Friendly Letter to Dr. Young (I)

in by Warren

Author: Philo Physic, a pseudonym of Joseph Warren

Date: June 8, 1767

Source: Boston Gazette

Related: by Philo Physic, May 25, 1767; Philo Physic, June 22, 1767; Philo Physic, July 6, 1767; Philo Physic, July 27, 1767

Sir,

It gives me great concern that I have been so unhappy as to fall under your displeasure: Yet as I am not sensible of having merited it, you much excuse my not making any acknowledgment of my offence.

You called upon every Physician on the continent to give their opinions upon the point in debate between Dr. Whitworth and you – At your request I delivered my sentiments, at least with honesty and impartiality; and tho’ they are very different from your’s, I cannot think that alone a proof of their being erroneous. I expected to have found something in your defence that might have appeared a little like truth and reason; but I confess I have been disappointed, whether by my own want of apprehension, or your unlucky manner of writing, I leave others to determine. You object to my method of stating the case; yet I believe it was as exact as could be taken from any thing published upon the subject: And it is most certain that you have not even the least cause of complaint, since I admitted for truth every thing which you related, (however improbable it might appear to me and to every one) it was from your own history of the case, that I infer’d the impudence of your conduct; and therefore I was under no necessity of proving that “the absolute reverse of your representation was true.”

You have indeed in your last performance denied that there was purulent matter expectorated at the time of your taking away the blood. It is to be observed, that this negation comes in by way of prop, to a cause which you seem sensible required some such extraordinary support. – But unfortunately for you, Dr. Whitworth’s declaring there was purulent matter constantly expectorated, will gain as much credit as your saying there was not; especially as his opinion is corroborated by the whole account given by the persons who attended the patient in her chamber. – But you seem to be sensible that the expedient of denying will not effectually answer your purpose; you have therefore in case of danger, provided yourself with another resource, by promulging a doctrine, which could it be maintained, would be of signal service to your cause. You say, “that be the cause of that violent pain and difficult respiration what it will, bleeding is the alone remedy.” This, had it fallen from any pen but your’s might have deserved a serious refutation: But as the world in general know better, and very little regard is likely to be paid to your authority, it is sufficient to remark, that in your next sentence you contradict yourself, where you say “that when a tumor in the lungs or any where else is too far advanced to be resolved, bleeding is then improper.” Now I suppose that even you will allow that after a tumor in the lungs has arrived to such a state as to be incapable of resolution; violent pain in the side and difficult respiration may and often do take place before the breaking of the abscess. Upon the whole, I must freely own that your last publication has by no means alter’d my opinion of the impropriety of your taking away blood from your patient. I should with much greater pleasure approve your practice, (if I might with honesty) than condemn it; for believe me, Sir, I do not envy you the friendship of those persons whose extraordinary fancy for all kind of exotics induces them to esteem you; nor do I feel the least passion excited by the idle reflections which you thought fit to cast upon me. – I only look upon them as the genuine productions of your very particular genius. But really when you attempt to put on the physician, and criticise upon the remarks which I made upon your practice, you are truly diverting. You blame me for saying that the suppression of expectoration caused a lodgment of matter upon the lungs; and in order to convict me of error, you produce a quotation from Dr. Whitworth, where he says, that the purulent matter is absorbed by the depleted blood-vessels. Now altho’ I am not under the least obligation to defend any thing which Dr. Whitworth has asserted, or to make any judgment conform to his theory; yet in the present case I cannot find that our opinions are at all incongruous; for it is well known to physicians, that whenever there is a lodgment of purulent matter, there is constantly an absorption of some part of that matter into the circulating mass of blood. You are likewise pleased to sneer at the estimate which I made of the diminution of the vital force which your patient suffered by your taking away her blood: no doubt you foolishly eno’ imagined that the loss of a seventh part of the blood, could not diminish the vital force, more than one 7th: had this been the fact, you might justly have censured my arithmetic; but indeed this criticism of yours, instead of being a proof of my inaccuracy, is only a proof of your being quite unacquainted with calculations of this kind. But if you have “inclination and abilities” to read the experiments made by the ingenious Dr. Hales, on the bloods and blood vessels of animals, you will find that I have not been at all extravagant in my computation.

My “trailing discourse on relaxation,” as you are pleased to call it, I would again recommend to your perusal, for it is possible you may not rightly understand it, as it is upon a subject confessedly new to you, (tho’ I believe from the days of Hippocrates to the present time, no physician besides yourself, was ever ignorant of it) – As to the authors which you have quoted in your defence, and on whom you seem to greatly rely, I have as great a reverence for their authori[ ] as you; but I would not implicitly follow any one; nor can I think that a cursory reading of them can any way intitle a man to the character of a physician. – Their design can never be understood, unless they are closely attended to; they have no doubt contributed greatly to the improvement of the medical art; but, detached sentences from them, will never support irrational practice: they always expect that their general observations should be applied with judgment, and proper regard to particular circumstances. In the present case you have by no means rightly construed their intention; and it might be easy to condemn you by those very witnesses whom you have summoned for your justification, several of whom earnestly caution against bleeding in the last stage of consumptions. – But there need be no more said in a case so plain. All who have knowledge enough to admit of conviction, are fully satisfied of your egregious mistake in acting in direct contradiction to the plain indication of nature, in suppressing an evacuation, on which alone your patient’s life depended; by which means those terrible symptoms were brought on, which (as the divine Hippocrates justly remarks upon the suppression of expectoration in a pulmonary phthisis) do always prove fatal. But I would have none imagine from the foregoing that I have any aversion to the lancet; I am sensible of its usefulness, and when properly applied, have frequently known it eminently serviceable: but I should always wish to see it in skillful hands; & I would have every one endeavour as far as possible to follow the advice of the justly celebrated Aretaeus, who says in his chapter upon vomiting blood, Een de o astheneoon ichnos kai leiphaimos Ee, mee tamnein phleba.[1]

To conclude, I heartily wish you an increase of knowledge, and a consequent diminution of the high conceit which you at present entertain of your own abilities; and until you discover some marks of these, I shall give myself no further trouble with so untractable a genius.

I am, Sir, with the greatest benevolence, your humble Servant,

Philo Physic.

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[1] (Editor’s Greek translation) … & I would have every one endeavour as far as possible to follow the advice of the justly celebrated Aretaeus, who says in his chapter upon vomiting blood, But if the ailing person is emaciated and lacking blood, do not cut a vein.

– Aretaeus, Concerning the Treatment of Acute Afflictions, Book II, Chapter II, The Treatment of the Bringing Up of Blood

[PHILO PHYSIC is desired to excuse our not inserting his Quotation from Aretaeus in Grecian Letters, as we have no Greek Types; but a Friend has given us the Words in English Letters, which we hope are as correct as the Difference of the Alphabets will admit of.]”

Commentary: Despite citations from classical medical literature in Greek, the tone of the discussion degenerates.

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