BENJAMIN RUSH. BY WILLIAM PEPPER, M.D., LL.D., PROVOST AND PROFESSOR OF THEORY AND PRACTICE OF MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA. An Address delivered before the American Medical Association at its Annual Meeting in Newport, R. 1., June, 1889. Reprinted from “ The Journal of the American Medical Association,” April 26, 1890. CHICAGO : Printed at the Office of the Association. 1890. BENJAMIN RUSH. BY PROVOST AND PROFESSOR OF THEORY AND PRACTICE OF MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA. WILLIAM PEPPER, M.D., LL.D., An Address delivered before the American Medical its Annual Meeting in Newport, R. 1., June, iBBg. Reprinted from “ The Journal of the American Medical Association,” April 26, 1890. CHICAGO : Printed at the Office of the Association 1890. BENJAMIN RUSH. Time, which destroys so much, has dealt kindly with the fame of Benjamin Rush. Like his great master Sydenham he was distinguished during life, and distinguished not through the absence of able rivals, but owing to surpassing power. But as with all true renown his fame has endured and grown, and it seems not unlikely that he will remain forever with us, not, it may be, as the greatest of our physicians, but as the first of our great physicians. His life of ceaseless, restless activity demands and will repay full description when all interdic- tion is removed from his private papers. I hazard the prediction that the largest publicity will but show more clearly the purity and intensity of his patriotism, the vivid and unselfish interest shown by him in every question which affected the hap- piness, the honor, or the prosperity of his country; and the undaunted courage which made it im- possible for him to be away from the front in every struggle. But it seems to me that the political services1 and influence of Rush—import- Note.—I am indebted to the family of Dr. Rush for the oppor- tunity of consulting and making extracts from some of his corres- pondence. A careful examination has also been made of the large collec- tion of letters (for the most part letters written to Dr. Rush) depos- ited in the Ridgway branch of the Philadelphia library ; with the exception of a single volume presumably containing matter, per- sonal and political, of interest to the historian and biographer which is there held in reserve. I may add that in order to place myself in a fair position to judge of his work and influence, his entire published writings have been read twice—once rapidly, once critically; and all accessible publications concerning him have been, in very large number, consulted. 1 The importance and extent of these services may be gathered from this brief statement: In 1776 (set, 3i) he was a member of the Provincial Conference of Philadelphia, and of the committee to which was referred the great question, whether it had become expedient for Con- gress to declare Independence. He was chairman of the com- mittee; the report they submitted was adopted and sent to Con- gress. This report includes near y all that has been so much praised in the Declaration of Independence, of which it might ap- pear to be the protocol. He was appointed by the State Conven- tion a member of Congress, in order that he might sign that De- claration. He was appointed Surgeon-General of the Army of the Middle 4 ant as they were—have comparatively little to do with the position he holds with us to-day. He never was a politiciah, though often engaged in public affairs. His high spirit, his impetuosity, his transparent character kept him for the most part aloof from political intrigues and dealings in which they would have prevented his success. He never sought political office or preferment. The appointments he held were alike honorable, laborious and unprofitable. He signed the De- claration of Independence, not merely because he was a member of Congress, but because he had been appointed for that specific purpose by the State Convention of Pennsylvania. The appoint- ment followed the presentation of his report, as chairman of the committee to consider the ques- tion whether it had become expedient for Congress to declare Independence. This report is a vigorous and animating production ; and so closely does it foreshadow the leading features of the Declara- tion of Independence, that it might appear to be a protocol or rough draft of that immortal doc- ument. He discharged with great energy and efficiency the laborious duties of his positions as Surgeon General, and later as Physician- General of the Army of the Middle Department; and like Washington and Franklin, and others in those primitive days, he refused pay for his public services. During those memorable years he wrote vigorous and influential papers and letters on the organization of the General and State Govern- Department in 1776; in 1777 he exchanged this position for that of Physician-General. He published important papers on public events ; especially four powerful letters on the Pennsylvania Constitution of 1776 ; a remarkable address in 1785 entitled “Considerations on the Test Laws of Pennsylvania ; ” and many able though shorter articles in 1786-1787 in favor of the adoption of the Federal Constitution. He was a member of the Convention of Pennsylvania for the adop- tion of that instrument which he thus describes: “It is a master-piece of human wisdom, and happily accommodated to the present state of society. I now look forward to a golden age. The new Constitution realizes every hope of the patriot and rewards every toil of the hero. I love my country ardently, and have not been idle in promoting her interests during the session of the Convention. Everything published in all our papers, except the Foreign Spectator, was the effusion of my Federal principles.” Allusion has been made elsewhere to his successful labors for amelioration of the penal code ; it was apparently in large part to accomplish this and the establishment of public schools that he accepted membership in the State Convention in 1787 for the for- mation of a State Constitution. He was then 42 years of age, and from that time onwards, although he always took a lively interest in every important public question, he devoted his whole energies to the cause of medical science and medical education. 5 ments ; but even then he was diligent in medical observation and writing. He shared the doubts of Samuel Adams and Richard Henry Lee as to the military genius of Washington ; and his unshrinking courage and vehement spirit led him into positions and ex- pressions which he doubtless regretted later when time and events had demonstrated the rare qual- ities of the great leader. But at the same time (1785), he projected the Philadelphia Dispensary, following the example of Franklin in regard to the Pennsylvania Hospital, and devoting himself with equal vigor and success to the collection of funds. He carefully prepared the public mind by describing the advantage of such an institu- tion, for it was the first of its kind in the United States. Public interest being aroused, combined efforts secured such liberal contributions that the Dispensary was placed upon a permanent basis, and for more than a century has continued its unostentatious but precious work. It is needless to remark that its example has been followed in hundreds of places. He had already attained such prominence in medical circles that in 1789, when the College of Physicians was established, he was called upon to prepare an address on the objects of the institution, which is published in the Transactions for 1793. It is a very able paper, altogether worthy of the occasion, and with far sighted sagacity it indicates the lines of development along which that venerable institu- tion has grown into such gratifying prosperity. He was profoundly interested in moral philos- ophy, and in 1787 read to the Philosophical Society, of which he was one of the most active members, an essay on the ‘ ‘ Influence of Physical Causes on the Moral Faculty,” which was of such remarkable originality as to attract the widest attention here and abroad. It de- servedly occupies the position of a classic. In the same year he became a member of the Con- vention of Pennsylvania for the adoption of the Federal Constitution and of that for the forming of a State Constitution. He labored, spoke and wrote incessantly, enthusiastically and forcibly,— not for partisan or personal ends, but in obedience 6 to the dictates of a lofty sense of patriotic duty, and to have the chance to press the reform of the penal code, and to promote public education.2 He was among the first to oppose capital pun- ishment. Ifittle can be added to the indictment he brings against it as ineffectual and injurious in its influence. Nor did he limit himself to de- nouncing evils ; his mind was essentially practi- cal and his lively imagination was chiefly occu- pied with suggestions of solid utility. His “ In- quiry into the Effects of Public Punishment upon 2 The important services rendered to education by Rush merit a separate memoir. He advocated consistently the highest practic- able standard of medical education. In 1792 he urged the impor- tance of thorough preliminary study, embracing the modern as well as the dead languages. He insisted upon the study of botany, zoology, and comparative anatomy. With equal force he urged the study of medical jurisprudence, and he was a pioneer in the study and teaching and practice of psychiatry. The admirable address of Dr. C. K. Mills on Rush in American Psychiatry, read before the Medico-Legal Society of New York, Dec. 8, 1886 ; and the opening chapter in Hack Tuke’s recent work (The Insane in the United States and Canada), which is an extended and judicious eulogium upon Rush, render it unnecessary to allude further to this, which must have consumed an immense amount of his time and energy, and which would of itself constitute a just claim to lasting fame. Veterinary science found in him its earliest champion in America. Throughout his life he pleaded eloquently for the pro- tection of animals from cruelty. In his inquiry into the influence of physical causes on the moral faculty in 1786 he exclaims, “I am so perfectly satisfied of the truth of a connection between morals and humanity to brutes, that I shall find it difficult to restrain my idolatry for the legislature that shall first establish a system of laws to defend them from outrage and oppression.” In 1807, he delivered the lecture introductory to his course “Upon the Duties and Advantages of Studying the Diseases of Domestic Animals and the Remedies Proper to Remove them;” and after an eloquent state- ment of the importance of the subject, and an allusion to the fact that up to that time no veterinary school had yet been established in the United States, he concluded with the following words; “ I have lived to see the Medical School of Philadelphia emerge from small beginnings and gradually advance to its present flourishing condition, but I am not yet satisfied with its prosperity and fame, nor shall I be so, until I see the Veterinary Science taught in our University.” This wish was not realized during his lifetime—nor un- til 1884, when the Veterinary Department of that Institution was es- tablished. But it was not only in the promotion of medical education that Rush was strenuous. He published important and influential papers on the establishment of public schools ; upon the mode of education proper in a republic ; upon the study of the Latin and Greek languages, with hints of a plan of liberal instruction with- out them ; and upon allied subjects. He advocated the establish- ment of a National or Federal University of which all office holders should be graduates (Mss. letter); and he urged and labor- ed for the establishment and prosperity of several colleges in Pennsylvania, in addition to the long and valuable services he ren dered to the University of Pennsylvania. He served on the com- mittee to raise funds for the establishment of Franklin College at Lancaster (now the justly prosperous and celebrated Franklin and Marshall College); he was one of the first Trustees of Dickinson College at Carlisle, a liberal benefactor, and a constant and earnest friend to it throughout his life. I have been amazed at the evi- dence furnished by his correspondence (Philadelphia Library col- lection) as to the extent of his labors for this institution—of which indeed it is clear that he was then regarded as the principal founder. Surely this is a noble record of wise and public-spirited activity. 7 Criminals and upon Society ” closes with a pow- erful plea for a truly reformatory system of pun- ishments. He exclaims, “ I have no more doubt of every crime having its cure in moral and phy- sical influence than I have of the efficacy of the Peruvian bark in curing intermittent fever. The only difficulty is to find out the remedy or reme- dies for particular vices.” It is one of Rush’s highest distinctions to have contributed power- fully, and probably more than all others, to the amelioration of the penal code subsequently effected. These were years of activity which we find it hard to parallel, for the range of subjects cover- ed, the vigor of grasp with which each is han- dled, and the far sighted sagacity and practical wisdom shown in the reforms urged or the original measures suggested. If he had no other claim to fame, Rush would stand high as a phil- anthropist and social reformer. He was inspired by no love of notoriety, not deterred by any dread of unpopularity. He denounced the evils of slavery as early as 1771 and was, with Franklin, one of the founders of the Society for the Protection of Free Negroes; of this he was annually elected president after Franklin’s death. He espoused the cause of non-jurors, and under the title of “An Inquiry into the Consistency of Oaths with Reason and Christianity,” he presented a master- ly and convincing argument against such tests. He was a discriminating but decided opponent of the use of ardent spirits. He did not aim at the total prohibition of stimulants, as he held that the weaker alcoholic beverages were com- paratively harmless. He did not deny that the use of spirits may be indicated in the low states of certain acute diseases, but he pleaded eloquent- ly for legislation against the abuse of ardent spirits, and he used his immense influence as a teacher and practitioner to discountenance their employment in disease save when absolutely necessary and then only with every precaution to guard against the formation of the alcohol habit. Rush was evidently a perfectionist. His en- thusiasm over the possibilities of human nature continually breaks out into expressions of sincere 8 exuberance. I fear he drew his inspirations more from the experience of his own nature, refined and elevated, which required no excitement but the claims of duty, and no pleasure but the pur- suit of knowledge and truth, than from the ob- servation and study of men as they actually exist. Very naturally and properly he opposed the use of tobacco as a habit attended with many injuri- ous results. “Were it possible,” he begins his observations upon the influence of the habitual use of tobacco upon health, morals and prosper- ity, “for a being who had resided upon this globe to visit the inhabitants of a planet, where reason governed, and to tell them that a vile weed was in general use among the inhabitants of the one it had left, which afforded no nourishment; that this weed was cultivated with immense care; that it was an important article of commerce ; that the want of it produced real misery ; that its taste was extremely nauseous ; that it was un- friendly to health and morals, and that its use was attended with considerable loss of time and property, the account would be thought incredi- ble, and the author of it would probably be ex- cluded from society for relating a story of so im- probable a nature. In no one view is it possible to contemplate the creature man in a more absurd and ridiculous light than in his attachment to tobacco.” And so he concludes the same obser- vations by reference to one from whom frequent evidences show that he drew much of his inspira- tion of humanity. He tells us that Dr. Franklin, a few months before his death, declared to one of his friends that he had never used tobacco in any way in the course of his long life, and that he was disposed to believe there was not much ad- vantage to be derived from it, as he had never met with a man who used it who advised him to follow his example. I do not touch upon these various points merely as proof of versatility and activity. It is a com- mon thing to see men who acquire a certain con- spicuous but temporary fame, owing to the bus- tling energy with which they assume many posi- tions and mix in many affairs ; but it is found that they have won no lasting credit from any of 9 their varied work. But for Rush it is fair to claim that in all the large affairs and questions with which he dealt he showed himself a pioneer and a leader, and that he did work of capital and enduring value. Very much of this depended upon his great gifts as a speaker and as a writer. He was in truth a man of letters of very high rank. Abundant testimony shows that his medi- cal lectures were consummately excellent—clear, impressive, eloquent, and at times instinct with dramatic power. I shall allude again to the im- mense effect they produced in aiding the diffusion of his medical views. His more elaborate ad- dresses and orations are admirable, and some of them, as those on Cullen and on Rittenhouse, and his address on “The Influence of Physical Causes on the Moral Faculties,’’ are splendid per- formances. Richardson3, to whom we owe the most appreciative of recent sketches of Rush, quotes from the eulogy on Cullen what he fitly calls a golden utterance ; justly applicable to Cul- len, it is a true expression of the spirit which moved Rush. “That physician has lived to little purpose who does not leave his profession in a more improved state than that in which he found it. Let us remember that our obligations to add something to the capital of medical knowledge are equally binding with our obligations to prac- tice the virtues of integrity and humanity in our intercourse with our patients. Let no useful fact, therefore, however inconsiderable it may appear, be kept back from the public eye ; for there are mites in science as well as in charity, and the re- mote consequences of both are often alike impor- tant and beneficial. Facts are the morality of medicine ; they are the same in all countries and throughout all times.’’ However he may have acquired it, he was mas- ter of a style in writing, of rare clearness, force and flexibility. It lends a charm to every pro- duction of his pen. His letters to his family and intimates, the discussions of important public ques- tions, his dissertations upon medical topics, are alike composed in this attractive style. Compact and well thought out arguments; vivid bursts of 3 The Asclepiad, 1885, B. W. Richardson, M.D. 10 imagination and passages of glowing eloquence ; bits of description of microscopic accuracy; apt illustrations, drawn from nature, history, litera- ture, art, most of all from Holy Writ; sententious phrases ; these are separate merits of the style, through all of which there breathes such candor and earnestness and humanity that the reader finds himself delighted with the man, as well as with the author. If time permitted, it would be easy to show that in the vital matter of education he was as active, as progressive, and as far ahead of his contemporaries, as he was in social science. I dare not even allude to his advanced views on the education of women, or I should be drawn into an extended eulogy of his position upon this question, which now, more than a century later, is but beginning to receive the attention its im- mense practical importance demands. His labors for the establishment of the public school system; his suggestions of “A Mode of Education Proper in a Republic;” his ‘‘Observations Upon the Study of the Eatin and Greek Languages as a Branch of Liberal Education, With Hints of a Plan of Liberal Instruction Without Them,” and his ‘‘Defense of the Bible as a School Book,” may be pointed out as evidences of what I have claimed for him. What deep gratitude must we ever owe, for our national stability and prosperity, to the illus- trious men, among whom Rush was notable, who recognized instinctively that universal education, thorough, sound and broad, was the only safety of the new Republic, and who continued the de- voted efforts which had won from foreign op- pression our liberties, in order to ensure us the means of maintaining them against no less deadly dangers at home. In every portion of Rush’s writings we find constant evidence of his genuine, unaffected piety. There is a vein of truth and sincerity in it which cannot be mistaken. Unquestionably he had his hard struggles with himself, with a nature excita- ble, sensitive and self-asserting. He stood in the slippery places of rapid success and early popu- larity. It was a time when men’s blood was up. 11 Opinions were held tenaciously and fought for willingly ; but throughout his writings, public and private, the subject of religion is continually referred to, and invariably in the most reverential tone, without a tinge of polemics or of sectarian- ism. Indeed, he urged, in a remarkable “Ad- dress to the Ministers of the Gospel of Every De- nomination,” published as early as 1788, that each sect should appoint a representative in a general convention of Christians, whose business shall be to unite in promoting the general objects of Christianity. He concludes: “America has taught the nations of Europe, by her example, to be free, and it is to be hoped she will soon teach them to govern themselves. Let her advance one step further and teach mankind that it is possible for Christians of different denominations to love each other and to unite in the advance- ment of their common interests. By the gradual operation of such natural means the kingdoms of this world are probably to become the kingdoms of the prince of righteousness and peace.” It is true that to the end of his life Rush continued to be active in the cause of philanthropy, of educa- tion, and of religion ; but we shall see that after the year 1789 his great work was purely medical. The almost incredible fact appears, then, that in twenty years up to that date, when he was but 46 years of age, he had already accomplished so much in public life, both political and medical; in professional work, as a teacher, as a writer and as a practitioner; in statesmanship, in phi- lanthropy, in education and in social science, as to secure lasting fame as a thinker of power and originality, and as a writer and orator of high rank. But ano less remarkable, and probably to us the most interesting, period of his life was to follow. Sydenham died in 1689, and just 100 years later, in 1789, Rush was elected to the chair of the Theory and Practice of Medicine in the College of Philadelphia, to fill the vacancy caused by the death of Dr. John Morgan.4 4 In 1791, when the charter and estates were restored to the col- lege, a reorganization was effected and the institution assumed the title of the University of Pennsylvania. Dr. Rush became the Pro- fessor of Institutes and of Clinical Medicine in the University. In 1797 he filled also the chair of Practice resigned by Dr. Kuhn in that year, though he appears not to have been formally elected to the latter position by the Trustees until 1805. 12 When we consider how important he rendered that position, and what lustre his subsequent work reflected upon the medical profession and upon medical science, it is not unreasonable that we should take note of this Centennial Anniver- sary of an event of the greatest significance in the history of American medicine. The air still vibrates with the national outburst of homage to the memory of the greatest of our heroes. The Centennial Anniversary of the In- auguration of Washington was fittingly made the occasion not only to illustrate our marvellous growth in power and prosperity, but to commem- orate the character and services of that incompar- able man. It may be that it was a thrill of sym- pathy with that fine retrospect, which made me feel that, in the discharge of the most difficult duty assigned to me to-day—of addressing this great audience representative of all branches of our profession in all sections of our land, it might not be amiss to select a topic which would remind us that for us members of the American medical profession this is an Anniversary year in an added sense. The truth is that Rush was at all times and in all places and before all else a great physician. He had entered public life from a sense of patri- otic duty ; he had labored for the improvement of society because he was irresistibly impelled by his large humanity ; but he threw himself into the service of medicine with passionate intensity. Ramsay, a favorite pupil and intimate friend, tells us that Rush wrote to him: 1 ‘ Medicine is my wife, science is my mistress, books are my com- panions, ray study is my grave.” As a matter of fact he married at the age of 32 years, and was so fortunate as to secure the hand of a woman whose character, charms and ability made their union a singularly happy one. At the close of his life, writing of the causes of insanity, he uses the following orthodox language: “ Celibacy is a pleasant breakfast, a tolerable dinner, but a very bad supper. The supper is not only of a bad quality but, eaten alone, no wonder it sometimes becomes a predisposing cause of madness.” Still we find him saying in 1808, in allusion to his 13 death : “When that time shall come, I shall re- linquish many attractions to life, and among them a pleasure which to me has no equal in human pursuits. I mean that which I derived from studying, teaching and practicing medicine.”5 Through the courtesy of Mr. Ferdinand J. Dreer I am enabled to reproduce here a facsimile of the certificate, given by Dr. Dorsey, as to the cause of Dr. Rush’s death :