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Destroying Angel: Benjamin Rush,
Yellow Fever and the Birth of Modern Medicine
by Bob Arnebeck
In A Journal of the Plague Year Daniel Defoe's narrator met his doctor friend just as the 1665 epidemic reached its peak and was easily convinced by the doctor, who cited statistics, that the force of the disease was spent. The narrator also noted how emboldened people became once they sensed the epidemic's end. Many still died but the conviction grew that if one got the disease, it would be more easily cured. Of course Defoe had written his "eyewitness" account 57 years after the epidemic.(1) Surrounded by death, the mortality harkened Rush, not to Defoe, but to the Bible. "O! that God would hear the cries and groans of the many hundred and perhaps thousand sick which still ascend to his throne every hour of the day and night from our desolating city!"(2)
The city was devastated. A letter said to have been written by Rush on the October 10 was widely paraphrased in newspapers around the country: "the disorder was now past the art of man or medicine to cure, that nothing but the power of the Almighty could stop it."(3) No one disputed that assessment. "It is not possible for me to pass the streets without walking in a line with the dead, passing infected houses, and looking into open graves...," Mrs. William Smith wrote. "I don't know what to write; my head is gone, and my heart is torn to pieces."(4) From Lansdowne, a stately mansion outside the city, the British diplomat George Hammond reported to London that there was no appearance of the epidemic's "ravages being checked.... It is certainly one of the most malignant that has ever visited in any age or nation."(5)
"Unless Providence sends an heavy driving rain or a very great change in your atmosphere in point of cold and moisture," a New York doctor wrote to Rush, "I see nothing but absolute destruction for your deserted city." Worse still, if the cold came and did not stop the epidemic, that would be proof that the fever was actually the plague and might last through the winter.(6) The churches finally began to close. The Mayor's Committee, once 28 strong, convened with only eight men joining Mayor Clarkson at City Hall. The markets did remain open; bakers made special exertions to supply bread; the post office moved to a healthier part of the city and opened an hour a day in the afternoon.(7)
Rush's letters oscillated between a strange euphoria and despair. After a refreshing sleep he wrote to his wife: "How precious is sound sleep in a city where thousands now pass wearisome and sleepless nights! How great is the gift of life in a place where upwards of a hundred fellow creatures die every day!"(8) (This euphoria of survival was not unique to Rush. On October 5, as he walked through the empty streets visiting the dying, Rev. Helmuth achieved a measure of ecstacy: "Blessed evening - blessed awful solitude - The thought: The city is distressed - so many families are distressed - but the Lord looks down upon the distressed, and who would not willingly be in a place on which the Lord looks down in mercy? This thought had so much comfort for me, that I forgot all the calamity around me...."(9))
However, the dominant chords in Rush's letters are depressing, and he took comfort in the 102nd Psalm:
I am like a pelican of the wilderness; I am like
an owl of the desert.
I watch, and am as a sparrow alone upon the house top.
Mine enemies reproach me all the day; and they that
are mad against me are sworn against me....
which made him weep.(10)
He looked for signs of a change in the atmosphere. When the wind blew from the northeast bringing clouds and cooler temperatures, Rush hoped that it was a sign of a coming "equinoctial gale." In his account of the epidemic, as was traditional in medical histories, he would note various natural phenomena. Blossoms appeared on fruit trees by the first of April; birds appeared two weeks earlier in the spring; the heat and drought of the summer were uncommon; a meteor was seen at 2 a.m. "on or about the twelfth of September" and fell on Pine Street; mosquitoes were numerous; cats died and perhaps not just because their owners had abandoned them; cherry trees blossomed in October; the weather did not change as expected with the changes in the moon.(11) Yet in the letters he wrote at the time, the only natural phenomena he harped on, other than the heat, was the storm so often experienced around the autumnal equinox. "An equinoctial gale with rain would do more for our city than a thousand physicians," he explained to his wife.(12)
The next day he lamented the shining sun and the return of warm weather. That inspired another spasm of resignation: "But God's will is done on earth as much by pestilential contagion and ignorant physicians as it is by the songs and praises of saints and angels in heaven."(13)
He continued, however, to respond creatively to the crisis. Salivation was one of the side effects to the calomel purges. While having drool constantly running from one's mouth was generally considered distressing, Rush noticed that those who did salivate invariably survived the fever. Rather than dismiss salivation as merely a result of survival, Rush decided salivation might be a cure. Cullen had thought salivation after mercurial treatment for syphilis essential for getting the venereal poison out of the body. In 1789 Rush treated a man with a bilious fever and pain in his right side with mercurial ointment. Once he began salivating, a day later, he began feeling better. Rush began rubbing mercurial ointment on his yellow fever patients' limbs, and then on the patient's gums to get salivation more quickly.(14) Inducing salivation was a therapy that would excite doctors for another fifty years.(15)
Unfortunately Rush had no time to write during its development. In the first week of October there were some 8,000 sick, and at times only two American and a handful of French doctors able to treat them.(16) Rush sometimes was able to visit patients, but often not.
Finally on October 9, he finally seemed to get genuine yellow fever, severe back pain followed by "all the symptoms of the fever." Fisher bled him which stopped the pains, and then gave him a dose and a half of the mercurial medicine. He puked several times during the night and had diarrhea in the morning. He felt relieved and was able to sit up. That afternoon his fever returned sharply, and he felt very tired, which he thought an alarming symptom. Fisher bled him which revived him.
The next morning his fever returned. He no longer saw patients, and even avoided rooms where patients had been. He decided to avoid contagion at all costs. Then on the night of the 11th, death, he thought, was upon him. He called his black man Marcus who slept in the room with him to get him a drink and "some nourishment." He revived but was bedridden for several more days.(17) On October 15 he was strong enough to sit up in bed, and strong enough to pray for rain, which he thought would purify the city more than cold. It did rain and he jotted down, "Rain. Blessed, Blessed be God for it."(18) At dawn on the 16th the thermometer read 37 degrees. The Federal Gazette reported that "the malignant fever has very considerably abated."(19)
Thanks to Timothy Pickering's daily visits, Rush did provide advice on the city's returning health. His apprentices noted a diminishing case load, which Pickering reported to the President, emboldening him to schedule a return to the Philadelphia suburbs, at least, by November 1.(20) The length of the epidemic and the damage it had done to the city's economy and reputation made reopening the city an overriding political issue.
Mayor Clarkson, an important Federalist politician and a marine insurer, led the optimists. True, upwards of ten a day were still being sent to the hospital, but most of them were from the poor suburb of Southwark. He took the occasion of a thank you letter to New York for its donation to the city of $5,000 to report that light rain and cool weather "appear to have given a check" to the disorder as shown by a decrease in funerals and applications to the hospital. A few days later he noted that the "general appearance" of the city was "pleasing;" physicians less busy; more people recovered than before; there was "an obvious difference" in the looks of those who remained, a new "cheerfulness;" several shops had reopened.(21)
To settle any argument the Committee decided to get an exact count of burials from all the graveyards. The numbers did show a decrease from a peak in deaths of 119 on October 11 to 65 on the 19th. Pickering held up a letter to the President so that he could get the official tally. But from the 11th to the 19th, 700 had been buried, almost a fifth of the total number of dead since August. Pickering told the President that he was taken aback by the number, but he continued to insist that things were much better. Rush had told him that the disorder had abated by "at least one half," and that the city would be "free of the contagion" by December when Congress was scheduled to convene.(22)
Then on Tuesday the 22nd the temperature climbed to 65. On the 23rd Rush wrote to Julia that the epidemic had "revived," and mortality was "nearly as great as before the late rain and cold weather."(23) But the epidemic was ending. For the first time since September 11, less than 40 were buried. The Gazette knew of no one sick. A correspondent asked if it was not time for the rest of the country to reopen communication with the city. On the 25th the Gazette reported that stores were opening, families returning, the wharves "once more enlivened," as a London ship came up to unload. The Committee still thought people outside the city should wait another week or 10 days before coming back in. It also published directions for cleaning houses that had been closed up. They should be aired out for several days with all windows and doors open. "Burning of nitre will correct the corrupt air which they may contain. Quick lime should be thrown into the privies and the chambers whitewashed."(24) John Welsh reported that it was dangerous to walk on the streets "so common is washing windows."(25) The high on the 28th was 37 degrees. John Mease cheered the "cold wind, which... leaves no longer room to hesitate about return of the inhabitants, and is corroborated by the new faces we begin to meet in the streets."(26) On the 31st a white flag was hoisted over Bush Hill with the legend "No More Sick Persons Here."(27)
Rush remained a pessimist. That certainly doesn't fit the historians' model of the dogmatic, theory driven optimist. Clearly he was overwhelmed by the evidence of the epidemic's virulence and disdained the role of civic booster even though he forfeited an opportunity to take credit for the improving state of the city. He predicted to his wife that many would die "from ignorance or carelessness,"(28) and proved to be a prophet. The white flag had to be struck, as a handful of new arrivals took the fever and died.(29)
On the 4th the Committee could "not say that it was totally eradicated."(30) Impatient at the equivocation in the city Governor Mifflin in Germantown prompted his port physicians James Mease (said to be "a walking skeleton") and Dr. Samuel Duffield to declare that the disease had "rapidly declined" and would be gone in two weeks, so Congress could meet as scheduled. Within three days Mifflin returned himself only to be confronted with reports that a ship from St. Domingo with passengers sick with yellow fever was below the city. Despite doctors giving the ship a clean bill of health, to avoid any panic, Mifflin ordered it to stay at quarantine.(31)
On the 7th Margaret Morris marveled at the streets "full of people and waggons loaded with furniture."(32) President Washington made a day trip to the city on the 11th, despite Attorney General Randolph warning that "we have not yet learned, that any radical precautions have commenced for purging the houses and furniture."(33) One returnee found the city "beautifully clean, nothing lying on the streets or gutters."(34) On the 13th stages north and south were running. John Welsh reported that the streets were "in an uproar and rendered the wharves impossible by reason of the vast quantities of wine, sugar, rum, coffee, cotton & c. The porters are quite savvy and demand extravagantly for anything they do."(35) On the 14th the Committee announced that while houses still had to be purified and infected clothing and bedding "washed, baked, buried or destroyed," anyone could come to the city "without danger from the late prevailing disorder."(36)
In a published notice Rush recommended that houses be aired out 3 to 4 days and nights, and that returnees avoid "cold, fatigue and intemperance."(37) But as Rush regained his strength what really worried him was not the commercial reputation of the city. He became obsessed with consolidating the scientific gains he had made during the epidemic.
Rush saw the epidemic as a challenge to orthodoxy. He couldn't get the example of Sydenham out of his mind. At first the great physician had left London during the plague like most of his colleagues. The class they served had left the city, and from time immemorial epidemics had played themselves out, then doctors returned and medical life continued as before. But Sydenham chaffed at being away and recognized the opportunity presented by the epidemic. He returned to the city, tried new approaches, fashioned new principles of medicine, rediscovered old, and was eventually hailed as the English Hippocrates.(38)
Rush saw that, save for several ex-students and some younger colleagues like Physick, the members of the College of Physicians did not see the epidemic as a call for new thinking. They were intent on defending orthodoxy from Rush. Adding to his frustration was that he wanted recognition of his moral achievement. He longed for all to recognize how he had merged Christian and scientific duty.
"They know but little of the obligations of Christianity," he wrote to Julia, "who give such a worthless reptile as I am the least credit for any one exertion in the cause of humanity, for I profess to believe in and to imitate a Saviour who did not risk but who gave his life, not for his friends but his enemies."(39) But finding no such recognition from his colleagues, he feared that his enemies were working against him.
"Many, many persons I fear are killed now by bark, wine, and laudanum to spite me." he explained to his wife. "Their rancor has no bounds. They watch my patients with great solicitude, and console themselves under my numerous cures by declaring that my patients had nothing but the common fall fever. The few whom I lose they say died of the yellow fever and are all killed by mercury and bleeding."(40)
In his notebook he recorded the report that Dr. Benjamin Duffield had accused him of killing 99 out of 100 patients and said he "ought to have a mad shirt put on."(41) He recoiled at letters from people in the countryside, including Julia, that suggested he was being hailed as a hero in the city. "This is far from being true," he wrote back. "...I am now publicly accused at every corner of having murdered the greatest part of the citizens who have died of the present disorder."(42)
Rush spent most of his time reading, principally Sydenham, and working on his notes about the epidemic. He longed to end his days teaching in New York. In Philadelphia, he saw nothing "but strife and misery." This bitterness became like a refrain in all his letters.(43)
During late October and early November, there were no published attacks against Rush, but he heard that Currie had written to Hodge attacking Rush's behavior during the epidemic, claiming that he had personally profited from the sale of calomel and jalap. To his wife Rush denied taking a dime for medicine. He had sent patients who could pay to the apothecaries so he could save his supply for the poor. As much as the letter upset him, he was eager to get and publish a copy. "It will show that I had a more formidable monster than the disease to contend with during the late calamity." But he never got his hands on it.(44)
He heard from a young colleague, Dr. Michael Leib, that Dr. Barton intended to try to expel Rush from the College of Physicians unless his friends pleaded in his behalf that he was "insane."(45) Rush had already resolved to quit the college. On November 5 he sent a one sentence resignation, and a copy of the Works of Sydenham. Less the symbolism of that be lost on the public, he saw that the weekly Gazetteer printed an "extract of a letter from Philadelphia," that explained that Sydenham had written the Bible of medicine. If the members of the college had been better acquainted with it, the death toll from the epidemic "would not have so greatly swelled."(46)
Some colleagues pleaded for him to remain in the college, and Julia's letters tried to sooth him with praise for his works from the Governor on down. She advised him not to get so upset at colleagues who had not earned the credit he had.(47) He promised to "attend" to her advice, then wailed on as usual. "Dr. Hodge (stimulated by the Wistar family) leads the van of my calumniators. I gave him no other offense than declining to consult with him.... I did not take this decisive step with my brethren till I made myself hoarse in trying to persuade them to adopt the new remedies, and until they had accused me in the newspapers of murdering my patients by bloodletting."(48)
Adding to the emotional distress must have been the increasingly equivocal results of his therapies. Not that the mounting death toll moved him to reconsider his practice. Father Fleming died because Coxe and Fisher could not bleed him in time.(49) George Bullock had concealed his illness, and then was poorly attended by an ignorant nurse.(50) Parry Hall died because after sitting up three nights with his dying sister-in-law nothing could have cured him.(51) Mrs. William Smith died because she was so depressed at the death of friends that she was beyond the power of bleeding and purging.(52) He was quick to assure Julia that without the new remedies the fever would have been as deadly as the plague.(53)
Then came his counterattack. Well served by his connections in the press, articles favorable to Rush and his methods lampooned his opponents. "Dr. K___", who "never smiled in his life, except at the rise of stock," and a disciple killed six patients with, respectively, chamomile tea, gin, laudanum, beef broth and "cayan pepper," bark, and killed the last by refusing to use the lancet despite the patient's begging to be bled.(54)
Rush's refusal to blame any of the rising death toll on his remedies, while freely blaming other remedies, has been held as evidence that by the end of the epidemic what science there had been in his crusade had been displaced by a personal vendetta. Powell faults Rush for not collaborating with Deveze, Currie, Wistar, Hodge and others during the epidemic, suggesting that demonstrated bad faith if not paranoia perhaps to the point of insanity. He argues his case by stringing together all the emotional outbursts in Rush's letters to his wife, contrasting them with the public statements of the other doctors.(55)
But Rush's letters to his wife afford a rare insight to a man's thoughts in the heat of battle. They are unique in this epidemic. We are spared what agonies of self justification the other participants went through as their patients died. Certainly anyone who has had a whiff of science today understands that personal vendettas can coexist with good science. It is unfair to assume that because Rush grew to despise Kuhn, Currie, Hodge, Duffield and others that he necessarily falsified data or ignored information that didn't flatter his ideas.
The crucial point is that no one could prove any other practice better. As evident as it is to us that bleeding during the last stages of yellow fever, lowering already low blood pressure, was lethal, it was not evident then. Despite suspicions, no one proved that a markedly larger number of deaths were caused by bleeding and purging. Judging from his and his family's letters, Benjamin Smith had a classic case of yellow fever. He was purged, bled at least twice, and died in five days.(56) There is no evidence that he was bled immediately before death. On the contrary his friend Dr. Griffitts blamed his death on his not being bled enough.(57) Also judging from the difficulty the Smith family had in finding a bleeder in that late stage of the epidemic, it is difficult to blame the enormous death toll in the first week of October on bleeding.
So Rush's principle excuse, that death resulted from lapses in care, is as valid as it is time worn. The mutual accusations of murder that physicians hurled at each other is just as time worn. Powell did not see any published accusations against Rush.(58) However, as has been noted previously, they are there, including the colorful suggestion that in bleeding in yellow fever one might as well "clap a knife" to one's throat.(59) Privately, it is clear that Deveze and most other French doctors thought Rush's remedies a principal cause of the mortality.
Rush's anger was not the result of paranoia. He did collaborate with others. Indeed, a former apprentice, Dr. Woodhouse, helped him develop his techniques for increasing salivation.(60) Throughout November he corresponded with Wistar. Reconciliation that in retrospect would have perhaps been valuable in elucidating the nature of yellow fever proved impossible. But Rush's position was not emotional or insanely protective of his discoveries. He shared with Wistar information he had received from New York explaining how calomel purges had been successful against yellow fever there in 1791. Wistar pleaded that he did credit calomel and was only being honest in tempering his praise of it. Rush could not tolerate Wistar's discounting the overwhelming evidence of calomel's benefits because in his own personal case he thought it too harsh, which, of course, Rush knew was Wistar's opinion even before he got sick.(61) Rush could not tolerate most of his colleagues because they had not truly engaged and been transformed by close observation of the epidemic. Rush would not mistake collegiality, like Wistar's thanking Kuhn, for science.
Eventually human contact restored Rush's equanimity. He would not leave the city for fear of spreading contagion.(62) But he had visits from those who had endured the long epidemic with him. Many brought presents. Margaret Morris thanked him for his "guiding principles."(63) He heard enough encouragement so that he was satisfied that he would "not be driven from the city." He was sent for by one of Kuhn's wealthiest patients.(64) The black leaders Jones and Allen came to share their experiences.(65) Many testimonials were public. Dr. Griffitts wrote to the press that he had been bled seven times in four days, and complained "what shall we say to the physicians who bleed but once."(66) The bookseller William Young wrote that the bark failed when 10 in his family were sick. Rush was too indisposed to attend, but they followed his printed directions and all recovered.(67) Jones and Allen told how they "recovered between two and three hundred people" by following Rush's directions.(68)
Meanwhile Julia was waiting for her husband to come to Princeton and get her. He told her that nothing would please him more. On Sunday the 3rd he went as far as the farm where baby Ben was staying. He took the precaution of only meeting people in the fresh air for fear of spreading infection, and would not let any one in the countryside come within 5 or 6 feet.(69)
Marcus got to work "preparing and purifying the house." All the furniture was placed in the yard over night. Rush worried that "no frost has touched them." On November 8 he decided that all contagion had been discharged from his body. His pupils contracted to their "natural fire" and he began having regular bowel movements.(70) But after a trip in the countryside on the 12th he felt "somewhat indisposed" and returned home to take calomel.
Julia realized she was not going to get an escort to the city. So she came to the farm where baby Ben was and sent word to her husband. She missed getting the letter he wrote to Princeton on the 11th worrying that four people had died of yellow fever that Sunday, one "from the contagion lodged in a surtout coat." But upon hearing that she was at the farm, Rush relented. He couldn't go out to see her, he explained, because he had a patient "with a disorder which cannot bear the loss of two visits a day at a certain hour without risk of his life." And he feared the ride out and "first interview" with her would be too exhausting. So he sent Fisher out to bring her in, if she wished. "If you come to town, you shall have the front room (now the purest in the house) to yourself. I will sleep in the room adjoining you with the door open between us."(71)
On the 13th she arrived. "My wife wept," Rush wrote in his notebook, "and was unable to speak for near a minute. She spent the day and night with me and returned the next day to Princeton." Their daughters were still there, and she was uncomfortable in the infected house. Rush promptly rented another. On November 22, the entire Rush family was together once again. The epidemic was over.(72)
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1. Defoe p 224.
2. Butterfield p 723.
3. Litchfield, Conn. Monitor Oct. 30, 1793.
4. Rush 1793 p 313.
5. Hammond to Grenville Oct. 12, 1793, LC.
6. Rodgers to Rush Oct. 14, 1793, Rush Papers.
7. Fed. Gaz. Oct. 5, 1793.
8. Butterfield p 704.
9. Helmuth pp 52-3.
10. Butterfield p 709.
11. Rush 1793, pp 5-7, 108-110.
12. Butterfield p 677.
13. Butterfield p 679.
14. Rush 1815 vol 3 pp 156-157.
15. Warner p 100.
16. Currie 1794 p 3.
17. Butterfield pp 710-1, 742-3; Rush 1793 pp 330-36.
18. Rush Notebook Oct. 15, 1793.
19. Fed. Gaz. Oct. 16, 1793.
20. Pickering to Washington Oct. 15, 1793, LC; Fitzpatrick, pp 121ff.
21. Minutes pp 66, 68, 71.
22. Pickering to Washington Oct. 21, 1793, LC.
23. Butterfield p 723.
24. Fed. Gaz. Oct. 25, 26, 29, Nov. 1, 1793.
25. Welsh papers Oct. 28, 1793.
26. Mease to Coxe Oct. 23 & 28, 1793, HSP.
27. Dawson to Wolcott Oct. 31, 1793, CHS.
28. Butterfield p 735.
29. Dawson to Wolcott Nov. 5, 1793, CHS.
30. Fed. Gaz. Nov. 4, 1793.
31. Ind. Gaz. Nov. 9, 1793; Butterfield p 739; Fed. Gaz. Nov. 14, 1793.
32. Morris to son, Nov. 7, 1793, Haverford.
33. Randolph to Washington Nov. 10, 1793, LC.
34. Coxe to Adams Nov. 11, 1793, MHS.
35. Welsh papers Nov. 13, 1793, HSP.
36. Minutes p 120.
37. Fed. Gaz. Nov. 2, 1793.
38. Rush 1977 pp 42ff; judging from biographies of Sydenham, Rush may have mythologized the doctor's heroics during the plague year, see Dewhurst p 31.
39. Butterfield p 705.
40. Butterfield p 717.
41. Rush Notebook Oct. 12, 1793.
42. Butterfield p 725.
43. Butterfield p 717; Rush Notebook Oct. 25, 1793.
44. Butterfield p 736; Powell suggests this letter never existed, p 205, however Currie published just such a letter in the Gaz. of U.S. of Oct. 6, 1797.
45. Rush Notebook Oct. 27, 1793.
46. Ind. Gaz. Nov. 9, 1793.
47. Julia Rush to Rush, Oct. 29, 1793, APS.
48. Butterfield pp 740-1.
49. Butterfield p 703.
50. Butterfield p 722.
51. Butterfield p 735.
52. Rush 1815 vol 3 p 167.
53. Butterfield p 738.
54. Ind. Gaz. Nov. 2, 1793.
55. Powell pp 195-215.
56. Morris to her son Oct 19, 21, 24, 1793, and to her sister Oct 22, 1793, Haverford.
57. Griffitts to Rush Oct. 19, 1793, Rush Papers, a portion in Rush 1793 p 273.
58. Powell p 207.
59. see Ruston letter in Fed. Gaz. Sept. 23, 1793.
60. Rush 1815 vol 3 pp 156-157.
61. Rush to Wistar, Nov. 18, 1793, Haverford.
62. Rush Notebook Oct. 18, 1793.
63. Rush Notebook Oct. 20, 1793.
64. Butterfield p 741.
65. Butterfield p 732.
66. Rush 1793 p 271.
67. Fed. Gaz. Oct. 23, 1793.
68. Fed. Gaz. Nov. 8, 1793.
69. Butterfield p 737; Rush Notebook Nov. 1, 1793.
70. Rush Notebook Nov. 8, 1793; Butterfield p 743.
71. Butterfield p 745; Rush Notebook Nov. 12, 1793.
72. Rush Notebook Nov. 13 & 22, 1793.