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FOR LEADERSHIP in medicine, as well as in most other daily activities, mind-eighteenth
century British colonists in North America looked overseas to the homeland. Physicians
of the New World practiced medicine under confusing philosophies in transition between
medieval and modern; while reluctant to relinquish deference to traditions and systems
centuries old, they had to grapple with the new problems posed by the raw new land.
Without anyone to fall back upon, physicians had to compare experiences with old
teachings; pioneer new therapeutic regimens based on quick bedside decisions.
The man who contributed most to systematization times of progress of medicine in
the American states, and who led the way in founding a body of medicine independent
from that of Europe, was Benjamin Rush. Without question Dr. Rush was the most striking,
the most impressive, and the most controversial figure in North American medicine
of his day. Brilliant and well educated, he was restless soul, impatient and impulsive,
quick to make decisions and to defend them against all disagreement. Through domineering
as a teacher, his magnetic personality profoundly influenced students. Through bitter
and acrimonious in attacks upon contemporary physicians, or in defiance of his own
methods, he had a way of gaining the confidence of his patients and of comforting
them. In times of great danger, when other physicians fled, Rush had the courage
to remain with his patients; he was never too tired or too busy to try to care for
them. Nor did he confine his attention, solely to medicine: he was an interested
in every phase of life about him; and he was an ardent proponent of inoculation,
and later, of vaccination, against smallpox. His work on mental illnesses was the
standard for a half century. Rush wrote illuminatingly on causes and treatment of
many diseases, and he pleaded for simplification of medical nomenclature and for
elimination of all but a few key drugs. He urged medical students to acquire practical
knowledge of veterinary medicine. Chief exponent, in his time, of bloodletting as
a therapeutic measure, Rush, wrote Flexner, “shed more blood than any general
in history.” Goodman credits his with dedication of his life sincerely and
unselfishly to profession which did not always use him kindly. Intensely human,
often a victim of self-deception, many times tragically and disastrously wrong.
Dr. Rush nevertheless stuck to his job, sick or well, with rare heroism. During
the tragic epidemics of yellow fever, according to Powell, “there was only
one doctor who would enter a fetid chamber, scorn all protections, sit on the edge
of a vomit-soiled bed, smile cheerfully to the frightened patient, and say blandly,
you have nothing but a yellow fever. Despite his faults, errors, and controversial
career, Rush’s influence on North American medicine was profound, lasting
until well past the middle of the nineteenth century.
Dr. Rush has been described as above medium height, his slender body erector, and
his manner dignified. His face was long and thin with forehead high and rounded
high cheekbones, and firm jaw. Bright piercing eyes under heavy brows, an aquiline
nose, long upper lip, and resolute mouth gave evidence of his stubborn determination
band indomitable will. In youth he wore a powdered wig, but he discarded this in
middle age, his own long, rather thin graying locks softening his sharp features.
Meticulous about appearance, he wore clothes with an air of elegance. Strong, well-shaped
hands and long slim fingers were indicative of sensitivity of touch and skill.
Benjamin Rush was born on Christmas Eve, 1745 (old calendar), or January 4, 1746
(new calendar- England did not adopt the Gregorian calendar until 1752). His birthplace
was the Rush farm at Byberry, Pennsylvania. He received his Bachelor of Arts degree
from the College of New Jersey (now Princeton) in 1760. The 15-year-old graduate
then apprenticed himself to a busy Philadelphia physician, Dr. John Redman. During
more than five years in this association, he was permitted to observe physicians
at work in Pennsylvania Hospital and to attend lectures by Dr. John Morgan (who
in 1755 had served as pharmacist at the hospital), and by Dr. William Shippen, Jr.Upon
his preceptor’s advice, Rush enrolled in the University of Edinburgh, Scotland,
in 1766, studying under the famed Dr, William Cullen. After receiving the degree
of Doctor of Medicine in June, 1768, with letters pf introduction from Benjamin
Franklin, Rush visited Paris and London, where he studied for a time under Dr. William
Hunter. He returned to Philadelphia in 1769 to enter practice and to receive appointment
as Professor of Chemistry at the college pf Philadelphia. His was the first formal
chair of chemistry in America; and there he joined Drs. Shippen, Morgan, Adam Kuhn,
and Thomas Bond, on the faculty of the medical department.
The decade, 1774-1783, was one of great significance to the embryo nation; to its
largest city, Philadelphia; and to Dr. Rush. When the First Continental Congress
met in 1774, Dr. Rush entertained many of its members, including John and Samuel
Adams, Patrick Henry, George Washington, Thomas Jefferson, and Benjamin Franklin.
After blood was had in 1775, Rush he4aded companies formed to manufacture needed
items for the Colonies, introduced the first spinning jenny for manufacture of cotton
cloth, and superintended a saltpeter factory. Rush is credited with supping notes
for and brining about publication of Thomas Paine’s Common Sense, which, more
than any other pamphlet, led Americans to embrace the cause of independence. Elected
to congress in 1776, Rush and his father-in-law, Richard Stockton, were among signers
of the Declaration of Independence. Later, in 1787, Rush was to be influential among
framers of the Constitution of the United States.
In April, 1777, his congressional term having expired, Dr. Rush accepted a commission
in the Medical Department of the Continental Army. True to his independent nature,
he became embroiled both in medical and in military controversies.
As the new nation and Philadelphia, its capital, settled back to postwar living,
Dr. Rush returned to practice and to teaching. As teacher, he exerted more influence
on the medical profession in America during the quarter century following the Revolution
that any other person. His students were in practice from Massachusetts to Georgia;
and Rush carried on heavy correspondence as their consultant. By 1786, his lectures
at the university embraced medicine and chemistry. He continued to teach thought
his life.
Greatest test of Dr. Rush’s ability as physician and as medical leader, and
certainly, of his physical and moral courage, came with Philadelphia’s tragic
epidemic of yellow fever in 1793. This devastating epidemic, and those of following
years, were to plunge Rush so deeply into controversy that his practice never fully
recovered economically; and top this day detractors attach a stigma to his name.
The first patients begin to show symptoms of “a serious bilious fever,”
and to die, in August, 1793. Dr. Rush, who had seen patients with yellow fever twenty
years before while an apprentice, recognized the disease. At first, his conclusions
were treated contemptuously by his fellow physicians. Before long, they were to
change their minds.
Fearing for his children, Dr. Rush sent them to Princeton, where their mother was
visiting; but, through thousands of citizens fled Philadelphia, among them many
physicians, Dr. Rush stayed on. Through never suspecting the true source of the
disease-infected Aedes aegypti mosquitoes-on serial occasions Rush nearly determined
the cause. He advocated that streets be cleaned; he believed puddles, ponds and
marshes should be drained; and he complained, more that once, of swarms of mosquitoes
that plagued the city.
Casting about for a solution one night, Dr. Rush, too tired to sleep, recalled a
paper on yellow fever written in 1744 by Dr. John Mitchell, advocating depletion
of the body with severe purges. Also Rush recalled use in military hospitals of
“ten and ten”-ten grains of calomel plus ten grains of jalap-as a purge.
Rush experimented, adding another five grains of jalap for good measure. Rush experimented,
adding another five grains of jalap for good measure. Along with purges, he prescribed
copious bloodletting, cool air, cool drinks, and light diet. Trial led Dr. Rush
to believe his treatment successful.
By mid-October, Rush estimated that no less than 6,000 persons were ill with the
fever, and “only three physicians were able to do business out of their houses.”
More than one hundred persons were dying daily. Rush worked day and night; patients
were on his door step at dawn; he prescribed as he ate his meals. His sister added
his apprentices as they put up purge powers, until her, too, died of the fever.
Dr Rush himself fell victim of the disease and was seriously ill with fever on another
occasion; but he survived vigorous application of his own treatments, prescribed
for patients from his bed, and rose again to minister to the sick. Finally, with
the advent of frost, the epidemic subsided. Philadelphia’s loss was 5,000
persons, one tenth of its population. Dr Rush record the experience the following
year in An Account of the Bilious Yellow Fever, as it appeared in the City of Philadelphia,
in the year 1763.
Further epidemics occurred in 1794, 1796, and 1798. The scenes if horror and desperation
were repeated. Rush doggedly stuck to his purging and bleedings, absorbing more
and mire abuse and criticism from fellow physicians and citizens; but never did
he run away from his responsibility as he was them. His practice suffered, however,
to the point where he was grateful to supplement his income by accepting, in 1767,
appointment as Treasurer of the United States Mint from his friend, President John
Adams.
Dr. Rush was to see the turn of the century, and to teach, to write, and to practice
a dozen years beyond it. Last volume of his many works was Medical Inquiries and
Observations upon the Diseases of Mind, which appeared in 1812. Although out of
date by today’s standards, it was the first work on psychiatry published up
the United States, and for half century, the only one. It became a standard reference
for physicians and medical students.
Dr. Rush continued working unto his sixty-eight year, calling on patients as late
as April 13, 1813. That night, a chill and general indisposition sent him to bed.
His condition did not improve, and on April 19, he died, rational and composed.
Benjamin Rush’s first venture into authorship was at age nineteen and he continued
writing until his last days. Despite his local contemporaries, Rush was respected
as a scientist and as a philosopher by such men of stature as spaced as a scientist
and as a philosopher by such men of stature as Franklin, Washington, Samuel and
John Adams, and Jefferson. The British physician, John Coakely Lettsom, called Rush
the “Sydenham of America”: and, indeed, Rush was influenced by Sydenham’s
rules regarding “bedside manner.” Through critics hold that his treatment
of patients probably did more harm than good, his methods were in keeping with medical
understanding of his day, and he sincerely believed in them. Says Goodman: “His
character was laid upon foundations of integrity and service, and once he was sure
within himself of the soundness and morality of his stand, he resolutely refused
to compromise.” He has been justifiably called the first great physician in
the United States of America.
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