Mentors Matter October 30, 2023
Benjamin Rush MD - “a rush to judgment”
Most famous American Physician
Benjamin Rush MD (1745 - 1813) was the most well-recognized physician in 18th century America and possibly the most famous American born medical doctor in history. One rea-son for his popularity was his political influence as “A Founding Father of the United States of America” and the only physician signer of the Declaration of Independence. He was equally one of the most famously hated physicians for his dogmatism in just about every-thing including medical science, theology, and politics.
American Influencer
Rush was absolutely brilliant academically, entering what would be Princeton at the age of 14, and writing the first chemistry textbook published in America. His accolades were di-verse as he founded the College of Psychiatry (1787) making him the Father of American Psychiatry, as well as the general surgeon of the US army, the treasurer of the US Mint, and one who helped initiate veterinary medicine in the US. His views for his time, and even for today, were very progressive. He advocated for woman in medical school and throughout all fields of education. He was avidly outspoken against slavery, starting the Pennsylvania Society for Promoting Abolition of Slavery. He established and financed the oldest Negro church in the country. Rush was against public punishment, and was instrumental in abol-ishing capital punishment for all offenses except for first-degree murder. He was an advo-cate for humane treatment of prisoners and he helped humanize care for the mentally ill. He believed animals should be offered advanced medical treatment. Concerned about the effects of alcohol on society, he was part of the temperance movement. He believed every one deserved an education and advocated free public education for all, paid by property tax. And he also began the first medical care clinic for the poor in America in 1786 as the first hospital of its kind.
American Ego
For Dr. Benjamin Rush’s insurmountable political and social accolades which brought him unparalleled historical notoriety, it is somewhat ironic that his medical practice, and partic-ularly his attitude as a physician, made him one of the most vilified physicians in American history. After graduating from Princeton, and then obtaining his medical license, he went overseas to Scotland, England, and then France where Benjamin Franklin became his pa-tron and financed some of his travels. Rush studied under several famous European physi-cians, some which were fascinated by electricity as a way of understanding the human body and healing it. Miasma theory was still the predominant theory in which putrid materials
from bad air infected people who breathed them in and got infected by them. Combining thoughts of miasma with electrical mechanics, Dr. Rush was taught and further developed the idea that when a person has fever, or shakes, or fast heart rate, or exhibits mania that this is an imbalance of one’s nervous system. There is an excess of nervous electrical activ-ity. Even today, we might call all of these a “stress response” from sympathetic nervous ac-tivity.
From this way of thinking, the excess nervous stimulation needed a “pressure valve” to let off steam and get rid of the putrid miasma and excess electrical activity. This was accom-plished by “bloodletting” which would “let out” the excessive nervous energy. Dr. Rush’s European training which he brought back at the age of 24 to Philadelphia in 1769 is not un-reasonable given the immense “buzz” surrounding electricity, and the time-honored though sharply controversial practice of bloodletting. His initial practice was very humble and charitable serving predominantly poor persons, often without charge, in the city of Phila-delphia.
But his downfall, which would continue to repeat itself among a long line of physicians and healers up to this present day with COVID, was his uncompromising, grandiose, and even evangelical belief that God had specifically shown him this revelation of healing. And given influences of the Enlightenment, one could systematize all diseases, and their therapies, by this single universal theory of disease. Benjamin Rush’s certainty was bucolic and even sharply satirical for any that disagreed with him. His smug intelligence and religious excep-tionalism made him a divisive personality.
Philadelphia Yellow Fever Epidemic 1793
The scale of history’s judgment of Dr. Benjamin Rush would be placed upon the fulcrum of 1793 during the worst yellow fever pandemic Philadelphia had ever known. From August to November 1793 , 4000 or more people died, nearly one-tenth of Philadelphia’s popula-tion. Bridges were closed. Travel was at a minimum. Quarantine was everywhere. Families abandoned some of the sick, including their own children. Mass graves with 10-15 bodies was not uncommon. Many of the wealthy including politicians and physicians left town. The Nation’s capital was in Philadelphia, and for the only time in American history, it closed. Out of the 80 licensed physicians in Philadelphia, ten of them died. And the majority of them left town. To Benjamin Rush’s credit, he claims he was one of only three physicians who stayed and worked maniacally seeing the sick, as many as 100 a day! For this, he was hailed as heroic.
But hand raising quickly turned to finger-pointing. Dr. Rush was so thoroughly convinced of his own theories and ideas of purgatives and bloodletting for yellow fever, that as the majority of Rush’s patients began dying, he doubled down literally on his theories, and later quadrupled his purgative doses and amounts of blood let. These extreme amounts of purga-tives and bloodletting was termed “depletion treatment”. Rush had what appears to be a type of religious epiphany in mid-September that God had chosen specifically him and this
depletion therapy to save the city of Philadelphia. Dr. Rush found it “very effective when em-ployed early” and performed it on the barely sick to the same degree as the critically ill. He himself became ill and performed the same extreme vomiting and bleeding regiment upon himself.
He used his own personal recovery as testimonial proof of the value of his therapies much like on late night nutritional and medical ads today. He also told of how many more of his patients were healed with his more aggressive regiment. Today, we would call this “sever-ity bias” a form of selection bias when you add a healthier population to your sicker popu-lation of treatment and end up with better results.
The medical society of Philadelphia was not as convinced so they decided to investigate Dr. Rush. The majority of the physicians strongly disagreed with Rush, some calling his tech-niques “murder” with serious discussions of bringing criminal charges. Dr. Rush resigned from the Philadelphia College of Surgeons. One of the physicians had taken a count of Dr. Rush’s patients and done a comparison study (?) and found that more of Dr. Rush’s patients were dying. Dr. Rush’s acerbic and defiant personality did not serve him well among his colleagues. To make matters worse, his politics were very mixed with his medicine, and when Alexander Hamilton who was of the opposing political party published publicly than anyone sick with yellow fever should go to Dr. Stevens, who did the typical mild supportive care of the day, and not Dr. Rush, it was public professional humiliation.
But Benjamin Rush for all of his advocacy of the poor, mentally ill, prisoners, women, slaves, and animals; and his personal professional sacrifice of staying in Philadelphia to treat the masses of dying during the onslaught of a viral pandemic, was not a man that was very easy to humble. He continued his therapies without the support of his medical profes-sion, as further waves of yellow fever hit in 1794, and 1797 (ironically from the importing of Haitian and African slaves from the West Indies). The papers turned against him. Law-suits ensued. He was even implicated in the death of George Washington who was severely bloodlet during his sore throat. Rush had moved from medical savior of Philadelphia to po-litical and professional pariah. And this was Benjamin Rush’s typical response,
“The success which attended the remedies which it pleased God to make me the instrument of introducing…in 1793 produced…the most violent and undisguised exertions to discredit these remedies…The public effusions of gratitude which issued from many persons who ascribed the preservation of their lives to my remedies pro-duced…the most inveterate malice….No, citizens of Philadelphia, it was for your sakes only I opposed their errors and prejudices, and to this opposition, many thousand people owed their lives.”
The Historical Ambivalence of Intent and Result
Looking at a person in history based upon what has been preserved and found in written record is not so unlike getting a medical history from the emergency medical technicians transporting a comatose patient with no family available in the room. You are at the mercy of someone else’s interpretation of a story that none of us were there for.
So, one must be careful and fair to Benjamin Rush, or any polarizing figure in history, that they be viewed within the context of their time, place, and culture. One must also avoid the false simplicity of labeling Dr. Rush as a good or bad professional physician or person. One must also take into account, that people think differently and behave differently at various times in their lives, and that certain circumstances like a viral pandemic where everyone is dying around you, and you are seeing a 100 patients a day in the front yard of your house-made-clinic might make anyone “not at their best.” And finally, one should be aware that while “love can cover a multitude of sins”, that good intent alone can not be used as justifi-cation for the malpractice of medicine.
So, with all of the caveats of judicial carefulness and historical contextual humility, perhaps all I can say who am no historian and did not live in Philadelphia as a physician in 1793, is that Dr. Benjamin Rush was a complicated character. Who could not look at his non-medi-cal accolades and be admiring? And who could not look at his vociferous medical dogma-tism and be horrified?
Again, context is everything. He lived in a post-Enlightenment era where reason and system could explain everything, and a unified universal theory carried more weight than variety. Having education then placed a person at the summit of humanity. Paternalism was ex-pected by those who had education. It was their human right which was defined by duty and forms the corpus of our national founding documents. In Philadelphia in the 18th cen-tury as a cosmopolitan hub of the newly formed United States, there were hundreds of bar-bers, surgeons, “healers”, home remedy shops, and quacks (much like today); and the idea of a person promoting themselves and a “miracle therapy” was part of ordinary American life. This was during the time of something we now call “The Great Awakening” in America, where the American culture was being born from the parents of “rugged and rebellious in-dividualism” mated with “religious freedom.” The result was often “God gave me….a vision, a gift, an inspiration” to say this or do this ——“even though none of the so-called tradi-tions or experts agree with me”. This kind of individualistic rebellion, much like the Ameri-can Revolutionary issues that fueled it, was not viewed by its adherents as narcissistic or anti-intellectual, but rather heroic and inspired. While we should be careful not to anachro-nistically “rush to judgment” by drawing too many parallels between the Philadelphia viral pandemic and our own in this version of Benjamin Rush; certainly there is plenty here as in all medical history to form an interesting differential to consider as diagnostic for our-selves.
*North, RL “Benjamin Rush, MD: assassin or beloved healer?” Proceedings Baylor University Medical Center ; 2000; Jan; 13(1): 45-49.