Bill Long 10/6/05
Benjamin Rush--Out for Blood
Before being properly introduced to this famous physician (1746-1813), let's hear the following words from his Defense of Bloodletting:
"I bled a young man James Cameron, in the autumn of 1794, four times between the 20th and 30th days of a chronic fever, in consequence of a pain in the side, accompanied by a tense pulse, which suddenly came on after the 20th day of his disease. His blood was sizy. His pain and tense pulse were subdued by the bleeding and he recovered. I bled the late Dr. Prowl twelve times [presumably the last time didn't kill him], in a fever which continued thirty days, in the autumn of the year 1800. I wish these cases to be attended by young practitioners."
This essay will briefly introduce us to Rush and to his views on bloodletting. Sizy, which word we now know, provided the link for me.
Meeting Benjamin Rush
It would be hard to find a person with more distinguished connections in the colonies than Benjamin Rush. He entered the academy of his uncle, a future President of Princeton, when he was eight, and then matriculated to Princeton as a junor five years later. He graduated in 1760 when he was still 14. His relatives persuaded him to become a doctor, and he studied in Edinburgh, then the leading training ground for doctors in the English-speaking world. Before leaving for Edinburgh in 1766, however, he sat up every night while his uncle, President Finley, was dying. Then, when in Edinburgh, he was urged by a Princeton Trustee to try to convinced the Rev. John Witherspoon to consider becoming Princeton's next President. The presence of the dashing and convincing young man helped win over Witherspoon, despite his wife's complaint that the very mention of going to America made her physically ill.
Upon return to the colonies, Rush became, at 23, the first professor of chemistry in America (at the future Univ. of PA). He married the daughter of Trustee Richard Stockton of Princeton in a ceremony officiated at by Witherspoon. After Rush was elected to the Continental Congress a few months later, he, along with his father-in-law and Witherspoon attended the Convention at which all three signed the Declaration of Independence.
His distinguished medical career saw him not only perform heroically in the yellow fever outbreak in Philadelphia in 1793, but he also supported abolition of slavery, relief for the poor and mental health resources for people so afflicted. In fact, he was named by the American Psychiatric Association in 1965 as the "father of American psychiatry." He has a medical college named after him and was considered to be one of the leading physicians in the fledgling United States at the time of his death.
But, he was a bloodletter and a vigorous defender of that practice. While the notion of bloodletting sounds strange to our ears today (though some select uses of it are now being recognized in medicine), it was one of the most consistently-practiced medical techniques in the history of Western medicine. While some physicians today attribute its putative success to the "placebo effect" of the doctor actually doing something when a very sick patient is before him, Rush would have taken a much more positive position. In short, he unabashedly defended the practice.
The Defence of Bloodletting
He doesn't hesitate to list advantages of bloodletting. "It frequently strangles a fever, when used in its forming state, and thereby saves much pain, time, and expense to a patient." What esle? "It imparts strength to the body, by removing the depression which is induced by the remote cause of the fever." "It reduces the uncommon frequency of the pulse," and, in other cases, "it renders the pulse more frequent when it is preternaturally slow." Also, "it renders the bowels more costive*
[*costive means "suffering from hardness and retention of the feces; 'bound' or confined in the bowels; constipated." In other words, if the bowels are rendered more "costive," they are better able to retain the (loose) feces. Glad you know that now?]
and checks vomiting and nausea. How does he know all this? Why, from experience. "The loss of ten ounces of blood reduced Miss Sally Eyre's pulse form 176 strokes to 140, in a few minutes, in the fever of year 1794." Another medical practitioner from Santo Domingo, Dr. Poissonier Desperrieres confirmed that it prevents, when sufficiently copious the troublesome vomiting which often occurs on the fifth day of the yellow fever. Rush had witnessed so many positive stories of bloodletting that he says:
"It has been common to charge the friends of blood-letting with temerity in their practice. From this view which has been given of it, it appears, that it would be more proper to ascribe timidity to them, for they bleed to prevent the offensive and distressing consequences..."
Not only is blood-letting successful, but it is relatively easy to administer. People don't want to receive this good remedy simply because it is hard to believe that something so simple can cure something so dangerous, as a "malignant fever." Then, the biblical illustration:
"Thus, the Syrian leper of old, viewed the water of Jordan as too simple and too common to cure a formidable disease, without recollecting that the remedies for the greatest evils of life are all simple, and within the power of the greatest part of mankind."
With that kind of unabashed boosterism, who really could rebut Rush effectively on blood-letting? It would't be until the mid-late 19th century that anesthesia was discovered and modern surgery began to develop that the blood-letters were fully discredited. That they persisted so long, however, is testimony to the faith of humans in the people we call doctors. Sort of a long journey from the "sizy" of Jonathan Edwards, but a fitting end to the story.
Copyright © 2004-2007 William R. Long