Building a Practice; Reformer Rush

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Upon returning to Philadelphia, Rush began practicing medicine. While he could also cultivate wealthier clients, as he did among fellow Presbyterians, it was first among the poor that Rush built his reputation. As Hawke notes, "His natural courtesy and kindness, his unfeigned sympathy for the distressed, won a wide following among the city's less prosperous."1 In Rush's words:

From the time of my settlement in Philadelphia in 1769 'till 1775 I led a life of constant labor and self-denial. My shop was crowded with the poor in the morning and at meal times, and nearly every street and alley in the city was visited by me every day. There are few old huts now standing in the ancient parts of the city in which I have not tended sick people. Often have I ascended the upper story of these huts by a ladder, and many hundred times have been obliged to rest my weary limbs upon the bedside of the sick (from the wont of chairs) where I was sure I risqued not only taking their disease but being infected by vermin. More than once did I suffer from the latter.2

Conscientious, charging what he thought a patient could pay (often nothing), Rush soon developed a reputation that in a while begat other business.3 While he would eventually become an elite physician, successful in many endeavors, Rush was, and would remain, intimately connected to his city, familiar with all aspects of its life.

A key to Rush's success was his appointment to the faculty of the College of Philadelphia as professor of chemistry, the first in British North America. Professorships were not well paid but were prestigious; Rush's name would become better known through his institutional connection. His lectures were reworkings of Black's from Edinburgh, and Rush never made an important contribution to chemistry. Later he held other appointments, especially as professor of the theory and practice of medicine at the University of Pennsylvania, successor institution to the College of Philadelphia, where his influence was vast. Rush's son James estimated that his father taught nearly 3,000 students between 1779 and 1812.4

Herman Boerhaave (1668-1738)

Boerhaave portrait: black and white engraving

Library, College of Physicians of Philadelphia

Dutch physician, anatomist, botanist, and chemist, and one of the most influential teachers of medicine in his time.

Even early in his career, Rush attracted controversy. Opinionated, not shy of expressing himself, he alienated the medical establishment, many of whom practiced medicine according to the theories of Herman Boerhaave, by advocating Cullen's system of medicine. Boerhaave (1668-1738) was a towering figure, a major medical theorist who was accomplished in other fields as well, including botany and chemistry. To sum up the controversy in very general terms, Boerhaavists were more supportive of the theory of humors and therapeutic bloodletting than Cullenists, who were solidists and much less supportive of bloodletting. That Rush began his career as an advocate of limited bloodletting is certainly ironic.5

Promoting reform was one means to build a more perfect country. While Rush remained throughout his life above all else a physician, his energy, ambition, zeal, and talents were such that he became an advocate for many causes. Franklin was certainly the great example of active citizenship, dedicated to making life better for people everywhere. Rush, also a believer in active citizenship, was more religious and parochial than Franklin, believing that it was America's destiny to be a freer, more just, and more godly society than any other known to history—a millennial patriotism built on the faith in the perfectibility of man.

Temperance became one of Rush's causes. His most famous essay is probably An Enquiry into the Effects of Spirituous Liquors upon the Human Body.6 As much a medical essay as a temperance one, it details the effects of distilled spirits, describing their physiological effects as if he were doing so from a pulpit. One should keep in mind, however, that Rush was not a tee-totaler. Wine and beer were acceptable with meals and, indeed, beer was considered to be nourishment. It was hard liquor that destroyed bodies and souls.

Rush was also an advocate for educational reform. In an address titled "Thoughts Upon Female Education" (1787) he advocated education for girls and young women. While the address envisioned education as preparing females to be good wives and mothers, it was progressive for the time, insisting, for instance, that "our ladies should be qualified to a certain degree by a peculiar and subtle education, to concur in instructing their sons in the principles of liberty and government," that is, women need to be educated citizens, too, at least so they can instruct their sons.8 Rush also wrote against corporal punishment in schools, in favor of a national university, and using the Bible as a textbook. Probably his most lasting contribution to education in America was the key role Rush played in founding Dickinson College in Carlisle, Pennsylvania.

An early example of Rush's strong belief in social justice is his anti-slavery essay, An Address to the Inhabitants of the British Settlements in America, upon Slave-Keeping (1773). In it he attacks the moral grounds of slavery, saying, for instance, that the vices supposedly characteristic of Negroes—idleness, theft and treachery—"are the genuine offspring of slavery" and not the result of their blackness or any natural inferiority.8 There are also horrific accounts of slave life in the West Indies (although Rush never visited the islands). The essay naturally angered slaveholders, though Rush himself owned a slave, whom he freed in 1794. He also became actively involved in abolition, serving as president from 1803 to 1813 of the Pennsylvania Society for Promoting the Abolition of Slavery, aiding the free black community and assisting with the establishment of the African Methodist Episcopal Church in Philadelphia.

1. Hawke, 85.

2. Autobiography, 83-84.

3. Quoted in Hawke, 85.

4. Goodman, p. 132.

5. Humoral theory traces back to Hippocrates and Greek medicine. In outline the theory states that disease stems from an unbalance of fluids in the body, the four humors being yellow bile, black bile, phlegm, and blood. The four humors could be correlated with the four temperaments (choleric, melancholic, phlegmatic, and sanguine), the four elements (fire, earth, water, air), and the four qualities of nature (dry, cold, moist, and hot). Solidists postulated that disease was sited in the solid tissue of the body—in Cullen's case, the brain and arteries. Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity, New York and London, Norton, 1997, 56-9; Lester King, The Medical World of the Eighteenth Century (Chicago: University of Chicago Press, 1958), 140; Richard H. Shryock, Medicine and Society in America: 1660-1860 (Ithaca, NY: Cornell University Press, 1972), 68.

6. Philadelphia: Thomas Bradford, [1784?]

7. Quoted in Goodman, 314.

8. Quoted in Hawke, 105.

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