Rush, Benjamin (1745-1813)

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Benjamin Rush (1745-1813)

Physician

Reformer. American patriot, signer of the Declaration of Independence, and between 1769 and 1791 professor of chemistry and medicine at the College of Philadelphia (now the University of Pennsylvania Medical School), Benjamin Rush was the best-known physician of the era. Born near Philadelphia in 1745, he was educated at Edinburgh, Scotland, considered the best medical school of the eighteenth century. He started practicing medicine in his home city in 1769. The next year he wrote Syllabus of a Course of Lectures on Chemistry, the first chemistry textbook in America. Rush was a deeply religious man who took a strict moral view of the issues of the day. To this active reformer, health was very much a moral issue, and he was an outspoken critic of slavery, drinking, and tobacco. Rush was the first doctor to publicly associate smoking with cancer.

Public Servant. Between 1777 and 1778 Rush served as surgeon general of the Continental Army (for which he took no pay), and in late 1785 he established the first free dispensary in the United States. As a delegate to the Pennsylvania constitutional convention in 1787, he supported ratification. Rush also served as treasurer of the U.S. Mint for seventeen years (1797–1813).

Yellow Fever Epidemic. Unlike some physicians who fled Philadelphia during the yellow fever epidemic of 1793, Rush remained in the city and worked tirelessly to care for the sick. The cause of yellow fever was unknown at the time, so most medical treatment had little benefit. Rush’s remedy most likely did some harm, for he was an advocate of bleeding as a general treatment for most serious ailments. During the epidemic, he employed bleeding to such an extent that William Cobbett described his practice as “one of those great discoveries which are made from time to time for the depopulation of the earth.” (Rush later sued Cobbett for libel and won.) Despite such criticism, he was one of the first physicians to link disease with poor sanitation and overcrowded living conditions.

Theory. Like many physicians influenced by Enlightenment thinking, Rush was prone to great unified theories, which were not always supported by observation. For example, he believed that fever was the result of “a spasm of the extreme arteries” (capillaries), which could be eased only by bleeding. Rush carried this idea to the extreme that all diseases resulted from capillary tension. Thus, as he told his students, there is really “only one disease in the world,” and therefore one cure. Most physicians agreed with him that bleeding was an effective treatment, although few would go to his extreme. Over the course of a week’s treatment he would sometimes draw as much as three quarts, half an adult’s total volume of blood.

Mental Health. Rush’s Medical Inquiries and Observations, upon the Diseases of the Mind (1812) was the first book on psychiatry written by an American. His linking of physical and mental health, his insistence that the mentally disturbed be treated in separate hospital facilities, and his personal devotion to his patients made him a pioneer in the treatment of the mentally insane. Although he believed that diseases of the mind and body arose from the same causes (and thus treated mental disorders by bleeding), Rush also emphasized the importance of dreams, encouraged patients to discuss or write about their feelings, and kept them busy at occupations that aided their rehabilitation.

Balanced Assessment . Despite Rush’s fame during his lifetime, later historians were not always kind. As one nineteenth-century writer put it: “in the whole vast compass of medical literature, there cannot be found an equal number of pages containing a greater amount and variety of utter nonsense and unqualified absurdity.” A more balanced view would take into account Rush’s support for social reform, his devotion to his patients and students, and his pioneering work in mental health and public sanitation. Much of the progress made by the next generation of physicians would be because Rush had the courage to make his ideas public where they could be discussed and modified.