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Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Five

The optimism generated by Rush's treatment was quickly consumed by the unchecked fear of the epidemic. Hutchinson's death was considered a defeat for medicine in general, not of a particular treatment. And the effect of the death of the prominent and popular doctor, who was a political leader as well,(1) cannot be underestimated. "For five days no two or more persons met when the first interrogatory was not 'How does Hutchinson.'" the young editor Samuel Smith wrote to his sister. Hutchinson had given Smith courage to stay in the city. Smith was aware of Rush's cures and believed the fever's "virulence has... been greatly subdued," but as he sealed his letter, a carriage waited to take him to Lancaster 60 miles away.(2)

As Hutchinson lay dying the state legislature hurriedly adjourned. A Quaker member moved that the state humble itself before God and close all theaters in the state permanently. No one had stomach for such a debate at that time. No member seconded the motion. After giving the governor new powers to stop and quarantine ships, the legislators fled the city.(3)

Many residents of the city stayed, but not necessarily because they had heard of Rush's success. Denial that there really was an epidemic is a characteristic reaction to any mortal epidemic.(4) John Welsh, who stayed at his post on South Front Street shipping gin and cheese, wrote that, "the doctors call the most of [the] complaints the remitting and intermitting fevers. The generality of the people believe it to be a species of the contagion less dangerous [than yellow fever.]" Welsh's office boy's family was sick on Pear Street, and report had it that just about everyone was sick there, but not with yellow fever.(5)

Rush had a patient there too, Dr. John Morris. He had been the patient of his fellow Quaker, Dr. Samuel Griffitts. Then on Friday Griffitts got sick and asked Rush to see Morris. Griffitts had started him on calomel and jalap, which worked exactly as expected. Griffitts thought Morris had favorable symptoms and would recover. (Margaret Morris, the doctor's mother, thought her son "struck with death.") On Saturday morning "his skin was as yellow as gold." He had convulsions and was delirious.(6)

Being called in on the Morris case was flattering to Rush in two respects. Griffitts was secretary of the College of Physicians, and Morris was a member. Both had confidence in Rush's remedies. Also an African-American nurse attended Morris. (There were other goings-on at the Morris house that were not so flattering, but Rush did not know about them. Morris's wife had tried to send their four children to her father, but he had refused to take them for fear that they carried the disease - a fear that may have been implanted by Rush's directions. That shock prostrated Mrs. Morris, leaving her mother-in-law to find refuge for the children and supervise care for her son.)(7)

When he arrived Rush gave Morris more calomel and jalap, and while not much encouraged, told Margaret that his fever was lower. The next morrning he had convulsions and died. Rush began his morning rounds by visiting the Morris house. Morris's mother "gave vent to the most pathetic and eloquent exclamations of grief." Rush "was dumb" and finding himself "sinking into sympathy," tore himself from her arms and "ran to other scenes of distress."(8)

In his notebook, Rush explained why Morris died even after taking calomel. He was a drunkard.(9) (Indeed, the attendance of his mother at his bedside was the first time she had seen him in months. She had shunned him because of his inebriety.) Although unaware of the Morris case in particular, the historian J. H. Powell scored Rush for finding excuses for the failure of his medicines rather than realizing their ineffectiveness.(10) Certainly Rush was right not to abandon his ground because of Morris's death. Then as now the constitution of a patient before treatment affects the success of that treatment. However, Rush was careful not to include Morris in the statistics he was amassing to prove the effectiveness of his medicine, which raises the question of how valid those statistics were. Troubling some contemporaries and all historians is Rush's subsequent inability to name those he claimed to have saved.(11)

Rush felt that his foremost duty was to save as many people as he could. Even from the perspective of the late 20th century, it doesn't seem unreasonable to ignore case studies and rely solely on simple mortality statistics to prove the effectiveness of a remedy during a virulent epidemic which threatened death within a week. And given the hero's acclaim Rush began receiving that Sunday his not taking valuable time to document his success is understandable.

Sunday sermons had set off lamentations that flattered Rush's belief that his mission was a holy one. There was a growing conviction among preachers that the epidemic was heaven sent.(12) There were other signs of divine disfavor. At 3 a.m. on Sunday morning there was a large fire on 2nd Street. Two people died in the blaze, (and most of the copies of Currie's pamphlet were burned in a nearby printing shop.)(13) Quakers recalled a visitor who had predicted "that he who sitteth on the pale horse whose name is death would be sent through the streets of Philadelphia."(14)

Rush girded himself with religious metaphors. "Hereafter my name should be Shadrach, Meshach, or Abednego," he wrote to his wife on the 10th, "for I am sure the preservation of those men from death by fire was not a greater miracle than my preservation from the infection of the prevailing disorder."(15) Rush saw himself as marshalling the forces of good, and so did others. The Quaker leader Richard Wells stopped him on the street on Sunday and told him "Doctor, you have been highly favored in your discovery and success. Be humble and thankful." In reply Rush quoted the Bible, "who am I and who am I from, that I should have been so highly favored."(16) As he crossed Arch and Third Streets in his carriage, people stopped him, and he was dragged "to six different and new applications." Dr. John Penington had run across Third Street to tell him that the disease yielded to strong purges "in every case."(17)

Rush visited and prescribed for upwards of 100 people that day. John Connelly, a prominent auctioneer who was Catholic, took him by the hand and "with a faltering voice and his eyes overflowing with tears told me that he carried me on his heart to the footstool of his Maker."(18) Thomas Willing, president of the Bank of the United States, sent a note to Rush on Monday: "the weak state of my stomach and heavy sweats in the night require some immediate check." Rush was soon at his side with purging medicines.(19)

President Washington invited his good friend Elizabeth Powel and her husband Samuel to accompany the presidential party to Mount Vernon for a long planned vacation. Elizabeth, with whom Washington had such a special chemistry that biographers would accuse them of having an affair,(20) liked the idea. Samuel excused himself and his stated reason for staying was in essence his confidence in his doctor, Rush. As Elizabeth explained in a letter to the Washingtons, Samuel argued that it was foolish to leave "the only spot where physicians [were] conversant with the disorder."(21)

Divinely compelled to save all he could, Rush offered to consult in Alexander Hamilton's case,(22) though he was the professed enemy of the Treasury secretary's policies, and no friend of the man personally.(23) Hamilton had put himself in the care of Dr. Stevens, a boyhood friend from St. Croix where both were raised.(24) Rush called on Stevens but he was well satisfied with his gentle remedies, bark, wine, small doses of "oil of peppermint and compound spirits of lavender," and "infusing" chamomile flowers into the secretary's body. When the secretary's condition worsened Stevens's had him held up in a tub every two hours as cold water was splashed over his naked body. After that he sipped a little brandy burnt with cinnamon, and, while he lay in bed, flannel cloths soaked in "wine impregnated with spices" were applied "to the pit of the stomach and changed frequently."(25)

That setback did not faze Rush. He seemed almost joyous at times. He bumped into an African American woman he knew, and cried "Hah! Mama, we black folks have come into demand at last." She squeezed his hand. Of course he constantly reminded himself of the misery, pledged not to forget the poor, and prayed for cleansing heavy rains or frost. But this was his moment. He felt that God was steadying him. He had health and "uncommon tranquility of mind." He did not have to hide the truth from patients. He simply told them "you have nothing but a yellow fever, and mercury and jalap are as certain a cure for it as bark is for an intermittent."(26)

However, he soon had more deaths to explain. That weekend he learned that one of his five apprentices, Warner Washington, had the fever. His situation put Rush into a dilemma. Washington, a 21 year old Virginian, did not send for Rush out of shame. He had been strickened at his mistress's house outside the city. Rush sent Stall out to treat him, but expected the worse. "From the violence of the symptoms and the progress of the disease," Rush explained to Julia, he feared Washington would not recover. He cautioned her that 99 out of 100 who took his medicine "on the first day recover, and all would recover probably, had I time to attend closely to them after the expulsion or extinction of the poison by the mercury." Then calomel seemed to do its usual wonders, by the next day Stall seemed to have Washington on the road to recovery.(27)

Delving into Rush's early cases in detail is necessary to show that Rush had better reasons to defend his remedies than he had to abandon them. Yet his sensitivity to failure is evident. Already he was shying away from his bold belief in the inherent power of his medicine, and reminding himself of the importance of the practitioner's art, his constant attendance and monitoring of symptoms. Actually it is not Rush's supposed zealous and dogmatic insistence on his remedies that is notable, but the ease with which he gave up his ground.

Unknown to Rush in Philadelphia, Dr. Colin Chisholm in the British West Indian island of Grenada, also discovered the efficacy, or apparent efficacy, of calomel in the treatment of yellow fever. For the duration of the epidemic Chisholm relied exclusively on calomel. That persistance was made easier by the environment Chisholm worked in, a small island with few doctors in a region notorious for malignant fevers. To make his work seem even more special, the British doctor decided that the fever he treated was not yellow fever, but a "nova pestis," a new disease never experienced by a British doctor before.(28)

Rush not only operated in a complex urban environment, but a newly arrived West Indian community, including several doctors, seemed immune to the disease and professed superior knowledge of its treatment borne of long experience with it in the islands. The French-born merchant Stephen Girard joked in a September 10 letter, "if the disease continues two weeks longer, there will be nobody left here but Frenchmen, for they do not die so easily."(29)

In early September, Rush had one rival for popular esteem. (30) David Nassy, a Frenchman, had been in the city for several years and was a member, as was Rush, of the American Philosophical Society. He responded to the epidemic by opening an office, and while he used remedies not much different than what Kuhn, Currie and Stevens offered, he followed long standing French tradition and included bleeding in his arsenal. When a patient sent for him, Nassy sent a bleeder ahead to take 6 or 8 ounces of blood out of the patient's vein.(31) A friend who had taken refuge along the Schuylkill wrote to Rush about another French doctor, who had just arrived from St. Domingo, who "lets blood plentifully."(32)

Rush clearly was ripe for self delusion. He had a powerful medicine being widely used that had a powerful affect on patients. Mortality in yellow fever epidemics is rarely over 50%, (33) so most of the patients Rush treated were bound to recover regardless of calomel. Rush's enthusiasm, patients' eagerness for salvation and the law of averages assured that calomel could delude the community into thinking he was controlling the epidemic.

Widely hailed as the savior he longed to be, Rush could have for the duration of the epidemic merely chronicled his "cures." As Redman's talk revealed the traditional role of the doctor facing an epidemic is simply to come up with something. In 1762 Dr. Kearsley found an old herbal recipe that seemed to provide relief. Rush's calomel and jalap not only relieved but, generated enthusiasm. Given that the majority of people thought of an epidemic as heaven sent, a judgment to be borne, Rush was not expected to do more. Rush, however, had hardly begun.

The usual fanatic, then and now, delights in being the instrument, usually very blunt instrument, of god. Rush became godlike. Unlike the usual fanatic, he did not revel in being free from further observation and discovery. He reveled in a new found power to be continually creative, inspired by heightened senses that seemed to magnify his powers of observation. In a word Rush became modern.

A case can be made that Rush's constant tinkering with his treatment arose not, as he claimed, from his observation of patients, but from his restless envy, his need to stay a jump ahead of all competitors, that it was the devil in him, not the god, which makes his energy seem modern. But as we shall see Rush was not one to conceal his paranoia. All evidence points to his changing his therapy because he decided he had misjudged yellow fever. He began recognizing a symptom he did not expect and which he feared calomel and jalap could not completely and readily control.

Also the number of sick increased, dashing his hope that his pills were preventatives as well. He blamed the increase on the number of volunteers who went out at three in the morning to battle the fire Saturday night. In ordinary times such exposure might lead to colds, but yellow fever was the reigning disease. Indeed, following the theories of Sydenham, Rush believed that yellow fever in effect drove all other diseases out the city.(34) Hence any change in environmental conditions that might debilitate residents was liable to increase the virulence of the fever. (This might not appeal to common sense as informed by the germ theory, but it still guides treatment in an epidemic like yellow fever. Any acute fever symptoms must be treated as yellow fever.)(35)

On the 9th Rush wrote to his wife that due to the colder weather, it was cloudy with a high of 70 degrees, some cases were taking on inflammatory symptoms, and that he bled two patients, but "not until they had been thoroughly purged."(36) Later he would write that after Tuesday September 10, "the pulse, the appearance of the blood, the spontaneous hemorrhages, and the weather (exclusive of the stimulus of the contagion) all indicated the use of the lancet."(37)

Although the use of purges, especially of calomel, finds no favor in modern practice, it is difficult to blame them for killing patients. The absorption rate of mercury in an inorganic compound is minimal(38) and the expression of its side effects take a few days at least and, save for patients with kidney problems,(39) are not in themselves immediately mortal. Modern treatment of yellow fever is "supportive,"(40) which means not only maintaining fluid levels and balance but relieving distressing symptoms like nausea and stomach distress. Purging to effect that is no longer popular but there's no denying that emptying the stomach and bowels can afford temporary relief. Bleeding a yellow fever patient is another matter.

While the doctors assembled in 1986 had not treated yellow fever because cases are generally confined to the fringes of jungles, they had had clinical experience with other hemorrhagic fevers. Recognizing that death by yellow fever is often from shock, the doctors concluded that "a principal goal is the identification of a decreased volume of circulating blood because of an excessive fluid loss."(41) In the 1970s, doctors thought that since the hemorrhaging was likely caused by the loss of the clotting agent vitamin K due to the destruction of liver tissue, supplements of the vitamin and other clotting agents were in order.(42) In the 1980s doctors discounted the possibility of correcting such deficiency in time and instead suggested that blood transfusions would best maintain proper blood pressure. Having no clinical cases such strategies could not be proven. A 1990 text on virology concludes "it is unknown to what extent fluid management and correction of hypotension and electrolyte and acid-base disturbances would reverse the apparently inexorable course of severe yellow fever."(43)

Usually it is the older theories of medicine which seem mechanistic. Not in this case. The modern view that blood loss requires measures to maintain blood volume and blood pressure models the body on a machine. Eighteenth century doctors noted a plethora of blood during pregnancy and during hemorrhagic diseases. They also observed a different quality to the blood. It was thinner, seemingly "dissolved." They concluded that the rapid decrease of blood volume could be an imperative in the treatment of such diseases. Nature seemed to indicate that the patient had too much blood. Their regard for blood differed from ours. They didn't understand blood's role in cell nutrition. Another of Rush's teachers, John Hunter, based his vitalistic physiology on blood. In itself blood was alive, and like life always tending towards fullness, redundancy and growth.(44)

Rush's religious scruples prevented him from embracing any form of vitalism.(45) In general he favored the view that nature was a machine set in motion by the will of God. The traditionally mechanistic view of the body supported bleeding by blaming disease on obstructions to the flow of blood which necessitated bleeding to prevent undue pressure on vital organs. Then in combination with other medicines and procedures like blistering to correct the obstruction, the body could regain proper balance.(46)

Rush was in the midst of developing his theory of arterial tension as the underlying cause of disease, thus tending to relegate blood to a fluid servicing the nerves. But both of these older mechanistic views of blood partook of the vitalist's conclusion: blood was a surfeit, quickly replenished, the gush of life and thus not so precious as we view it today, but expendable in the effort to maintain health. In his account of the epidemic Rush would write that "the theory of fever which led me to purge, determined me to use blood-letting, as soon as it should be indicated." That is, the idea of Mitchell's which sanctioned depletion with purges, also sanctioned bleeding.(47) But he was not so decisive at first. There was no talk of theory. For the moment he relied on the age-old reason for bleeding, to relieve inflammation.

On Tuesday the 10th, realizing that he was unable to treat all who demanded his services, he decided to write a broadside, "Dr. Rush's Directions for Curing and Treating the Yellow Fever," outlining a regimen of self medication. At the first sign of symptoms, "more especially if those symptoms be accompanied by a redness, or faint yellowness in the eyes, and dull or shooting pains about the region of the liver, take one of the powders in a little sugar and water, every six hours, until they produce four or five large evacuations from the bowels..." He urged that the patient stay in bed and "drink plentifully" of barley or chicken water. Then after the "bowels are thoroughly cleaned," it was proper to take 8 to 10 ounces of blood from the arm if, after purging, the pulse was full or tense. To keep the body open he recommended more calomel or small doses of cream of tarter or other salts. If the pulse was weak and low, he recommended camomile or snakeroot as a stimulant, and blisters or blankets soaked in hot vinegar wrapped around the lower limbs. To restore the patient he recommended "gruel, sago, panada, tapioca, tea, coffee, weak chocolate, wine whey, chicken broth, and white meats, according to the weak or active state of the system; the fruits of the season may be eaten with advantage at all times." The sick room should be kept cool and vinegar should be sprinkled around the floor.(48)

But while he had begun to bleed, he had lost no confidence in his purging powder. Along with Stall two more of his apprentices, John Coxe and Edward Fisher, moved in with him. Soon they both felt ill. That did not daunt Rush nor them. "They have seen so much of the efficacy of mercury in the disorder," Rush wrote to his wife, "that they treat their complaint with as much indifference as a common cold."(49)

Even as he shifted his ground, Rush cut a remarkable figure. "The pleasure of the Lord continues to prosper in my hands," he began his September 11 letter to his wife.(50) But yellow fever was as remarkable. Sixteen hours later, Rush wrote in his notebook, "an awful day."(51)

That day, September 11, the printer Benjamin Franklin Bache printed a September 7 letter Kuhn, his step-father-in-law,(52) had written to a doctor who had inquired about his treatment of the fever. He described in detail his use of stimulants like elixir of vitriol and decoction of bark to treat a patient's debility. He noted the wines he thought best - Rhenish, Lisbon and Madeira diluted with lemonade, and explained how to give a bath: "the patient is to be placed in a large empty tub, two buckets full of water, of the temperature of about 75 to 80 degrees of Fahrenheits thermometer, according to the state of the atmosphere, are to be thrown over him." He noted that such treatments were successful in Philadelphia, as they had long been in England, Silesia, and the West Indies. Kuhn did not even allude to Rush's treatment.(53)

Giving publicity to the very treatment which had killed Hutchinson, appalled Rush. Unfortunately for the calm of the community, Rush had a predilection for controversy in politics, religion and medicine. His most notable previous dispute in medicine had been over the army hospitals during the revolutionary war. He eventually resigned his position as superintendent of hospitals in the mid-Atlantic states because after supplying evidence for the court martial of William Shippen, Jr., the chief of the army medical service, Shippen was exonerated. Rush couldn't understand why everyone was not outraged at his evidence that soldiers in the hospital were dying needlessly due to over crowding and lack of supplies. He almost gave up medicine as an outcome to train for the law.(54)

There is no better breeding ground for dogmatism than heated controversy. The temptation to fudge facts to support arguments is strong. But it must be remembered that both sides of the question are prone to such lapses. Some historians suggest that Rush's ferocious arguments drowned out the sensitive, sensible observations of other doctors.(55) That's not the case. Rush was out on a limb, arguing a novel approach to treating a prostrating fever. To make his point his rhetoric had to be hotter. The seemingly calm points raised by his opponents, with that lack of passion that too many historians equate with the true scientific approach, are as absurd from our perspective as Rush's claims. Kuhn's discussion of the proper vintage wines for treating a fever that was killing people in a week betrays a dogmatism and lack of acquaintance with the reality of the situation.

At first Rush seemed to trust popular opinion to vindicate his remedies. Rush wrote to his wife that the "increasing number" of patients coming to him refuted Kuhn. His recent cures of four servants at the British embassy "will swell the triumphs of mercury, jalap, and bloodletting."(56) But he could not let Kuhn's letter go uncontested.

What was extraordinary about Rush's performance in this controversy was not any display of dogmatism, but his attempt to include the public in the process of scientific discovery. In a letter he wrote that day for the Federal Gazette, Rush explained how he had used lenient purges and the methods employed by Dr. Redman in 1762 and had lost three out of four patients. Dr. Wistar had the same experience in his practice. Then he briefly described his reasons for using mercury and bloodletting after purging. Like Chisholm in Grenada, he appreciated the need to obviate a defense of his remedies based on current medical theory by highlighting the uniqueness of the current crisis, (although he didn't go so far as Chisholm in proclaiming the recognition of a completely new disease.) This yellow fever was, due to differences in climate and season, not the same as the yellow fever of the West Indies or the fever in 1762. So "prescribing for the name of a disease without due regard to the above circumstances has slain more than the sword."

While Kuhn, who had signed his letter A.K., had not mentioned Rush, Rush identified A.K. as Kuhn. Rush charged that, if persisted in, Kuhn's methods of treating the fever "would probably have aided it in desolating three fourths of our city." His methods on the other hand rendered the fever no more dangerous than "a common intermitting fever."(57)

As befits a man out on the limb, Rush's insecurity was considerable. He was able to confine expressions of it to letters to his wife. He bitterly attacked "the prejudices, fears, and falsehoods of several of my brethren, all of which retard the progress of truth and daily cost our city many lives." "Could our physicians be persuaded to adopt the new mode of treating the disorder, the contagion might be eradicated from our city in a few weeks. But they not only refuse to adopt it, they persecute and slander the author of it." As for his letters to the newspapers, he told Julia, "they will... help the people to cure themselves, not only without but in spite of physicians who know nothing of the disorder."(58)

Then Kuhn was back in print claiming that of the 60 cases of fever he saw most were common remittents. He saw 7 cases of yellow fever, 4 were his patients. Of those 4 he cured 3 and the other was on the way to recovery when Kuhn got sick. Of course that was Hutchinson.(59) An unsigned article, most likely written by Rush himself, attacked Kuhn's methods more pointedly. The writer reminded Kuhn of Sydenham's teachings: "no two epidemics of unequal force can long exist together.... The common bilious remittents yielded to the ruthless and solitary despotism of the prevailing epidemic on the 5th of the present month." Therefore everyone with symptoms of fever should take Rush's cure. Indeed, "the great advantage of the mode of cure adopted by Dr. Rush, consists in its preventing, not curing a yellow fever...." The letter concluded by asking Kuhn to keep "his opinions to himself,... and not add to the mortality of the disorder," by lessening "the confidence of some of the citizens in the only remedies which are safe, practicable, and successful (in 99 cases out of 100) in the present epidemic."(60)

Rush paraded dogmas anonymously. His next signed letter in the newspaper confined itself to facts. Dr. Penington had assured him that with purging and bleeding he had not lost one of 48 patients. Of six patients he had treated by the "West India mode..., he had not saved one." Rush did not mention that Penington himself was then prostrate with the fever.(61)

Adding to Rush's insecurity was that the day he first attacked Kuhn, that "awful day," he admitted in his notebook that he "lost" several patients. In general he blamed the deaths on the patients' not taking medicines. But one case underscored the inadequacy of his prescription. His apprentice Washington had seemed to be on the way to recovery. Then came a note from Stall, who had been caring for him, explaining that Washington could not survive long. He had not had a stool for two days, despite "10 & 15." His pulse was "tense altho' it is low." Stall asked: "Shall I bleed him?"(62)

Stall's confusion arose because Rush had just instructed him to bleed only when the pulse was "full and tense." Rush's reply is lost. Warner Washington died that day and Rush had trouble sleeping that night. In his Thursday morning report to his wife, the pleasure of the Lord was no longer manifest.(63) His response was to once again to reexamine the symptoms of yellow fever and change his prescriptions.

The difficult case he had then was William Sansom. Friends were already preparing for his burial.(64) Rush noted that despite taking calomel, Sansom's pulse rate had dropped to 48 strokes a minute. By accepted practice he was in need of stimulation, and Rush had recommended such a course in his broadside. But he could clearly see, as others did as well, that Sansom was dying and beyond the power of herbal teas. Then he saw that Sansom's eyes were dilated.(65)

In his recently published collection of essays he had described what he called dropsies of the brain in which dilation of the pupils was a principal symptom. From autopsies Rush knew such a condition was a classic case of inflammation caused by fluid in the brain. He had noted cases in which the stimulus in the brain was so great as to uncharacteristically cause a low and weak pulse. As for all inflammations, the remedy was bleeding. He had also noted the failure of mercury in treating the condition.(66)

As a rule, as his writings and lectures attest, Rush was a moderate bleeder. Yet in Sansom's case he was clearly seeing the fever re-establish itself in a new seat, the brain. So he bled Sansom profusely, and bled him again. In his book J. H. Powell faults Rush for adhering to theory even when it involved harming patients.(67) But at that point Rush was not insisting on a theory of depletion. Clearly he changed his prescription because he sensed it would fail and that Sansom would die.

It would seem that given such signs of perilously low blood pressure, by modern standards, forcing the patient to lose blood would be fatal. However, after bleeding, Sansom's pulse was restored.(68)

Rush did not wait until Sansom was up and about before proclaiming the virtues of copious bleeding. On Friday the 13th, Sansom's cousin Benjamin Smith reported that Sansom was better Wednesday night and all of Thursday. But on Friday Rush's optimism and the patient's symptoms seemed to vary. Smith wrote that Sansom "had a bad night again and is very poorly this morning, tho' somewhat better. Dr. Rush expresses great hopes of him." But Smith thought Sansom continued "very ill" and was "in great danger."(69)

The day before that grim assessment, Rush publicly trumpeted his bleeding Sansom. In an open letter to the College of Physicians titled "Use of the Lancet in Yellow Fever," he urged bleeding when the pulse was "slow and tense," and he blamed that "state of the pulse" on brain inflammation as indicated by dilating pupils. "I have bled in one case where the pulse beat only 48 strokes in a minute, and recovered my patient by it. The pulse became more full and more frequent after it." Bleeding should be frequent, "twice in many, and in one acute case four times, with the happiest effects. I consider intrepidity in the use of the lancet at present to be as necessary as it is in the use of mercury and jalap in this insidious and ferocious disease."(70)

Thus, after boasting that his remedies could save the city, Rush corrected himself two days later, publicly. He was not demonstrating the arcane art of theoretical medicine but the scientific process. If his remedies in the long run failed, the joy of his enemies, he knew, would have no bounds. But what was important to him in the short run was that the refinement of his prescriptions gave him power to match the power of the fever, and it was a power he could share. He explained in his notebook: "went to Kensington. Several families called to me. I could not attend them - but called to Mr. Easby 'To purge and bleed the whole village.'"(71)

He addressed a letter "To His Fellow Citizens," which was printed on Friday. In it he sanctioned bleeding up to 12 ounces before purging, and thanked God that the success of his remedies made the fever no more serious than measles or influenza, provided his remedies were resorted to in the fever's "early stage."(72)

Then Rush himself got the fever. On the 14th Rush exhausted himself bleeding a boy, and rode home in the cool night air. He did not sleep well and fearing the onset of a pleurisy, a recurrent condition with him, he had Stall take blood. On Sunday the wind came again from the south bringing sultry weather. He visited 20 patients that morning. During one visit he had to lie down to regain his strength. As he comforted the family of his next patient he smiled and explained "you see me here just taking the disorder, and yet I have no fear as to its issue." When he returned home at 2 p.m., he was seized "with a chilly fit and a high fever." He had a taste of his own medicine, calomel and jalap, and went to bed.

Next morning he raved to his wife about his curing himself: "in consequence of losing blood and taking one of my purges I am now perfectly well - so much so that I rested better last night than I have done for a week past. Thus you see that I have proved upon my own body that the yellow fever when treated in the new way is no more than a common cold." Rush told her that he thought his methods could cure the plague itself.(73)

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1. Bell, p 113.

2. S.H. Smith to sister, Sept. 7, 1793, LC.

3. Clay. Gaz. Sept 5, 1793.

4. Rosenberg, p 281.

5. Welsh papers Sept. 7, 1793, HSP.

6. Morris to son, Sept. 19, 1793, & to sister, Sept. 25, 1793, Haverford.

7. Ibid.

8. Butterfield p 655.

9. Rush Notebook Sept. 8, 1793.

10. Powell p 124, 125.

11. Shryock (1) p 247.

12. Fed. Gaz. Sept. 7, 1793.

13. Fed. Gaz. Sept. 9, 1793.

14. S. Dillwyn to father, Sept. 9, 1793, HSP.

15. Butterfield p 657.

16. Rush Notebook Sept. 8, 1793.

17. Butterfield p 655

18. Butterfield p 655.

19. Willing to Rush, undated, in Rush Paper.

20. Flexner, pp 86-7.

21. Powel to Washington, Aug. 8, 1793 (misdated), LC.

22. Barton to Coxe, Sept. 9, 1793, HSP.

23. Corner pp 366--8.

24. Butterfield p 657n.

25. Fed. Gaz. Sept. 16, 1793; Rush 1793 pp 216ff.

26. Butterfield pp 656, 658.

27. Butterfield pp 651, 656.

28. Chisholm, p 117

29. McMaster, pp 212ff.

30. Welsh papers Sept. 12, 1793.

31. Nassy p 35.

32. McConnell to Rush, Sept. 10, 1793, Rush Papers.

33. Zuchau p 494.

34. Butterfield p 654.

35. Strode p 413.

36. Butterfield p 656.

37. Butterfield p 695.

38. Ellenwood p 1050.

39. Taylor, pp 312ff.

40. Berkow p 58.

41. Monath, pp 647-650.

42. Berkow, p 58.

43. Fields, p 800.

44. Hunter, pp 76ff.

45. Carlson p 356.

46. Haller p 42.

47. Rush 1793, p 258.

48. Rush 1793 p 22?.

49. Butterfield p 656.

50. Butterfield p 659.

51. Rush Notebook Sept. 11, 1793.

52. Tagg, p73.

53. Rush 1793 pp 207-211.

54. Corner pp 131-37.

55. Duffy p 67; Powell p 214.

56. Butterfield p 659.

57. Rush 1793 pp 211-2.

58. Butterfield pp 659, 664.

59. Rush 1793 p 213-4.

60. Gen. Adv. Sept. 16, 1793.

61. Fed. Gaz. Sept. 13, 1793.

62. Rush papers, undated under "S."

63. Butterfield p 662

64. Drinker diary Sept. 14, 1793.

65. Rush 1793 p 48.

66. Rush 1793a pp 166, 169, 170, 205, & 227.

67. Powell p 213. In criticizing Rush, Powell did not analyze the pivotal cases Rush had. It should be added that Powell, as I do, credits Rush with boldness that is modern, but Powell makes plain that he didn't think Rush's performance had any shred of scientific respectability. Weakening his position, in my view, is that Powell didn't analyze any of the cases of those doctors he thought performed more credibly.

68. Butterfield p 661.

69. B. Smith to D. Smith, Sept. 13, 1793, Haverford.

70. Butterfield p 661.

71. Rush Notebook Sept. 12, 1793.

72. Butterfield p 660.

73. Butterfield pp 664, 665, & 669.