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SUMMARY:
In 1793, during a yellow fever epidemic in Philadelphia, Benjamin Rush adopted a therapy that centered on rapid depletion through purgation and bleeding. His method, especially his reliance on copious bloodletting, was at first widely condemned, but many American practitioners eventually adopted it. Although the therapy struck many observers as being radical, in large part it grew from premises that had substantial support. Rush was convinced that it worked and that heroic methods were the key to conquering disease. In particular, massive bleeding became central to his therapeutics.
KEYWORDS: Benjamin Rush, yellow fever, bloodletting, therapeutics
The yellow fever epidemic that struck Philadelphia in 1793 took perhaps five thousand lives, but it was only one of several major visitations during the 1790s. In the course of the eighteenth and nineteenth centuries, New Orleans, Charleston, and other southern cities suffered outbreaks that were far more lethal. Nevertheless, the epidemic of 1793 retains an almost mythic status. Beyond the widespread death that it brought and the dislocation that resulted from the flight of more than one third of the population of Philadelphia, it is remembered for having prompted the introduction of a radical new therapy by the most prominent physician in the city, Benjamin Rush. The core strategy in his method was rapid depletion, through powerful purgatives and copious bloodletting.1
This epidemic in fact marked the defining moment in the therapeutics espoused by Rush, and his method would in turn have a significant impact on how disease-not merely yellow fever, but disease in generalwas treated in America. Oliver Wendell Holmes, in a talk given to the Massachusetts Medical Society in 1860, commented:
If I wish [a student] to understand the tendencies of the American medical mind ... I would make him read the life and writings of Benjamin Rush. . . . He taught thousands of American students, he gave a direction to the medical mind of the country more than any other one man; perhaps he typifies it better than any other.2
Holmes spoke not as an admirer, but as a severe critic of Rush and of the "heroic" tradition that he personified.
Rush's reputation as a physician has turned primarily on the issue of his therapeutics, particularly as regards yellow fever. With the...