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.
Benjamin Rush. (Corbis Corporation. Reproduced with permission.)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 separateentity 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.
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
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