Kevin R. Loughlin, MD, MBA
Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, United States
Today the reach of only a few physicians extends beyond the medical profession. Contrast this to the influence of Benjamin Rush, signer of the Declaration of Independence, confidant and adviser to Thomas Paine, provocateur of the Boston Tea Party, friend and colleague of Adams and Jefferson, early abolitionist, women’s advocate, and one of the fathers of American psychiatry. Rush was born in 1745 and died in 1813, and his legacy is etched throughout the historical record of that era. However, his passions are captured in the voluminous written record he left behind. He was a prolific writer and author on subjects spanning medicine, religion, education, and government. He graduated from Princeton in 1760 and received his medical training in Edinburgh and Philadelphia.
He began his medical practice in 1769 in Philadelphia. He quickly became recognized as one of the leading physicians of the city and was named Professor of Chemistry at the College of Philadelphia. His medical interests were extensive, ranging from the role of fermentation in digestion to the importance of personal hygiene in contagion.
He took a leadership role in the yellow fever epidemic in Philadelphia in 1793 and contracted the disease himself. Rush blamed the disease on “noxious miasma”. Rush’s stature within the medical profession grew not just in Philadelphia, but throughout the colonies. It has been said that every outstanding physician down to the Civil War was either a pupil of Rush or of a Rush pupil.
Rush was prescient in his interest in many areas of medicine, including mental illness. He argued for better care of the insane and published his magnum opus, “Medical Inquires and Observations Upon the Diseases of the Mind” in 1812. He is credited as one of the founders of American psychiatry. Though forward thinking in many ways, he stubbornly held on to his advocacy of blood-letting throughout his career. This engendered ridicule in the Philadelphia press and resulted in a lawsuit by Rush against a publisher, William Cobbett, who reviled him as, “a remorseless Bleeder ... to puff his preposterous practice”. In one of the ironies of history, the libel suit was found in Rush’s favor on the very day, December 14, 1799, that George Washington died after having been bled of 2365 ml in twelve hours for an apparent acute bacterial epiglottitis.
Despite his participation in so many aspects of colonial medicine, Rush was involved in a myriad of non-medical issues of his era. Rush was at the vanguard of colonial resistance to increasing British taxation. On October 20, 1773, in response to Parliament’s passage of the Tea Act, Rush wrote a letter, “To His Fellow Countrymen: On Patriotism,” published under a pseudonym. This letter contributed to the growing colonial resentment against the British, which culminated in the Boston Tea Party later that year.
Rush was mentor to Thomas Paine, who brought him for his review a manuscript he had written and had titled “Plain Truth”. Rush liked the work, but suggested changing the title to “Common Sense” and helped Paine find a publisher.
Benjamin Rush was one of the fifty-six signers of the Declaration of Independence. At first he was a critic of George Washington and wrote a letter to Patrick Henry advocating Washington’s removal as commander-in-chief. This personal aminus softened over time, and Rush and Washington ultimately became trusted colleagues. Rush was a lifelong friend of John Adams and Thomas Jefferson, and is credited with promoting the rapprochement between them in their later years.
Beyond his role in American independence, Rush was active in various social causes. He advocated public education and along with Abigail Adams was an early supporter of the education of women. He was involved throughout his life in the abolitionist and temperance movements.
An unanswered question remains. Why, two hundred years after his death, has Rush been largely forgotten among the panoply of the Founding Fathers? Were his interests and influences so expansive that they diffused his rightful recognition as a Founder? Historians may continue to debate his place in American history, but let us, today’s physicians, learn from this life so well lived. Rush taught us that the true obligation of a physician goes beyond the wards of the hospital. We must, like Benjamin Rush, be true physician-citizens and ensure that our society is fair and humane to all its members.
Perhaps no greater encomium was paid to Benjamin Rush than the words of John Adams in a letter to Thomas Jefferson on the occasion of Rush’s death, “No man would apologize for me if I should say that in the estimation of unprejudiced philosophy, he has done more good in this world than Franklin or Washington.”
KEVIN R. LOUGHLIN, MD, MBA, is a professor in the Department of Surgery at Harvard Medical School and Director of Urologic Research at Brigham and Women's Hospital in Boston, MA.