Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Ten

Confirmation of many of Rush's points came quickly. In the summer of 1794 yellow fever epidemics terrorized New Haven and Baltimore, and Philadelphia had enough cases to cause controversy over the question of whether there was an epidemic. In 1795 New York had an epidemic on a scale that could no longer be concealed by city officials. The general thrust of Rush's argument that yellow fever was a national and on-going threat was confirmed. In his own practice his remedies were almost universally successful. Granting the argument that many of the fevers he treated were not yellow fever, still the ability of his patients to survive despite the extent of bleeding and purging they underwent was impressive. Where there were yellow fever epidemics, Baltimore, New Haven and New York, reports came of the success of his remedies.

Meanwhile, as promised in his account of the 1793 epidemic, Rush extended his depleting therapy successfully to other diseases. By the end of 1795 he was at work on three essays: an account of the 1794 epidemic in Philadelphia, a theory of fevers, and a defense of bloodletting. In his lectures, he sharpened the outlines of his new system of medicine and began teaching the unity of all diseases.

As late as 1900, the 1794 epidemic in New Haven would be cited as the best evidence for proving the importation of yellow fever.(1) On June 10 a 27 year old woman complained of violent head, back and limb pains and nausea. On the 14th the pains stopped "and she was elated with the prospect of a speedy recovery." That evening "she vomited matter resembling coffee-grounds." She died the next day. A few days later a niece who had lived with her a week died with the same symptoms. On June 20, a merchant and his clerk both died in New York City after having left New Haven a few days previous.(2) "Sickness and death prevail in the town," Ezra Stiles, president of Yale College, wrote in his diary.(3)

Three doctors, asked by the city's selectmen to investigate, found that a sloop from Martinique "infected with the contagion of the yellow fever" had been near the victim's house. A chest of clothes that belonged to one of the seamen who died of yellow fever had been opened by the merchant in the presence of his clerk and the first victim.(4) Unfortunately for William Currie this seeming confirmation of his theory was not made public until 1796. For New Haven official the imperative to conceal the existence of any epidemic disease outweighed any other consideration.(5) Old ideas encouraged the age-old reaction to the epidemic.

Baltimore had a Rushite in its midst, a young doctor who had just returned to the city after hearing Rush's 1793-94 lectures. In late August there was an alarm that yellow fever prevailed at Fell's Point. An investigating committee quickly corrected the rumor. Drunkenness and the heat, not an epidemic fever, caused the deaths, which were not excessive for that time of year. The committee did worry that incoming ships were not being properly inspected for sick passengers and crew.(6)

Baltimore was one of the fastest growing cities in the country with a population of around 15,000. Fell's Point was occupied almost exclusively by the sailors, laborers, tradesmen, their families and attendant low life that flocked to a booming port. When people died there, it was easy to blame rum. The city proper was across a quarter mile of marsh and sand.(7) Then on September 17, a letter in the Philadelphia Gazette, sent from Baltimore six days earlier, reported "that we have yellow fever among us is denied now only by ignorance." The writer ridiculed doctors who gave the dangerous fever other names. Most likely Rush or one of his apprentices gave the letter, sent by his former student Thomas Drysdale, to the newspaper.(8)

A few days later, Drysdale again attacked myopic colleagues for misidentifying the disease, and celebrated the wisdom of the people who were "more wise, and of one opinion. They never saw such a disease, and therefore unanimously admit, it is the Yellow Fever." Up to 23 people had been dying a day, 30 in the last 24 hours. "The mortality in proportion to the number on the Point, exceeds the melancholy multitude which died in Philadelphia." People were dying within 12 hours of getting the fever. At the Point streets were deserted and "every person who remains looks as if a Thunderbolt had bursted over his head."(9)

It might be wished that Rush had not influenced his student to attempt such histrionics, but it is clear, that without Rush's influence what happened in Baltimore in 1794 would have been hushed up and the facts manipulated. Health committees created to battle yellow fever did not necessarily hold public health sacrosanct. Their purpose was to give the impression of disinterested action, while in reality fulfilling the age old imperative of protecting the city's reputation.

In Baltimore the health committee only began reporting deaths when the death toll began to decline in October. It attacked "the false and exaggerated accounts" of sickness in the city, which it blamed on "a young man desirous of establishing his own reputation at the expense of truth and of the town in which he lives." Only 344 people had died in August and September, many children with small pox.(10)

In New Haven the health committee only published favorable statistics. At the same time the committee reported that only 5 were sick, Stiles wrote in his diary that out of 20 patients, 16 to 18 had died. Soon his Yale students fled the city in "terror" and "gentlemen" moved families out of town.(11)

The pattern also occurred in New York in 1794 and 1795. In 1794 there was a clustering of deaths along the East River around the New Slip. The city's health committee kept information about it from reaching newspapers. At the end of September the committee finally announced that there had been a small epidemic that was successfully contained.(12) In 1795 the committee denied an epidemic existed for a month and when the death toll rose enough to cause panicked flight from the city, it assured the world that the fever struck only one side of town killing the lower class and immigrants almost exclusively.(13)

Even in Philadelphia the new health committee set saving the city's reputation as its highest priority. By early summer 1794 there was general agreement that measures had been taken to prevent the reoccurrence of the contagion regardless of whose theory one embraced. The wharves were cleaner and state officials were quick to impose quarantines and investigate later. What the city would do once yellow fever was discovered in the city was more problematical. One thing was clear. It would not be up to the doctors to raise the alarm. The five member health committee appointed by the governor would sift the evidence. None of the members had served on the Committee in 1793. They were men of affairs not medicine.(14)

By early June Rush knew of yellow fever in the city. Physick had a woman under his care who had the disease. Rush told him to inform the mayor but not make the case public. On the 12th Rush saw a case of violent puking and great head pain. On the 14th he was called to see Dr. James Mease's sister. Her mother, who had nursed James in '93, knew she had yellow fever. Rush only called it a "malignant intermittent." Blood letting and purging saved all those patients. Mease's sister lost 60 ounces. Meanwhile Rush learned of several cases of swelled testicles. From his reading about epidemics, he knew a similar symptom had been prevalent during a 1741 yellow fever epidemic in St. Domingue.(15)

That yellow fever struck away from the waterfront, before any one raised an alarm about a sickly ship in the harbor, proved his assertion that sporadic cases of yellow fever were common in the city. However, Rush had seen no evidence of contagion, and thanks to delightful summer weather, he didn't expect to.(16) That yellow fever didn't spread due to a healthy environment also proved his model of the 1793 epidemic.

In late August rumors spread that people were dying of yellow fever. To investigate the alarm, the health committee began polling the city's doctors. On August 25 two members of the health committee called on Rush and asked if he thought yellow fever was in the city. "The conflict of my mind," he wrote in his notebook, "has been great in concealing the existence of the disease so long."(17) He told the committee that he had seen 26 cases of yellow fever, but added that he "had seen no case in which it had been contagious." "In every case" where he had been called early, and where his prescriptions had been followed, "the disease had yielded to medicine." As a precaution he thought the committee should open Bush Hill and he recommended that one of his former apprentices be put in charge. If one was, Rush offered to visit the facility two or three times a week. He also advised the committee to clean filth from gutters and remove stagnating water "to prevent the spreading of the disorder."(18)

Only two other doctors reported yellow fever cases.(19) On September 1 the committee assured the governor that there was "no infectious or contagious diseases prevailing." To be on the safe side the committee did order Bush Hill made ready for fever patients.(20)

Then Rush discovered that the fever "appeared to be contagious in several families." He "considered it as criminal to conceal any longer the prevalence of the disease." On the 2nd he wrote to the mayor warning that yellow fever was in the city and that it was contagious. However, Rush did not make the letter public nor did the mayor.(21)

Rush's opponents had already launched a pre-emptive strike ridiculing his remarks to the committee. In the Gazette of the United States, a correspondent argued that if the disease was not contagious as Rush told the committee, then why call it yellow fever and needlessly alarm people? If he had 26 cases since June, why had other physicians had none, why no cases at the dispensary? The claim was made only to support the theory of local origin of the disease. It was wrong to sacrifice the reputation of the city and lead to its desolation because of "a rage for being esteemed the most learned man in the universe."(22)

Rush was once again exposed to the "clamors of my fellow citizens" and "calumnies of some of my brethren, who, while they daily attended or lost patients in the yellow fever, called it by... less unpopular names." "A proposal has been made in a company of citizens to 'drum me out of the city.'" Once again he was said to be insane.(23)

He blamed Kuhn for the innuendos, and assuaged his anger by spreading gossip, privately, that Kuhn lost a patient, who was yellow before and after death.(24) Richard Allen told him that Kuhn had asked him for help to bury a girl who died "of something like the yellow fever." Allen also knew a patient who sent Kuhn away preferring to have Allen purge, bleed, and cure him.(25)

Once again Rush donned the robes of a martyr. "My fate hard!" he wrote in his notebook. "If my patients die, I bled them to death; if they recover they had not the yellow fever. My remedies cruel and unpopular, but not unnatural! I rejoice in the persecution they expose me. People oppose them as they do repentance - they wish for future happiness without depletion of their sins." A few days later he painted his opponents in even darker colors. They were angry at his ability to invariably cure those struck with the killing disease: "Great clamor continues against me for having broken the association of idea between the yellow fever and death." Such was the scorn some had for their savior.(26) As he explained in a letter he wrote to Coxe, who had gone on to study at Edinburgh, while yellow fever had become "epidemic," there were "so few circumstances of terror or distress that scarcely anybody has left the city on account of it."(27)

Rush seemed to realize that proclaiming his success, before the city even realized it was in the midst of an epidemic, would only make him sound like a quack. Drysdale's experience afforded Rush a solution to his problem. Philadelphia newspapers printed Drysdale's letters celebrating "the evacuating system in yellow fever," including this paean: "I continue to triumph by remedies the most simple, over a disease, the most awful of any I ever saw. Thanks to Heaven and to Dr. Rush for my success."(28) At the same time, Drysdale gave letters he got from one of Rush's apprentices to the Baltimore newspapers describing how Rush was being persecuted for reporting yellow fever cases.(29)

In mid-September he tried again to alert his fellow citizens to the danger. He told the health committee, that the fever was contagious and urged them to so inform the public so they would "apply early for medical aid."(30) The committee took no action. Its chairman Robert Wharton was an old family friend and a patient.(31) He was also a merchant, a veteran and a sportsman famed for his courage. He bluntly told Rush that the committee did not print his letter because it did not want to hurt the demand for fall goods.(32)

Determining whether Rush really was seeing and treating yellow fever is problematical. Not until mid-September was there real independent confirmation. There was a cluster of cases near Penn Street, 20 or 30 died, none of them notables.(33)

To Rush's chagrin the issue was soon out of the hands of the doctors. In revenge for Baltimore's harsh treatment of refugees from Philadelphia the year before, a movement began among Philadelphians to quarantine that city.(34) But first Philadelphia itself needed a clean bill of health. The health committee called for a meeting of doctors so that each could report on dangerous cases of fevers they were treating. Currie reported one case; Rush reported a dozen but all under control thanks to his remedies. The committee certified Philadelphia healthy.(35) In his notebook Rush labeled that report "false and scandalous," but he made no waves.(36) The city quarantined Baltimore soon after. On October 2, a cold front made the dispute between the two cities moot.(37) In 1795 Philadelphia joined in battle with New York, quarantining that city while its health committee insisted there was no contagious fever in the city.(38)

His unhappy relationship with the health committee and the evident failure of health committees elsewhere to collect and respond properly to medical evidence worried Rush enough that in his account of the 1794 epidemic he discussed measures a city should take to limit the spread of a malignant fever. First all physicians must be compelled by law to report cases. A committee of doctors should investigate. If the fever seemed to have come from a ship, the offending ships must be cleaned and its cargo carried out of the city. If it seemed to be of local origin, the offending putrefying matter must be removed, covered or destroyed. Meanwhile the infected area should be chained off and all citizens removed, and then nature's way of killing contagion should be imitated by bringing fire hoses and drenching the streets with water. The object was to enhance "the improbability of the sick creating a reflected atmosphere of contagion."(39)

Not that he made any observations during the disease that fortified those strictures with proofs of any particular mode of contagion. Most of the cases were caused, he thought, from the air polluted by filth, but some spread by contagion. In one case a sick man who had come from Baltimore spread it to an acquaintance in Philadelphia. To explain this phenomena, he suggested that all fevers had varying degrees of contagiousness and he ranked yellow fever below small pox, measles, influenza, and plague. It could spread from person to person, but not necessarily.(40)

Meanwhile the preponderant opinion in Baltimore and New York was that fevers there were of local origin. While Philadelphia commercial interests had thought blaming the fever on chance importation boded better for the city's reputation, the rival ports reasoned that if yellow fever was not contagious and arose from local causes then no quarantines need be erected against their commerce.(41) Rush was encouraged by their support for local origin,(42) but not at their complacent attitude the New York and Baltimore about the threat the disease posed. Not for an instant did Rush suggest that yellow fever was not so terrible as it seemed in 1793. What checked it was the power of his medicine. Yellow fever still was a more fearful destroyer than any disease but the plague. He realized that he could smell yellow fever. Patients that year brought back memories of the sulphurous odors of the previous year. He demonstrated to his apprentices that by rubbing his hand, he could create that odor.(43) When he saw sweat exude "from the soles of the feet of Richard Wells's maid, which tinged a towel of a yellow color," he was no longer surprised at the affect the contagion was having on him. Despite taking all precautions including living on vegetables and avoiding all the usual "exciting causes of fever," in sickrooms he often became "languid and fainty" and once had a burning stomach and runny eyes for two days after a visit.(44)

He saw 120 yellow fever cases that season, and cured all but four by bleeding and purging. His success did not arise, he thought, from any mildness of the disease but because his therapies were even more heroic than 1793, nine pounds of blood and 150 grains of calomel in one case. While he didn't write case histories, he had a complete record of his bleeding and purging.(45) He was inspired by his successes to stake his claim as one of the giants of medicine. In concluding his account of the 1794 epidemic Rush announced the conquest of yellow fever. He thanked God for letting him subdue, "in a great measure, the force of a once formidable and mortal disease."(46)

While a closer look at the evidence relieves Rush from the obloquy his claims in '93 have earned from historians, surely his claim after the epidemic of '94 is indefensible. To his credit Rush didn't publish it immediately. He let his account of 1794 hang fire until the summer of 1796. However the delay did not arise from any doubts about the claim. Rush simply thought the time had come to expand the lessons he learned from yellow fever into a comprehensive new system of medicine and a new guide to the treatment of all diseases.

In the spring of 1795 Rush got a measure how much he had changed in six years. In 1789 he was nursing his disappointment at not winning a job in the new federal government.(47) Upon the death of David Rittenhouse, the Director of the Mint, President Washington offered the job to Philadelphia's now most illustrious man of science. He refused the position that largely entailed overseeing a few craftsmen, a virtual sinecure, explaining that he was devoting himself "to the establishment of a new system of physic."(48)

Yellow fever provided the clinical evidence that allowed him to fulfill an ambitious program that answered the patriotic calls for a revolution in medicine that he had been making for years. His earlier recognition of the similarities between the nature of consumption and gout had not led to any greater success in the treatment of either disease. Yellow fever broke the log jam that kept a life time of clinical observations from finally floating his long sought theory of the unity of disease. The power of yellow fever was such that it could exhibit the symptoms of all other diseases. He often described yellow fever as "disguised" as other less mortal illnesses.(49) Therefore the system that cured yellow fever must, with judicious variations, cure other diseases.

During the winter of 1794-95 he used bleeding and purging to treat gout, dropsy and insanity. He had reasons based on observation of yellow fever to suspect that gout with its procession of hemorrhaging boils, rashes, and blotches; dropsy with its fluid build up; and insanity with its delirium and stupor would all respond to his purging and bleeding because yellow fever, which he had cured, exhibited all those symptoms. He met with such success that he pushed on to work on a new theory of fevers. (It bears noting that in extending his therapy, driven though he may have been by a new theory, he was not a fanatical doctrinaire. In treating madness, he bled profusely, 100 ounces in one case, but modified depletion with the stimulation of a cold bath.)(50)

Here again we reach the crux of the issue between Rush and his modern critics. Despite his pretensions his work did not lead to the conquest of any disease, and confused proper analysis that might have led to progress. A good case can be made that he must have harmed patients. But a good case could not be made then. Instead there was more evidence that he was indeed curing people. As for his building a new system of medicine, he actually never succeeded in publishing one as comprehensive as Cullen's, Brown's, and Erasmus Darwin's, whose Zoonomia was published in 1795. But he created a whirlwind. Never had an American scientist addressed a problem so alarming to the public with such a mass of observations so exhilarating in their purport. The synergy created from the seemingly successful demonstration of the powers of observation, theory and practice attracted great attention especially among younger doctors and students.

What stirred Rush's enthusiasm most was the efficacy of bloodletting. In his "Defense of Bloodletting" he listed 23 benefits beginning with its ability to prevent a fever's on-set in the first place.(51) Bleeding's effect was "as immediate and natural in removing fever, as the abstraction of a particle of sand is, to cure an inflammation of the eye, when it arises from that cause."(52) The reason was that fever arose from "morbid and excessive action in the blood-vessels" connected "with preternatural sensibility in their muscular fibres." Blood was "the most powerful irritant" which acted upon the blood vessels. By removing some of it, one lessened "the principal cause of the fever."(53)

From this distance it is easy to concentrate on the absurdity of Rush's assertions. But if we engage in that exercise we lose a sense of Rush's appeal to contemporaries who did not understand fully blood's role in cell nutrition and for whom blood transfusion had not become a symbol of life saving.(54) Contemporaries were attracted by Rush's startling simplifications. Their attractiveness may be a measure of the fundamental despair of that era when people faced a continual round of nagging and too often acute fevers and discomforts. Rush skillfully encouraged bleeding with the characteristic encyclopedia of goodies so attractive to the age.

Bleeding imparted "strength to the body," reduced the fast pulse, sped up the slow pulse, checked nausea and vomiting, made purges more effective in constipated patients, brought on healthy sweats, checked unhealthy sweats, removed dryness and blackness from the tongue, eased pain especially headache, relieved hot skin and hot stomachs, removed chilliness, sometimes stopped diarrhea, cured intolerance for light, removed coma, induced sleep, stopped spontaneous bleeding, prevented chronic diseases like consumption, prevented gangrene, prevented alarming symptoms thus giving patients and family members confidence, allowed mercury to bring on salivation more quickly, improved the effect of tonics like bark, and prevented relapses.

He could cite cases to illustrate each of bleedings' boons. Not that he exactly gave a case study. His descriptions were more akin to testimonies at a religious revival. Dr. Physick called him in for consultation after Mrs. John Fries had not responded to four bleedings. Her pulse was scarcely perceptible. "I found her hands and feet cold," Rush wrote, "and her countenance ghastly, as if she were in the last moments of life." He suggested nothing to Physick, but smiled when the young doctor ordered another bleeding. "During the flowing of the blood the pulse rose." Indeed it rose too much and she had to be bled again to subdue it. After losing 150 ounces, almost 10 pounds of blood, in 15 bleedings, she was cured.(55)

In his "On the Proximate Cause of Fever," he argued that the plethora of symptoms that puzzled physicians represented only different states of fever, not different diseases. Rush broke down all diseases into one of the 38 "states of fever," from the "malignant" to the "cutaneous state of fever," like prickly heat and elephantiasis. The latter, he thought, was "a translation of an intermittent [fever] to one of the limbs." Hence, "there is but one fever. However different the predisposing, remote, or exciting causes of fever may be, whether direct or indirect debility, whether heat or cold succeeding to each other, whether marsh or human miasmata, whether intemperance, a fright, or a fall, still I repeat, there can be but one fever.... Thus fire is an unit, whether it be produced by friction, percussion, electricity, fermentation, or by a piece of wood or coal in a state of inflammation."(56)

Reality would eventually defeat Rush's pretensions; as luck would have it other research at the time bore him out. Despite all the horrible excretions of yellow fever, which could make the pus of smallpox seem pale in comparison, no one could prove specific contagion of the disease. So his premise of the unity of fevers seemed valid. Your intermittent fever could become deadly yellow fever if you did not take care of yourself and remove yourself from debilitating air..

Isaac Cathrall tried to demonstrate Currie's ideas that the fever was spread by specific contagion much like small pox. He took "black matter" from the stomach of a yellow fever victim, and applied it to his own tongue and lips. He immersed two ounces of beef into the "black matter" and fed it to a small cat. He fed beef soaked in black matter to a dog. Finally he "inserted" the black matter and blood serum from a yellow fever victim under his skin. The cat remained lively and cheerful; the dog "manifested no obvious signs of uneasiness;" and Cathrall lived to write up his disappointing results.(57)

Bleeding, especially among Rush's generation, while often used, had never been popular. Yet too often what criticism there was of bleeding in yellow fever was still couched in terms flattering to the general thrust of Rush's ideas. Colin Chisholm thought bloodletting fatal but like Rush he noted the liver as the principal site of the disease; noticed the dilation of pupils; applauded the calming effect of the purges - "patients became calm, less restless, less anxious;" raved about salivation; and used some enormous doses - 400 grains over 21 days in one case.(58)

Thanks to Rush bleeding won adherents in Baltimore and New Haven.(59) In New York in 1795 purging and bleeding were widely used to fight the fever. A young New York doctor, 24 year old Elihu Smith, kept a journal. His experiences during the epidemic showed how Rush's new theories inspired those in the next generation who were ambitious to become leaders of the medical profession. Or rather, inspired such an ambition in Smith, because it was the beauty of Rush's theories, the simplicity of his therapies, and the moral force of his example that drew Smith to the war against yellow fever.

Smith was one of the bright young men of his generation, a Yale graduate who was already an accomplished poet, playwright, and editor.(60) But he was having serious doubts about his career as a doctor. Since coming to New York in 1793, he had been taken aback by the difficulty of starting up a medical practice. At that moment he had one patient, a venereal complaint. He had not completely given up but a book store, literary magazine or working in his father's apothecary shop in Litchfield, Connecticut, were more likely projects.(61)

In Smith's case the idea that he was awed by Rush's reputation and heroism to mouth his theories and mimic his therapies does not hold. Smith had attended Rush's lectures in 1790-91, rooted for him in 1793, but in 1795 when Dr. Amasa Dingley, Harvard '85, told him on September 7 that "the prevailing fever" was the same that "desolated Philadelphia," Smith didn't believe him. Four days later Smith bumped into his first yellow fever case, his brother-in-law who confessed to being unwell the past two days with a headache and pain in the bowels. Finally Smith recognized the terror: "This whole city is in a violent state of alarm on account of the fever. It is the subject of every conversation, at every hour, and in every company; and each circumstance of terror acquires redoubled horror, from every new relation. In reality there is reason to be alarmed." Smith re-read Rush's account of '93 and joined Dingley on his rounds. He finally found his career.(62)

Rush was a very interested bystander to these events. "Do inform me immediately," he wrote to a New York doctor, "what are your remedies? If bleeding and purging, to what extent do you use them? How many patients do you lose in a given number, and what is the practice of the other physicians in New York? An answer to these questions by the post (so accurate as to bear the public eye) will much oblige me and all the other friends of reason and of the lancet in Philadelphia."(63)

Rush gave some passages of his yet to be published "Defense of Bloodletting" to the newspaper. It instructed physicians on how to tell if more bleeding was necessary by looking at the blood already drawn. He also argued that when more bleeding was indicated it must be profuse. He cited the commonly accepted estimate that the average sized man had between 25 and 28 pounds of blood, (11 pounds actually.)(64) He also argued that blood was quickly replenished citing a case in Germany in which a man lost "75 pounds of blood in ten days" from hemorrhoids.(65)

Among New York physicians a consensus soon formed on the value of purges, although calomel was not used by all.(66) Everyone gave Rush due credit. In a letter to Philadelphia Dr. William Smith lauded the "justly celebrated Rush" for showing the need for purging when the stomach was in a highly inflamed state. "His work on this subject," Smith added, "will be useful when all jealousies sleep in the silent grave."(67)

Bleeding was less popular. David Hosack found in the New York hospital that in the majority of cases when bleeding was used "the disease terminated fatally." Yet there was no acrimony among doctors over the procedure, perhaps because so much venom came from laymen. A tailor named Alexander Cuthill placed a newspaper advertisement "challenging the physicians of New York, to give their reasons publickly for their using the Lancet, Calomel, Bark, and Cantharides, or Spanish Flies, in the present prevailing sickness." He offered to cure "as Buchan [a British author on home remedies] recommends in a common cold" with a purge of castor oil.(68) Cuthill threatened to indict Dingley, the principal exponent of bleeding in the city, for murder unless he defended his methods. Cuthill, according to Smith's diary, began "going, whenever he hears D[ingley] has a patient, & telling the sick man that he will kill him."

Seeing first hand the kind of persecution Rush went through in 1793, Smith was moved by Rush's dispassionate observations on the blood of yellow fever victims. After reading the article, he dedicated himself to proving the superiority of Rush's methods. "Do I not see ignorance, pride, stupidity, carelessness, & a superstitious veneration for foreign writers, & a mean jealousy of an illustrious writer of our own country, go hand in hand, & as it were, conspire, against the lives of men?" he asked himself in his journal. "I think I do. I think I have had sufficient opportunity to determine that his principles & practice are equally & certainly sound. I think I should apply them, in nearly all their extent." So he resolved to be useful and go forward like Rush, "animated by a sacred love of truth, & filled with an ardent humanity & tender zeal for the welfare of my fellow creatures."

Smith saw Dingley draw two pounds of blood from a man in two days, "with great advantage." Then when one of his own patients had a serious relapse with feeble pulse and severe fever, Smith brought out his lancet. "I determined to bleed him," he wrote in his journal. "He tottered out to a chair in the yard. I took away 18 oz. He rose, & walked, with a steady step, to the end of the yard; & after a discharge, returned; went down stairs, & returned to his room."

His next case was not so happy. He joined Dingley in trying to cure the apothecary Nathan Webb with bleeding and purges. Their patient suffered one of the worst side effects of venesection. "We were near an hour employed in attempting to stop a bleeding which took place from a vein which had been opened before," Smith wrote in his journal. "The blood was entirely destroyed in its texture; the man stupidly insane; the house deserted; a negro nurse only remaining; except a drunken relation of the landlord, who with oaths & imprecations, refused to allow our moving the sick man, from an apartment five feet wide by twelve long, into an unoccupied, airy room. We did it however - & exerted every thing in our power to restore sensibility & hope to a man, thus forlorn, & without relation or friend near him, to yield any assistance." When they called the next morning they found Webb dead.(69)

Smith expressed no doubts about bleeding. What modern critics chastise as Rush's self-glorifying excuses for the failures of his therapies, Smith recognized as the reality of trying to treat patients with a mortal disease in the 1790s. Failure rededicated Smith to work with Rush in perfecting the therapies which seemed so potent against the powerful disease.

Go to Chapter 11

1. Hoadley pp 224-240.

2. Webster (1) pp 174-179.

3. Hoadley p 228.

4. Webster op. cit.

5. Phil. Gaz. Aug. 1 & 22, 1794.

6. Daily Int. Aug. 15, 1794.

7. Moreau pp 76-79.

8. Phil. Gaz. Sept. 17, 1794.

9. Phil. Gaz. Sept. 20, 1794.

10. Daily Int. Oct. 2, 1794.

11. Phil. Gaz. Aug. 22, 1794; Hoadley p 228.

12. Daily Int. Oct. 28, 1794.

13. Davis pp 18-22.

14. Phil. Gaz. May 5, & Aug. 4, 1794.

15. Rush 1815 vol. 3 pp 198-200.

16. Phil. Gaz. July 31, 1794.

17. Rush Notebook Aug. 26. 1794.

18. Rush 1796 pp 8-9, Rush Notebook Aug 25, 1794.

19. Rush 1815 vol 3 p 200.

20. Phil. Gaz. Sept. 2, 1794.

21. Rush 1796 p 13.

22. Rush 1796 pp 9-12.

23. Rush 1796 p 13; Butterfield p 750.

24. Butterfield p 750.

25. Rush Notebook Sept. 22 & 27, 1794.

26. Rush Notebook Sept. 4 & 7, 1794.

27. Butterfield p 750.

28. Phil. Gaz. Sept. 20, 1794.

29. Daily Int. Sept. 19, 1794.

30. Butterfield p 749.

31. Rush account book

32. Rush Notebook Sept. 12 & 15, 1794.

33. Folwell p 3.

34. Carey broadside Evans # 26731.

35. Phil. Gaz. Oct. 2 & 3, 1794.

36. Rush Notebook Oct. 2, 1794.

37. Daily Int. Oct. 24, 27, 1794, & Phil. Gaz. Oct. 16, 18, 25, 1794.

38. Phil. Gaz. Aug. 29, Sept. 1, 1795; Argus Sept. 5, & 24, 1795.

39. Rush 1796 pp 58-9.

40. Rush 1796 pp 80-1.

41. Seaman pp 42-48; Bayley pp 99-115.

42. Rush 1815 vol 3 pp 218-9.

43. Rush 1815 vol. 3 p 217.

44. 44 Ibid. 211, 216.

45. Ibid. 220-23.

46. Rush 1796 p 118.

47. Hawke p 385

48. Corner p 234.

49. e.g. Rush 1815 vol 3 p 213.

50. Butterfield pp 762-3.

51. Rush 1815 vol. 4, pp 174-178.

52. Ibid. p 194.

53. Ibid. p 173.

54. Qvist p 102.

55. Ibid. p 186.

56. Rush 1815 vol. 3 p 10, 36; Rush 1796 pp 132-3.

57. Cathrall (2) pp 90-91.

58. Chisholm pp 113-159.

59. Daggett to Rush Sept. 14, 1794, Rush Papers vol. 4. p 2.

60. Cronin pp 12-16.

61. Ibid. p 45.

62. Ibid. pp 48-61.

63. Butterfield p 764.

64. Binger p 229.

65. Phil. Gaz. Oct. 1, 1795.

66. see Bayley and Seaman, op. cit., and A. Hosack pp 27-36.

67. Phil. Gaz. Oct. 7, 1795.

68. Argus Sept. 24, 1795.

69. Cronin, pp 60, 65, 66, 67, 69.