Few of us will ever have the opportunity to live a life as full of service to mankind as did Benjamin Rush, the medical advisor to the Lewis and Clark Expedition.

Benjamin was born on Christmas eve, 1745 in the town of Byberry Pennsylvania, a neighborhood in the northeast part of modern day Philadelphia and at that time about twelve miles from the colonial era city.  His parents were named Susan and John. Benjamin’s father died when he was only six, and his mother, who ran a grocery shop that help support her seven children put Benjamin under the care and educational oversight of her brother Dr. Samuel Finley at Nottingham, Maryland.  Young Benjamin was apparently quite a talented and dedicated student, and was admitted into the junior class at Princeton.  He graduated from that prestigious university when he was but 14 years old.

After considering a career as a minister or an attorney, young Rush decided instead on following the field of medicine.  He obtained an apprenticeship in Philadelphia with the much respected physician, Dr. John Redmond.  When in his apprenticeship, he had great opportunity to attend lectures at the College of Philadelphia (later the University of Pennsylvania) as well as follow the tutelage of his preceptor, Redmond.  The apprenticeship lasted for six years in which Rush was said among other accomplishment, to have translated into English, much of the written works of Hippocrates from the original Greek.

In colonial and early America, most medical training was accomplished by the apprenticeship program.  But Rush, wanting a more “refined” and thorough education matriculated to the University of Edinburgh in Scotland, to further his academic preparation for the practice of medicine.  Here he studied for two additional years.  His doctoral thesis was done on the study of digestion which he accomplished by eating various meals and inducing himself to vomit.  The emesis (vomit) was then determined by Rush to be acidic.  Edinburgh awarded him his M.D. degree in 1768.

It was while studying at Edinburgh, that Rush came under the medical teaching of Dr. William Cullen, a bright, shining star in the medical world of the mid 18th century.  Although some remarkable progress was being made in the fields of basic medical science, much of clinical medical practice was still philosophical in nature and not based entirely on experimental evidence.  Many of the therapies used in medicine at that time, were the same as they had been for centuries; namely, purging, blistering the skin, bloodletting, increasing urination, changes in diet, and avoidance of extremes of hot or cold.  Physicians at that time were completely ignorant of the existence of viruses, bacteria.  The Germ Theory of Disease, authored by Robert Koch, was still nearly 100 years in the future. Most surgical therapies were not in existence at this time.  Surgery of appendicitis would not appear in history until the 1880s.  Oxygen was not discovered until 1772 and was not identified as an element until around 1775.  Consider for a moment the elementary physiological fact that nearly every modern school child knows, that we breath in oxygen, and exhale carbon dioxide.  This was not discovered until the late 18th century. 
   I use these illustrations to show that basic science was still in its infancy at the time that Rush learned how to be a physician and that even the best trained doctor in the world at the time of Rush’s medical training knew essentially nothing about realities of biology, chemistry, microbiology and other medical sciences.  Medical treatments for various illnesses were based on the doctor’s observations of various illnesses, and then using these observations, trying to make sense of the illness by a process of mental reasoning (philosophy).  Many of Rush’s therapies were quite logical, given his framework of what caused disease, however logic does not alway equate with being  correct.

A classic example of this process of philosophical medicine can be seen in the following scenario.  Rush noted that many diseases manifested fever.  He observed that the onset of illness was often preceded by what he called a “state of debility”.  He reasoned that the nervous system in this state of debility was “under-excited”.  He further reasoned that in order for this state to be corrected, that the nervous system over-responded, and stimulated the arteries into a state of spasm.  He again reasoned, that this arterial spasm was being excited by the patient’s blood, and that this arterial spasm could be corrected by removing some of the offending substance; blood!  You can understand that his reasoning was based on his observations and that his reasoning is somewhat logical...but unfortunately entirely incorrect based on a modern understanding of human physiology.  He simply did not know very much about the actual function of the human body.

Many of Rush’s therapies for various illnesses involved bloodletting.  A wound was made by a lancet in a vein of the patient’s arm or hand and Rush would prescribe anywhere from 8-80 ounces of blood to be bled into a collecting bowl.  Of course, this “bleeding” would decrease the volume of blood in the patient’s arteries, veins, capillaries and vascular beds in various organs.  This decreased blood volume would  lower the patient’s blood pressure.  Rush’s logical “proof” that his therapy was beneficial, was that he observed that his patients would “relax” after a good bloodletting!  Some undoubtedly lost consciousness in addition to “relaxing”.  Other therapies used by Rush were various chemical and herbal laxatives.  Rush believed that disease  was either caused by, or contributed to, by constipation.  It was only logical to increase bowel movements as therapy.  This was accomplished by such medications as herbal laxatives (e.g. powdered rhubarb), or chemical compounds such as calomel (mercurous chloride) , a very potent and poisonous compound which acted directly on the gut to produce potent bowel movements!  Rush incorporated both calomel and Jalap, (another herbal laxative) in his own favored medicinal compound, the “Bilious PIlls of Dr. Rush”.

In various Yellow Fever epidemics that ravaged Philadelphia during the 1790s, Rush worked himself to exhaustion, often treating over 100 patients daily, often without pay and without regard to his own personal safety.  He pledged his attention to his patients, even if it cost him his life.  Many other physicians simply left the city when these epidemics occurred during the summer and fall of several different years.  Rush’s therapies for the disease consisted of heavy uses of calomel and bloodletting.  His therapeutic approach met with severe criticism from several other physicians in Philadelphia, but Rush would not alter his methods.
 
Being a friend of Thomas Jefferson, he became an obvious choice as the medical adviser to the now forming Corps of Discovery in 1803.  Jefferson sent his young protege, Meriwether Lewis for about two weeks of intense medical training prior to leaving on the exploration of the western part of the continent.  Rush furnished Lewis with a set of research questions to help discover various aspects of Indian culture and medicine.  Judging from the bloodletting activity of “Dr.” Lewis on the trip, Rush gave Lewis some good instruction on the indications for bloodletting...nearly every illness!

Rush recommended his “bilious pills” as well, with Lewis taking several hundred of them along in the medicine chest.

Rush accomplished much in his life outside of medicine.  He was a signer of the Declaration of Independence and friend to many of the founding fathers of the United States.  He served for a time as the Continental Army’s surgeon general.  After the revolution he became a professor of medical theory and clinical practice at the University of Pennsylvania (1791).  He also founded Dickinson College in Carlisle, Pennsylvania that championed women’s education.  He is known as the “Father of American Psychiatry” due to his work and writing about mental illness and his ideas of treating mentally ill people with respect and with hopes that treatment could improve their lives.  He was an ardent abolitionist, opposed the death penalty and was a very devout Christian, being the founder of the Philadelphia Bible Society.  He attended various Protestant denominations during his life.  His theology ranged from Calvinistic as a young man, to a belief in the universal salvation of all men in his later years.

Rush’s was married to Julia Stockton, (daughter of another signer of the Declaration of Independence) in January, 1776.  They had 13 children.
 
Benjamin Rush died, likely the victim of pneumonia, on April 19, 1813 and was laid to rest in the cemetery of Christ’s Church Philadelphia at Fifth and Arch Streets in Philadelphia.
 
Thomas Jefferson shortly after Rush’s death, in a letter to John Adams, (Rush was largely responsible for healing the friendship between these two), wrote:

“Another of our friends of seventy-six is gone, my dear Sir, another of the co-signers of the Independence of our country.  And a better man than Rush could not have left us, more benevolent, more learned, of finer genius, or more honest.”

Benjamin Rush was an incredibly gifted and active man.  Although his medical treatments meet with subtle amusement in this day of MRI scanners and many  sophisticated medications, he did the best job he could with the knowledge which he possessed.

Book recommendation:
Broadsky, Alyn; Benjamin Rush -  Patriot and Physician, Truman Talley Books, St. Martin’s Press, New York, 2004.

A FURTHER COMMENT BY DR. PECK