Nothing to Recommend Him but His Unparalleled Impudence

Therapeutic Bleeding in late 18th English practice

in about Warren

Date: April 27, 1767

“Though no Person is less desirous of censuring a stranger than I am, yet when I find an ignorant empirick displaying his malice against me in a news paper, only because I was unhappily necessitated to condemn his ill-founded practice, I think none can blame me if I give a fair and true account of this particular case, in which I disapproved of his conduct: On the 6th of February last I was called to visit Mrs. D—s, she informed me that about a year ago she had been seized with a vomiting of blood, which soon went off, but left a constant cough attended with pain of the stomach and a difficult respiration, a few days before I saw her she began to expectorate very freely a purulent matter slightly tinged with blood.  She was at this time vastly emaciated and weak, and had a low quick pulse and great depression of spirits; I mentioned to her her error in not calling assistance earlier, and deliver’d such a prognostick as every honest sensible practitioner would in a like case.  I think from the above account it appears very clear, that an abscess had actually formed upon the lungs, and suppurated before I saw her, and that the matter she was bringing up was from the ulcerated lungs, I judged the indications were these, viz. to assist and promote the expectoration, to prevent as far as possible, an absorption of the purulent matter into the circulating mass, to correct the acrimony of the vitiated fluids, and to support as far as might be the debilitated vessels; I prescribed to her accordingly, and put her into such a course of medicine as I thought best calculated to answer the above intentions; she continued under my care without any very remarkable alterations till the 27th of the month, when upon my entering the chamber I found a porringer with at least twelve ounces of blood, which I was informed had been taken from my patient by one Young.  I was offended at the impudence of the fellow who had thus stole in without ever consulting me, or knowing what I had previously done, and astonished at his stupidity in thus depriving the miserable patient of the little prospect she before had of recovering, I expressed my just resentment, and told the nurse it was impossible for the woman to bear such a loss of blood, and that the consequence would infallibly be a much speedier dissolution than would have otherwise happened.  I then took my leave, with a design to quit the patient entirely.  And I now appeal to every gentleman of the faculty, in this or any other place, for a justification of my censures upon the Mountebank.  Every gentleman knows that blood-letting in such a case as the above described must be attended with the most fatal consequences, as it is directly contrary to every indication of cure.  By blood-letting the solids already too much relaxed are further relaxed and weakned, whereas it is our business in such cases to strengthen them.  By emptying the vessels they will be more disposed to absorb the purulent matter, and so increase the acrimony of the fluids, whereas it is our business to alter the already too acrid state of the juices; it is our duty also to keep up expectoration; but by weakning the vessels or absorbing the matter to be brought up, expectoration is necessarily prevented; in short, none but a fool or a madman would have proposed blood-letting in such a case, and the event was such as might reasonably have been expected.  On the sixth of March I was informed that the intruder was dismissed, and I was again sollicited to visit the patient. – I complied, but I found her in the last stage of her illness, almost continual cold colliquative sweats, a trembling irregular vibration of the artery, quick and weak respiration, almost total loss of strength and speech. – I enquired of the attendants what were the symptoms that took place after her loss of blood – that she lost her strength immediately, that she never was out of her bed but once and then only for a few minutes, afterwards, altho’ before that time she was able to get up every day; I was told also, that in six hours after this barbarous transaction all expectorations ceased, and she could never afterwards be brought to raise any thing worthy of notice.  After my seeing her this time, she continued sinking every hour until the 13th of March, when death closed the scene. – Thus reason and the event agree in condemning this unwarrantable operation.  I am satisfied that no one who attends to the foregoing circumstances, which are plainly and fairly related (and to many of which the persons who attended in her chamber can attest) will hesitate to pronounce that the woman’s death at that time was occasioned by the injudicious method in which she had been treated; how far a plea of ignorance may palliate the guilt of the criminal I will not undertake to determine.  As to the authorities which he has produced in his vindication, I will just premise, that all the authorities on earth can never make that right which is essentially wrong – but justice to those authors obliges me to inform the public that it never was their design to justify such a conduct as this fellow has pursued, what they designed for the good of mankind, has unhappily been misapplied, they never intended to countenance every quack, who is just able to read their writings, in promiscuously shedding the innocent blood of their fellow men, none of those gentlemen ever meant to encourage blood-letting where there was an actual suppuration; any man who reads them with the least attention will find that they would all be understood to speak of the stages of the disease before any abscess has formed upon the lungs.  Pitcairn says expressly in the sentences immediately preceding the quotation brought by Young, “at present I speak of that sort which comes under our care in the first degree.”  The ac[c]urate Doctor Morgan, in page 317 of Philosl. Princips. of Mede. forbids blood-letting “in all deeply fixed radicated diseases.”  The justly celebrated Doct. Huxham, speaking of inflame[m]ations of the lungs in page 193 of Essay on Fevers, &c. says, “When once an abscess is actually forming, bleeding can be of no farther service; nay when once the phlegmon is too far advanced to be resolved, bleeding is really disadvantageous.”  Many authorities might be produced, but in so plain a case it cannot be necessary.  I cannot before I leave this subject help taking notice of the extreme facility with which this man leaps over the bounds of truth in his narration, it appears to me that he has published his history of the case not with any regard to facts, but has in order to exculpate himself given such an account as he thought most likely to excuse his conduct; I only refer the Gentlemen of the faculty to his state of the case, where I think they may be convinced of the inconsistency of that relation.  As to what he says of having signified to her nurse that her case was desperate and scarce any hopes of recovery – I can only say that the person who attended in her chamber informed me that Young said that although her case was very hazardous, yet he believ’d he could cure her.  He says she took no medicines after she was let blood; I know not what she took, but the people about her affirm that she took what Young ordered; but I have already taken more notice of this blunderer than he deserves, I shall only add here, that it gives me real concern to see such an ignorant pretender so suffered without rebuke to depopulate this town.  I believe no pretender to medicine in this country ever did in so short a time send so many people prematurely to their graves, as he has since his arrival in this town.  It is much to be regretted that a man who has nothing to recommend him but his unparalleled impudence, should receive the least countenance in this place, where there are persons of approved abilities.  But a fellow who descends to the lowest art of ingratiating himself with the people, whose constant employment in other business renders it impossible that they should be judges of real merit, will always be able to seduce some of the unwary into his snares; there this fellow, who is the ridicule of all the truly learned, is the great Apollo of the ignorant, they greedily swallow his jargon and dub him a man of boundless erudition, only because they cannot find any meaning in what he delivers; they are struck with astonishment at his miraculous fictions, and with a kind of devotion attend with gaping mouths whilst he informs them of his remarkable dreams, and relates to them that he has seen in his sleep the human body transparent, and had opportunity of examining into every minute part of the animal system; thus the ignorant are deluded and impiously cheated out of their lives.  I therefore think it my duty to bear a public testimony against all such cloaked murderers; for though there may be some few instances in which such folly and rashness is not attended with those fatal consequences which are justly to be expected, yet it is certain that medicine in the hands of the ignorant, is like brands arrows and darts in the hands of a fool.  I also think that humanity obliges every man to do his utmost to prevent such abuses; for though the Gentlemen of the Faculty may think that it is sufficient to treat such empiricks with contempt, yet I believe upon serious reflection they will not find it consistent with the principles of benevolence, to suffer (if they can prevent) their fellow citizens to be so cruelly butchered by the rash hand of a vain boaster, they can have only this consolation that such ignorant conduct will serve as a foil to set forth with greater lustre their own superior abilities. – The foregoing is done purely to disabuse the public, but I shall take no further notice of this stroller in this way.

            [signed Dr.]M[iles]. Whitworth.”

Source: Boston Evening-Post, April 27, 1767, issue 1649, page 1

Commentary: In the prior issue of the Boston Evening-Post, Dr. Thomas Young had defended his reputation as a physician from rumors that he killed a tuberculous woman by inappropriate therapeutic bleeding. Young named neither the people circulating this story nor the name of the deceased patient.

As no documentation or publication referring to this unfortunate woman’s demise survives prior to Young’s newspaper article, I presume that the accusations of medical malpractice had been made verbally around Boston town. Dr. Young’s letter is the story’s first appearance in print. Dr. Young wanted to refute what he considered to be a false allegation, and to demonstrate to the reading public his mastery of medicine and the texts justifying his clinical actions.

In his response to Young, Dr. Miles Whitworth identifies himself as the first physician involved with the deceased patient’s care, hints at her identity by using only some letters of her last name, contradicts Young’s account of the clinical situation, and cites medical authorities as stating that bleeding was not appropriate in this advanced stage of tuberculosis.

A few clarifications of terms utilized by Dr. Whitworth will lead a modern reader to better appreciate his points. ‘Unwarranted care’ is what we would label medical malpractice. The ‘warranting’ meant matching clinically appropriate interventions to the state of disease, as opposed to guaranteeing results. Malpractice, of the type litigated in court, was virtually unknown at the time. ‘Empirick’ is an imposter or quack. The ‘faculty’ were medical college and apprentice-educated physicians in the community. A formal medical society did not yet exist anywhere in New England. Licensing of health care professionals did not begin until well into the following century. Nevertheless, Massachusetts physicians had a track record of cooperating on the basis of shared professional expectations and courtesies, as they had done with impressive results during the smallpox outbreak and inoculation campaign of 1764.

Is Dr. Whitworth sounding a bit testy? Do we suspect that the editor of the Boston Evening-Post is stoking this dispute between physicians? Will Joseph Warren, then a 25 year old doctor in practice under four years, noisily enter the fray? Tune in for subsequent posts.



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