| In Philadelphia, the most important medical event of the
last decade of the 18th century was the yellow fever epidemic
in 1793. These epidemics had always occurred periodically. Philadelphia
is low country and there were many marshes surrounding the city,
which were the breeding ground for the mosquito Aedes Aegypti.
As usual, Dr. Benjamin Rush stayed in Philadelphia while his wife
and children took refuge at her home at Princeton.
By 1793 the population of Philadelphia Haas was 58,000. Benjamin
Rush saw his first case of the fever in August. On the day of
the outbreak twelve people died on Water Street in Philadelphia.(28)
By midsummer 6,000 people were stricken. Most of the physicians
had succumbed or fled the city. At one point Rush was one of only
three physicians in Philadelphia available to treat she sick.
During the rest of this epidemic Rush saw 100 to 120 patients
a day. He assigned his apprentices to see an additional twenty-five
to thirty patients a day. Members of the African Church who volunteered
were inspiring. They served as nurses for most of Rush's patients.(29)
Dr. Rush relied on mercurial purges (mercury, calomel, castor
oil and salts) and a bland vegetable diet to treat yellow fever.
The purges were intended to accelerate the discharge of bile.
Following the purges he advised bleeding of ten or twelve ounces.
Often he prescribed repeated bleeding. He had no idea of the true
etiology of the disease but he recommended draining the local
marshes and he advised those who had fled the city not to return
until after frost or heavy rains. These recommendations were published
in the Federal Gazette (Philadelphia) 12 September 1793. This
public printing was inspired by the shortage of physicians and
want of the assistance of bleeders. Since the Philadelphia College
of Physicians was not meeting he communicated to the membership
by mail in September. Various Philadelphia chemists and druggists
carried, "Dr. Rush's mercurial sweating powder for the yellow
fever with printed instructions".
Rush was very aggressive with the lancet, but it is important
to realize that he believed that experience as well as theory
sustained him. Stimulating remedies had failed him. His success
with depletion by purges encouraged him to use other depleting
remedies such as bleeding. There was abundant testimony and support
even among the profession that blood letting worked. As late as
1813 the distinguished Dr. David Ramsey observed, “it is probable
that not less than 6,000 of the inhabitants of Philadelphia were
saved from death by purging and bleeding during autumn of 1793".(30)
Of course not all the physicians were so enthusiastic. The most
general practice was to bleed and then give Madeira wine, quinine
and laudanum. Benjamin Rush believed that he had contracted the
disease in mid-September. He had himself bled, and took one of
his own purges. This exemplifies the difficulty of accurate diagnosis
and the evaluation of therapy.
In most cases prodromal symptoms are mild with chilliness, headache
and bone aches. Jaundice and hemorrhage may appear by the fourth
or fifth day.(31) Many frightened people
who had a headache and were feeling ill were treated and apparently
cured of a disease they had not actually contracted.
Dr. Rush did in fact contract yellow fever in mid-October. His
sister had died and he had lost three of his apprentices earlier.
His mother had recovered.
In his use of the lancet Rush faithfully followed the authority
of Dr. Thomas Sydenham whose name and authority he revered above
all others.(32) Rush had undertaken dissections
of some who expired and found "the liver either inflamed
or obstructed, and the bile much vitiated in the gallbladder or
in the small bowels".(33)
Rush was physically able to resume his practice and teaching duties
around the end of the first week in November at a tine when the
incidence of new cases was dropping off sharply.
For Dr. Benjamin Rush the rest of the decade was to be one of
distress. He received much criticism from his colleagues over
his use of the lancet and that was bad for his business. Mr. Thomas
Jefferson at this time was building what was then referred to
as Jefferson's Republican party. Little Jamie Madison in the House
of Representatives and Benjamin Rush were working in Jefferson's
behalf. In fact, as early as 1789 Rush wrote his best friend John
Adams saying, "I find you and I must agree not to disagree,
or we must cease to discuss political questions".(34)
In 1792 an English writer named William Cobbett came to the United
States. Cobbett's genius for savage journalistic satire was his
greatest talent. He found a public delighted by yellow journalism.
He soon became the principal mouthpiece of the Federalist conservatives.(35)
Cobbett's attacks on Dr. Rush were vicious and unrelenting and
centered on his use of the lancet in his medical practice. He
finally went so far as to claim that Washington's death at Mt.
Vernon was a victory for Rush as one of Rush's pupils had attended
Washington and signed the report on his death.
It is true that General Washington was bled, but only against
the advice of a one time student of Dr. Rush who was in attendance.
In October 1797, Rush filed suit for libel against Cobbett and
in December of 1799, Rush was awarded $5,000. This spurred Cobbett
on and he started publishing a libelous tract called "The
Rush-Light". Rush's emotional travail and the trial left
him somewhat embittered. By the time Cobbett sailed for England
in June of 1800, the Rush controversy had enriched Cobbett more
than Rush.(36) One important financial gain
that came along in 1797 occurred when President John Adams appointed
Benjamin Rush as Treasurer of the Mint. He had been offered the
position in 1795, but originally turned it down. Adams, a moderate
Federalist, knew full well that Rush had openly supported the
Jeffersonian party in the election of 1796. The moderate Federalists
generally respected Dr. Rush and supported the appointment although
the U.S. Minister to Portugal did write a friend, "I
confess I was surprised to see him appointed treasurer of the
mint. I hope he won't bleed that to death also."(37)
As mentioned above, Rush had been placed in charge of the "maniacal
patients" in the Pennsylvania Hospital as of 1787. He worked
for over thirty years on improvements in the care and treatment
of the mentally ill. His first main paper on the subject "An
Enquiry Into The Influence of Physical Causes Upon The Moral Faculty"
was delivered before a large audience at the American Philosophical
Society in 1796. At the request of the Society this essay was
printed.(38)
A second very important essay, "On the Influence of Physical
Causes in Promoting an Increase in the Strength and Activity of
the Intellectual Faculties of Man", developed from his annual
lectures to his students and was published in 1799.(39)
This was enlarged and reprinted in 1812.(40)
When Rush took over the responsibility for these pathetic people,
they were housed in cells in the basement of the Pennsylvania
Hospital and regarded as public curiosities. His letter of November
1789, to the managers of the Pennsylvania Hospital(41)
was the first of many which changed the lives and care of these
patients.
When the hospital board failed to act, he lobbied the Pennsylvania
legislature and helped to obtain a grant of $25,666 from the legislature
to the Pennsylvania Hospital for a wing to accommodate patients
diseased in body and mind. This grant was approved in 1793.(42)
By 1798 he proposed two warm and two cold bathrooms on the first
floor, a pump and also employments such as spinning, sewing, churning
for deranged women. He also advised grinding Indian corn, cutting
straw, weaving, digging in the garden, sawing or planing boards
as useful for the men.(43)
By 1810 Benjamin Rush was able to report to the Managers of the
Pennsylvania Hospital that the Hospital was receiving referrals
of the mentally ill from nearly all states of the Union.(44)
This report of course included new requests for (1) the isolation
of noisy patients in a distracted state of madness; (2) separate
floors for each of the sexes; (3) more amusements for the patients;
(4) the appointment of an intelligent man and woman to attend
the different sexes, who were to share and direct their amusements
and divert the patients by conversations and reading; (5) restrictions
against visitation or observation of patients without orders from
the attending physician; (6) feather beds, mattresses, and rocking
chairs for those who could afford them and where the degree of
madness was such that injury would not be done to those articles;
and (7) provision to each cell of a closed stool with a pan half
filled with water in order to absorb the fetor from their evacuations.
"The inventor of this delicate and healthy contrivance (Dr.
Clark of Hardcastle in England) deserves more from humanity and
science than if he had discovered a planet."(45)
The above was published in Rush's Diseases of the Mind
1812.
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