Benjamin Rush and the
State of Medicine in 1803

The state of American medicine in 1803 was deplorable by modern standards. According to Dr. Chuinard, “Bacteriology, hygiene, and preventative medicine were unknown sciences.” To this, Dr. Peck adds that the “concepts of germs, contagious diseases, and parasites”, of which we are familiar today, were unheard of. “Infectious illness in various forms took staggering numbers of people into early graves, often with a helpful push from their learned physicians. The viral diseases of smallpox, measles, influenza, and yellow fever mercilessly” killed millions, while parasitic diseases like malaria and typhoid infected millions more.

There was little that the average colonist could do to combat disease, and it was unlikely that most would ever see old age. Ailments such as cancer, diabetes, and heart disease which we associate with the aged, were virtually unknown in the 18th and 19th centuries.

By the early 1700’s there were no guilds or professional associations to standardize or regulate medicine, which meant that anyone could call himself a doctor. By 1775, there were only 400 doctors with medical degrees practicing in the American colonies, all of them residing on the Eastern seaboard. By 1805, only one in five doctors in America had any formal training. Frontier doctors and colonial moms (like Lucy Lewis Marks) used a combination of herbal cures or simples, animal-based remedies, and a healthy dose of superstition to cure their patients and loved ones. Settlers brought European herbal remedy books with them to the colonies. Bancke’s Herbal (1525) and Culpepper’s Complete (1625) were two of the favorites, both offering lists of beneficial herbs and plants, as well as recipes for inevitably foul-tasting cures.

Unfortunately for colonists, American plants differed from those commonly found in England and Europe. Herbs and medicines were available by import but purchasing them was expensive. English herbs could also be grown in the colonies, but climatic differences often made results uncertain. So American colonists were forced to develop new pharmacopeias and collect and experiment with “new world” plants. They often turned to native peoples for help. Though native medicine varied from tribe to tribe and had a strong spiritual element that colonists did not understand, there were things to learn from the natives, of whom one colonist remarked were a “well-fashioned people, strong and sound of body.”

Most native tribes used “splinting, traction, and immobilization to treat fractures.” They treated burns, skin ulcers, and infections with a combination of remedies which included the use of herbal poultices, the use of heat and sweats, the washing and dressing of wounds, and the opening of wounds to drain (via an incision). Natives also made use of extensive pharmacopeias which included plants that are commonly found in modern medicines. Insulin, cocaine, quinine, ipecac, and witch hazel were all derived from Native American plants.

For those living in cities, there was the potential for hiring a professional doctor. After receiving a basic education in grammar school or from a private tutor, the future doctor might go to a university, and then participate in an apprenticeship program with an experienced physician for one to five years. Such was the path of Lewis’s medical mentor Dr. Benjamin Rush. To understand the medical treatments and methods taught by Dr. Rush it is important to note his training, and the methods by which he developed his theories of disease and treatment.

Dr. Rush was born in Pennsylvania in 1745. Though the family had some financial difficulties after the death of his father, his mother’s remarriage bought financial stability and made it possible for Rush to pursue a formal education. He attended a Presbyterian boarding school in Nottingham, Maryland where he was taught by Reverend Samuel Finley. In his autobiography, Rush noted that in 1759 he was “removed from Dr. Finley’s School to the Jersey College” or the University of New Jersey (later Princeton) where he was admitted as a junior and studied a standard curriculum of science, math, English literature, Latin and Greek. “In the month of September 1760 [Rush] was admitted to the degree of Batchelor of Arts.” Benjamin Rush was fifteen years old when he graduated college and had planned to pursue a legal career. Upon the advice of his former teacher Reverend Finley, he decided to become a physician instead. In later life, Rush said of his choice, “I now rejoice that I followed Dr. Finley’s advice. I have seen the hand of heaven clearly in it . . . I may have acquired more fortune and rank in life in the profession of law, and probably have escaped much of the vexation and distress that are connected with the practice of medicine, but I am sure I have been more useful in the latter profession. . .”

Rush began his medical career as an apprentice to Dr. John Redman of Philadelphia in February of 1761. He worked with Dr. Redman for five years. In his autobiography, Rush described his daily duties as an apprentice “In addition to preparing and compounding medicines, visiting the sick and performing many little offices of a nurse to them, I took the exclusive charge of his [Redman’s] books and accompts [accounts.]” Redman made his library available to his young apprentice, and through his readings Rush encountered the lectures of Dutch doctor Hermann Boerhave, whose teaching had a profound effect on the young physician.

Rush was also able to attend some of the first anatomy lectures ever held in the American colonies. These were conducted in Philadelphia by Drs William Shippen and John Morgan, also major influences on the young Rush. Shippen and Morgan were the founders of America’s first medical school. They approached the College of Philadelphia in 1765 with an idea for adding a medical school to their program. This was accomplished in November of the same year, with Morgan teaching the theory and practice of medicine, and Shippen teaching anatomy.

Shippen had an especially hard task, since it was nearly impossible to find cadavers on which the medical students practiced. In order to obtain specimens, Shippen was forced to steal corpses and was formally accused of grave robbing in 1765. He admitted to stealing dead bodies, and noted that they were “unclaimed, or the bodies of the executed or suicide victims.” Though grave robbing was met with repugnance and hostility, it was tolerated, as long as would- be doctors used the bodies of “unwanted” or African American persons and did not flaunt their activities.

Rush developed a close relationship with Dr. Morgan, who helped him to learn “materia medica” the study of medications, including the use of herbal remedies, preparation of medicines, and proper dosing. When Rush finished his apprenticeship in 1766 he could legally have become a practicing physician.

Instead, he decided to study abroad, and departed the colonies for the University of Edinburgh in Scotland where he remained until 1768. This was a common practice for American physicians, who had begun to seek medical degrees by the 1760’s, slowly helping to form a medical “elite” in the colonies.

Edinburgh Medical School opened in 1726 and graduated 17,000 doctors in its first one hundred years. The school was popular with would-be American physicians because it was inexpensive; had no religious limitations, taught classes in English (unlike many schools which used Latin) and did not require a specific course of study. Rush, like the other students, was allowed to pick and choose the classes that he wanted, and only had to pay for those he actually attended.

At Edinburgh, Rush continued his study of Dr. Boerhave, a professor at the University of Leyden, who promoted a “neat and all-embracing system of disease.” He believed that the body was a hydraulic mechanism full of pumps and pipes. In a healthy person, this system would work correctly, but if a pipe should clog, it would force the pumps to work harder and faster to push blood around the obstruction. This caused friction and heat or fever which showed the doctor that a problem existed.

Boerhave’s “cure” was to bleed his patients, which in turn reduced the friction and fever. In addition to time spent with Boerhave’s theories, Rush studied under William Cullen, a teacher at Edinburgh who had developed a theory that disease was caused by “nervous excitation” and its effect on bodily solids. Rush would combine the philosophies of Boerhave and Cullen to develop his own “monistic explanation for disease”, which he felt was caused by a “hyperactive state of the arteries . . . called hypertension (fever – in modern terminology).

When Rush returned to the colonies in 1769, he opened his own practice, became the medical consultant for the city almshouse in Philadelphia, and was asked to join the College of Philadelphia as a professor of chemistry. He became a prolific writer, publishing more medical essays by 1773 than any other physician in the colonies. “He was also the most doctrinaire practitioner of the age, staunchly defending [and teaching] European theories of disease long after his contemporaries began to make clinical observations” which called them into question.

Historian Norman Risjord, noted that because of his writing, lectures, and teaching, Rush had a dramatic impact on American medicine, literally training thousands of doctors in his “hypertension theory”, which may have “caused untold injury and delayed for years the development of clinical pathology in America.”

Though Rush’s treatments may seem barbaric to the modern American, they were the standard for all medical professionals of his day. He was best known for his use of copious bloodletting and calomel purges. Rush believed that bloodletting was a universal cure for all ills (even mental problems) and felt that a patient could be bled of 6-8 pints over several days (the body only contains 12 pints), with the blood replenishing itself in a day or two. In reality, a body will not replenish that level of blood loss for weeks.

Dr. Peck writes that Rush “bled virtually all his patients, often repeatedly, [and] often more than once daily.” To this he added chemical purges, which called for the patient to “evacuate” the toxins that led to disease. A doctor could purge a patient by inducing vomiting, sweating, or diarrhea. Rush’s favorite “purge inducer” was calomel, a “profound intestinal irritant which [he] administered in whopping doses.” Calomel was a white tasteless power which consisted of mercury chloride.

When taken in small doses calomel led to the evacuation of the bowels. If taken over time or in heavier doses, calomel induced heavy salivation, bleeding gums, mouth sores, tooth loss”, and other serious side effects as the patient succumbed to mercury poisoning. Rush would eventually patent his own medication, “Dr. Rush’s Pills” or the “bilious pill”, commonly referred to as “Thunder Clappers” which mixed calomel with jalap, a second powerful purgative, and which had “explosive” results. Calomel was so commonly used in the late 18th century that it inspired verse, “The doctor comes with good free will, but ne’er forgets his calomel.”

By the 1780’s Rush was perhaps the most famous doctor in America, but people had begun to question his methods. When a yellow fever epidemic struck Philadelphia in 1793, leading to 4,000 deaths, Rush’s patients died in large numbers. He had used his favorite treatments of bloodletting and purges in an attempt to cure them and had few successes. When the epidemic ended, Rush’s reputation had suffered. By 1797 a “backlash against doctors was growing” in the United States. Rush found himself “ridiculed by his detractors and sarcastically referred to as ‘the bloodletter’ in the press.

As early as 1777 Philadelphia papers criticized his medical tactics publicly; and in 1788, Federalist author William Cobbett called Rush a “potent quack”, whose disciples had slain “tens of thousands” with bloody purges. Rush sued Cobbett for libel and won in 1799, but “his medical career never [again] reached its former heights.” By 1813, the year of Rush’s death even Thomas Jefferson admitted to reservations about his friends’ methods. He wrote of Rush, “In his theory of bleeding and mercury I was ever opposed to my friend . . . whom I greatly loved; but who had done much harm, in the sincerest persuasion that he was preserving life.”