RUSH, BENJAMIN

(b. Byberry, Pennsylvania, 4 January 1746; d. Philadelphia, Pennsylvania, 19 April 1813)

chemistry, medicine, psychiatry.

Rush was born the fourth child of seven. He lost his father, John, when he was five but was fortunate in having a sturdy, emotionally and religiously steadfast mother (Susanna Hall Harvey), who opened a grocery store to support her children. At the age of eight Rush was sent to the school conducted by his uncle, Rev. Samuel Finley, and there came under the sway of the “Great Awakening” sweeping the colonies. His religious views were extended and polished under President Samuel Davies at the Presbyterian College of New Jersey (later Princeton), where he received the bachelor’s degree in 1760. He remained devout throughout his life, viewing the world as a great unity, so constructed by a benevolent God that everything was comprehensible, meaningful, and existing for a purpose.

Under Davies’ influence Rush contemplated the law as a career but decided instead in favor of medicine. He apprenticed himself to Dr. John Redman in Philadelphia for the next five years and during that time also took courses at the newly founded College of Philadelphia. He was exposed to some chemistry in the lectures on materia medica by John Morgan, who encouraged him to continue his medical education at Edinburgh, with the prospect of an appointment to the chair of chemistry on his return.

Enrolling in the medical program at the University of Edinburgh late in 1766, Rush furthered his chemical career by attending the lectures of Joseph Black for two consecutive years. In preparing his doctoral dissertation Rush applied his chemical bent to a study of the digestive processes in the human stomach. After vigorous self-experimentation that included induced vomiting of special meals, he decided that the acidity of the stomach contents was caused by fermentation. Rush erred in his conclusion and realized it only in 1804, when faced with the new experimental evidence produced by his student John R. Young.

After his graduation Rush toured factories in England, investigating their use of chemical reactions, and visited leading French chemists: Baumé, Macquer, and Augustin Roux. On his return to America, he was appointed professor of chemistry on 1 August 1769 at the College of Philadelphia (today the University of Pennsylvania Medical College). The following year he issued the nowscarce Syllabus of a Course of Lectures on Chemistry. With the lectures presented in a medical context, it is not surprising that he devoted a quarter of this slim volume to pharmaceutical chemistry.

The appointment of Rush ushered in the formal beginnings of chemistry in America. Rush was pleased to accept this responsibility, not only for the increase in professional stature but also for the satisfaction he derived from following in the footsteps of two leaders of eighteenth-century medicine who also had been professors of chemistry: Herman Boerhaave of Leiden and William Cullen. He was determined that chemistry should be useful to the larger community, and therefore offered a course to the educated public in 1775 and to the students of the Young Ladies Academy of Philadelphia in 1787. In his teaching Rush closely followed the outlines of Joseph Black’s course but, unfortunately, did not follow his teacher’s penchant for experimental demonstrations.

Experimentation in general was not Rush’s forte; he employed his chemical training only to expose the true nature of a quack cancer cure and to study the chemical composition and therapeutic effectiveness of various local mineral waters. He did use his knowledge to good avail during the Revolution, when he served on a governmental committee promoting the local manufacture of gunpowder; at that time his instructions for the manufacture of saltpeter were widely reprinted.

Rush’s teaching of chemistry ended in October 1789, when his early mentor, John Morgan, died and Rush took over his position as professor of the theory and practice of medicine. Rush never lost interest in the selection of his successors, all of whom were his students: Caspar Wistar (1789–1791), James Hutchinson (1791–1793), James Woodhouse (1795–1809), and John Redman Coxe (1809–1818). Another student whom Rush encouraged was John Penington, who organized the first chemical society in the United States in 1789.

Rush began his practice of medicine in 1769. At first largely among the poor, it gradually grew to include a wide spectrum of society. Rush had been trained by Redman to honor the clinical observations and insights of Sydenham and to accept Boerhaave’s theoretical system; but at Edinburgh he enthusiastically shifted his allegiance to Cullen’s theory. With his professorship of 1789 he again began to modify his theoretical focus, and a collegiate reorganization that made him professor of the institutes of medicine (physiology) and clinical practice in late 1791 forced further reconsideration of his views of basic physiological processes. Developed in his teaching during these academic years and in his medical experiences with the yellow fever epidemic of 1793, his ideas were fixed by 1795. Whereas Cullen had made the nervous system (its overenergetic or underenergetic reactions) the center of his theory, Rush narrowed his focus to the responsiveness of the arterial system. Using fever as his paradigm, he said that a state of motion (or what he called the convulsive or irregular action) in the arteries was the sole cause of disease. Since the majority of illnesses appeared to him to arise from increased tension, he logically but overenthusiastically applied bleeding and other depleting remedies to his patients. History has roundly but often excessively condemned him for the vigor of this treatment.

As a physician Rush also must be seen as a successful and popular teacher of some 3,000 students during the forty-four years of his career. Many did not accept his theories, and the doctoral dissertations written under Rush in his later years leave a clear impression that his pupils had outstripped him in their ability to appreciate the growing experimentation in the medical sciences. More important, however, he inspired them; remained their medical consultant for life; and taught them to be observant, dedicated to their patients, and aware of the nuances of the doctor-patient relationship.

Rush’s restless mind explored many spheres: theory and practice, medical jurisprudence, the physiology of balloon ascents, transcultural and especially Indian medicine, geriatrics, dentistry, veterinary medicine. Although active in many areas, he was concerned primarily with medicine and became widely recognized as the leading physician in the United States.

In 1787 Rush was placed in charge of the insane at the Pennsylvania Hospital. Psychiatric reform was accelerating throughout the Western world; and Rush was in step with such leaders as Vincenzo Chiarugi of Italy, Philippe Pinel of France and the Tuke family of Great Britain. Recognizing the need to see man as a whole, with body and mind “intimately united,” Rush was deliberately unorthodox in devoting a large part of his physiological lectures to a discussion of the operations and functions of the mind. As he passed from his physical theories to psychology, he developed a complex body of theory based on a mixture of associationism and faculty psychology. Rush’s practice and teaching of psychiatry culminated in the publication of Medical Inquiries and Observations Upon the Diseases of the Mind (1812), the first book on psychiatry by a native American. In this work he discussed, among many other topics, “moral derangements,” a concept that had concerned him as early as 1786, when he published An Enquiry Into the Influences of Physical Causes Upon the Moral Faculty. He realized that not only intellect but also behavior and the emotions can be disturbed, and his attempts at understanding these phenomena represent his most creative contribution to psychiatric thought.

A man of the Enlightenment, Rush evinced the best qualities of the age–humanism, optimism, and a fervent belief in the progress of knowledge. These traits were visible in his political reform activities: he signed the Declaration of Independence and fought for the federal constitution. He helped found Dickinson College, supported greater education for women, and called for a network of colleges culminating in a national university. He opposed slavery and capital punishment, supported temperance and penal reform. As a proselytizer and inspirational teacher Rush had a great impact on the American scientific scene. But for all his confidence in the clarity of his observations, Rush’s usual mode of validating his hypotheses was through analogy; and he never came to appreciate the experimental method for its true worth. As a medical theorist he belonged ’much more to the eighteenth-century system builders. For the field of science his importance lies, as Lyman Butterfield has so aptly said, in his role as “an evangelist of science.”

BIBLIOGRAPHY

I. Original Works. Rush’s chemistry is in the reprint of his Syllabus of a Course of Lectures on Chemistry (Philadelphia, 1954), which contains a thoughtful introduction by L. H. Butterfield, and in the student notes of his lectures. Rush collected what he considered to be his most important writings in Medical Inquiries andObservations, 2nd ed., 4 vols. (Philadelphia, 1805). To this should be added his Medical Inquiries and Observations Upon the Diseases of the Mind (Philadelphia, 1812: repr. New York, 1962) and his earlier An Inquiry Into the influence of physical Causes Upon the Moral Faculty (Philadelphia. 1786). The Autobiography of Benjamin Rush, G. W. Corner, ed. (Princeton, 1948): and Letters of Benjamin Rush, L. H. Butterfield, ed., 2 vols. (Princeton, 1951), provide a rich background to his life and associations and contain bibliographies listing all published works and MSS .

II. Secondary Literature. Two major biographical studies exist: N. G. Goodman, Benjamin Rush, Physician and Citizen, 1746–1813 (Philadelphia, 1934), is more of an intellectual history: C. Binger, Revolutionary Doctor: Benjamin Rush, 1746–1813 (New York, 1966). is a warm, humanistic account of the man himself. D. J. D’Elia, “The Republican Theology of Benjamin Rush,” in Pennsylvania History, 33, no. 2 (1966). 187–203, provides important insights into Rush’s philosophical stance. Essential to a study of his early career is W. Miles, “Benjamin Rush, Chemist,” in Chymia, 4, (1953), 33–77: and H. S. Klickstein offers additional information in “A Short History of the Professorships of Chemistry of the University of Pennsylvania School of Medicine, 1765–1847.” in Bulletin of’ the History of Medician, 27, no. 1 (1953), 43–65. Rush’s use of chemistry in his doctoral dissertation is discussed in D. F. Musto, “Benjamin Rush’s Medical Thesis, ’On the Digestion of Food in the Stomach.’ Edinburgh, 1768,” in Transactions and Studies of the College of Physicians of Philadelphia, 4th ser., 33, no. 2 (1965), 121–138.

A good evaluation of Rush the physician is given by R. H. Shryock in “Benjamin Rush From the Perspective of the Twentieth Century,” in Transactions and Studies of the College of Physicians. of Philadelphia, 4th ser., 14, no. 2 (1946), 113–120. J. H. Powell, in Bring Out Your Dead (Philadelphia, 1949), shows Rush’s dedicated but vehement behavior in the Philadelphia yellow fever epidemic Rush’s psychiatry is summarized in Shryock’s “The Psychiatry of Benjamin Rush,” in American Journal of Psychiatry, 101 (1945), 429–432: and in E. T. Carlson and M. M. Simpson, “The Definition of Mental Illness: Benjamin Rush (1746–1813),” ibid., 121, no. 3 (1964), 209–214. Carlson and Simpson have also shown the importance of his writings on the moral sense in their “Benjamin Rush’s Medical Use of the Moral Faculty,” in Bulletin of the History of Medicine, 39, no. 1 (1965), 22–33.

Eric T. Carlson

Rush, Benjamin

WORKS BY RUSH

SUPPLEMENTARY BIBLIOGRAPHY

Benjamin Rush (1746–1813), American physician, politician, and social reformer, was born in Byberry, Pennsylvania, the son of a farmer and gunsmith. After graduating from the College of New Jersey (later Princeton) in 1760, he was apprenticed to the physician John Redman. He entered the University of Edinburgh in August 1766 and received his medical degree in June 1768, after presenting a thesis, De coctione ciborum in ven-triculo, based on several experiments performed on himself and a friend. Shortly after his return to Philadelphia in 1769, Rush was elected professor of chemistry in the College of Philadelphia (now the University of Pennsylvania) and began the practice of medicine.

Like his contemporaries Franklin and Jefferson, Rush was a representative of the American Enlightenment. As a republican, he was an ardent proponent of American independence. In 1776 he was made a member of the Continental Congress and signed the Declaration of Independence. He joined the Continental Army in December 1776 and from April 1777 to January 1778 served as surgeon-general of the armies of the Middle Department. But differences arose between Rush and William Shippen, the director-general, which led to Rush’s resignation and resumption of private practice in Philadelphia. In 1789 he was appointed professor of the theory and practice of medicine in the medical faculty of the College of Philadelphia.

At the same time Rush continued his social and political activities. He felt obliged to use his mind and pen in any way that would advance national unity and foster political stability in the young American republic. Thus, he advocated the national constitution of 1787 and helped to frame the Pennsylvania state constitution of 1790. From 1797 to 1813 he served as treasurer of the United States Mint. Moreover, recognizing the relationship between an informed public opinion and popular sovereignty, Rush saw the need to prepare the citizens for the task of governing. Consequently, he advocated a national system of education, with various state-supported schools, including a national university and technical schools. In addition, Rush also championed higher education for women, and he was largely responsible for the founding of Dickinson College in western Pennsylvania.

But Rush’s efforts for the public good went beyond education. His major impulsion to action arose from the desire to improve the conditions of men in a rational manner. He was an early and passionate proponent of the abolitionist cause, serving as president of the Pennsylvania Society for Promoting the Abolition of Slavery. He advocated temperance and legal control of drinking. Penal reform was another cause that Rush made his own, and in 1787, together with Franklin and several like-minded men, he organized the Philadelphia Society for Alleviating the Miseries of Public Prisons. It was this group that succeeded in having the death penalty in Pennsylvania abolished for all crimes except murder in the first degree. Rush was likewise a principal founder, in 1786, of the Philadelphia Dispensary for the Poor, the first free dispensary in the United States.

As a physician, Rush, like so many of his medical contemporaries, is a characteristic figure of the transitional period during which modern medicine was just beginning to emerge. Medical practice was based on empiricism, tradition, and theories that lacked any firm scientific foundation. Moreover, like other physicians of his time, Rush supported his opinion and practice by argument rather than experiment.

Rush’s most significant contribution to medicine and to social welfare was his study of mental illness. In 1812 he published Medical Inquiries and Observations Upon the Diseases of the Mind, the first American treatise on mental illness. It remained the only American work of its kind for more than fifty years after its publication. Basing his treatise on observations made at the Pennsylvania Hospital, where he was in charge of mental patients for some thirty years, Rush attempted to provide a systematic account of mental disorders in terms of theory and practice. He viewed mental derangement as basically due to disease of the cerebral arteries, and his therapy was intended to relieve this pathology. Treatment was designed to affect the circulation of the blood and included purges, emetics, bleeding, a bland diet, and hot and cold showers. At the same time, Rush was aware of psychic components in mental illness and urged the patients to write down what troubled their minds and to read what they had written. It is clear that he was aware of the ill effects of repressed emotions. Rush was humane to his mental patients, but he recommended coercion under some circumstances and even advocated corporal punishment in extreme situations. Like his contemporary Philippe Pinel, Rush knew the importance of enlightened hospital management in dealing with mental patients. It was due to his efforts that a separate wing for the insane was added at the Pennsylvania Hospital in 1796. Rush likewise recognized the need for well-qualified persons to serve as attendants in establishments for the mentally ill, as well as the necessity of keeping the patients and their quarters as neat and clean as possible. He also advocated occupational therapy; the separation of those patients who were disoriented and violent from the others; the provision of exercise and recreation for the patients; and the treating of the mentally ill with respect and kindness.

Rush exerted a significant influence on the practitioners of his time and for several generations after his death. His most important achievement was his pioneer endeavor to raise the study and treatment of the mentally ill to a systematic, scientific level.

George Rosen

[See alsoPsychiatry, article onChild Psychiatry; and the biography ofPinel.]

WORKS BY RUSH

1768 De coctione ciborum in ventriculo. Edinburgh: Bal-four.

(1786) 1839 Inquiry Into the Influence of Physical Causes Upon the Moral Faculty. Philadelphia: Cist. → Delivered before the American Philosophical Society, February 27, 1786.

(1812) 1930 Medical Inquiries and Observations Upon the Diseases of the Mind. 4th ed. Philadelphia: Grigg.

The Autobiography of Benjamin Rush. Edited with an introduction and notes by George W. Corner. Princeton Univ. Press, 1948.

The Letters of Benjamin Rush. Edited by L. H. Butterfield. 2 vols. Princeton Univ. Press, 1951.

The Selected Writings of Benjamin Rush. Edited by Dago-bert D. Runes. New York: Philosophical Library, 1947.

SUPPLEMENTARY BIBLIOGRAPHY

Binger, Carl 1966 Revolutionary Doctor: Benjamin Rush. New York: Norton.

Dain, Norman 1964 Concepts of Insanity in the United States: 1789–1865. New Brunswick, N.J.: Rutgers Univ. Press. → See especially pages 15-25.

Deutsch, Albert (1937) 1949 Benjamin Rush: The Father of American Psychiatry. Pages 72-87 in Albert Deutsch, The Mentally 111 in America. Rev. ed. New York: Columbia Univ. Press.

Goodman, Nathan G. 1934 Benjamin Rush: Physician and Citizen, 1746–1813. Philadelphia: Univ. of Pennsylvania Press.

Lloyd, James H. 1930 Benjamin Rush and His Critics. Annals of Medical History 2:470-475.

Pepper, O. H. Perry 1946 Benjamin Rush’s Theories on Bloodletting After One Hundred and Fifty Years. College of Physicians of Philadelphia, Transactions and Studies Fourth Series 14:121-126.

Rosen, George 1952 Political Order and Human Health in Jeffersonian Thought. Bulletin of the History of Medicine 26:32-44.

Shryock, Richard H. 1945 The Psychiatry of Benjamin Rush. American Journal of Psychiatry 101:429-432.

Shryock, Richard H. 1946 Benjamin Rush From the Perspective of the Twentieth Century. College of Physicians of Philadelphia, Transactions and Studies Fourth Series 14:113-120.

Wittels, Fritz 1946 Contribution of Benjamin Rush to Psychiatry. Bulletin of the History of Medicine 20:157-166.

Benjamin Rush

1745-1813

American Physician, Politician and Medical Educator

Benjamin Rush was the most prominent American physician of his day. He was the first professor of medical chemistry in America, a signer of the Declaration of Independence, a hero of the yellow fever epidemics of the 1790s, and the founder of American psychiatry.

Rush was born on December 24, 1745 (Old Style) or January 4, 1746 (New Style) in Byberry, Pennsylvania. He prepared for college at his maternal uncle Rev. Samuel Finley's academy in West Nottingham, Pennsylvania, then graduated from the College of New Jersey, later called Princeton University, in 1760. For the next six years he was the medical apprentice of John Redman, a prominent Philadelphia physician. He then studied under Alexander Monro secundus (1733-1817), John Gregory, John Hope, Joseph Black (1728-1799), and William Cullen (1710-1790) at Edinburgh, where he received his M.D. in 1768.

In 1769 he began teaching chemistry as the fourth faculty member of the Medical Department of the College of Philadelphia, later called the School of Medicine of the University of Pennsylvania, the first medical school in America.

An ardent American patriot, Rush was Surgeon to the Pennsylvania Navy from 1775 to 1776, a member of the Continental Congress from 1776 to 1777, and Physician-General of the Military Hospitals of the Middle Department of the American Army from 1777 to 1778. He helped Thomas Paine publish Common Sense. In January 1776 he married Julia Stockton and six months later both he and his father-in-law, Richard Stockton, signed the Declaration of Independence.

From 1775 to 1777 Morgan, and from 1777 to 1781 Shippen, served successively as Director-General of Military Hospitals and Physician-in-Chief of the American Army. Throughout the war Rush plotted against both of them and alternately helped each to plot against the other.

In the wake of Carolus Linnaeus (1707-1778), many European and American intellectuals became obsessed with classification. Cullen's Synopsis nosologiae methodicae [Synopsis of Methodical Nosology] (1769) attempted to classify all diseases and regarded each disease as a separate entity to be treated with its own specific cure. Rush led other medical theorists in reaction against nosology. He criticized Cullen for treating the "name" of the disease, not its "proximate cause" or symptoms. He believed that there was only one disease, fever, existing in many manifestations and indicating only one set of cures: phlebotomy (bloodletting), emetics, purgatives, radical depletion, modifications of diet, lowering of room temperature, and drinking great quantities of water. These prescriptions would be adjusted for the qualities and severity of each manifestation.

A long debate arose. Confrontations between nosologists and "single-disease-singlecure" theorists were derisive, unrestrained, and occasionally even brutal. Alexander May, one of Rush's students at the University of Pennsylvania, wrote his medical dissertation in 1800 as a vicious personal attack on Cullen and his followers; but Rush himself, even though he strenuously opposed Cullen, never lost personal respect for him.

In 1791 Rush relinquished his professorship of chemistry to become professor of clinical medicine. As a clinician he was a follower of Thomas Sydenham (1624-1689), whose observations were keen but whose cures were often repugnant. Rush was one of twelve founding fellows of the College of Physicians of Philadelphia in 1787, but resigned in 1793 because the majority of fellows disapproved of bloodletting, mercurial purges, and other extreme methods Rush used to treat the yellow fever that was then devastating the city. Along with his letter of resignation to his old teacher Redman, President of the College, he sent a copy of Sydenham's works.

The epidemic resulted in his masterpiece, An Account of the Bilious Remitting Yellow Fever as it Appeared in the City of Philadelphia in the Year 1793 (1794).

Toward the end of his life Rush turned his attention toward what is now called psychiatry. His Medical Inquiries and Observations upon the Diseases of the Mind (1812) was the first American book in the field.

Always politically active, he was a delegate to the Pennsylvania convention that adopted the federal Constitution in 1787 and from 1799 to 1813 he served as Treasurer of the United States Mint.

In many ways Rush remains an enigma. He was hot-tempered and sometimes bitter, yet he accepted Shippen's forgiveness and eulogized Shippen when he died. He encouraged scientific research, yet he clung stubbornly to prescientific dogmas of bloodletting and violent purges. He often felt depressed, defeated, ready to give up, and worried that he would die young, yet he strived tirelessly in both politics and medicine and produced a tremendous amount of work.

ERIC V.D. LUFT

ONE DISEASE OR MANY?

In Sepulchretum, sive anatomia practica ex cadaveribus morbo denatis (1679), Théophile Bonet included the first systematic attempt to classify all diseases. The usual term for disease classification, "nosology" (nosologia), was coined in the 1720s. Nosology grew in popularity throughout the eighteenth century. It dominated medical philosophy and medical research from the 1770s until the 1820s. The most influential nosologist was William Cullen, whose Synopsis nosologiae methodicae (1769) defined the field for 30 years. Other prominent nosologists were François Boissier de la Croix de Sauvages, Erasmus Darwin, Philippe Pinel, John Mason Good, David Hosack, and Thomas Young.

Because nosologists believed that every disease was a distinct "thing," they treated the relation between nosology and therapeutics as a metaphysical question; and because they believed that the accurate classification of diseases would suggest specific cures, they also treated it as a clinical question. They considered nosology primarily practical rather than theoretical. Against nosological medicine, the philosopher Immanuel Kant is supposed to have said, "Physicians think they do a lot for a patient when they give his disease a name." Clinicians no longer believe that the classification of diseases has anything to do with curing them.

Most physicians of the late eighteenth century accepted some form of nosological theory, but Benjamin Rush, one of Cullen's former students, inspired a large minority to assert against Cullen that there is only one disease, appearing as many different kinds of symptoms. Another of Cullen's former students who disagreed with him was the notorious John Brown, for whom all diseases were either "sthenic," i.e., marked by over-excitement, or "asthenic," i.e., marked by under-excitement. Whichever pole characterized the disease, the patient's body had to be moved in the other direction. Prescriptions generally included some combination of alcohol and opium (which were also Brown's personal drugs of choice).

ERIC V.D. LUFT

Benjamin Rush

Benjamin Rush (1745-1813), physician, patriot, and humanitarian, represented the epitome of the versatile, wide-ranging physician in America. He insisted on a theoretical structure for medical practice.

Benjamin Rush was born on Dec. 24, 1745, on a plantation at Byberry near Philadelphia. He graduated in 1760 from the College of New Jersey (now Princeton) and then studied medicine in Philadelphia until 1766. He completed his medical education at the University of Edinburgh, Scotland. Here he studied under many of the greatest medical teachers of the time, most notably William Cullen, proponent of the concept of rational rather than empirical medical systems. Rush received his doctorate in 1768, then returned to Philadelphia.

Rush practiced medicine and was soon made the first professor of chemistry in America at the College of Philadelphia. He joined the American Philosophical Society and became a permanent part of Philadelphia's scientific and medical circle, though his outspoken views made as many enemies as friends. In 1774 he helped organize the Pennsylvania Society for Promoting the Abolition of Slavery and became an outspoken defender of American rights in the brewing quarrel with Great Britain. In 1775 Rush suggested that Thomas Paine write a tract in favor of American independence under the title Common Sense; Paine did and the pamphlet was very influential in turning public opinion toward independence. Rush continued to be active in the American independence movement, was a member of the Continental Congress, and signed the Declaration of Independence.

Appointed surgeon general of the armies of the Middle Department in 1777, Rush found the medical services disorganized and mounted an attack on William Shippen, the director general of medical services. When George Washington upheld Shippen, Rush resigned and resumed his medical practice. He began delivering lectures at the University of the State of Pennsylvania in 1780 and joined the staff of the Pennsylvania Hospital in 1783. By 1789 he was professor of theory and practice in the university. He became professor of the institutes of medicine and clinical practice in the University of Pennsylvania in 1792 and professor of theory and practice in 1796. From this base he developed a wide following.

Rush's great reputation as a teacher made him appear a more important innovator than he was. His major contribution was to introduce Cullen's concept of a rationally deduced medical system to replace empirical folk practice. He also supported the theory of John Brown of Edinburgh proposing a single cause for all disease—imbalance of the nervous energies. According to this theory, all illness was attributable to excesses or deficiencies in nervous energies; moderation in all things was the preventive medicine, but once illness occurred, either bleeding or purging was necessary. Rush was a zealot on bleeding and in extreme cases would remove as much as four-fifths of a patient's blood. His excesses in this brought much criticism, but his emphasis on moderation as a preventive was popular. He was thus led to advocate temperance, and he is sometimes regarded as the founder of the temperance movement in America.

Rush also became interested in the plight of the mentally ill and the poor, established the first free dispensary in the United States, and campaigned against public and capital punishment and for general penal reform. He also concerned himself with education, advocating education for women, less emphasis on classics and more on utilitarian subjects, and a national educational system capped by a national university. His ideas were behind the founding of Dickinson College in 1783.

The test of Rush's medical theories came during the yellow fever epidemic of 1793. His initial theory that the epidemic was partly caused by poor sanitation resulted in ostracism by fellow physicians. Rush bravely stayed in Philadelphia to treat yellow fever victims, while many other medical men fled. His treatment was bleeding, and he was charged with causing many more deaths than he prevented. Although Rush held to his theory, he was either unwilling or simply unable to keep records so that the theory could be checked against fact. However, his published accounts of the epidemic, especially his suggestion that poor sanitation was an ultimate cause, attracted attention in Europe.

Rush also did pioneering work relating dentistry to physiology and was influential in founding veterinary medicine in America. Both fields had been considered beneath the dignity of the professional. His observations on the mentally ill seem to presage modern developments in psychoanalytic theory, especially his Medical Inquiries and Observations on the Diseases of the Mind (1812).

Rush's insistence on a rational, systematic body of knowledge for the medical profession certainly helped set the stage for the later medical revolution in America. He died in Philadelphia on April 19, 1813.

Further Reading

Primary sources on Rush include The Autobiography of Benjamin Rush, edited by George W. Corner (1948); Rush's Letters, edited by L. H. Butterfield (1951); and John A. Schutz and Douglass Adair, eds., The Spur of Fame: Dialogues of John Adams and Benjamin Rush (1966). Although several books have been written about Rush, there is no definitive study. The only fully documented scholarly work is Nathan G. Goodman, Benjamin Rush: Physician and Citizen (1934). Carl A. L. Binger, Revolutionary Doctor: Benjamin Rush (1966), is fairly sound. A popularized work is Sarah R. Riedman and Clarence C. Green, Benjamin Rush (1964). For general background see Daniel J. Boorstin, The Lost World of Thomas Jefferson (1948), and Brooke Hindle, The Pursuit of Science in Revolutionary America, 1735-1789 (1956).

Additional Sources

Blinderman, Abraham, Three early champions of education: Benjamin Franklin, Benjamin Rush, and Noah Webster, Bloomington, Ind.: Phi Delta Kappa Educational Foundation, 1976. □

Benjamin Rush (1745-1813)

Sources

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.

Sources

David Freeman Hawke, Benjamin Rush: Revolutionary Gadfly (Indianapolis: Bobbs-Merrill, 1971);

Richard Harrison Shryock, Medicine and Society in America, 1660–1860 (New York: New York University Press, 1960).