The Paradoxical Doctor Benjamin Rush

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As it happened, the eighteenthcentury patient often was no worse off in the hands of such therapists than in those of formally trained physicians. But still the only hope of progress in curing illness lay with the scientifically educated. Quackery could not build on its hit-or-miss successes or learn from its failures. A serious concern for quality led Rush to decide, in 1766, to join the small company of academically schooled doctors. With his mother’s blessing and promise of support, and with recommendations from Redman, he sailed for Edinburgh. After a voyage made miserable by seasickness, he took up residence in the frowning but intellectually alive Scottish city and entered the universe of eighteenth-century scientific thought.

The courses into which he plunged were in anatomy (but the students did not perform dissections), botany, chemistry, and the theory and practice of “physic.” Almost no clinical or laboratory work was involved. The best-liked teachers were lecturers who summed up existing knowledge most attractively. Not until Rush did some 1768 postgraduate work in London hospital wards did he see many patients or handle instruments. Apparently he preferred it that way. He delighted in chemistry, which offered such “rational entertainment,” and he remarked condescendingly of London doctors: “Few of them indeed practice medicine upon philosophical principles, but notwithstanding this, they have enriched the science with a number of very useful facts.”

Rush’s most adored professor was William Cullen, in “institutes of medicine.” Like other eighteenth-century theorists Cullen had two objectives. One was to classify diseases in the orderly way in which the great botanist Linnaeus had arranged plants and animals. The purpose was to allow for a systematic approach to cures. Once a doctor knew to what “family” or “class” a symptom belonged, he could then use the remedies proved to work for that general category of sickness. The second goal of medical speculation was to find a single underlying explanation for disease, as majestically all-embracing as Newton’s laws of motion.

The search for such a unifying concept satisfied the era’s constant taste for order and regularity, so evident in eighteenth-century music, poetry, and architecture. It also made medical study a pleasure for anyone who, like Rush, was philosophically inclined. It did little, however, to encourage hard specific research. Pathological examination of organs, autopsies, chemical analyses of bodily fluids, microscopic study of tissues (even though microscopes were available), were all neglected, and basic discoveries like the germ theory had to await the following century.

When Rush studied at Edinburgh, one of the reigning medical “philosophies” was that of Hermann Boerhaave, a Dutch doctor who saw the body as a kind of hydraulically operated machine. Fluids coursed through its various pipes and gutters, and illness resulted from interference with their natural flow and pressure. But Cullen explained to Rush and other eager disciples that Boerhaave was wrong. Life was a form of energy, emanating from the brain and transmitted to the solid parts of the body through the nervous system. Diseases were caused either by an excess ofthat energy or a short supply of it. In the former case it was the doctor’s job to reduce “tension” by “depleting” the patient through bleeding and similar measures. If, on the other hand, the system was sluggish, stimulants and restoratives were called for.

Rush became and remained Cullen’s ardent defender for more than twenty years, after which he developed a theory of his own that bullion Cullen’s foundations. It clearly appealed to his appetite for “rational” thought. And it also involved a struggle to overcome nature, something like the Christian’s hand-to-hand combat with sin or the pioneer’s clash with the wilderness. For in battling to raise or lower the energy level of the diseased victim, the doctor piayed an active, even a “heroic,” role.

The real heroes of the day were the suffering patients. The doctors actually knew very little. Without anesthetics or aseptic techniques surgery was seldom a cure, more often killing through shock or infection. And known medicines were few. The resources of pharmacology could mildly alleviate pain or inflammation. In addition, there were drugs that could induce the sick person to vomit, perspire, and defecate copiously, and these were used with special vigor when doctors thought that “depletion” was called for.

The lucky patients were those whose physicians were “vitalists” and believed in letting natural healing processes work unaided. The patients of these doctors were left alone. Or if diagnosis indicated that building up was needed, they were fed such dainties as eggs, broth, and wine. By most other practitioners, however, patients were submitted to the puking, purging, and bleeding routine that only the hardiest could survive.