American Medical Biographies/Rush, Benjamin

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Rush, Benjamin (1745–1813).

The "American Sydenham," as he was termed by Lettsom, was born in Byberry Township, Philadelphia County, on December 24 1745. His family were English Quakers, but, curiously enough, both his father and grandfather were gunsmiths. After going as a boy to the academy kept by the Reverend Samuel Finley, later president of Princeton College, at Nottingham, he entered Princeton, where he received the degree B. A. in 1760. He spent the subsequent six years as an apprentice to Dr. John Redman (q. v.), one of the most prominent physicians of Philadelphia, and during this time translated the "Aphorisms of Hippocrates" into English and kept a medical notebook from which was subsequently derived the only account written by an eyewitness, of the yellow-fever epidemic which occurred in 1762 in Philadelphia. He also was one of the ten pupils who attended the first course of lectures on anatomy given by Dr. William Shippen, Jr. (q. v.).

In 1766 he entered the medical school of Edinburgh University and took his M. D. there in 1768, his graduation thesis being called "De Coctione Ciborum in Ventriculo." Thacher says it was written in classic Latin, and adds quaintly "and I have reason to believe without the help of a grinder of theses." While he was at Edinburgh, President Finley, of Princeton College, died, and the trustees elected the celebrated Dr. Witherspoon, of Paisley in Scotland, as his successor. The latter at first declined the appointment, but the trustees appointed young Rush as their deputy, and his solicitations at length prevailed on the eminent Scotchman to accept the position. From Edinburgh, Rush went to London and from thence to France to study, returning to Philadelphia in 1769. In the same year he was elected professor of chemistry in the college of Philadelphia, thereby rendering complete the medical faculty of the first medical school established in what is now the United States. The other teachers were John Morgan, William Shippen, Jr., and Adam Kuhn (q. v. to all). Clinical lectures in association with their teaching were also given at the Pennsylvania Hospital by Dr. Thomas Bond (q. v.).

Upon the death of Dr. John Morgan in 1789, Rush succeeded him as professor of the theory and practice of medicine in the College of Philadelphia. When, in 1791, that institution was merged with the University of the State of Pennsylvania to form the University of Pennsylvania, Dr. Rush was appointed professor of the institutes of medicine and clinical medicine. In addition to his public teaching Dr. Rush had a large number of private students, and it has been estimated that in the course of the forty-four years in which he was actively engaged in teaching he instructed 2,250 pupils. His lectures, judging from the notebooks of his pupils and from the statements of those who heard the lectures, were models of lucidity and comprehensiveness. He had the gift of imparting to his students some share of his own wonderful enthusiasm and thirst for knowledge. The prevalent medical teaching of his day was that of Cullen. Diseases were classified and every disease was supposed to possess an appropriate specific treatment. Underlying principles were entirely disregarded in an effort to build up a purely artificial classification of diseases and their treatment. Rush attacked the prevalent theories of medicine at once. He proclaimed the importance of the principles upon which a correct knowledge of the practice of medicine could only be based. "In his public instructions, the name of the disease is comparatively nothing, but its nature everything. His system rejects the nosological arrangement of diseases, and places all their numerous forms in morbid excitment, induced by irritants, acting upon previous debility. It rejects, likewise, all prescriptions for the names of diseases, and by directing their application wholly to the forming and fluctuating state of diseases, and of the system, derives from a few active medicines all the advantages which have been in vain expected from the numerous articles which compose European treatises upon the materia medica. This simple arrangement was further simplified by considering every morbid state of the system to be of such as neither required repletion or stimulation."

The author of the above quotation then goes on to state in pathetic terms what an advantage this has given the students who have studied under Benjamin Rush over those who, like himself, bad been obliged to learn by the old methods.

One marked peculiarity in Rush was his readiness to acknowledge an error and retract opinions proven erroneous by subsequent researches or events. One of his active and enquiring mind, continually employed in original researches and constantly by his writings and teaching endeavoring to advance medical science, was bound to err sometimes, and it redounds to his credit that when such mistakes were seen, he promptly acknowledged the fault.

His therapeutic standbys were the lancet and calomel. The latter he called Sampson, and his enemies in derision were wont to say "because it has slain its thousands." It was in the yellow fever of 1793 that Rush had the efficacy of these two therapeutic agents especially impressed upon him and the lesson he then learned as to their value, he never allowed himself to disregard. He states that he and other physicians of Philadelphia had been completely nonplussed in their efforts to find a method of treatment which seemed in any way to control the course of the disease. In this extremity he found among some papers in his library a manuscript which had been prescribed to him by Dr. Franklin years previously. It was an account of the yellow fever of 1741 in the Province of Virginia, written by a Dr. Mitchell. In it the latter put forth the strongest claims of the value of free purgation in the treatment of yellow fever, even where the disease was accompanied by an extreme degree of debility, and a very feeble pulse. Rush, upon reading Mitchell's manuscript, reasoned that the feeble pulse seen in so many cases was the result of debility from "an oppressed state of the system." He proceeded to immediately put his ideas into effect by administering enormous doses of calomel and jalap to all his patients. In addition to this he practised copious venesection, put the patient upon a low diet and used applications of cold water to the surface of the body, combined with the drinking of large quantities of water. He also advised that the temperature of the sickroom be low.

Rush hastened to impart his ideas to his fellow practitioners, and, indeed, to the public at large. The results achieved by his methods were certainly most gratifying. An oft-quoted statement is contained in his notebook for September 10. "Thank God! out of one hundred patients whom I have visited or prescribed for this day, I have lost none." He was overwhelmed with patients, and at length was himself taken ill and underwent a course of his own treatment. After his recovery he resumed his labors and remained at them until the epidemic was ended.

He shared the common fate of the famous in stirring up detractors. By his proclaiming his belief that the yellow fever was the result of filth in the streets of their city and not an importation, he caused the greatest anger among the citizens of Philadelphia. His most infamous assailant was William Cobbett, in his Peter Porcupine's Gazette. Rush sued him for defamation of character, and, having won his suit, gave the $5,000 which the law awarded him to the poor. Another famous quarrel in which Rush was involved occurred in the yellow-fever epidemic of 1797. Rush again published and adhered to his views on the efficacy of bleeding and purgation and also to the claim that the disease arose from the filthy condition of certain parts of the city. The United States Gazette published a very severe article on Rush, which he supposed had been written by a Dr. Ross. John Rush, son of Benjamin, wrote a bitter reply to Dr. Ross, and after some further interchange of literary hostilities proceeded to cane him. Dr. Ross challenged Dr. Benjamin Rush to a duel, as he declared him responsible for his son's actions. Rush refused the challenge and published the whole correspondence in the newspapers. One result of the controversy over the yellow fever in 1797 was the founding of the "Academy of Medicine of Philadelphia" by the adherents of Dr. Rush. The latter resigned from the College of Physicians, but always protested that he bore no ill-will towards that body. Dr. Physick was the first president of the new society.

In 1783 Dr. Rush was elected physician to the Pennsylvania Hospital, a capacity in which he served until his death. During that time he never missed a daily visit and was never more than ten minutes late. Morton's "History of the Pennsylvania Hospital" contains a most interesting account of his many services to that institution, particularly the reforms and advanced methods advocated by him in the treatment of the insane.

Dr. Rush served in a number of important political and military capacities. He was a member of the Provincial Congress of 1776, and as such signed the Declaration of Independence. On April 11, 1777, he was appointed by Congress, surgeon-general of the medical department of the Continental Army. Of his military services but little information is ascertainable. He became involved in the Conway cabal, being an ardent partisan of Gates and Samuel Adams in their criticism of what they termed the Fabian policy of Washington. With the downfall of the cabal Rush realized that his prospects for advancement in the Army were shattered, and wisely retired to the field of professional activity in which he had occupied so prominent a position. One invaluable result of his military experience remains in his pamphlet entitled "Directions for Preserving the Health of Soldiers," which was published by order of the Board of War. It is an excellent exposition of the rules of military hygiene and camp sanitation. He refused to draw any salary for his military services. In 1799 he was appointed Treasurer of the United States Mint, a position which he held until his death, when his son was appointed to succeed him.

Among his many activities may be mentioned his membership in the American Philosophical Society, before which he read a number of communications and of which he was at one time vice-president. He was chief among the founders of the Philadelphia Dispensary in 1786, the first dispensary established in this country. He assisted in founding the institution now known as Franklin and Marshal College, at Lancaster, Pennsylvania, and also in the founding of Dickinson College, at Carlisle, Pennsylvania.

Three subjects which were particularly near to his heart were the freeing of the negroes, the abolition of the death penalty, and the restriction of the immoderate use of alcohol and tobacco. On all these subjects he wrote many disquisitions and delivered frequent addresses.

He was very active in founding the Bible Society, and also in many other projects for the furtherance of religion, St. Thomas' Church, a large negro place of worship, was founded through his activity.

When he was a young man he wrote in stilted phrase to Dr. Ramsey: "Medicine is my wife; science is my mistress; books are my companions; my study is my grave; there I lie buried, the world forgetting, by the world forgot." In the latter part of his life he had put away this preternatural gravity and after having married a wife and begot thirteen children by her he writes in treating of the causes of insanity "celibacy is a pleasant breakfast, a tolerable dinner, but a very bad supper. The supper is not only bad, but, eaten alone, no wonder it sometimes becomes a predisposing cause to madness." His wife, whom he married in 1776, was Miss Julia Stockton, of a New Jersey family.

In addition to his printed works, which were published in seven volumes, Rush edited editions of some of the most famous English works on medicine, including those of Sydenham. Among his writings, besides those which have been already mentioned, there are several worthy of special note. He wrote of the disease we now term thermic fever, describing it with great accuracy in "An Account of the Disease occasioned by Drinking Cold Water in Warm Weather." There are also a number of other treatises by him on climatic affections, all possessing distinct value. Probably his best known book is his "Medical Inquiries and Observations on the Diseases of the Mind." Pepper stated that "His more elaborate addresses and orations are admirable, and some of them, as those on Cullen and on Rittenhouse, and his address on "The Influence of Physical Causes on the Moral Faculties' are splendid performances." John Shaw Billings said of Rush's writings that they "Excel in manner rather than matter."

In Ramsay's sketch is included the accompanying letter, written by Mrs. Rush to Dr. Mease (q. v.), shortly after her husband's death, describing his last illness.

"At nine o'clock in the evening of Wednesday, the fourteenth of April, 1813, Dr. Rush, after having been as well as usual through the day, complained of chilliness and general indisposition, and said he would go to bed. While his room was prepared and a fire making, he became so cold that he called for some brandy and drank it; he then went to his room, bathed his feet in warm water, got into a warm bed, and took some hot drink; a fever soon came on, attended with great pain in his limbs and in his sides; he passed a restless night, but after daylight a perspiration came on, and all the pains were relieved except that in his side, which became more acute. He sent for a bleeder, and had ten ounces of blood taken from his arm, with evident relief. At ten o'clock Dr. Dorsey called and saw him, heard what had been done, and approved of the treatment; observed that his pulse was calm, but rather weak, and advised him to drink plentifully of wine whey, which was immediately given to him. He remained the rest of the day and on Friday with but little apparent disease, though never quite free from fever, and always complaining when he tried to take a long breath. On the morning of Saturday he awoke with an acute pain in his side, and desired that the bleeder might be sent for; to this I objected on account of the weak state of his pulse. I proposed sending for Dr. Dorsey, but Dr. Rush would not consent to his being disturbed; he reminded me of his having had a cough all the winter, and said 'this disease is taking hold of my lungs, and I shall go off in a consumption.' At eight o'clock Dr. Dorsey saw him and, upon feeling his pulse, objected to his losing any more blood, and called in. Dr. Physick, who agreed in the opinion that bleeding was improper. The pain in his side, however, continuing, and his breathing becoming more difficult, Dr. Physick consented to his losing three ounces of blood from his side by cupping; this operation relieved him so that he fell into a refreshing sleep, and towards the evening of Saturday his fever went off, and he passed a comfortable night, and on Sunday morning seemed free from disease. When Dr. Physick saw him, he told me that Dr. Rush was doing well, that nothing now appeared necessary but to give him as much nourishment as he could take; he drank porter and water and conversed with strength and sprightliness, believing that he was getting well, until about four o'clock in the afternoon when his fever returned, but in a moderate degree. At five o'clock Dr. Physick and Dr. Dorsey visited him, and found him not so well as in the morning, but did not appear to apprehend what so soon followed, for at that time nothing was ordered different from the morning. At nine o'clock they again visited him, when they found him so low as to apprehend a fatal termination of his disease. Stimulants of the strongest kind were then administered; you, my friend, know with how little effect!"

A detailed list of his writings can be seen in the "Surgeon-general's Catalogue," Washington, District of Columbia.

Amer. Med. Biog., James Thacher, 1828.
Benjamin Rush, Address before the Amer. Med. Assoc., June, 1889.
Lives of Emin. Am. Phys., S. D. Gross, Philadelphia, 1861.
Recollections of Dr Rush, J. C. Lettsom, London, 1815.
Mitchell, T. D. The Character of Rush, Philadelphia, 1848.
An. Eulogium on Dr. Rush, D. Ramsay, Philadelphia, 1813.
Amer. Med. and Phil. Reg., New York, 1813–14, vol. iv.
Jour. Amer. Med. Assoc., Chicago, 1890, vol. xiv.
New England Jour. Med. and Surg., Boston, 1813.
There is a portrait in the Surg.-gen.'s collection, Washington, D. C.