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Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Two

Given the extent to which he would later champion his view of the epidemic, it is surprising how quiet Rush was about his discovery at first. Despite his pretensions of being the city's foremost physician, he asked Dr. Foulke to inform the mayor.(1) That summer, as usual, Rush's wife Julia and half of their children went to Princeton, New Jersey, to rusticate with her family. In his letter to her, dated August 21, Rush reported that there is "a malignant fever" along Water Street that has "carried off twelve persons." He did not call it yellow fever and used a passive voice to suggest its cause: "It is supposed to have been produced by some damaged coffee...."

He assured Julia that it has not spread beyond the "reach of the putrid exhalation which first produced it." He did not tell her that it was "highly contagious," as he had informed Drs. Foulke and Hodge. It wasn't even the principal health problem in the city. The influenza, he reported, was still spreading. He alluded to his trials in the last fever epidemic in the city and decided that while he was not as busy as he was in 1780, "now most of the cases I attend are acute and alarming, and require an uncommon degree of vigilance and attention." Then he turned to family business and tried to boost his wife's confidence in some land speculation he had undertaken in central Pennsylvania.(2)

On the 22nd, the day he posted the letter, he joined a celebration south of the city in honor of raising the roof on "the African church," the first church for African-Americans in the New World which he had suggested Philadelphia's 2,000 free blacks build. His letter to her sent the next morning was all about the celebration. The "malignant fever" was "stationary;" the influenza "as violent" as yesterday.(3)

We can respect Rush's equivocation if we realize that to raise alarms about epidemic fevers, especially those unfamiliar in Europe, was bad form in the New World. "The yellow fever had prevailed in this city four times between the years 1699 and 1793," Rush told his medical students in an 1801 lecture, "and yet no history of its origin, symptoms, or treatment, had been left to us by any of the physicians who witnessed it."(4)

Beginning with the Bible and Thucydides, epidemics had won a niche in literature. However colonial Americans did not want to call attention to the plagues in the land of milk and honey, at least plagues that killed white people. (Those that swept away Indians were duly celebrated as evidence that God wanted to "make room" for the whites.)(5) In The Dispute of the New World, the History of a Polemic, 1750-1900, Antonello Gerbi shows how the claim that the newly discovered continents of the North and South America were more moist than Europe, Africa, and Asia let go a flood of deductions including the notion that these humid continents dampened the growth of the nobler animals, man included, and fostered an abundance of reptiles, insects and fevers. The best minds of the New World dedicated themselves to refuting such accusations.(6)

The attitude of Benjamin Franklin toward epidemics is instructive. He received a handwritten monograph from Dr. John Mitchell about the 1737 and 1741 yellow fever epidemics in Virginia, but didn't reprint or even extract any of it in his newspaper or almanac, even after Philadelphia had its own yellow fever epidemic in 1747. And that was fine with Mitchell who said he wrote solely to inform himself, or perhaps develop his ideas in a book on the country's natural history, climate and diseases. That said, he questioned, "if any desired such information, which very few, too few among us do."(7) (Before he died in 1790, Franklin gave Mitchell's manuscript to Rush who promptly incorporated some of its information into his medical school lectures.)(8)

What really excited Franklin was a New World medicine that cured one of the chronic killers of the Old. In Poor Richard's Almanac he championed Dr. John Tennent's cure for pleurisy, the Virginia rattlesnake root, which the Seneca Indians used to cure snakebite. He thought the symptoms of snakebite and pleurisy similar and thus insisted that rattlesnake root could cure the lung ailment then a scourge in Europe and America (Franklin had it twice.) Franklin was the first snakeroot oil salesman, and why not. New herbal cures from America made, and still make, good copy.(9)

Why then did Rush break with the past? In the standard historical treatment of the epidemic, Rush's reaction to it is less a function of scientific observation and duty than his own infatuation of impending destiny for himself and his country. He gets credit for "brilliant" observations, but, as one commentator writes, Rush's approach to medicine was "absolutely saturated with the American myth, and millennialism." That is to say, Americans freed from the inequalities of the past by their new republican government, an event very much the special work of God, would lead the world to the coming kingdom of Christ on earth.(10)

As difficult as it is for us today, linking politics, religion and science was natural for Rush, and many other scientists of his day. While at medical school in Scotland, he was thrilled to meet unabashed republicans. Studying the constitution of patients went hand in hand with conversations about correcting the constitution of government. He did meet Deists like Hume but also Christian republicans who associated the rights of man with the on-going Protestant revolution.(11) A tireless worker with a facile pen, back in Philadelphia Rush fought in the pamphlet war that helped prepare the nation for revolution. Elected to Congress in 1776, he was there to sign the Declaration of Independence.(12)

It is not difficult to explain why Rush associated the revolution with the second coming. He was raised under the influence of two prominent Presbyterian ministers, Samuel Finley at the West Nottingham, Maryland, Academy, and Samuel Davies at Princeton. Both firmly believed in the eminent coming of Christ and raised the clarion call to prepare not only oneself but all of society, indeed all the world. They both preached that God had a special mission for America. A fervent millennialist, Rush believed that change for the good would soon become epidemic. He wrote a series of pamphlets trying to reform his fellow men. For example, he called for the abolition of slavery, an end to capital punishment, education for women, and a peace office to work to end war.(13)

Rush did not hide his millennialist agenda. At the Pennsylvania convention to ratify the Federal Constitution, he told the delegates that as surely as God parted the Red Sea for Moses, He guided the hands that wrote the Constitution.(14) In speeches and essays throughout the 80s and as late as 1790, he suggested that the American revolution would not be complete until their was a revolution in medicine led by American doctors devoted to fulfilling God's plan of world rejuvenation under Christ.(15) Because he developed his new cure of fever and new system of medicine after a decade of parading such pompous pieties, Rush's claim to scientific respectability is held to be tenuous at best.(16)

But here again it is a question of an overview of Rush obscuring what happened at a crucial moment in his life, and in the life of the nation. The epidemic did not present itself at first as a golden opportunity for a Christian nationalist. It presented a dilemma that put the imperatives of nationalism and christianity at odds. Should he tell the truth, as he saw it, or follow the time honored tradition of reserving judgment to protect the reputation of his city and country? What made him come down on the side of science was the very millennialism that earns the scorn of modern commentators. Rush's religion made him a better scientist by forcing him to higher standards of observation and accountability. The enthusiasm and rhetoric might be distasteful to modern sensibilities, but in 1793 someone filled with God's good news was incapable of slipping back into the secrecy, the arcanum, the chauvinism that remained a part of science, medicine especially.

While religious fundamentalists today revile science for contradicting the Bible, for Rush the idea of the Millennium was the justification for scientific research. The divine promise of the millennium was the proof that all diseases would be conquered. "I had long believed," Rush wrote immediately after the epidemic, "that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy."(17) Many historians cite that admission as proof of Rush's unscientific bias, claiming that it shows that his zealous insistence that there had to be cure caused him to falsify evidence to prove that he had indeed found a cure.(18)

Such a criticism is untenable. After practicing medicine for almost 30 years, Rush had not made a career of proclaiming cures. Finley and Davies had taught that while it was sinful not to work to end suffering, truth set one free.(19) To consciously lie for fame was recognized as an ever-present danger. To use religion to shortcut science, to cheat, would be sinful. Rush wanted to write a book on medicine and the Bible, but he knew the truth about disease would be discovered through scientific means. His working title for the book, which he never published, was "an attempt to explain sundry passages in the Old and New Testament by the principles of medicine and the laws of the animal economy."(20) There could be no contradiction between the good effected by rationalism and the Bible, no belief that falsification of experimental results was in anyway godly.(21)

There is some debate over exactly how demanding being a millennialist is, and a suggestion that it prompts one to jump to happy conclusions. "A millennialist is always in the right place at the right time," one commentator wrote apropos Rush, "and finds justification in the carrying out of his projects.... And what one does is always seen as profoundly significant. The promise of excitement, the immediate personal gratification of riding the flood-tide of history, can draw from the individual a boundless quantity of energy and optimism."(22)

This view conveniently forgets that Rush had a keen appreciation of the prophet's gloom and did not neglect the dark passages of Revelations. There would not be steady progress to perfection. In that August 21 letter to his wife, he also mentioned the persecutions in England against all who tried to challenge the reactionaries' hold on society. "The devil who is the present tenant of the world," he wrote, "will not quit his hold of it till he has done the premises all the mischief that lies in his power, but go he must sooner or later, with all his family of nobles and kings."

The manichean world-view inculcates an often biting self-criticism that is beyond the mere chauvinist. Patriotic medicine is bound to be lightweight, but apocalyptic medicine condemns the practitioner to a considerable struggle. By equating truth with good, Rush was adding burdens not throwing them off. The excuse of so-called pure science, that eventually an application of a new idea will be found, was no help to the millennialist scientist. His mission was not complete until he a had rational tool for moral good.

Doing God's work allowed Rush to take the proper scientific attitude. In the forming days of the epidemic he had to be all sense and react to danger in the most scientifically sensible way without regard to the reputation of his city or country. As the gloom of his letters written early in the epidemic show, this choice exacted a psychological cost. While most doctors were rationalizing away the relatively low death toll, characteristic of the beginning of any epidemic, Rush was at sea in gloomy probabilities.

On Thursday, three days after Rush recognized the fever, Mayor Matthew Clarkson alerted the city commissioners of "a dangerous, infectious disorder," and ordered them to see that the wharves were cleaned up, and also requested the College of Physicians to meet and advise him on measures to take. Governor Thomas Mifflin had equal call to be concerned since the port was vital to the whole state. He had the port physician James Hutchinson tour the waterfront and report.(23) Hutchinson not only walked up and down Water Street. He wrote a note to twenty other physicians he suspected might have patients there and asked for their opinions.(24)

Rush was no stranger to the deteriorating conditions on Water Street. He was treating Peter LeMaigre, and Thomas Miller, another young merchant, and his baby son. Rush also had several patients on other streets: John Chaloner, an auctioneer on 3rd Street who recently visited LeMaigre; Frederick Starman, a merchant on 2nd Street, who had gotten a whiff of the wind blown putrefaction from the wharves; and a Danish sea captain in Kensington, whose ship had just left the Arch Street wharf.(25)

a view of the city from Kensington

Yet as he made his tour of that street Hutchinson decided there was really nothing extraordinary going on. He determined that, in a block where a goodly portion of the 248 ships then along the waterfront were moored and that teemed with upwards of 400 residents, only 67 were sick, not really many during the "sickly season" as the months of August and September were commonly called because of their propensity to spawn fevers. Most had influenza or "common remittents." There were only 12 cases of "malignant fever." Hutchinson even demonstrated how safe the block was. He found an old woman alone in a small, stinking, enclosed room. He threw open the window and sat with her awhile. When contagion might be in the air, doctor's usually kept their visits very brief.(26)

It was Hutchinson's nonchalance which galvanized Rush. In his letter to fellow physicians Hutchinson asked for "facts... relative to the existence of the disorder," where it prevailed and what caused it. Rush did not equivocate: "A malignant fever has lately appeared in our city, originating I believe from some damaged coffee, which putrefied on a wharf near Arch-street. The fever was contained for a while to Water Street, between Race and Arch Streets, but I have lately met with it in Second Street, and in Kensington; but whether propagated by contagion, or by the original exhalation, I cannot tell.... I have not seen a fever of so much malignity, so general, since the year 1762."(27)

Rush went out on a considerable limb. While the letter was not immediately made public, Rush knew that Hutchinson could incorporate it in his report. He also knew that Hutchinson had an intense disliking for him. Rush had once blocked the publication of a monograph Hutchinson had written. (Or so Hutchinson said; Rush evidently did nothing to block other avenues of advancement, as Hutchinson joined him on the faculty of the medical school.)(28) If terror did not spread as it had in 1762, Hutchinson could embarrass him.

The exchange of letters took place on Saturday, August 24. The College of Physicians scheduled a meeting on Sunday afternoon. Saturday afternoon it began to rain, an occurrence not to be ignored. Not only had it been a dry summer, but since the days of Hippocrates, rain was credited with the power to cleanse the air.

Instant histories of the epidemic would recall the 24th and 25th as a weekend of panic.(29) Letters from one family are extent and give a different perspective. The Quaker merchant Benjamin Smith on Front Street was recovering from the influenza. All that remained of it was a troublesome cough. His wife Debby seemed to be coming down with the same bug. At least he was well prepared to be her physician. He would see that she soaked her feet in hot water, sipped chamomile tea until it brought on a sweat, drank plenty of "gruel water" and kept her body "open" with purging salts. Then that evening, Debby's fever became worse and she complained of "a violent pain in the head." Smith sent for Debbie's mother, Margaret Morris, who gave her Peruvian bark which seemed to lessen her attack and by morning she seemed out of danger. Margaret also opined that the rain which by morning was heavier would rid the city of sickness.(30)

As we shall see, in late September and October Rush would long for heavy rains to clean the air. But in late August as it fell around him, he didn't even mention it is his letter to his wife that Sunday. The terror he found as he walked along the rainy waterfront Sunday morning was too stark. "I witnessed a scene...," he wrote to his wife that night, "which reminded me of the histories I had read of the plague. In one house I lost two patients last night.... [The] wife is frantic with grief." Thomas Miller had bled profusely from the mouth before dying.(31)

During the dengue fever epidemic people seldom died and never died like that. As soon as he got home he ordered his boys confined to the house, on 3rd and Walnut some five blocks from the Miller house, and obliged them "to use precautions against the disorder." Rush assured his wife that he was using "every precaution that experience has discovered to prevent taking the infection."(32) He had a patient's bedding removed before a visit to allow noxious air to dissipate, rinsed his mouth out with vinegar before and after seeing the patient and, while at the bed side, stopped his nose up with a cloth soaked in vinegar, avoided breathing, did not swallow his spittle, and dipped fingers in camphorated vinegar before taking a pulse or otherwise touching the patient.(33) Compounding his alarm was that he did not know how to treat the disease.

Medical historians have accused Rush of letting his theories dictate his treatment of yellow fever. As J. H. Powell wrote in Bring out Your Dead, "first of all [Rush] was a theorist."(34) Nothing could be further from the truth. In August 1793 Rush had discarded the theories he had operated under in his first 20 years of practice and he was then in the throes of developing his own theories, basing much of his thinking on a rather slowly developing disease, tuberculosis. Now he faced a disease that seemed to kill in from 1 to 7 days. When the Episcopal Bishop William White asked about the Water Street fever, Rush had no reassuring theory. He repeated the age old advice when an epidemic threatened. The best preventative was "to fly from it." Mrs. White, especially, who was not in good health should be taken to their country home.(35)

It is really not that necessary to explore Rush's medical education in depth because as is evident from reading Rush's early writings, and those of his teacher Cullen and chief contemporary influences like John Brown, epidemics were not their primary concern. Since the Great Plague of 1665 in London, England had been remarkably exempt from killing epidemics. The medical issues of the 18th century were the efficacy of bark in controlling intermittents and the efficacy of inoculation in controlling smallpox. The predominant fevers, when influenza wasn't giving people two weeks of aches and coughs, were called "low and nervous fevers."(36) They were deemed manageable, and indeed, what Rush learned from Cullen was about the classification and management of disease.

When he returned to Philadelphia in 1769, set up practice and began teaching chemistry at the medical school, Rush ruffled many feather by not only teaching the doctrines of his mentor Cullen, but at the same time denigrating the doctrines of Herman Boerhaave upon which practice in the city had been largely based.(37) In a nutshell Cullen emphasized nerves, tensions and spasms, while Boerhaave, who died in 1743, emphasized blood, fermentation and putrefaction. Making sense of their theories when applied to fever is not easy, but the key to Cullen's ideas seems to be this: since stimuli like fear or cold can cause a fever, it is unwarranted to assume that all fever is caused by the introduction of morbific matter into the fermentation of the stomach or into the blood. Poison was but one cause of fever, and probably not a fundamental cause because often when the poison was expelled, fever remained.(38)

By shifting the focus from blood to the nerves, Cullen was able to emphasize non-drug therapies, and while he did bleed patients, he hedged its use with so many cautions that he was generally considered opposed to bleeding.(39) Rush emphasized the importance of diet and exercise in preventing and treating disease.(40) With patients he made his first mark by promoting Sutton's more restrained method of inoculation for smallpox.

However, to his chagrin Rush found the lessons of Cullen inapplicable to America's diseases, especially fevers.(41) For example, Cullen decided the intermittent and remittent fevers were the same because they both were caused by marsh miasma, both responded to the same remedies, and one often turned into the other.(42) In America such fevers were far more prevalent and blurring the distinction between them was not so helpful. Remittent fevers, as yellow fever was initially identified, could be deadly. The deadly strain of malaria was more common in America than England.

Rush did not go to great lengths in the 1770s and 80s to explain why Cullen was wrong. In 1789 he won the appointment to teach the practice of medicine at the Pennsylvania medical school which meant he either had to teach Cullen's theories or come up with his own. In his 1791 lectures he faulted Cullen not so much for his pathology and physiology as for his compunction to classify diseases. By being so concerned about the name of a disease and what Cullen called its species and genus, the physician trapped himself into prescribing for the name of a disease rather than the condition of the patient.(43)

After disavowing Cullen's classification of disease, Rush had two roads he could take: coming up with his own system of classification better suited to the American reality, or following the lead of the most notorious apostate among Cullen's students, John Brown, who denied the importance of causes in medicine and advocated treating symptoms only, which he simplified into two basic forms of disease. Medicine was nothing more than correcting the debility of patients which manifested itself either as over-excitement requiring sedation or under excitement requiring stimulation.(44)

Given his decade of revolutionary rhetoric, it's not surprising that Rush followed the radical path blazed by Brown. But it is important to note his initial reluctance and the chaste way in which he tried to revolutionize medical theory. Indeed in 1791, he faulted Brown for "reducing" diseases "nearly to one class," and simplifying treatment to the mere art of applying the right stimulant to correct the evident debility in the patient.(45) (Rush was more perceptive than most who summarize Brown's work in recognizing that he insisted on stimulation to treat many symptoms that for centuries had been thought to require sedation, like the inflammation of pleurisy.)(46)

Emulating Dr. John Fothergill, a London physician and Quaker who was virtually the patron in one way or another of every important physician from the Quaker city in the second half of the 18th century, Rush decided to contribute to medical science not through comprehensive works but with short essays. Fothergill called his works "medical inquiries and observations" and so did Rush.(47) By 1789 he had written enough to warrant a volume. The second volume came out in July 1793. In each volume he had an essay on the treatment of what we call tuberculosis. In the difference between the essays one can best see how Rush was tending before yellow fever changed his approach to medicine.

In the 1789 essay he observed that one of the best cures for consumption or tuberculosis was exercise in fresh air. But he shied from explaining why that might be. "In relating the facts that are contained in this essay." he wrote, "I wish I could have avoided reasoning upon them; especially as I am confident of the certainty of the facts, and somewhat doubtful of the truth of my reasonings."(48) In July 1793 Rush published a second essay on consumption, largely because he had developed a basis for reasoning upon disease.

At that time it was obvious to most serious medical thinkers that a new basis for classifying disease had to be based on morbid anatomy. The Italian Morgagni's work on the seats of disease was familiar to Rush.(49) But it must be remembered that despite his new knowledge Morgagni himself used the old medicines based on the Platonic stricture that to cure one part one had to treat the whole body.(50) Rush decided that the tubercles on the lungs found when consumptives were dissected were the final anatomical excess of the disease not its signature, not the cause of the general distress and debility of the patient. He decided that what was important in effecting a cure was not the condition of the lung, but the general state of the patient. At times consumptives exhibited symptoms found in patients with gout, rheumatism or madness.(51)

Taking that approach seemed to open the door out of the maze created by Cullen and other classifiers. Rush wondered if the diseases Cullen and others gave different names were not in fact gradations of the same disease. The grade of the disease could be distinguished by reading certain general signs like the pulse which Rush thought must give the most accurate expression of the pathological state of the body.(52) In his lectures Rush defined fever's proximate cause as "irregular action in the arterial system, from excess or deficiency of action in the vital or moving powers." These actions "appear to be seated in the muscular fiber of the arteries."(53)

Many commentators have assumed that since Rush theorized that the cause of disease was in the blood vessels, in practice he was compelled to bleed. In his books and lectures he did not make that deduction. In his second essay on consumption he suspected that "every state of disease has its appropriate dose of medicine, the knowledge and application of which, can alone constitute rational, or insure uniformly successful practice."(54) In his lectures he wondered "May there not be in nature some medicine which can take down the arterial convulsions without the use of the tedious methods of cure now in practice?" Among those tedious methods, we must assume he included bleeding.(55)

This was hardly a theory of medicine that could be readily applied to the treatment of a killer like yellow fever, and certainly didn't suggest the heroic methods of cure which Rush would soon promulgate. Clearly discernable is Rush's yen for simplifying diagnosis and treatment but when first presented with the onslaught of yellow fever's symptoms, he was incapable of merely feeling the pulse and coming up with some appropriate dose.

Far from being the man with the ready theory when the epidemic struck, because of his disavowal of Cullen and Brown, and the rude state of his own theory, Rush was ill prepared, and that deepened his gloom. He first attacked the disease, rationally enough, with the purges that relieved symptoms in 1762. But they afforded no relief in 1793.

Then he tried the miracle drug of the 18th century but his patients thought bark offensive, even when mixed with wine. When given through the anus in a glyster, bark had no effect. Ipecac, another happy addition to the European pharmacopeia from the new world, was a vomit often used to relieve bilious fevers. Rush found its use problematical because in many patients the pressing need was to stop vomiting. He used cataplasms and poultices on the chest, neck or extremities and vinegar baths as a last resort to revive comatose patients. The idea to wrap patients in blankets soaked with vinegar came from a 50 year old book by an obscure British army surgeon.

Rush tried cold baths after he talked to Dr. Edward Stevens, who had just arrived from the West Indian island of St. Croix, where he had treated yellow fever cases. Bathing was not common in the United States and bathtubs were rare. So by cold baths, Stevens meant standing the patient in a tub and having cold water poured over the body. In one patient Rush injected bark "into the bowels every four hours." He had "buckets full of cold water" thrown "frequently" upon his patients. Three out of four died. When patients did recover, he decided they would have recovered even without his treatment.(56)

On Thursday, the 29th, at the nadir of his depression over his inability to cure the fever, Rush wrote a gloomy letter to his wife. One patient, the stonecutter William Stiles who lived on South 3rd Street, "exhibited signs of the plague before he died." Some apprehended that it was the plague, but Rush knew it wasn't, though "it comes nearer to it in violence and mortality than any disease we have ever before had in this country." He listed its various symptoms: "Sometimes it come on with a chilly fit and a high fever, but more frequently it steals on with headache, languor, and sick stomach. These symptoms are followed by stupor, delirium, vomiting, a dry skin, cool or cold hands and feet, a feeble slow pulse, sometimes below in frequency the pulse of health. The eyes are at first suffused with blood, they afterwards become yellow, and in most cases a yellowness covers the whole skin on the 3rd or 4th day. Few survive the 5th day, but more die on the 2nd and 3rd days. In some cases the patients possess their reason to the last and discover much less weakness than in the last stage of common fevers. One of my patients stood up and shaved himself on the morning of the day he died. Livid spots on the body, a bleeding at the nose, from the gums, from the bowels, and a vomiting of black matter in some instances close the scenes of life."(57)

He wrote later that he was "baffled" by such "malignity" and "obstinacy" which he had never before observed in any disease. "Heaven alone bore witness to the anguish of my soul in this awful situation."(58) Rush did not take comfort in the fact that other physicians were as unsuccessful as he. Traditionally epidemics were a time when doctors could bravely announce that prevention was the better part of cure, or devoutly note the power of God.(59) With his political background and religious scruples Rush could have led both parades. It seems he was beyond such calculations. He had told his medical students in past lectures that the flight of physicians from London during the great plague disgraced the profession and he hoped that no American physicians would flee an epidemic.(60) So he had effectively cut off any retreat. But patriotism only compelled him to stay, not the manner in which he would act.

In a sense his medical theory did compel him. Its evident inadequacy to deal with horrifying reality brutally punctured the conceit he had fostered in recent essays and lectures that he was indeed on to some great new discovery in medicine. Later in the epidemic, after the disease had virtually broken him, he would rationally discuss why he stayed on to fight it,(61) but at this point, he could relay it only in highly charged religious terms. What is interesting is how he interpreted the epidemic as both God's judgment and challenge. In closing a letter to his wife he wrote that his real trust was in God. His very being was "in a more especial manner in God alone." He asked his wife to pray for his protection, adding "I hope I shall do well, I endeavor to have no will of my own." That gave him strength to "subdue" his sympathy for patients, "otherwise I should sink under the accumulated loads of misery I am obliged to contemplate."

He read the Bible that night, the 45th chapter of Jeremiah, his favorite prophet: "The Lord saith thus; Behold, that which I have built will I break down...." One passage so struck him that he quoted part of it to his wife: "seekest thou great things? Seek them not, for behold I bring evil on all flesh." Rush added "what powerful antidotes are war and pestilence to pride, vanity, and ambition!"(62)

Rush's harshest critic is, not surprisingly, the one biographer who was also a physician and thus most interested in underlining his apostasy to scientific medicine. In summarizing Rush's performance in 1793 Carl Binger writes, "Rush's egregious and obsessional stubbornness and his singular incapacity for self-criticism must be looked upon as an automatic defensive maneuver in the face of the overwhelming anxiety and tragedy that surrounded him. He simply had to be right, especially since he felt appointed by God to save his afflicted city."(63)

Actually at the beginning of the epidemic, Rush wallowed in self criticism and got out of it not by clutching to God to save himself from the demands of science, but by seeing God's lesson as a call to elevating science above the compelling moral duty of sympathy and compassion for suffering. At this point he did not know what God had in store for him but he trusted that if he confined himself to the scientific imperatives of observation, research and experimentation, without willfully doing so to trumpet his half cooked theories, then, and only then, would he be doing his duty.

Go to Chapter Three

1. Rush 1793 p 26.

2. Butterfield pp 637, 638

3. Butterfield pp 638, 640; Corner p 202.

4. Rush 1977, p 144.

5. Cronin, p 90.

6. Gerbi pp 3-34, 254-58.

7. Franklin, vol 3 p 43.

8. Rush 1815 vol. 3, p 127.

9. Franklin vol 3, p 41; when in England Tennent did couch his discovery in terms of a cure for an epidemic, vide "An epistle to Richard Mead, concerning the Epidemical Disease of Virginia, particularly on pleurisy and peripneumony. Wherein is shown the surprising efficacy of the seneca rattle-snake root in diseases owing to a viscidity and coagulation of the blood...," John Tennent, Edinburgh 1738

10. Carlson, p 40.

11. Corner, p 109; D'Elia pp 30-5.

12. Corner pp 109ff; Hawke pp 142ff.

13. D'Elia pp 11-17.

14. Hawke, p 353.

15. Rush Essays, p 205; D'Elia pp 66-75.

16. D'Elia p 23.

17. Rush 1815 vol 3., p 126.

18. e.g. see Powell pp 127-8 who suggests "it never occurred to him that he might be wrong."

19. D'Elia pp 12, 17.

20. Butterfield, p770.

21. D'Elia who develops Rush millennialism as an influence on his politics suggests it was anti-scientific, p 23. For views on how science and millennialism complimented each other see, Bozeman, pp 49ff, 120, and Jacob, p 130.

22. Carlson, p 43

23. Fed. Gaz. Aug. 30, 1793.

24. Rush 1793, pp 16-17.

25. Rush Notebooks for the end of August.

26. Amer. Daily Adv. Aug. 28. 1793; Biddle, pp 255-56. In large measure, I think Biddle's recollection of Hutchinson's last days, which informed Powell's account, see Powell pp 29-30, are inaccurate. Most contemporary accounts including Hutchinson's letter to the Governor give the impression that Hutchinson discounted the extent and danger of the epidemic.

27. Rush 1793 p 17.

28. Bell, p 101; Butterfield, pp 653 & 654.

29. Carey p 30.

30. B. Smith to D. Smith, Aug 25, 1793, Haverford.

31. Butterfield p 640; Rush Notebook Aug. 25, 1793.

32. Butterfield p 641.

33. Amer. Daily Adv. Aug. 28, 1793.

34. Powell p 124.

35. Rush Notebook Aug 18, 1794.

36. Creighton p 247.

37. Corner p 82.

38. Cullen, p 78.

39. Thomson p 160.

40. Corner p 80.

41. Corner p 87.

42. Thomson, p 75

43. Rush 1977, p 11.

44. Garrison, pp 314-5.

45. Rush 1977, p 12.

46. Brown p 78.

47. Corner p 54n; Bell, p 102.

48. Rush 1815 vol 2, p 44.

49. Carlson p 245.

50. Jarcho, pp 1ff.

51. Rush 1793a p 103.

52. ibid p 115.

53. Smith's notes

54. Rush 1793a p 131.

55. Smith's notes.

56. Rush 1793 pp 193ff.

57. Butterfield p 644.

58. Rush 1793 p 196.

59. e.g. Cipolla p 7.

60. Smith's notes.

61. Rush Notebook Oct 18, 1793.

62. Butterfield pp 641, 647.

63. Binger, p 230