JAMES BRADFORD LEWALLAN
Copyright James Lewallan 2001

 Philadelphia, in 1793, because of the conspicuous suffering, dying, and lack of hope, looked like the broken and weary camp at Valley Forge in 1777.  Not only did the people show the physical signs of the fever with jaundice of the eyes and skin, but the buildings and streets also reflected a Camus-like setting.  The people boarded up the houses and walked cautiously, and hearses replaced the carriages that once carried the frivolous and jovial.2  How was the city to stop this catastrophe that in the end would kill nearly four thousand and prompt the flight of around twenty-five thousand more?  Drastic times led to drastic measures and spawned radical ideas; the method Rush chiefly advocated to fight the fever called for a radical method of treatment that opened blood floodgates, rivaling those of any revolutionary war battle.

 The radical treatments Rush employed were bloodletting and purging, or simply, depletion.  Rush documented extensively his defense for, and the methods used to bleed the patients.  The actions of Rush caused great controversy among his contemporaries and ignited a war the doctor battled vehemently.

 Understanding what caused the dispute, and what made the system so radical, requires knowing precisely what Rush meant by bleeding, the extent to which he bled, and why he thought bleeding would cure the fever.  The doctor’s definition of bleeding in regards to yellow fever is as follows:

By the proximate cause of fever I have attempted to prove that the inflammatory state of fever depends upon morbid and excessive action in the blood-vessels.  It is connected, of course, with preternatural sensibility in their muscular fibers.  The blood is one of the most powerful stimuli which act upon them.  By abstracting a part of it, we lessen the principal cause of the fever.  The effect of bloodletting is as immediate and natural in removing fever, as the abstraction of a particle of sand is to cure and inflammation of the eye, when it arises from that cause.

 Rush left little time for careful observation and consideration of statistics.  Amidst the clamor and chaos that swept through Philadelphia, the doctor treated many, and many died.  The defense Rush prepared for his depletion method served him well in two ways, as the hypothesis he presented to the city and the College of Physicians at the outbreak, and as the bastion he hid behind when mortality rose and his critics took notice.

Consider first his medical education as the progenitor to two conflicting views on the origin and curing of disease.  Rush learned under William Cullen, an English physician who said disease resulted from a retarded nervous system.  John Brown, Rush’s classmate under Cullen, believed disease resulted when over or inadequate stimulation of the nervous system occurred.  Cullen seized the iatrophysicists method of treatment by assuming the body was machinelike and needed charging as in a lantern.  His student Brown adopted Brunonianism, a more iatrochemistic philosophy in which the body is a series of chemical processes.   Hence, Brown suggested curing disease with chemicals.  Rush favored the iatrophysic view and believed that bleeding and purging removed the body of bad or excess blood, just as too much, or dirty kerosene would not function well in a lantern.

  Rush depended heavily on the iatrophysic view and enumerated the reasons for bleeding in Defense of Blood-Letting:  bleeding alleviated blackness from tongue, checked nausea and vomiting, lessened pain in body with most relief in the head, removed obstructions in the lymphatic system, and reduced body heat and sweating.   Rush’s list was simple and dogmatic with no proof of success or scientific explanations why these actions occurred.  He considered his prognosis as right and just as any other theorist, no matter the proof. The most advantageous aspect of bleeding, Rush argued, was the doctor’s ability to choose the time and place of extraction of bad blood that the body would naturally discharge through other orifices via diarrhea, vomiting, and menstruation.   He was partly right; the black coloring in the vomit and stool was evidence that the body cured itself by discharging antigens via the digestive system.  He was more wrong than right; bleeding did not cure the body: it merely reduced the black color and relaxed the brain.  Obviously, without blood for the body to discharge, there were no crucial white blood cells and platelets to fight the disease.

Defense’s lack of evidence, and the experimentation of other physicians fighting against the fever, naturally evolved into speculation surrounding Rush.  His weak defense provided footholds for others to seek fame or defend what they thought was a better cure.  Some of the critics, with similar revolutionary fervor, opposed Rush for reasons not related to medicine.  The numerous critical assailants hinged on two chief points of disagreement: the cause and origin of the epidemic, and what was the best treatment.  Insufficient evidence in Defense produced colleagues who feared the doctors continuing practice, which increased the cities morbidity and mortality, and because, Rush “had no patience for pathology, laboratories and experimentation because these activities took the doctor away from his primary job: the care and treatment of patients.”
 
Rush’s main critic was English pamphleteer William Cobbett, who compared the doctor’s neglect of experimentation to an ugly old hag that despised beauty.   In The Rush Light, Cobbett carefully analyzed the proliferation of deaths in the city after the “Pennsylvanian Hippocrates,” as he called Rush, initiated the bleeding system. Cobbett supported his critique with tables which showed the increased mortality in September after Rush reduced the epidemics severity to that of the common cold (Appendix 1).   Other critics back up Cobbett’s accusations in similar tables (Appendix 2).  Cobbett’s biting sarcasm, however, was not enough to thwart Rush, who successfully quieted his adversary with a law suit.

Whereas Cobbett attacked Rush chiefly on his ignorance, others focused on the doctor’s theories of origin and methods of treatment.  Dr. Adam Kuhn led opposition in Philadelphia claiming the fever was not an epidemic, and its origin was foreign.  Rush opposed Kuhn and stated the disease originated in a shipment of coffee gone rancid on the Philadelphia docks near Water Street, and preached that the fever was epidemic, requiring flight from certain streets and a massive clean up of the city.   Kuhn gathered a following, the Kuneans, who gained strength when Dr. William Currie denounced Rush. Currie claimed merchants imported the fever from southern ports, and the mercury and bleeding techniques were hostile to the patient.   Even those “who had escaped the fatal effects of bleeding . . . carried death in their countenance,” observed a physician and Rush’s contemporary, Samuel Thomson.  Again, Rush found strength in his ability to counterattack the competition through his influence in the College of Physicians; but the critical attacks hampered his work, caused family dissonance, and gave him a bad name among many in Philadelphia.

Yellow fever was not Rush’s only enemy in his personal and professional war during the 1790s.  What drove Rush to whole-heartedly battle vehemently, for acceptance that bleeding was needed to stop the epidemic?  In the closing lines of the Defense, Rush drew similarities between his medical work and Gutenburg’s printing press which led to a literary renaissance, and how the lodestone advanced navigation and resulted in the discovery of the New World.   Rush then, claimed his patriotism to the country, not by being a nonconformist or a medical anarchist, but by being American, progressive, and visionary.
 
Although, Rush’s revolution ignited because of the yellow fever outbreak, his method of bleeding and vision precipitated from his Americanness, his enterprising religious, political, and proud state. The doctor’s Christian faith, as active as the faith of Bradford or Hutchison earlier, and as American in its plurality, relates directly to his justification of bleeding. Rush investigate and appreciated many Christian denominations.   His ability to merge and reconcile different doctrines into one, personal religious dogma also allowed Rush to sieve through medical dogmas and formulate a workable treatment for the fever.  The crux of Rush’s bleeding system was, surprisingly, his newly grasped Armenian theology.  The ability to choose the time and place of relieving pain through bleeding was bloodletting’s great advantage, according to Rush.  This free will countered the reality that the body, controlled by the creator, healed itself by producing the black stool and vomit resulting from natural blood discharge.   His Armenian fervor contributed to Rush’s certainty of salvation for all men and of a God who, in loving compassion for his creation, would provide another Moses to deliver his people from the disease.  Rush claimed Luke 10:19 as his charge as a medical savior, “Behold, I give you the authority to trample on serpents and scorpions, and over all the power of the enemy, and nothing shall by any means hurt you.”   Considering the verse a promise, Rush viewed his work as God’s divine decree.  An editor for the Federal Gazette wrote, “The almost universal success with which it hath pleased God to bless the remedies . . . enables Dr. Rush to assure his fellow citizens that there is no more danger. . .”   Although his family suffered greatly from the fever, the doctor was never bedridden; this he saw as a miracle. Rush took from his faith the justification for bleeding and gained a confidence suitable for sustaining him through the criticism.

In the political arena, like the religious one, Rush was a dissident. His political exposure to the revolution during his zealous youth and his abundant pride gained after he signed the Declaration of Independence spilled over into his vision for medical reform.   Namely, politics influenced the bleeding method, and caused problems with his medical practice.  Just as the writings of Thomas Paine were a stimulus for the American Revolution, they galvanized the political zest of Benjamin Rush.  In his critical slant, Cobbett attributed the bloodletting to the doctor’s love for Paine, and attributed his theory to his irresistible animosity towards British medical tyranny.    Some scholars contended this drive stemmed from Rush’s idea that there was a “parallel between the ‘old principles in medicine, and the elitist and undemocratic European political system, both of which were crumbling.”  Rush saw Europe’s control of medical education and foresaw the molding of most doctors in the colonies to the archaic practices of the European institutions.  For Rush, this path meant adherence to medical practices that disregarded the systematic approach to medicine which he learned from his reformed teacher Cullen.  He also knew the British would want to regulate the market of chemicals used by the iatrochemists in curing disease, hence, maintain their stature as the foremost in science and medicine.  The doctor saw these reasons poor excuses to hold onto failing medical methods.

Another political factor contributing to Rush’s bleeding hypothesis was the political wrangling impacting Philadelphia’s economy.  Opponents of Rush tried ardently to thwart the doctor’s notions that the fever was homegrown and epidemic.  This factor, to the dismay of the wealthy businessmen, would lead to a flight of people and an avoidance of the lucrative harbor traffic.   These hurdles were primary in Rush’s adamant arguments.  If he could convince the city leaders he knew the only cure, he would not only receive much fame, but also maintain amiable status with the city’s elite and not harm the delicate economy.
 
Those wishing to thwart the claims of Rush also utilized the political arena, a mistake which partly enraged Rush’s political-medical philosophy and proliferated the bleedings.  According to Rush, the controversy over bloodletting “was wholly political,” and evolved from “the prejudices and errors of our countrymen,” namely a rejection of whatever the French, who had experimented with bleeding, practiced.  Therefore, by claiming bleeding as a cure for the fever, Rush was indirectly revolting against Britain and the scores of British trained physicians surrounding him.  “In political contests men hate without killing, but in that hatred they commit murder every hour of their lives,” said Rush, showing that the criticism of his theory impacted him severely.  In short, the political impact on Rush’s work was positive and negative.  The effect showed he viewed man’s rights and their relation to government through the perspective of medical development, a complement to the country’s national growth.

Lastly, and most influential to Rush’s technique, was his pride.  His pride in the bleeding or himself was the backbone of his confidence in religion, politics, and theories on medicine.  Rush’s surety of his system mimics the patriot’s mindset of an entitlement to freedom and the power to obtain it and redefine a developing country. Similarly, Rush saw an immediate salvation for Philadelphia and a bright future for the nation medically.
 
As he aged, Rush’s confidence shifted.  Early in Rush’s writings he exalted humility.  He advocated establishing a practice among the farmers and common people for the sake of “showing them that you assume no superiority over them from your education, and that you intend to share with them in those toils, which were imposed upon man in consequence of the loss of his innocence.”   Later, however, invoking divine acceptance, Rush spoke of a lack of mental enlightenment capable of appreciating the fullness of his genius.  By claiming that his work should be “reserved by heaven for a more virtuous and enlightened race of men,” Rush negated the earlier lofty rhetoric on humility with his prophetic dictates.

Rush’s opponents viewed such confidence with disdain, just as the British viewed the pride of the colonials as untimely.  Much of the animosity Cobbett had for Rush developed from the critic’s hatred for the doctor’s affinity for independence.  Cobbett, though conspicuously bias, argued that Rush “refused to consult with any physician who has not been weak enough to adopt his practice.” Rush had, he continued, the vice of one with the “most insolent pretension to superiority ever set up by mortal man.”   Simply, Cobbett claimed the bleeding remedy did not grow out of an epochal discovery for curing yellow fever, but a need for Rush to be at the helm of something great.  The critics thwarting of Rush’s proposals was what he saw as an attack on his personal character.  Thus, supporting the bleeding treatment was the idea he could call his own, and defending it was a battle against his personal attackers.

Benjamin Rush, by having an open exploratory mind, allowed his religion, politics, and personality to influence his treatment of the Philadelphia yellow fever.  Some saw Rush as a radical, but his progressive attitude and impulse for change was the same attitude the colonialists used in motivating the country for the Revolutionary War.  Sadly, Rush’s bleeding prognosis lasted at the expense of many lives and his popularity as a teacher in Philadelphia before and after the epidemic left errant philosophy on the minds of his nearly 3000 students.  The story of Rush and his battle with yellow fever is a biography of an eclectic man hoping to channel the political zeal of his youth with the missed opportunity to fight in the War for Independence into a war on disease.  Unfortunately, the progressive patriot Rush was wrong in his bleeding theory and the new nation was not ready for a man who so intricately wove varying spheres of life into one.  In Rush’s defense if better methods of treatment existed there was no proponent as adamant as Rush, and few medical professionals contributed as generously to the improvement and growth of the country.

1. For further information on Dr. Rush see Pennsylvania Gazette.  17 February 1796.  Database on-line. Available from
http://www.accessible.com/about/pennsylv.html. Internet. Accessed 26 February
2001; Microsoft Encarta Encyclopedia, 1998 ed., s.v. “medicine” [CD-ROM]  (Palo Alto, CA: Microsoft Corporation, 1997).

2. Francis R. Packard, History of Medicine in the United States, vol. 1 (New York: Hafner, 1963), 133-135.

 . Benjamin Rush, Medical Inquiries and Observations: Containing An Account of the Bilious Remitting and Intermitting Yellow Fever, As is Appeared in Philadelphia in the Year 1794, Together with An InquiryInto the Proximate Cause of Fever, and A Defence of Blood-letting as a Remedy for Certain Diseases, vol. 4 (Philadelphia:  privately printed, 1796), 187.

 . Benjamin Rush, to the College of Physicians, 12 September 1793, in Letters of Benjamin Rush, ed. L. H. Butterfield, vol. 2 (Princeton: Princeton University Press, 1951) 661.

 . Rush, Inquiries, vol. 4, 207-208.

 . Oscar Reiss, Medicine in Colonial America (Lanham, Maryland: University Press of America, 2000), 396.

 . Benjamin Rush, Medical Inquiries and Observations, vol. 3, 5th ed. (Philadelphia: privately printed, 1819), 175-176.

 . Rush, Inquiries, vol. 3, 174.

 . Reiss, 171.

 . William Cobbett, The Rush Light (Philadelphia: privately printed, 1793), 38.

 . Cobbett, 69.

 . Packard, 143.

 . Packard, 147.

 . Samuel Thomson, A Narrative of the Life and Medical Discoveries of Samuel Thomson: Containing an Account of his System of Practice, 8th ed. (Columbus, Ohio: Pike, Platt, & Co. Agents, 1832), 193.

 . Rush, Inquiries, vol. 4, 256.

 . Benjamin Rush, The Autobiography of Benjamin Rush, ed. George W. Corner (Princeton: Princeton University Press, 1948), 163-165.

 . Rush, Inquiries, vol. 4, 188.

 . Luke 10: 19 NKJV.

 . “To His Fellow Citizens: Treatment for Yellow Fever,” Federal Gazette, 12 September 1793, in Letters of Benjamin Rush, ed. L. H. Butterfield, vol. 2 (Princeton: Princeton University Press, 1951), 660.

 . Cobbett, 31.

 . Charles B. Strozier, “Benjamin Rush, Revolutionary Doctor,”  American Scholar 64, no. 3, summer 1995 [magazine on-line]; available from http://fulltext.asp?resultSetId=R00000000&hitNum=8&booleanTerm=Rush%2c%20Benjamin&f.html; Internet; accessed 26 February 2001.

 . Reiss, 392.

 . Rush, Inquiries, vol. IV, 251.

 . Rush, Autobiography, 162.

 . Benjamin Rush, Medical Inquiries and Observations, vol. I, 4th ed. (Philadelphia: Griggs and Dickinson Printers, 1815), 253.

 . Rush, Inquiries, vol. IV, 255.

 . Cobbett, 13-14.