I was scarce enter'd 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 Physitians 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 Grand-Father, 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 Hippocrates, Amicus Galenus, sed magis Amica Veritas: And this being a Sub­ject [Page 4] of no small Moment to Men's Lives and Healths, the best of Wordly Enjoy­ments: I conceive my self Obliged not to pass it over in Silence, but to Com­municat 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 thro' Town and Countrey 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, least 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 &c. which his Adver­sary endeavours to Refute with his Melius Inquirendum, or an Answer to Dr. Oliphant's Discourse, &c. 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 supplys in his Melius Inquirendum, (viz. [Page 5] the frightfull consequences of the Opera­tion of the Vomit, with the number of his Vomits of Luke-warm Water, &c. and of his Bleeding, Purging, and Cly­stering the Seven days before: And then proceeds to refute the Dr's. Reasons, and to shew his mistakeing, misunderstanding and misapplying the several Authoritys, he quotes, all which is loaded with a few Quibles and Reflections; and then con­cludes.

Now with the Ordinary's leave, I'le 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 Eme­tick 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 Practise of the best Physicians both Anci­ent and Modern.

[Page 6]The first thing herein, which offers it self, is the Dose of the Emetick 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 moderat one, tho 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 increas'd 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 [Page 7] had languished with a Fever about 40 days, most of which time he had faint Sweats, with burning Heats, little Sleep, great Ra­vings: 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, &c. 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 mens 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, &c. was not a suffici­ent Argument against giving of Emetick 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 [Page 8] to be pursued, and perhaps with more vi­gor 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 repeted 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 (tho 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 Medecin has been blamed for the like, when it would naturally have rather hindered, then provoked it. Next the Patients Hands and Feet were Cold, his Pulse quite gone, and Spasmadick Con­tradictions affected his whole Body: These truly seem Frightful, but yet are never [Page 9] 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 dy­ed in earnest, who now only to the Or­dinary seem'd to be a dying? And here the Question comes to be sum'd up: Whether this be a Practice agreable to right Reason, the Rules of Art, and the Practice of the best Physicians both An­cient and Modern?

This indeed deserves a serious Conside­ration, tho, 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 [Page 10] 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 administred, 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 ceas'd.

Thirdly, May we not fairly presume, [Page 11] 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 Vitious Hu­mors, 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 Humors 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.

[Page 12] Fifthly, May it not be consonant to right Reason to think, that, if Vomits and other Evacuations are given to ex­pel the offending Humor, 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 shew, 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, tende, &c.

I must now go to the next Paragraph, [Page 13] where the ordinary Censures the Dr. for Labouring in Vain, since it was never de­nyed, that Vomits in Fevers is no No­velty: but then its strange, he had not sooner ordered one more effectual, than Whey and Luke-warm 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. Truely 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 hastned 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, tho by the Ignorance [Page 14] 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; &c. But on the other side, if it happens, that a Patient die in the hands of an honest Skilful Physician, who fol­lows effectual Remedies, tho plainly off the Distemper, or for his being called too late, 'tis Odds, but the Wise and ta­tling 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 uneasie to the Patient, and frightful to the Ignorant bystanders in their Opera­tion, and less grateful to the Pallat, tho 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, [Page 15] 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 Opi­ats. 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, tho never so proper, he'll certainly faill of Success, as the Sequel proved, his Vomits of Whey did. But further, if the Disease be still rampant, tho the Patient was ve­ry low, yet was there more room for Evacuation, than Opiats 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 Opiats 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 [Page 16] Assertion, but that it would swel 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 Emeticks, 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 Burthen of the whole, therefore the Dr's Conjecture does not seem to [Page 17] 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 vitious Humours out by Vomit, Sweat, or otherways: The Patient certainly re­covers, not only without Vomits but with­out Physitian, 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 Natures indication of an Honest Physitian may be very Con­venient to render the Cure more certain and speedy, tho 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 administred 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 then blunt ones; Fooles and Knaves ought not to prophane 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. Physicians Colledges wherever they be constituted, are Partys; and A­pothecarys are too much byassed by their [Page 18] interests to such Drs. as Write longes [...] Bills, and can Spin out a Cure from a Week to above a Month, and the Vulga [...] tho most concerned, are the least capable common fame, for the most part a Lyar▪ 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. &c. Now a good Homward 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 Symptomes then [Page 19] 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 Hu­mors at once.

Page 9th. It is a little wonderful, the Ordinary at his Return should be surprized 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 Morbifick Matter was spent, he ought not to have expected; for oftimes the last Fit of an Intermitting Fever, when most of the Saburra is expell'd, 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 Humors, it had been a great cruelty to have torment­ed a weak Patient with blistering Plasters, in order to draw them out.

[Page 20]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 administred.

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 [Page 21] 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, tho 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 triffle away no time with too gentle Methods, is not only the Duty of a Physi­cian, but an evident Demonstration of his great Skill and Judgment; 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 House-Wife can tell, that, when an inner and outer [Page 22] 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 supplyed, as none denys, its fitter 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 li­tle stronger, or the Patient 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 Patients Strength, so proportioned the Dose of the Emetick 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 [Page 23] 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 authen­tick 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 [Page 24] his Opinion; but, if none but skilful and circumspect Persons were permitted to practice, as no other ought, then sharp Knives and Swords ought not to be negle­cted, Skilful Persons knowing ful well how to use them to the best purpose.

This in brief is faithfully my Opinion, a [...] it naturally arises from the several Tract [...] published in this Case; And if any person whatsoever, perusing this Letter, wil [...] please to shew 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 acknowledg [...] my Obligation to him: For I can neve [...] think my self too Old, nor too Wise, t [...] learn, tho I presume I shall never, jurare i [...] verba Magistri, Authorities unless agreeable to common Sense and Matter of Fac [...] tho never so highly applauded by other [...] have but a very slender Influence on m [...] Mind, which notwithstanding is ever readily submitted to right Reason, tho 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.