24. Against blood-letting it has been urged, that the Indians of our country cure their inflammatory fevers without it. To relieve myself from the distressing obloquy to which my use of this remedy formerly exposed me, I have carefully sought for, and examined their remedies for those fevers, with a sincere desire to adopt them; but my inquiries have convinced me, that they are not only disproportioned to the habits and diseases of civilized life, but that they are far less successful than blood-letting, in curing the inflammatory fevers which occur among the Indians themselves. 25. Evacuating remedies of another kind have been said to be more safe than bleeding, and equally effectual, in reducing the inflammatory state of fever. I shall enumerate each of these evacuating remedies, and then draw a comparative view of their effects with blood-letting. They are, I. Vomits. II. Purges. III. Sweats. IV. Salivation. And, V. Blisters. I. Vomits have often been effectual in curing fevers of a mild character. They discharge offensive and irritating matters from the stomach; they lessen the fulness of the blood-vessels, by determining the serum of the blood through the pores; and they equalize the excitement of the system, by inviting its excessive degrees from the blood-vessels to the stomach and muscles. But they are, 1. Uncertain in their operation, from the torpor induced by the fever upon the stomach. 2. They are unsafe in many conditions of the system, as in pregnancy, and a disposition to apoplexy and ruptures. Life has sometimes been destroyed by their inducing cramp, hæmorrhage, and inflammation in the stomach. 3. They are not subject to the controul of a physician, often operating more, or less than was intended by him, or indicated by the disease. 4. They are often ineffectual in mild, and always so in fevers of great morbid action. II. Purges are useful in discharging acrid fæces and bile from the bowels in fevers. They act, moreover, by creating an artificial weak part, and thus invite morbid excitement from the blood-vessels to the bowels. They likewise lessen the quantity of blood, by preventing fresh accessions of chyle being added to it; but like vomits they are, 1. Uncertain in their operation; and from the same cause. Many ounces of salts and castor oil, and whole drachms of calomel and jalap, have often been given, without effect, to remove the costiveness which is connected with the malignant state of fever. 2. They are not subject to the direction of a physician, with respect to the time of their operation, or the quantity or quality of matter they are intended to discharge from the bowels. 3. They are unsafe in the advanced stage of fevers. Dr. Physick informed me, that three patients died in the water-closet, under the operation of purges, in St. George's hospital, during his attendance upon it. I have seen death, in several instances, succeed a plentiful spontaneous stool in debilitated habits.