- - Sunday, August 19, 2018

ANALYSIS/OPINION:

DR. BENJAMIN RUSH: THE FOUNDING FATHER WHO HEALED A WOUNDED NATION

By Harlow Giles Unger

Da Capo Press , $28, 320 pages

Of the heroic men who signed the Declaration of Independence, Dr. Benjamin Rush surely deserves high rank for all-around versatility.

In addition to putting his life on the line (literally) by defying the king of England, the Philadelphia physician had careers that culminated in becoming known as “The Father of American Medicine” as well as “The Father of Psychiatry.”

Born into a prosperous Pennsylvania Quaker family in 1746, Rush did his medical studies in New Jersey and then at the University of Edinburgh in Scotland, “then considered the finest in the English-speaking world,” as historian Harlow Giles Unger writes.

Medicine was in its infancy when Rush began his practice in the late 1700s. One flinches at some of the “cures” he employed.

For instance, a treatment for gout was to cut into the foot to “drain off water.” As a sometime sufferer from gout, I can only comment “Ouch!

A “medical” theory dating to the ancient Greeks held that draining large amounts of blood from a patient’s veins would rid his system of poisons causing his ailments. The hollow-point needle had yet to be invented, which meant the vein had to be opened with a knife. “Bleeding” was routinely prescribed.

But Rush did introduce to Philadelphia an “all-but-painless” method for inoculating patients against smallpox, by infecting the arm with a small puncture and inserting a dab of pox-infected flesh.

When he began practice in Philadelphia, other physicians joined him in founding a “Society for Treating the Poor Gratis.” Patients were treated in what is now Independence Hall.

Rush’s career was interrupted by the American Revolution. At the signing of the Declaration of Independence, he noted the “awful silence” when he and others were called upon to sign what could be “our death warrants.”

He soon was in the field with the Continental Army (as an unpaid civilian). War shocked him with its “awful plentitude of horrors.” Few physicians had treated battlefield traumas; wounded soldiers were left to care for themselves.

Rush challenged the system, declaring, “If it be criminal for an officer to sacrifice the lives of thousands by his temerity in battle, why should it be thought less to sacrifice twice their number in a hospital by his negligence?”

He decried “the ignorance, cowardice, the idleness and the drunkenness of our major generals” who cared naught for the wounded. (Suffice to say he made enemies.)

His solution was a pamphlet that set guidelines for keeping for soldiers healthy — routines such as diets and cleanliness. His reforms led to creation of the Army Medical Corps.

Once peace came, Rush embarked upon an unusual medical practice. Defying inactive political leaders who ignored the needy, he created the Philadelphia Dispensary for the Poor, treating thousands of patients annually without charge.

His interests extended far beyond medicine. He worked for prison reform — advocating vocational training for inmates, rather than idle incarceration. He sought to make Philadelphia live up to its reputation as the “City of Brotherly Love” by abolishing slavery. (He failed.) He campaigned for women’s rights, universal public education and the abolition of child labor.

Keen observation played a major role in his development. He preached “the reciprocal influence of the body and mind upon each other” (which Mr. Unger notes “is now recognized as behavioral medicine”). He was a strong advocate of hospital hygiene.

Over the years he wrote a four-volume work, “Medical Inquirer and Observations,” which was recognized as the “basic text — indeed “the Bible of medical practice in the United States in the next century.”

Then came the greatest challenge — and controversy — of Dr. Rush’s career: An epidemic of yellow fever that struck Philadelphia in 1793.

Physicians routinely wrote off the ailment as a routine “autumnal fever” related to the sharp seasonal drop in temperatures. Treatments ranged from small doses of laudanum to “gargles” of “lemonade, chicken broth, skimmed milk and wines.”

Rush chose bleeding, often three times a day, each of 20 ounces or less, and sometimes 100 ounces every five days.

As Mr. Unger observes the loss of 20 percent or more of a person’s blood (32 ounces for the average adult) can cause fatal shock.

But Rush cannot be faulted. Mr. Unger, who attended medical school, notes that Rush’s treatment “was logical at the time, given the lack of instruments and research to prove otherwise.” And as he writes, “untold thousands — perhaps millions — of patients survived bloodletting.” He also surmises that the procedure “killed many of his patients.”

When a critic accused him of causing unnecessary deaths, he sued for libel — and won.

A highly readable account of a humanitarian who cared for others more than for himself. A hero of his era.

• Joseph C. Goulden writes frequently on intelligence and military matters.

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