21 - Benjamin Rush: Physician, Pedant, Patriot
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.