Please to Insert the Following

in by Warren

Author: Philo Physic, a pseudonym of Joseph Warren

Date: May 25. 1767

Source: Boston Gazette

Related: by Philo Physic, June 8, 1767; Philo Physic, June 22, 1767; Philo Physic, July 6, 1767; Philo Physic, July 27, 1767

“Messieurs Edes and Gill,
Please to insert the following in your next Paper, and you will oblige the Writer.
As the attention of the public has been for sometime engaged by the controversy between Dr. Whitworth and Dr. Young; and as those gentlemen have both requested the opinion of their brethren of the faculty, I shall with freedom deliver my sentiments, not designing to incur, nor fearing to meet the censure of any one. – It is not my business here to make critical remarks upon the manner or style in which the gentlemen have been pleased to communicate their tho’s to the world. I can only say, that I shall never endeavor to copy candour & courtly elegance from Dr. Whitworth, nor shall I attempt to obtain a character for manly sense and perspicuity, by taking Dr. Young for my pattern. – The grand question is, Whether Dr. Young acted the part of a sensible judicious physician, in taking away blood from his patient? or whether his conduct was unwarrantable and deserving of censure. The gentlemen seem both to agree in this, viz. That the woman had been for a considerable time unwell; that at the time when this blood was taken away, she was “vastly weak and emaciated; that an abscess had some time before formed upon the Lungs, which had suppurated; and that the patient was at this time discharging the matter from the ulcerated lungs by expectoration.” There is nothing in this account that can in the least justify blood-letting, and no judicious physician would prescribe it in such circumstances. But Dr. Young asserts further, that on the third or fourth day of his attendance, (the time of his taking away the blood,) the fever rose high – she had a labouring pulse, difficult respiration, and pain in the side. Dr. Whitworth makes no mention of these circumstances in his history of the patient; and one would naturally conclude from his manner of writing, that he was not acquainted with them. But as Dr. Young is the person accused, good nature obliges me to admit for truth what he has related, since Dr. Whitworth has not expressly denied it. Let us therefore examine these particulars which the gentleman founds his reason for venaesection, can any way justify him. – It is very well known to every practical physician, that violent pain in the side, and difficult respiration, are often bro’t on by the lodgment of the sharp acrid matter proceeding from the ulcers in the lungs, which is continually corroding the tender vessels; and it is known that bleeding has a direct tendency to check expectoration, and to confine the acrimonous matter upon the lungs. – And does not the event give reason to suppose that this was the case with Mrs. D—s? For altho’ a considerable quantity of blood (probably a seventh part of what was then circulating in the large vessels) was taken away, yet the hemoptoe was not prevented. – But granting, (what appears to me very improbable) viz. that a new abscess was at that time forming on the lungs: yet I doubt whether this would be sufficient to excuse Dr. Young’s conduct, since he must lessen the vital force at least one quarter in this already weak sinking woman – and also bring on (by putting a stop to expectoration) a load upon the lungs, much more dangerous than that which he expected to remove, by taking away the blood. Upon the whole, I must conclude, that after taking a fair impartial view of the case, no man can defend Dr. Young’s practice; and therefore he would have acted very wisely in generously acknowledging his mistake; especially as it was apparent to all who attended the patient, that her death was hastened by that ill-timed evacuation – But I cannot close without remarking the strange complaisance of Dr. Young in looking upon Dr. Whitworth as the father of the theory of relaxation by blood-letting. I would not deprive Dr. Whitworth, or any other gentleman of that honor which is his just due; yet I am very sorry that a person of Dr. Young’s supposed abilities should never have heard, read, or thought any thing upon this subject, which is so important a branch of medical knowledge. It is indeed true, that when there is a sanguinary plethora, taking away blood will by restoring the equilibrium, between the solids and fluids, give the vessels, as Dr. Young observes, “liberty to contract; but when the vessels are not crowded, taking away blood, instead of giving them liberty to contract, tends greatly to prevent their contraction, by taking away the stimulus, which is in a great measure the cause of the contraction of every animal fibre.” – Further, a very little knowledge of natural philosophy might have satisfied Dr. Young, that the force with which the vessels contract, must be in proportion to the force with which they were distended. I mean, provided the distention is no greater than the vessels can bear. Again, it is well known that by lessening the quantity of blood, where there is no plethora the secretions are lessened; and by a deficiency of the secretions, the animal functions are weakened, that is, the solids are relaxed. – But I shall not insist so largely on this matter as I might, because I believe the Doctor had no thought of entering into such kind of enquiries, when he declared himself ready to meet Dr. Whitworth to discuss any medical questions that should be proposed. I must nevertheless desire him to get a little better acquainted with the animal system as soon as he possibly can, lest he should again fall into some unhappy error. And I would particularly recommend it to him, never to quote any authors, until he is very well satisfied that he rightly understands them. – And to this end I believe it would not be amiss for him to read them wholly through, which it is plain he never has done yet, otherwise he would not have been a stranger to the theory of relaxation by bleeding: for Dr. Robinso[n] (an author whom Mr. Young quotes) in P. 99, of the 2d part of his new method of treating consumptions, says as follows, “What effects taking away of blood, the fountain of life, can have on the constitution, besides greatly to relax the solids, I am unable to determine.” – But though I would not push this matter too close upon Dr. Young, yet I must desire every man who pretends to practice physic, to acquaint himself thoroughly with the effects of blood-letting, for it is certain that a prudent management in this matter will often preserve the life of the patient, and an imprudent use of it, may often prove fatal. And no man who is ignorant of the theory of the relaxation of the solids, by taking away blood, can be an adequate judge of the propriety or impropriety of that evacuation, but must very frequently fall into the most dangerous mistakes. – But the compass of a news-paper is much too small to admit of my doing justice to so important a subject. I must therefore conclude, with expressing my earnest wish, that (instead of boasting of their present attainments) the gentlemen of the faculty would apply themselves to such studies as may qualify them for being truly useful to mankind.
Philo Physic.”
Commentary: A pseudonymous Warren inserts himself as the voice of the medical profession into a public malpractice dispute taking place in the newspapers between Drs. Myles Whitworth and Dr. Thomas Young. The case involved a Mrs. Davis, who succumbed to what was probably pulmonary tuberculosis, and focused on whether therapeutic bleeding was applied properly. Dr. Young was already an active Boston Whig, a circumstance that might have obliquely influenced the situation.

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