague in these latter Times, which must have Dispeopled that Kingdom, if they had kept to their Blooding, Ptisans, and Diaphoreticks, even with much ado, says he, it yielded to Antimony, Helebor, Elaterium and Coloquint.  
I shall end with this, that I am sorry a great many People should have so rashly past their Judgement, in an Affair, which it seems, they understood so little, especially when they had better ground for it than the false insinuations and Malicious whisper of one who, is very far from being a Judge in these Matters himself, or the open talking of some men who are so mean as to think it worth the while to be his Emissaries.  
FINIS.