Rush, Jefferson and Medicine

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In 1803, Meriwether Lewis came to Philadelphia to receive scientific training. Thomas Jefferson, who besides being President of the United States was also President of the APS, had written to Rush, fellow APS member and as well as personal correspondent, saying that it would be "very useful to state for [Lewis] those objects on which it is most desirable he should bring us information" and asking Rush "to prepare some notes of such particulars as may occur in [Lewis's] journey & which you think should draw his attention & enquiry."1 Rush responded by preparing a list of questions that Lewis could use to determine the health and religious practices of Native Americans. Rush also prepared a list of health rules that Lewis could use to preserve the health of his men.

Letters and other documentation contain evidence of only one meeting between Rush and Lewis: May 17, 1803. Disappointingly for the historian, besides the lists of questions and health rules, a few brief comments in letters, and a note on a list of medical supplies that says 50 dozen Bilious Pills were obtained "to Order of B. Rush,"2 no documentary evidence exists about how other many times Rush and Lewis might have met or what specifically they discussed.

Jefferson, long acquainted with Rush, knew his merits, his interests, and his politics (Rush supported Jefferson), and deemed a trip to Rush useful for Lewis's preparation. In one sense, however, it was out of character for Jefferson to send Lewis to Rush. Jefferson objected to the highly theoretical medicine of his time. Jefferson believed that medicine—indeed, all scientific endeavor—should have at its heart experimentation and observation. Theory should develop from facts rather than facts squeezed to support a theory. Lewis was undoubtedly aware of Jefferson's belief that science has at its core observation and experimentation, with the aim toward discovering useful knowledge. As Courtney Hall has noted,

Two characteristics of Jefferson's thinking led him to make some rather sharp criticisms of the medical thought of his time. The first of these mental traits was his firm belief in observation and experiment as sine qua non for any scientific inquiry. . . . Another firm belief which underlay much of his thinking was in the practical utility of a method or idea as a test of its value. Science should contribute to human welfare to be worthy of the thought of men, he once said.3

Jefferson made his thoughts about contemporary medicine explicit in a letter to Caspar Wistar, another of Lewis's Philadelphia mentors, with whom he discussed fossils and mastodons. Wistar, author of the first American textbook on anatomy, was at one time a friend of Rush's, but they had a falling out when Wistar "deserted" Rush by not enthusiastically endorsing Rush's heroic bleeding and purging regime during the epidemic of 1793.4 Jefferson wrote Wistar that he agreed that current treatments have some utility—bowel diseases being relieved by purgatives, inflammation by bleeding, syphilis with mercury, for instance—but "symptoms are so infinitely diversified" that it is difficult to establish they are for a specific disease. Jefferson goes on to say:

Having been so often a witness to the salutary efforts which nature makes to reestablish the disordered functions, [the physician] should rather trust to their action, than hazard the interruption of that, and a greater derangement of the system, by conjectural experiments on a machine so complicated & so unknown as the human body, & a subject so sacred as human life. Or, if the appearance of doing something be necessary to keep alive the hope & spirits of the patient, it should be of the most innocent character. . . . But the adventurous physician goes on, & substitutes presumption for knoledge. From the scanty field of what is known, he launches into the boundless region of what is unknown. He establishes for his guide some fanciful theory of corpuscular attraction, of chemical agency, of mechanical powers, of stimuli, of irritability & repletion by mercury, or some ingenious dream, which lets him into all nature's secrets at short hand. On the principle which he thus assumes, he forms his table of nosology, arrays his diseases into families, and extends his curative treatment, by analogy, to all the cases he had thus arbitrarily marshalled together. I have lived myself to see the disciples of Hoffman, Boerhaave, Stahl, Cullen, Brown, succeed one another like shifting figures of a magic lantern, & their fancies . . . becoming, from their novelty, the vogue of the day, and yielding to the next novelty their ephemeral favor. The patient, treated on the fashionable theory, sometimes gets well in spite of the medicine. The medicine therefore restored him, & the young doctor receives new courage to proceed in his bold experiments on the lives of his fellow creatures. I believe we may safely affirm, that the inexperienced & presumptuous band of medical tyros let loose upon the world, destroys more of human life in one year, than all the Robinhoods, Cartouches, & Macheaths do in a century. It is in this part of medicine that I wish to see reform, and abandonment of hypothesis for sober facts, the first degree of value set on clinical observation, and the lowest on visionary theories.5

The letter is a synopsis of theory of the previous 100 years. Perhaps he left Rush off the list out of kindness to his friend, whom he "greatly loved," but "who has done much harm, in the sincerest persuasion that he was preserving life and happiness to all around him" with his theories about bleeding and purging.6

Despite Jefferson's antipathy toward academic medical theorists, he believed in medicine as a worthwhile pursuit. There was in fact a sacredness to it: the uncovering of the order of a God-created world by studying the human body. For Jefferson as for Rush, a healthy population was the sign of a healthy society.7

1. Jefferson to Rush, 28 Feb. 1803. In Donald Jackson , ed., Letters of the Lewis and Clark Expedition with Related Documents, 1783-1854. 2 vols. Urbana: University of Illinois Press, 1978), 19.

2. Jackson, Letters, 80.

3. Courtney R. Hall, "Jefferson on the Medical Theory and Practice of His Day," Bulletin of the History of Medicine, vol. "I (1957), no. 3, 239. Jefferson's attitude toward medicine was heavily influenced by the French physician and medical reformer Pierre Jean Georges Cabanis (1757-1808). Cabanis was a philosophic empiricist, a follower of John Locke, who believed that the mind was a tabula rasa and that all conceptions of phenomena originate in careful observation. Medicine, so heavily laden with theory, was greatly in need of reform. See Pierre J. G. Cabanis, Revolutions of Medical Science and Views Relating to Its Reform, London, 1806.

4. J. H. Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 (New York: Time, 1965), 217-19.

5. Jefferson to Wistar, 21 June 1807, in Albert Ellery Bergh, ed., The Writings of Thomas Jefferson, 20 vols. (Washington, D.C.: Thomas Jefferson Memorial Association, 1905), 14:426-28.

6. Jefferson to Thomas Cooper, 7 Oct. 1814. In Paul Leicester Ford, ed., The Works of Thomas Jefferson (New York: Putnam, 1905), 200.

7. See George Rosen, "Political Order and Human Health in Jeffersonian Thought," Bulletin of the History of Medicine, vol. XXVI (1952), no. 1, 32-44.

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