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Oct. 17th, 2019 02:36 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
seekingferretRush: Revolution, Madness, and the Visionary Doctor who Became a Founding Father by Stephen Fried
Fried wrote The New Rabbi, one of my favorite books ever about contemporary Judaism. This book has little to do with Judaism, the connection is just that both The New Rabbi and Rush interested the Philadelphian Fried as Philadelphia stories. But Fried does pay appropriate attention to Rush's connections to the Philadelphia Jewish community of the time. Also, Fried is an amazing writer and this book was so much fun to read.
Benjamin Rush was the youngest signer of the Declaration of Independence, a last minute addition to the Continental Congress when John Dickinson resigned, reluctant to commit to the bold act when he still thought reconciliation and compromise was possible. At the time, Rush was already one of America's leading doctors; in subsequent decades he became not only the most important medical figure in America, but one of its most important political figures as well, a link between Jefferson and Adams who helped guide the country's leaders when partisanship threatened the fragile Union.
The most exciting part of the book is the chapters discussing Rush's participation in the Revolutionary War, and the chapters discussion his treatment of the 1793 Philadelphia Yellow Fever epidemic.
Rush served as a surgeon in the Continental Army, and was at several battles including Trenton and Brandywine, treating not only Continental soldiers but also British soldiers who happened to fall behind enemy lines. Fried has some interesting stories of that interplay and how Rush negotiated his Hippocratic obligations. He also got needlessly politically entangled both in debates about who should run the medical service for the whole army, and also in whether General Washington should be replaced with a tactically superior general. A letter Rush sent to Patrick Henry urging for Washington's replacement became a politically sore subject later in Rush's life.
In 1793, as the Yellow Fever epidemic literally decimated Philadelphia, Rush was the leading medical expert of the city, and he got swept up in debates about whether a more aggressive program of bleedings and purging was preferable or not. There don't seem to be good data on the question, as science was practiced in a more anecdotal way, so it's hard to say whether Rush's more aggressive position was right.
It's a little weird to analyze the medical choices of pre-20th century physicians... Their paradigms for medical theory are so wildly incorrect that nothing they do can be said to be motivated by valid reason. But many of the actual treatments worked to some degree, either at treating symptoms or stimulating immune response or doing a variety of other things that would help patients. My favorite science story of all time is the 18th century insanity cure that consisted of infusing a placid lamb's blood into a patient to calm their blood. Most of the time it killed the patient, but occasionally it seemed to work. Why? Some modern medical historians theorize that if the insanity was caused by syphilis, the horrific immune response to the invading blood would cause a fever that killed the syphilis. A lot of the Benjamin Rush, medical doctor stories go along similar lines. If you bleed a patient with a disease, it doesn't cure him by relieving elevated blood pressure, as Rush believed, but it might trigger various bodily systems that did help fight the problem. So was Rush a good doctor? In some senses, yes, unquestionably. He was dedicated and patient and kind and communicated clearly to his patients. In terms of his effectiveness, it's more ambiguous.
In any case, the one unambiguously good thing we can say about Rush in this situation is that he vigorously opposed Matthew Carey's racist efforts to blame the African-American community of Philadelphia for price gouging their nursing services during the plague. Rush was a lifelong and ardent abolitionist and a friend of the black church, though Fried struggles to make sense of a mid-life episode where he appears to have owned a single slave for a decade or so before freeing him. It seems plausible that the mechanisms of slavery were simply a tool Rush used to provide this man with legal and documented emancipation, but it's not clear that this was the case; Fried eventually just concludes that people were complicated and moves on.
Fried devotes a lot of time to one of the major interests of Rush's later years, the humane treatment of the mentally ill (to the best of his ability in a time when knowledge of mental illness was so much less than it is today.) Rush spent a lot of effort trying to get mental patients locked up in the basement of Pennyslvania Hospital out of the basement and into treatment. He believed mental illness was a combination of physical and mental ill, and so he sought to treat it with bleedings and purgings and medications as well as with talking therapies. How successful he was is unclear, but his efforts led directly to the foundation of the APA, yet more of his amazing legacy on American medicine.
Fried wrote The New Rabbi, one of my favorite books ever about contemporary Judaism. This book has little to do with Judaism, the connection is just that both The New Rabbi and Rush interested the Philadelphian Fried as Philadelphia stories. But Fried does pay appropriate attention to Rush's connections to the Philadelphia Jewish community of the time. Also, Fried is an amazing writer and this book was so much fun to read.
Benjamin Rush was the youngest signer of the Declaration of Independence, a last minute addition to the Continental Congress when John Dickinson resigned, reluctant to commit to the bold act when he still thought reconciliation and compromise was possible. At the time, Rush was already one of America's leading doctors; in subsequent decades he became not only the most important medical figure in America, but one of its most important political figures as well, a link between Jefferson and Adams who helped guide the country's leaders when partisanship threatened the fragile Union.
The most exciting part of the book is the chapters discussing Rush's participation in the Revolutionary War, and the chapters discussion his treatment of the 1793 Philadelphia Yellow Fever epidemic.
Rush served as a surgeon in the Continental Army, and was at several battles including Trenton and Brandywine, treating not only Continental soldiers but also British soldiers who happened to fall behind enemy lines. Fried has some interesting stories of that interplay and how Rush negotiated his Hippocratic obligations. He also got needlessly politically entangled both in debates about who should run the medical service for the whole army, and also in whether General Washington should be replaced with a tactically superior general. A letter Rush sent to Patrick Henry urging for Washington's replacement became a politically sore subject later in Rush's life.
In 1793, as the Yellow Fever epidemic literally decimated Philadelphia, Rush was the leading medical expert of the city, and he got swept up in debates about whether a more aggressive program of bleedings and purging was preferable or not. There don't seem to be good data on the question, as science was practiced in a more anecdotal way, so it's hard to say whether Rush's more aggressive position was right.
It's a little weird to analyze the medical choices of pre-20th century physicians... Their paradigms for medical theory are so wildly incorrect that nothing they do can be said to be motivated by valid reason. But many of the actual treatments worked to some degree, either at treating symptoms or stimulating immune response or doing a variety of other things that would help patients. My favorite science story of all time is the 18th century insanity cure that consisted of infusing a placid lamb's blood into a patient to calm their blood. Most of the time it killed the patient, but occasionally it seemed to work. Why? Some modern medical historians theorize that if the insanity was caused by syphilis, the horrific immune response to the invading blood would cause a fever that killed the syphilis. A lot of the Benjamin Rush, medical doctor stories go along similar lines. If you bleed a patient with a disease, it doesn't cure him by relieving elevated blood pressure, as Rush believed, but it might trigger various bodily systems that did help fight the problem. So was Rush a good doctor? In some senses, yes, unquestionably. He was dedicated and patient and kind and communicated clearly to his patients. In terms of his effectiveness, it's more ambiguous.
In any case, the one unambiguously good thing we can say about Rush in this situation is that he vigorously opposed Matthew Carey's racist efforts to blame the African-American community of Philadelphia for price gouging their nursing services during the plague. Rush was a lifelong and ardent abolitionist and a friend of the black church, though Fried struggles to make sense of a mid-life episode where he appears to have owned a single slave for a decade or so before freeing him. It seems plausible that the mechanisms of slavery were simply a tool Rush used to provide this man with legal and documented emancipation, but it's not clear that this was the case; Fried eventually just concludes that people were complicated and moves on.
Fried devotes a lot of time to one of the major interests of Rush's later years, the humane treatment of the mentally ill (to the best of his ability in a time when knowledge of mental illness was so much less than it is today.) Rush spent a lot of effort trying to get mental patients locked up in the basement of Pennyslvania Hospital out of the basement and into treatment. He believed mental illness was a combination of physical and mental ill, and so he sought to treat it with bleedings and purgings and medications as well as with talking therapies. How successful he was is unclear, but his efforts led directly to the foundation of the APA, yet more of his amazing legacy on American medicine.