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The Paradoxical Doctor Benjamin Rush
“ To spend and be spent for the Good of Mankind is what I chiefly aim at ”
December 1975 | Volume 27, Issue 1
But while moving into the public spotlight Rush was laying the solid foundations of his medical practice in a way that revealed his basic traits. He did his best to make some practical moves. The first of them was getting support for an appointment as professor of chemistry at the College of Philadelphia, which gave him status and needed income. Another was the frequent publication of short medical papers. It might be added that a third was a happy and also advantageous marriage to Julia Stockton, daughter of a highly successful New Jersey lawyer-landowner. (By a historical coincidence Rush’s father-in-law was also a signer of the Declaration, as was John Witherspoon, the clergyman who married them.) Thirteen children came of the match, and Rush apparently had no difficulty in maintaining his studious habits even when his home was full of offspring.
Yet at the same time Rush could not refrain from quarrelling with his colleagues. He announced his loyalty to Cullen’s theories in terms that stung those doctors who followed Boerhaave. With deliberate or unconscious self-revelation he wrote in his autobiography many years later:
The system of Dr. Cullen was calumniated. … Perhaps my manner of recommending it provoked this opposition, for I know by experience as well as observation that an indiscreet zeal for truth … has cost more to the persons who have exercised it, than the total want of zeal for any thing good. … One of the physicians of the city I remember complained in severe terms of my having given at my table in the presence of a number of students of physic, the following toast, “Speedy interment of the System of Dr. Boerhaave, and may it never rise again.”
With that kind of tact it was not surprising that Rush did not at first get a large number of referrals from Philadelphia’s other doctors. He made up for it, in part, by cultivating a practice among the city’s poor. Day in and day out he made his way among ramshackle huts, treating patients who lay on vermin-infested mattresses, administering doses and “glysters” (enemas) with his own hands. Even though payment was irregular, Rush’s practice grew large enough in this way to give him a reasonable income. His work with the indigent also broadened his clinical experience.
But even more, it tended to confirm his democratic leanings, his sense of doing good in the world, and his sizable self-righteousness. Rush would insist in later writings that medical practice should be stripped of “imposture” and “mystery.” He urged frank discussion with patients, the writing of prescriptions in English, and a simplification of medical instruction so that “a young man will be able to qualify himself to practice physic at … much less expense of time and labour than formerly.” Simple ways might be best, and the American landscape itself might produce cures unknown to the Old World. “Who knows,” Rush declaimed after the Revolution, “but that, at the foot of the Allegheny Mountains there blooms a flower that is an infallible cure for the epilepsy? Perhaps on the Monongahela or the Potomac there may grow a root that shall supply by its tonic powers the invigorating effects of the savage or military life in the cure of consumptions.”
Circumstance and temperament made Rush a walker of solitary paths. Temperament, especially, ended his Revolutionary political career, after a medical battle in which he was right in principle but tactically outgeneralled. In April of 1777 he was appointed surgeon general of the “Middle Department” of the colonies, where the campaigning centered. Full of confidence, Rush prepared to tackle the job of keeping the American army healthy. He began with a manifesto to the officers on preserving the health of the troops. As Rush noted, “a greater proportion of men perish with sickness in all armies than fall by the sword.” His suggestions were full of hard good sense, though often presented on the basis of inaccurate theories and full of allusions to the practices of the Romans. Rush urged the adoption of a vegetarian diet and the elimination of liquor from the army, a pair of unlikely changes that probably would have induced mutiny had they ever been adopted. But he also insisted that “too much cannot be said in favor of CLEANLINESS .” He wanted the soldiers’ hair kept short, compulsory baths two or three times a week, frequent changes of linen, and careful cleansing of cooking utensils after each use. He urged that tents not be overcrowded and that camps be kept away from “marshes and millponds.” He also wanted the troops to air their blankets daily and to have the straw that filled their beds changed regularly.
Curiously enough, these wholesome ideas arose out of Rush’s conviction that disease was carried by the “effluvia,” or foul vapors that arose from decaying or putrid matter. The major point of his sanitation program was to prevent the “putrefaction” of the perspiration that accumulated in long hair and unwashed uniforms, and to keep large bodies of troops away from stagnant waters or garbage and dungheaps (which should be “buried or carefully removed every day”). Rush had no idea that the measures he proposed would work by reducing exposure to germs and the vermin that carried them. He was, characteristically, wrapping his own acute observations of the connection between dirt and disease in a mantle of a mistaken hypothesis that satisfied his mind and that he would never test.