The Paradoxical Doctor Benjamin Rush

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Rush, like other doctors, stayed at his post and worked with grim intensity to care for the sick. Sleeping fitfully and irregularly, he was visiting as many as a hundred patients a day and was having to fight off the relatives of more, who crowded his waiting room and tearfully clamored for help. Three of his students and his sister died. And on September 14 Rush himself came down with the fever. He purged and bled himself and was able to resume his rounds within a few days, but he collapsed a second time on October 4 and was sick for several more weeks. There was no question of his heroic devotion to helping those who filled the hospitals and sickrooms of the doom-haunted city.

There was no question, either, that he resorted to his favorite remedy with so much zest that other doctors took issue with him in the newspapers. Rush ignored their criticisms, and he continued not only to open the veins of his patients often and long but also tripled and quadrupled their dosages of such purgatives as jalap and calomel. From some victims he took as many as eighty ounces of blood in five days. And all the while he stubbornly insisted that he was curing his patients. “At no period,” he wrote, “did I lose more than one in twenty of those whom I saw on the first day, and attended regularly.” Overall, he claimed, he had saved some six thousand fellow citizens by his drastic treatments.

It is hard to believe that Rush did not fatally weaken many of those whom he treated, and it is certain that he did not really undertake any careful correlation of mortality statistics with various kinds of treatments. His powers of observation were great, but his willingness to apply them critically to his own ideas was limited. When he was right, it was, as in the case of his military sanitation theories, for the wrong reasons. Believing that yellow fever was spread by the “effluvia” from rotting waste heaps and slimy rain barrels, he unsuccessfully urged a clean-up of the docks and streets. Had this been done, it would have helped to kill off the mosquitoes that actually carried the virus from victim to victim as they bit and sucked blood. But at the same time Rush refused to budge from his theory that the disease was entirely local in origin, which called down the wrath of civic boosters on his head—and was incorrect. It was in fact brought in from the Caribbean by visiting passengers and sailors.

Philadelphia had new epidemics of yellow fever in 1794 and 1797, and Rush doughtily clung to bleeding his patients. As a result he was attacked mercilessly by two newspapermen, John Fenno and a transient from England, William Cobbett. Fenno denounced Rush’s “lunatic system of medicine,” while Cobbett referred to the “remorseless Dr. Rush” who might bleed him “white as this paper” before he would admit an error of opinion. He also denounced the doctor’s followers, the “Rushites” who had “slain their tens of thousands.” Rush, no man to turn the other cheek, struck back at Cobbett with a libel suit and won a judgment of five thousand dollars in damages plus three thousand dollars in costs, a large sum for the day. Cobbett was only able to pay four thousand. Rush donated it to charity and had the satisfaction of seeing a dead-broke Cobbett leave Philadelphia. But the whole controversy had pained him so much that in the autumn of 1797 he courted and got an offer of a professorship on the medical faculty of New York’s Columbia University. The arrangement fell through when Alexander Hamilton, a Columbia trustee and a political enemy of Rush, blocked the appointment.

It is pleasant to end with a happier image of Rush than that of intractable knight of the lancet. From 1783, when he joined the staff of the Pennsylvania Hospital, until the end of his life, Rush took a particular interest in the care of the insane. He summed up more than a quarter of a century of experience in primitive psychiatry with his final medical volume, Medical Inquiries and Observations upon the Diseases of the Mind , in 1812.

Rush believed that mental disease, like every other kind, was due to overstimulated blood vessels in the brain. And he was willing, in some cases, to subject the unhappy “maniacs” to his purging and bleeding routines, to tame their savage fancies. But he likewise had a common-sense notion that the best treatment was to reduce excitement by calming and soothing the patients. Nor did he think of them as animals to be chained, flogged, and abused, as was the common custom. He noted that “degraded as they are by their disease, a sense … of joy, of gratitude, of neglect, and of injustice is seldom totally obliterated from their minds.” His prescription for “derangement” included pleasant surroundings, useful occupations, the conversation of others when feasible, and the sense of being still a part of the human community. Rush even suggested getting the “madmen” and “madwomen” under his care to unburden their distressed minds by writing out their fantasies for discussion, vaguely foreshadowing psychoanalysis.

Though he could and did occasionally suggest restraints and harshness, in general Rush saw a connection between mind and body and thus was disposed to handle insanity as an illness instead of a curse or a sin. He who was so willing to storm the citadel of an inflamed vascular system, knife in hand, conceded that something less than a frontal assault on the nervous system was needed to deal with the mentally ill. In that area of treatment he was inclined to cooperate rather than to wrestle with nature.