The Paradoxical Doctor Benjamin Rush

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But he was busy medically as well. He had gone from teaching chemistry to lecturing on the theory of medicine at the College of Philadelphia, and when that was merged into the modern University of Pennsylvania in 1789, he held the chair of “institutes” and clinical practice there until his death. Teaching was never merely routine for him. He usually delivered his lectures while seated, but occasionally rose to make a particular point. Opposite each page of his lecture he left a blank one on which he made notes and additions as questions and ideas came to him. Every four years or so he would work up a complete new set of lectures. He wrote voluminously to his many students, and he continued to publish medical observations on a wide range of subjects.

For in the end Rush wanted to make his major contribution to mankind’s perfection as a doctor. “While the world, from the progress of intellectual, moral and political truth, is becoming a more safe and agreeable abode for man,” he opined in 1789, “the votaries of medicine should not be idle.” The “convulsions” of the American Revolution had thrown open “the doors and windows of the temple of nature,” ran his mature medical credo. “… We have already drawn from them discoveries in morals, philosophy and government, all of which have human happiness for their object. Let us preserve the unity of truth and happiness, by drawing from the same source … a knowledge of antidotes to those diseases which are supposed to be incurable.” Instead of arguing, as some later “votaries” were to do, that politicians should adopt the detachment and objectivity of science, Rush urged the scientists to help in the search for the great principles at the root of good government.

His personal search led him, in 1789, to the formulation of his own overall theory of disease, and his defense of it for the remainder of his days illuminated all his strengths and shortcomings. He discarded his old master Cullen’s elaborate “tree” of over a thousand diseases arranged by type and substituted for it the idea that almost all illnesses were forms of fever. And fever was caused by overstimulation of the blood vessels. The body, through fatigue, chilling, or some other factor, fell into a state in which the arteries were easily shocked into hyperactivity. The resulting feverish states could be classified by their symptoms, duration, and end results.

By reducing hundreds of illnesses to a few fevers, all arising from a single cause, Rush hoped to demystify and democratize medical practice. A simpler “nosology,” or classification of diseases, would also allow for a shorter list of remedies to be mastered. Briskly seizing analogies from physics and religion, he defended his slashing simplification. “Fire is a unit,” he observed, “whether it be produced by friction, percussion, electricity.” The “multiplication” of diseases was “as repugnant to truth in medicine, as polytheism is to truth in religion.” The physician who thought that every inflammation of every part of the human system was a distinct affliction resembled “the Indian or African savage, who considers water, dew, ice, frost, and snow, as distinct essences.”

The lamentable flaw, clinically speaking, in Rush’s scheme was that it led him to a virtual war on the fever patient’s circulatory system. He believed that the blood maintained the irritation of the veins and arteries and that removing an “excess” of it was as useful in reducing fever “as the abstraction of a particle of sand is to cure an inflammation of the eye.” By depleting the overexcited body through venesection the doctor supposedly could promote its restoration to equilibrium by rest and nourishment. Bleeding would be as effective as sweats, purges, and other prescriptions to reduce pain and restlessness. And it could be undertaken on a heavy scale. So long as the pulse remained “tense” or “full,” ten to twenty ounces (equivalent to one or two large glassfuls) could be removed repeatedly, even “until four-fifths of the blood contained in the body” was drawn away.

Rush’s testy defense of his views provoked quarrels only with other doctors until 1793, when differences of medical opinion spilled into the public prints during a savage epidemic of yellow fever. The killing disease often hit the city in the summer season, spreading from the wharves, where ships recently in from the West Indies unloaded their cargoes of sugar, coffee, chocolate, and spices. It spread rapidly, bringing down victim after victim. Its symptoms were a dark flush to the skin of the face, jaundiceyellow eyes, a high fever, and acute pains. Eventually internal hemorrhaging led to the dreaded “black vomit” of mingled blood and bile, followed in an alarming proportion of cases by death.

 

By the end of August, 1793, the number of fever cases began to escalate alarmingly. Those who could do so fled the city. Those who remained began to die like flies. There were 1,443 deaths in the city in September out of a total population of 45,000. The toll for a single week in October was 720. Altogether, between August i and November 9, some 4,044 deaths took place in the city, most of them due to the plague. The corpses lay unburied; deserted shops and homes were looted; and Philadelphia, the seat of the United States government, was paralyzed.