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I've copied this letter from Rush to Dr. Caspar Wistar for two reasons. First because it is important to complement the published letters of Rush written during the epidemic. Second because it emphasizes the importance Rush placed on collegiality in medicine. We may look askance at all medicine of this period because doctors did not do double blind testing or have the ability to verify the beneficial effects of medicine in ways we would now accept. However we should still try to understand the method used to test medicines at that time: the creation of a consensus among physicians who freely share their experiences with treating patients and with self-treatment. Rush could not understand how a colleague he thought he had convinced could change his mind, and then in explaining his own treatment of the disease to the public, not candidly report his earlier exchanges with Rush.

Sir,

My reason for believing that Mr. Bache had witnessed the good effects of mercurial purges among my patients was, that he had spoken of their efficacy to two Physicians (whose names shall be mentioned if necessary) in the highest terms. He even declared that he had seen them cure the yellow fever, after the black vomiting had come on. The last thing that I should have expected was, that he would have concealed such agreeable information from his Preceptor, then confined with the same disorder.

Had you told the public that you had prescribed the mercurial purge, in a single case and said nothing of the issue of it, I would have supplied the deficiency. Had you only said that you gave it, and the patient did not die, it would have furnished a useful contrast to the case of the person who took the saline purge & died, but had you said that you gave it, & that I had informed you, that the patient had recovered, it would at least have stifled any complaints. Had you even added your doubts of it efficacy, from its having puked that patient, it would not have lessened its credit, for hundreds knew that it did equal, & frequently more speedy service, when it had that effect. - It was to ensure a discharge of bile from the Stomach when lodged there, that I so uniformly united Jalap with Calomel. Without it, the calomel seldom puked, and never purged, as much [as] the disease required.

In speaking of the effects of purging in the yellow fever, you give full credit, to the authority of Dr. Redman & Dr. Mitchell. After the numerous instances of cures being suddenly performed by mercurial purges which I mentioned to you, exclusive of Capt. Bethel's family (where you were sure the contagion had existed,) why did you refuse to place me upon the same footing as those gentlemen? Had I ever deceived you in a single fact? You had received no counter information to the facts I had mentioned to you to produce indecision in your mind, for you say you had heard "of no dispute" about them. There are few men in Philad. whose word I would have treated with so little respect as you have done mine in your publication. I had not merited such treatment from you. Did you prescribe Turpeth mineral, or the mercurial purge, when you returned to the city? If the latter - upon whose word, or experience did you first give it?

It has been remarked that you mention your indecision as to the use if the mercurial purges twice in your letter, and that it is the only repetition contained in it.

In having wished for your support, while I was contending against the ignorance, and slanders of so many of our Physicians, I did not expect to derive the least credit from it to myself. I am but an humble copiest in the use of Calomel & Jalap in bilious fevers. I learned that form of giving mercury from a Senior Surgeon in the military hospitals of the United States in the year 1777. Several communications which I have lately received assure me, that it had been given in various ways in the same disorder several years ago in the State of New York, and with great Success.

My opinion of the motive of your conduct in your publication, and of its influence upon the practice of some of our Physicians is as fixed & immutable as truth itself, and should the above comments upon your letter (with others which might be made) be as generally known, as your friends have circulated their abuse of me, longer dashes, and other invectives would be connected with your name, than any that have come from

Yours & c

Benj. Rush

Novem 18th, 1793

PS: Since writing the above, in looking over my notes upon the late Epidemic, I find the following remarks: Sept 1 "Mrs. Bethel - much relieved by calomel & Rhubarb. It vomited, and purged her copiously - also sweated her."