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 Medecine.

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 Physick 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 imployed out of Custom and Fashion, as necessary Implements of Death-bed 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 Practise, we cannot say the World it altogether in the wrong: An affected starch't Gra­vity with a sawcy Assurance, and a parasitical Cunning to get into the Acquaintance and good Opi­nion of People, is almost all that does intitle 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 Politicks 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, [Page]but the Generality of the World does not so much as pretend to understand the first Elements of Physick, 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 spruc'd himself up with a little forc'd Rhetorick 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 Stale 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 Gigantick Wit, then pre­sently they throw Dirt on the whole Faculty, & proclaim Physick to be nothing else but Conjectural ill grounded Notions wrapt 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 Inhumane 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 [Page]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 Humors, which of it's 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 plyed 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 uneasie, 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 ought 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 Clister, which had the desired Effect, so that next day I orde­red a Vomit of an Ounce of Emetick 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 Harts-Horn at a time. The Evacuation of Gall that followed the taking of the Vomit, both upwards and downwards, was so Surprizing, 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 [Page]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 Judgment and Knowledge are equal to his Years and Experience, and my self gave good Hopes of his Recovery; but his Phy­sician, who, it seems, is equally good at the Cure and the Prognostick, 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 Physick, 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 Surprizing 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, &c. 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 easie Parable Medicine made up of Domestick and Safe Ingredients, no Edge-Tools, an Injection of Milk and Sugar to bring it downwards.

A Short Discourse, &c.

IT is beyond my Design to Discourse of the several Causes and Natures of Fevers, or of their several Names and Divisions. I confine my self 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 witt, 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 enquire what are the Antecedent Causes of producing this quanti­ty of Bile in the Body, neither shall I Dispute, whether it be Generated immediatly 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 it's Stagnat­ing in the Stomach, and consequently not [Page 2]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 ought to precede them or not, This may be Discust by a very plain Calculation.

I suppose the Fever beginning, and the quan­tity of Gall and other Humors 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, then it is but as one to Ninteen; that is, the proportion of the Blood is diminished in respect of that Matter, which gives Fewel 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 [Page 3]the Blood, they are but as one to Fourty; 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 Euclide 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 Ballance on the last's 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 dayes 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 extream 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 [Page 4]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 Physick. 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 [Page 5]Hysop, Oyle and Water, common Oxymel, &c. 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 Medicins, 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 my self.

I shall begin with Hippocrates, who Aph 21. Sect. 1. says, Such Humours as are to be carryed 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 Cholerick, 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 [Page 6]the only effectual Vomitive he knew, & which they were almost always in a dread to give, and by it's 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 write 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 Clymats, 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 Curat. Febr. When (says he) there hap­pens an Evacuation of Bile of it's 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 it's 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 Humor 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, &c. And, Cap. V. Which treats of these things which are to be observed in the Metho­dical [Page 7]Cure of Fevers, he says, Not only therefore in very Acute Diseases, whose Matter is Turgid (af­ter Hippocrates'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 cryed down by the Dogmatical Physicians for a while, until their safe and easie Operation brought them in, in spite of Humor and Prepossession.

Platerus who lived about fifty years after him, and whom Sylvius, 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 Humors 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 look't 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 German 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 it's 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, Sylvius, 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 Cloaths 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 [Page 9]and Third day she was much the same, on the Fourth day after she had taken a Vomit, which was an Ounce of Emetick 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.

Sylvius 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 chiefly conducible, when there is an extraordinary heat, the provok­ing of Sweat, when there are Signs of a troublesom 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, sayes 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 [Page 10]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 enquire 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 perswade me to abstain from it. And indeed the giving a Vomit where such an Inclina­tion to Vomiting has preceeded, 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, &c. Now, sayes he, The Danger of that Diarrhea lies here, that when the Pati­ent [Page 11]is sufficiently weakned 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 it self, and Exert it's Power to throw off by Despumation the Morbifick Matter, is now entirely hindred by that Evacuation.

Now lest you should doubt that this Hu­mor that Nestles in the Stomach, except it be carried off by Vomiting, will sometime thereafter make this Tragedy; if you'll en­quire, 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 applyed, 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 Emetick 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 Humors 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 Humors, &c.

‘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 [Page 13]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 Dector 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 intituled, 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 it's 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, sayes 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 [Page 14]better ground for it than the false insinua­tions and Malicious whisperings 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.

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