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 AN EULOGIUM






       UPON






BENJAMIN RUSH, M. D, 
 
AN  EULOGIUM/      7 j   /
UPON
BENJAMIN J,USH,  M.  D.
PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDI-
  CINE AND OF CLINICAL PRACTICE IN THE UNIVERSI-
  TY OF PENNSYLVANIA.
WHO  DEPARTED THIS LIFE APRIL 19, 1813,
IN THE SIXTY-NINTH YEAR OP HIS AGE.
WRITTEN AT THE REQUEST OF THE MEDICAL SOCIETY
  OF SOUTH CAROLINA, AND DELIVERED BEFORE THEM
  AND OTHERS, IN THE CIRCULAR CHURCH OF CHARLES-
  TON, ON THE 10th OF JUNE, 1813, AND PUBLISHED AT
  THEIR REQUEST.
       BY DAVID RAMSAY, M. D.
MEMBER OF THE SOUTH CAROLINA MEDICAL SOCIETY
                                     \
          PHILADELPHIA:      / '. *, / & '
PUBLISHED BY BRADFORD AND INSBtEEFJ .'•>,
   AND INSKEEP AITD BRADFORD, NEtFYORK.
          James Maxwell, Printer.
              1813. 
 
PREFACE.
   The medical society of South Carolina, on hear-
ing of the death of Dr. Rush, impressed with high
respect for his memory, resolved to go in mourning
on the melancholy  occasion.  They also directed an
Eulogium, commemorative of his merits to be pre-
pared, and read before them  at their next meeting;
and appointed one  of their members to perform that
duty.  The following was written in conformity to
their request.  The subject being the character of a
learned professor and distinguished practitioner of
medicine, and the persons, before whom it was at
first intended to be delivered, being all physicians, the
work naturally assumed a medical complexion.  Be-
fore the day of delivery arrived, several of the citizens
of Charleston, expressed to several of the members of
the medical society, a wish that the intended tribute 
VI
of respect to the memory of Dr. Rush should be de-
livered in public.  When the society next met, they
therefore adopted  a resolution to that effect, and ap-
pointed a committee to fix on time and place for a
public exhibition.  This change involved some diffi-
culty.  The Eulogium was already written in a plain
didactic style, to be soberly read before a small num-
ber of professional gentlemen, and was not calculated
for delivery before a promiscuous popular assembly.
To accommodate to the change, much of the medical
part of the work was omitted. By a subsequent vote
of the society, the author was  requested to prepare
a copy for publication.   This made it  proper to re-
place  what had been omitted in the public delivery of
the Eulogium, and also furnished  an opportunity of
enlarging the medical part of it.   These statements
are  made to account for the difference between what
was delivered and what is now published.
    The  intention  of the society was to do honour
to the memory of Dr. Rush, and to do good to the
public, by holding up his bright example for imita-
tion.  To answer these purposes it was necessary that
not only a short sketch of his life, but of his profes-
sional merits, should be brought into view.  Most of
the members of the society, were of opinion that Dr.
Rush had improved both the theory and practice of 
vii
 medicine;  and had in fact introduced a new system.
 It was therefore incumbent  on their representative,
 to show what these improvements were, and in what
 respects his system was better than those which had
 preceded it.   This opened a  wide field and  might
 easily  have been expanded  into a considerable vo-
 lume.   A concentrated view of the most prominent
 particulars was deemed most suitable to the present
 occasion: this has been attempted, and the result is
 now submitted to the public.   In drawing it up Dr.
 Rush's works have been carefully consulted, and  in
 stating his doctrines and practice, his own language
 has been preferably used.  No man  understood his
 principles or defended them better than  himself.  In
 support of these principles, and the practice grounded
 on them, the author adds his own experience, which
 has been uniformly in their favour ever since they
 were promulgated, and a declaration  that in his opi-
 nion Dr. Rush has done much  to improve  both the
 theory  and practice of medicine, and as far  as his
 reading extends, more than any one physician either
living or dead:  that the merit of Dr. Rush is far from
being founded  on  lucky accidents, such as finding
new remedies for old  diseases, but in the discovery
of principles respecting the  animal economy, which
 simplify the  practice  of physic, apply to all cases. 
viii
and furnish the physician of real talents, with a clue
to direct his practice in the treatment of new diseases
or new combinations  of old diseases,  and in cases
either new or old of uncommon difficulty, and in every
disease to discover its nature, and the remedies most
likely to relieve it.
                               David Ramsay.
Charleston, July 2, 1813. 
EULOGIUM, &c.
MR. PRESIDENT, AND GENTLEMEN OF THE
             MEDICAL SOCIETY:

 FRIENDS AND COLLEAGUES,
    In obedience to your commands, I rise to per-
form the pleasing, painful duty you assigned to me at
your last meeting.  To do honour to the memory of
Dr. Rush, who did honour not only to our profession
but to his  country,  and to human nature,  is in
unison with the finest feelings  of the heart.   Our
society has not only abundant but peculiar reason to
mourn over the death of this  illustrious physician.
He was the preceptor of sixty of its members; more
than one half  of  all who have ever associated  with
us since  our institution in 1789.  We do not weep
alone."  Whilst we drop the tributary tear, we have
with us the sympathy of our fellow citizens over all
the United States; for the name of Dr. Rush gave  a
splendour to the American character, and greatly
added  to its reputation  throughout the republic of
                       3 
                       10
letters.  His works are read coextensive'y with the
language  in which they  are written, and  are daily
quoted as standard medical authority by the  learned
of different nations.  Crowned heads have done him
homage; but his fame has a more solid foundation in
the hearts and affections of several hundreds of his
pupils, and many thousands of his countrymen, who
admire his talents and virtues,  and are grateful  for
the good he has done.  Numerous  societies on both
sides the Atlantic have done him and themselves  re-
ciprocal honour  by enrolling his name in the list of
their members.  He has been one  of the most pro-
minent pillars, on which  his country's  claim to  be
ranked  among learned  nations has preeminently
rested, ever since Dr. Franklin was no  more.  Few
or none of his cotemporary fellow labourers in the
field of medicine can prefer superior or even equal
claims, as reformers and improvers, of the theory and
ipractice of medicine.  His life  was a  blessing not
only to our country,  but to the great family of man-
kind.  Let us review it, so that, from his bright ex-
ample, we, our children, and our children's children
may be stimulated to go and do likewise.  We will
then extract good from evil and derive a benefit from
a great and irreparable national calamity.
    Benjamin  Rush was born  December 24, 1745
(old style) on his father's plantation,  about four- 
11
teen miles to the northeast of Philadelphia.  His an-
cestors migrated from England to Pennsylvania soon
after its first settlement in the seventeenth century.
In the eighth or ninth year of his age, he was sent for
education to Nottingham, about sixty miles south-
west from Philadelphia, where an academy had been
long conducted with great reputation  by  the  Rev.
Samuel  Finley, D. D. afterwards president of the
college in Princeton, New-Jersey. The inhabitants of
this retired spot were plain country  farmers, who
cultivated  so indifferent  a  soil that they could not
derive a living from it without strict  economy and
the daily labour of their own hands. Their whole time
was occupied in providing the necessary supplies for
their support in passing through  this world, and in
preparing them for a better. To assist them  in the
latter, they enjoyed the blessings of public preaching
and the faithful evangelical labours of one of the wisest
and best of men.  In their  comparatively  depressed
situation, as to worldly matters, their  morals were a
virtual reproach to the inhabitants  of many districts
who enjoyed  a much greater proportion of the good
things  of  this life.  Almost every  dwelling house
was so far a church that the reading of the word of
God, and the offering up  of family prayers, generally
recurred every day; there were few, or rather no ex-
amples of, or temptations to immorality of any kind. 
12
 Among these people, remarkable for their simplicity;
 industry, morality,  and religion, young Rush spent
 five years of his early youth in acquiring a knowledge
 of the Greek and Latin languages.   He  there  also
 learned much of human nature, and began  to class
 mankind according to their state of society;  a  dis-
 tinction of which he profited very much in his future
 speculations in political philosophy.   The transition
 from  the variegated scenes of Philadelphia to this
 sequestered seat of learning,  industry, and religious
 habits, could not fail of making a strong impression
 on his observing mind. He there acquired a reverence
 for religion—its consistent professors  and teachers:
 a prepossession in favour of regular orderly conduct,
 of diligence, industry, punctual attention to business,
 and in general of such steady habits as stamped a
 value on his character through life.  In laying a solid
 foundation for correct principles and conduct he was
 essentially  aided by the faultless example, judicious
 advice, and fatherly care of the learned and pious Dr.
 Finley. This accomplished instructor of youth was
 not only diligent and successful in communicating
 useful knowledge, but extended his views far beyond
 the ordinary  routine of a common education.  He
 trained his pupils for both worlds, and in his inter-
 course with them, had respect to their future as well
as present state of existence.  To young Rush he was 
13
devoted by peculiar ties:  for he was fatherless and
the son of the sister of his beloved wife.  A recipro-
cation of affection took  place  between the  parties,
much to the credit and advantage of both.  Benjamin
Rush found a father in his  uncle Finley,  and  when
adult, repaid the obligation in kind by acting the part
of father to his  son,  James  E.  B. Finley,  left  an
orphan when very young, by the death of his father
in 1766.  This new  obligation  was gratefully ac-
knowledged by the subject of it, particularly by giv-
ing the name of Benjamin Rush to his first born son.
This youth, in the ninth year of his age, was honour-
ed with an affectionate letter,  from his  illustrious
kinsman, after whom he was named, shortly before
his death.*  The good advice contained therein, if

  *  This circumstance produced two letters.  The first was
written in reply to the father, announcing the birth  of a son,
and his name. In it Dr. Rush observed, " 1 rejoice very much
in the addition which has been made to your happiness by
the birih of a son, and am much flattered by the honour you
have done me by imposing my unworthy name upon him, in
connexion with your illustrious father's. I shall always con-
sider him as a grandchild, and shall expect to have  him pre-
sented to me to receive  my benediction  before  I depart
hence and am no more. Kiss him a thousand times for me."
  The other letter was addressed to the boy himself, as soon
as he was capable  of reading, and understanding what was
written.  This  letter contained the  following observations:
"You will be inexcusable if you do not make a scholar, and
still more so if you do not make a good man.  Aristotle, the
preceptor of Alexander the great, always rebuked his royal 
u
followed, cannot fail  of producing happy effects.
Thus, kind offices of respect and affection have been
reciprocated in  these families through three genera-
tions, and seed  is sown  that promises to bear good
fruit in the fourth.  The whole, considered in a con-
nected view, holds out encouragement to abound in
works of kindness, for they often bring their own

reward.
    Benjamin Rush, after finishing his preparatory
course of classical  studies at Nottingham,  was, in
1759,  entered a student  in the college of Princeton,
then under the superintendance of president Davies.
This eloquent preacher was pronounced by his pupil,
Rush, not only in early youth, but in his adult age, to
have been the greatest pulpit orator this country had
produced.  Under  the tuition of this distinguished

pupil, when he saw him about to do an improper act, by say-
ing, "remember whose son thou art." In like manner, when
you are  tempted  or disposed to neglect your  studies, to
behave disrespectfully to your parents, or improperly to your
brothers and sisters, or your schoolmates, " recollect whose
son and whose grandson  you are."  Do not  dishonour the
blood and the name you have derived from them. If it were
possible for your excellent grandfather to be made unhappy
in Heaven but for a moment, it would be by hearing or see-
ing you commit a sin of any  kind. But I hope better things
of you, and that by your good conduct, and above all by your
early piety, you will add (if that be possible) to the happi-
ness of your grandfather and to the comfort and joy of all
your relations and friends." 
15
preacher, and able instructor, he, whose life we  are
reviewing, obtained the degree of A. B. in 1760, and
before he had completed his fifteenth year. The next
six years  of his life were devoted to the study of
medicine, under the direction of Dr.  Redman, who
in his day, ranked among the most eminent of  the
faculty in Philadelphia.  The writings of Hippocrates
were among the first books  Benjamin Rush read in
medicine, and while he was an  apprentice he trans-
lated his aphorisms from Greek into English.  He
also began to keep a note-book of remarkable occur-
rences, the plan  of  which he  afterwards improved,
and continued through life.  From a part of this
record, written in the seventeenth year of the age of
its author, we derive the only account of the yellow
fever of 1762 in Philadelphia,  which has descended
to posterity.  In the same year he was  one of Dr.
Shippen's ten pupils, who attended the first course of
anatomical lectures given in this country.  Two years
after, and while he was a daily attendant in the shop
of Dr. Redman, he commenced his brilliant career as
an author.  On the  expiration  of his apprenticeship,
Benjamin  Rush went, in 1766, to Edinburgh, to
pfosecute his studies at the  university in that city,
then in the zenith of its reputation,  and there was
graduated M. D. in 1768. His Thesis " De coctione
ciborum in Veritrictilo" was written in classical Latin, 
                       16
and I have reason to believe, without the help of a
grinder of Theses, for it bears the characteristic
marks of the peculiar style of its author.  Its ele-
gant  latinity was the least part of its merits.   The
eagerness of its author to acquire professional know-
ledge, induced him to test a medical opinion in a way
against which  a  less ardent  student would have re-
volted.  To ascertain whether fermentation had any
agency in digestion, he made three unpleasant expe-
riments on his  own stomach.  By taking five grains of
an alkaline salt, he first destroyed any acid that might
be accidentally  in  it, and immediately  afterwards
dined on beef, peas, bread, and beer.   Three hours
after dinner, he took an emetic of two grains of emetic
tartar.  The contents of his stomach, when thrown
up, were proved to be acid by the usual tests.
   The experiment was repeated with veal instead of
beef,  and water instead of beer; but in all other parti-
culars, the same as before, and with a similar result.
    The experiment was repeated a third  time; but
with fowl instead of beef or veal, and cabbage instead
of peas, and unleavened bread instead of that which
is in common use; but in all other particulars the
same as before.  The result was similar to what it
had been in both the preceding experiments.   From
these facts, thrice repeated, an inference was drawn,
that the aliment in the human stomach, in the course 
17
of three hours after deglutition, underwent the acete-
ous fermentation.
  While  Dr. Rush was a student of Edinburgh, he
had an opportunity of distinguishing himself, and at
the same time of rendering  an acceptable service to
his alma mater, Nassau Hall.  On the death of presi-
dent Finley, in 1766, the Rev. Dr. Witherspoon, of
Paisley, in Scotland, was chosen his  successor.  He
at first declined an acceptance of  the  office,  and it
remained  vacant more than a  year.  The trustees of
that institution entertaining a high  opinion of their
alumnus Rush, appointed  him their  commissioner
to solicit Dr. Witherspoon to accept the  presidency
of Princeton college, and the  presbytery, of which
he was a member, to  consent to  his  dismission.—
These commissions were ably and successfully exe-
cuted.  The address and talents of the young com-
missioner inspired the parties with a  belief that a col-
lege which had already produced such fruit was wor-
thy of their attention.   I leave it to others to appre-
ciate the consequences of this successful negociation,
to the interests of religion and learning in America,
and  only refer you to the observations of Dr. Miller,
the learned historian  of the eighteenth century, on
this  event.*   Dr. Rush spent in  London the next
   * The arrival of Dr. Witherspoon in America, from North
Britain, is entitled to notice among the  events which contri-
                         c 
18
 winter after his graduation in Edinburgh.  In the fol-
 lowing spring he went over to France, and in the fall
 of the same year returned to Philadelphia, and com-
 menced the practice  of physic.   In  1769  he  was
 elected professor of chemistry in the college of Phi-
ladelphia.  This addition to Drs. Shippen, Morgan,
 Kuhn and  Bond, who had  began to lecture a  few
years before, made a complete set of instructors, and
fully organized this first medical school in America,
By a subsequent arrangement in 1791, the college was

 buted to the advancement  of literature and science in our
 country.  It is not to be supposed, that a mind so vigorous,,
 enlightened, and active as his, and placed in a conspicuous
 station, could fail of contributing to the literary advancement
 of any community in which he resided.  Invited to under-
 take the office of president of the college of New-Jersey*
 this great man arrived at Princeton, in the year 1768, and im-
 mediately entered on the duties of his new station. He produ-
 ced an important revolution in the system of education adopt-
 ed in this seminary.  He extended  the study of mathematical
 science, and introduced into the  course  of instruction oi;
 natural philosophy, many improvements which had been lit-
 tle known in most of the American colleges, and particular-
ly in that institution.   He placed  the plan of instruction in.
moral philosophy on a new and improved basis, and was, it is
believed, the first man who  taught  in America the substance
 of those doctrines of the philosophy of the  human mind,
 which Dr.  Reid afterwards developed with so much success.
 And finally, under his presidency, more attention began to be
paid than before, to the principles of taste and composition,
 and to  the study of elegant literature.—Miller's Retrospect
 yf the eighteenth century. 
19
merged in an university, and Dr. Rush was appoint-
ed professor of the  institutes and practice of medi-
cine,  and of clinical practice  in  the  university of
Pennsylvania.
    In this and his preceding  capacity,  as  lecturer
in chemistry, Dr.  Rush has been a public teacher
of medicine for forty-four years, and has in  several
instances, and particularly in that of him who  now
addresses you, taught two successive generations,
for the father  and son have both been his pupils.
From his first commencing practice Dr. Rush always
had a considerable number of private pupils.  Their
whole number  cannot now be exactly ascertained,
but it is recollected that they amounted to fifty in the
last nine years of his life.  His  class pupils, for seve-
ral of the first years in which he gave lectures, varied
from sixteen to thirty, but since 1789 have been from
year  to year rapidly  increasing.   In  1812  they
amounted  to four hundred and thirty.  His pupils
were generally changed every second or third  year.
From these data, it is not an improbable conjecture
that,  in the  course of his  life,  Dr. Rush has given
public instructions to two thousand two hundred and
fifty pupils.  These have extended the blessings  of
his instructions and improvement,  in the theory and
practice of medicine, over the United States, and in a
few instances to  South America,  the  West Indies, 
                       20
and the eastern continent.  On his  return to Phila-
delphia^ found theBoerhaavian system of medicine,
which locates diseases in the fluids of the human
body, to be generally accredited. Having acquired at
Edinburgh a partiality for the spasmodic system of
Cullen, he  publicly taught it as preferable to that of
Boerhaave; but his active  mind daily brooding over
the medical systems of others, correcting them by his
own observations and reasonings, and  bringing the
whole to the test  of experience in its  progressive
course, began to  receive new light.  He  was con-
vinced that medicine was in its infancy; that there was
great room for improvement. Instead of being proud
of his attainments, he was disposed to exclaim " Heu
quantum ncscimus."—Of how much are we ignorant?
It would require a much longer time than is allotted
to the exercises of this day, to give a complete view
of the improvements Dr. Rush has introduced in our
profession.   A slight sketch of the most prominent is
all that your time will permit to be brought into view
on this occasion.
   When Dr. Rush began to lecture, diseases were
reduced in the manner of the botanists, to orders,
classes, genera, and species. In Cullen's Genera Mor-
borum, the names of one thousand three hundred and
eighty-seven diseases are enumerated, each supposed
to have something appropriate, and requiring in some 
21
respects, different treatment.   This embarrassing,
perplexing mode of acquiring a knowledge of disea-
ses, has been simplified by our American professor
who has substituted in its place the state of the system.
In his public instructions, the name of the disease is
comparatively nothing, but the nature of it every
thing.  His system  rejects the nosological arrange-
ment of diseases, and places all their numerous forms
in morbid  excitement, induced by irritants, acting
upon previous debility.   It rejects likewise, all pre-
scriptions for the names of diseases, and by directing
their  application wholly to  the  forming and fluctua-
ting state of diseases, and of the system, derives from
a few active medicines, all the advantages which have
been in vain  expected from the  numerous articles
which compose  European  treatises upon the materia
medica.  This simple arrangement was further simpli-
fied by considering every morbid state of the system
to be such as either  required depletion or stimula-
tion.   The art  of healing diseases, is  therefore  ac-
quired by the student, who, from the pulse and other
auxiliary sources of  information, knows the state of
the system of his patient, so far as to be a competent
judge whether depletion or stimulation is indicated,
and when this is ascertained, is farther instructed so
as to be able  to select the remedies which are best
suited either to deplete or stimulate, according to  the 
                        22
 strengdi, habits, and other peculiar circumstances of
 his patient.  The younger members of our profes-
 sion cannot appreciate the value of this  arrangement
 as well as those who are seniors. The latter have had
 to undergo  the uphill work of coming at the names
 of diseases by a circuitous rout, the former have been
 led by one or two plain paths, which speedily brought
 them to the same goal, or what is equivalent thereto,
 or rather far superior to it.  The old system requires
 reading and memory; the new, judgment and obser-
 vation. It is no exaggeration to say that a student of
 an investigating mind, on the present simple plan of
 acquiring a knowledge of the healing art, can be bet-
 ter  prepared for entering on  his profession in three
 years,  than he could on  the former system  in five.
 Contemplating diseases through this new light, our
 professor found that a great majority of them, in  this
 new and plentiful agricultural country,required deple-
 tion, and that, of all modes of depletion, bleeding  was
 the easiest, safest, and shortest; and next to it cathar-
 tics.—That these two remedies, judiciously applied,
 with a suitable regimen,  earned to a proper extent,
 and discontinued at the  proper period,  would often
extinguish an otherwise formidable disease when in
the forming state,  or lay a foundation for its cure after
it was actually formed.  Practice, founded on these
simple principles, removed much present evil, and pre- 
23
vented more. It was about the year 1790, and twenty-
one  years after Dr.  Rush had been a practitioner
and professor of medicine, when he began to publish
his new principles in medicine.*   These were more
or less developed by him in his successive annual
course of lectures, for the subsequent twenty-three
years of his life.   They were also discussed in inau-
gural dissertations by many of  the  candidates for
medical degrees  in the same period.  These young
gentlemen were at full liberty to  sift their merits  or
expose their fallacy. Freedom of inquiry was inculca-
ted on them, not only as a privilege, but as a duty.
It is  believed that no man  understood the human
pulse better than Dr. Rush.  In his lectures he  used
to call it  " the nosometer of the system." In his
printed defence of blood-letting, he asserts that the
following distinct states of the pulse indicate the ne-
cessity of bleeding:
   1.  A full, frequent, and tense pulse.

   * In the autumn  of 1789,1 visited Dr. Rush, and was re-
ceived by him in his study.  He observed that he was pre-
paring for his next course of lectures in self-defence; that
the system of Cullen was tottering; that Dr. John Brown had
brought forward some new and luminous principles of medi-
cine, but  they were mixed with others which were extrava-
gant;  that he saw a gleam of  light before him leading to a
more simple and  consistent system of medicine than the
world had yet seen, and pointed out some of its leading fea-
tures. 
                       24
  2. A full, frequent, and  jerking  pulse, without
tension.
  3. A small, frequent, but tense pulse.
  4. A tense and quick pulse, without much preter-
natural frequency.
  5. A slow but tense pulse,  such as occurs in the
apoplectic, hydrocephalic, and malignant states  of
fever, in which its strokes are from sixty, to nine in a
minute.
  6. An uncommonly frequent pulse, without much
tension, beating from one hundred and twenty to one
hundred and  seventy  or one  hundred and  eighty
strokes in a minute.
  7. A soft pulse, without much frequency or fulness.
  8. An intermitting pulse.
  9. A depressed pulse.
  10. An imperceptible pulse.
  These two last to  be carefully distinguished  from
the same states of the pulse,  which arise  from  an
exhausted state of the system.   In the conclusion, he
observes, if all the states of pulse which have  been
enumerated, indicate bleeding, it must be an affect-
ing consideration, to  reflect how many lives have been
lost by physicians limiting the use of the lancet only
to the  tense or full pulse.
   To assist us in judging of the propriety of repeating
venesection from the appearances of the blood, he enu- 
25
merates the following six varieties, each indicating a
different grade of inflammation:
   1. Dissolved blood.
  2. Blood of a scarlet colour, without any separation
into crassamentum or serum.
  3. Blood in which part of the crassamentum is dis-
solved in the serum, forming a resemblance to  what
is called the iotura carniumt or the washings of flesh
in water.
  4. Crassamentum, sinking to the bottom of a bowl
in yellow serum.
   5. Crassamentum, floating in  serum, which is at
first turbid, but which afterwards becomes yellow
and  transparent, by depositing certain red and fiery
particles of blood in the bottom of the bowl.
   6. Sizy  blood, or blood covered with a buffy coat.
   Whereupon, he asks, if  bleeding be indicated by
all the appearances of the blood, which have been
enumerated, " how many lives have been lost by phy-
sicians limiting the use of  the lancet to those  cases
only,  where  the blood discovered an inflammatory
crust?" Dr. Rush  overlooked no source of informa-
tion, but principally depended on the pulse.  From
long and accurate  acquaintance with  all its varie-
ties and the circumstances by which it was affected,
he made himself acquainted with the  state of  his
patient's system, and by suitable remedies reduced
                       i> 
                       26
it to its proper  standard, and generally removed the
disease.  Pursuing the train of reasoning and obser-
vation just  stated, and applying it to practice, our
professor adopted modes of treating several diseases,
which had not been usual in this country, and which
by many practitioners have  been deemed improve-
ments in the practice  of physic.   Dr.  Rush carried
bleeding and the depleting  system farther than ever
had been done before by any of his cotemporary phy-
sicians.   He in like  manner urged the use of calo-
mel, to which he gave the name of the Sampson of the
materia medica, farther than was  common among
the  physicians who had preceded  him.  Instead of
making a profitable secret of his innovations in prac-
tice, he  came forward boldly; taught them to his nu-
merous pupils;  published them  to the world, and
defended them with his pen. The witlings of the day
concurred in the propriety of the name of Sampson,
which he had given to this  favourite remedy,  calo-
mel;  but for a very  different reason,  because, say
they, " it has slain its thousands." Unmoved by the
sneers of some,  the misrepresentations of others, and
the general partiality  for old  opinions and aversion
to innovations, Dr. Rush steadily pursued his course
through evil report and good report. The same hand
which subscribed the  declaration of the political in-
dependence of these states, accomplished their eman- 
                       27
cipation  from medical systems formed in foreign
countries, and wholly unsuitable to the state of dis-
eases in America.  These Dr. Rush pronounced to
be of a higher grade, and to require more potent re-
medies than were usually prescribed for similar dis-
eases in the old world.  It cannot be denied that the
depleting  mercurial  plan of  treating  diseases  so
strongly  recommended by our professor,  has  done
mischief in the hands of persons who did not under-
stand it,  or  were ignorant of the limitation and cau-
tions necessary  in its application, or who were not
sufficiently attentive to the varying symptoms of their
patients. But it  is nevertheless true, that the system,
compared with those which  preceded  it,  is a  good
one, and that the objections to it apply to every effi-
cient, energetic  plan of treating diseases.   He is un-
worthy of the name of a physician, who does not oc-
casionally risk his reputation by bold but judicious
efforts to save the lives of his patients.  It is to be re-
gretted that the great reformer who introduced the in-
novations,  commonly called the American system of
medicine, did not live a few years longer to discover
more of the laws of the animal econom}r, more prin-
ciples in medicine, and at the same time, to perfect
those he had already discovered and promulgated.—
Than Dr. Rush, no man  more readily retracted his
opinions, when new light from any quarter whatever 
28
pointed out their defects. Such candour is a character-
istic of a great mind. He knew only one being, the great
Eternal,' who changeth not,' and also knew that when
a fallible imperfect mortal gave up his opinion, on be-
ing convinced that it was erroneous, he became wiser
than he was before.  Much did he lament the injury
sustained by the  medical world,  from the obstinate
adherence of the celebrated John Hunter, to opinions
he had once promulgated, and characterised him in
his lectures, as one " who never gave up any thing he
had once asserted till he gave up the ghost."  It was
not so with Dr.  Rush; his latter works and lectures
frequently announce his reasons  for relinquishing
doctrines he believed  and taught in younger  life.*

   * An illustrious instance of this change of opinion on con-
viction, took place in the mind of Dr. Rush respecting the
nature  and origin of the yellow fever. He first believed and
taught, that it was imported and contagious; but afterwards
retracted both opinions  for the following reasons:
   " The yellow fever does not spread in the country when
carried thither from the cities of the United  States.
   " It  does not spread  in yellow fever hospitals, when they
are situated beyond the influence of the impure air in which
it is generated.
   " It  does not spread in cities from any  specific matter
emitted from  the  bodies of sick people.
   " It is not propagated by the artificial means  which propa-
gate contagious diseases. Dr. Firth inoculated himself above
twenty times in different parts of his body with the black matter
discharged from the stomachs of patients in the yellow fever,
and several times with  the serum of the blood, and the sali- 
29
A friend to free inquiry,  he invited his numerous
pupils to think and judge for themselves, and would
freely, and in a friendly  manner, explain his  princi-

va of patients ill with that disease, without being infected by
them; nor was he indisposed  after swallowing half an ounce
of the black matter recently ejected from the  stomach, nor
by exposing himself to the vapour which was produced by
throwing a quantity of that  matter  upon iron heated over ft
fire."
   There are some seeming exceptions in favour of the pro-
pagation of this fever by contagion, but they admit of expla-
nation on other principles.  The circumstances which seem
to favour the communication of the yellow fever from one per-
son  to another, by means of what has been supposed to be
contagious, are as follow:
   1. A patient being attended in a small, filthy, and close
room, has  sometimes communicated the disease.  But the
 excretions of the body when  thus accumulated, undergo an
additional  putrefactive process, and acquire  the  same pro-
 perties as those putrid animal matters which  are known to
produce malignant fevers.
   2. A person sleeping in the sheets, or upon abed  impreg-
 nated with the sweats or other excretions, or being exposed to
 the  smell of the foul linen or other clothing of persons who
 had the yellow fever, may catch it from him. But, the disease
 here, as in the former  case, is communicated in the same
 way as from any other putrid animal matters.
   The yellow fever is said to arise from the effluvia of a
 putrid body that has died of that disease; but it may be an-
 swered, that a dead body in a state of putrefaction from any
 other disease, would produce under the same circumstances
 of season  and predisposition the same  kind and degree of
 fever.
   That the yellow fever is propagated by means of an impure
atmosphere, at all times, and in  all  places, may be  inferred
 from the following fact: 
30
pies, resolve their doubts, listen  to their objections,
and either yield to their force, or show their fallacy.
    Dr. Rush's principles of medicine were  by him
successfully  applied, to the cure of  consumptions,

  It appears only in those climates and seasons of the year in
which heat acting upon moist animal  and vegetable matters
fills the air with their putrid  exhalations.   A  vertical sun
pouring its beams for ages upon a dry soil  and swamps, de-
fended from the influence of the  sun by extensive forests,
have not in a single instance produced this  disease.
  It is unknown in places where a connexion is not percep-
tible between it and marshes, millponds,docks, gutters, sinks,
unventilated ships, and other sources  of noxious air.
  In the United States, no advocate for the specific nature
or importation of the yellow fever has ever  been able to dis-
cover a single case of it beyond  the  influence of an atmos-
phere rendered impure by putrid exhalations.
  It is destroyed like its fraternal diseases,  the common bi-
lious and intermitting fevers, by means of long, continued
and  heavy  rains.
  It is completely destroyed by frost.   As neither rains nor
frosts act in sick rooms, nor affect the bodies of sick people,
they must annihilate the disease, by acting exclusively upon
the  atmosphere. Very different in their nature are the small-
pox and measles, which are propagated by specific contagion.
They do not wait for the suns of July or August; nor do they
require an impure atmosphere, or an exciting cause to give
them activity.  They spread in the winter and spring as well
as in the summer and autumnal months: wet and dry weather
do not arrest their progress, and frost (so fatal to the yellow
fever) by rendering it necessary to exclude cold air from sick
rooms, increases the force of their contagion, and thereby
propagates them more certainly  through a country.   The
yellow fever is likewise destroyed by  intense heat and high
winds.  The latter, we are sure, like heavy rains and frosts, 
31
dropsies, hydrocephalus internus, apoplexy, gout, and
other diseases of the body, and also to madness and
other diseases of the mind. He considers the pulmo-
nary consumption as a disease resulting from causes
which induced general debility, and that the only hope
of discovering a cure for it should be directed to such

do not produce that salutary effect by acting upon the bodies
or in the rooms of sick people.
  If these arguments prove that  the yellow fever  is not
contagious, they also  prove  that it cannot originate from
importation.   In support of this opinion it may be farther
observed, ''that the yellow fever in the West  Indies, and
in all other countries where  it is endemic, is the offspring
of vegetable putrefaction, Heat, exercise, and intemperance
in drinking dispose to this fever in hot climates; but they
do  not  produce it without  the  concurrence of a remote
cause.  This remote cause exists, at all times, in some spots
of the West India islands;  but in other parts, even  of the
same  islands,  where there  are  no marsh exhalations, the
disease is unknown. In short, this disease appears, according
to Dr. Lind, in all the southern  parts of Europe after hot
and dry weather.
  The same causes (under like circumstances) must always
produce the same effects. There is nothing in the air of the
West Indies above other hot countries, which disposes it to
produce a yellow fever. Similar degrees of heat, acting upon
dead and moist vegetable matters are capable of producing
it, together with all its various modifications  in every part
of the world.
  The substance of this note is extracted from Dr. Rush's
works, third and fourth volumes.  His  opinions on the non-
contagiousness and nonimportation of yellow fever have been
strongly opposed in Philadelphia and Newyork; but in Char-
leston, S. C. all the physicians concurred with him. 
                       32
remedies as act upon the whole system. He observes
that the symptoms which mark its first stage should
be carefully studied, not only by physicians, but by
the parents and friends of those who have a hereditary
predisposition to the complaint. These are a slight
fever increased by the least exercise,  a burning and
dryness in the palms of the hands, rheumy eyes upon
waking from  sleep, a dryness of the skin, more espe-
cially of the feet in the morning; an occasional flush-
ing in one, and sometimes in  both cheeks; a hoarse-
ness; a slight  or acute  pain in the breast; a fixed pain
in one side, or shooting pains on both sides; headach;
occasional sick and fainty fits; a deficiency of appetite,
and a general indisposition to exercise or  motion of
every kind.
   The remedies for consumption in this stage of
the disease, are simple and certain. They consist in a
desertion of all the remote and exciting causes of the
disorder, particularly  sedentary employments, damp
or cold situations, and whatever tends to weaken the
system. When from ignorance or neglect the disease
has been suffered to advance to its inflammatory state,
he recommends blood-letting, a vegetable  diet, cool-
ing  medicines, a  dry situation, country air  distant
from the sea. The higher and drier the situation
which is  chosen  for  the purpose of enjoying  the
benefit of this remedy the better.  A change  of  cli- 
                        33
mate.  Countries between the thirtieth and fortieth
degrees of latitude are most friendly to consumptive
people. When going to a warm climate for the win-
ter is not practicable,  he advises them to  pass their
nights as well as days  in an open stove-room,  in
which nearly the same degrees of heat were kept up
at all  hours.  This practice, in several  cases,  is a
tolerable substitute for a warm climate. Loose dres-
ses and  a careful  accommodation  of them  to the
changes  in the weather.  Artificial  evacuations by
means of blisters and  issues.  A salivation has  per-
formed many cures in different parts  of the United
States. It is to be lamented that in a majority  of
the cases in which the mercury has  been given, it
has failed of exciting a salivation. Where it  affects
the mouth  it  generally succeeds in  recent  cases.
In the hectic state of the  complaint  a  salivation fre-
quently  cures. It should never be advised until the
inflammatory diathesis of the  system  has  been in a
great degree reduced.
    As a radical remedy, and to prevent a  return  of
the complaint, exercise is recommended. This must
be proportioned to the state of the disease and the
strength of the patient, and may be either rocking in a
cradle, or riding on an elastic board, commonly called
a chamber horse, swinging, sailing, riding in  a car-
riage or on horseback, and walking. 
                       34
    There are two 'methods  of riding for  health  in
 this disease.  The first is by short excursions;  the
 second is by  long journeys. In slight consumptive
 affections, and after recovery from an acute illness,
 short excursions are sufficient to remove the existing
 debility; but in the more advanced stages of con-
 sumption they are seldom  effectual.
    In a consumption of long continuance or of great
 danger, long journies on horseback  are  the  most
 effectual modes of exercise.  They afford a constant
 succession of fresh objects and company, which divert
 the mind from  dwelling  upon the danger of  the
 existing malady; they are, moreover,  attended by a
 constant change of air. Travelling, to be effectual in
 this disease, should be conducted in such a  manner
 as that a patient may escape the extremes of heat and
 cold.  For this purpose he should pass the winter
 and part of the spring in Georgia and South  Caro-
 lina, and the summer in Newhampshire, Massachu-
setts,  or Vermont, or,  by crossing  the lakes, and
 travelling along  the  shores of  the St. Lawrence to
 the city of Quebec.
    In these journies from north to south, or from
 south to north, he should be careful to keep at a dis-
tance from the seacoast. Of  all modes of travelling,
 the best, where strength permits, is riding  on horse-
back.  This should  be continued,  with  moderate
 intervals,  from six to  twelve months; but the cure 
35
should not be rested upon a single journey. It should
be repeated every two or three years till the patient
has passed the consumptive stages of life.  Nay, he
must do more: he must acquire  a habit of riding
constantly, both at home  and  abroad;  or "  he must
learn to live  on horseback."  Where benefit is ex-
pected  from a  change of climate as  well  as  from
travelling,  patients should reside  at least two years
in the place which is  chosen for that purpose.
    With respect to dropsies,  Dr. Rush states, that
though true, it has not been generally observed, that
dropsical effusions are sometimes promoted, and their
absorption prevented  by too much action in  the arte-
ries.  That  debility,  under certain circumstances,
disposes to excessive action, and that excessive action
occurs in one part of the  body at the same time that
debility prevails in every other; and  that an undue
force or excess of action occurs  in the arterial sys-
tem in certain dropsies.  The  symptoms which indi-
cate a morbid excitement and preternatural  action of
the arterial system are a hard,  full, and quick pulse,
sizy blood, alternation of dropsies with certain dis-
eases which were evidently accompanied by excess
of action in the arterial system, and bad effects result-
ing from the use of stimulating medicines.  In these
tonic or  inflammatory dropsies,  the  remedies are
blood-letting, vomits, purges, medicines which, by
lessening the action of the arterial  system, favour the 
                        36
 absorption anc- evacuation of water, such as nitre j
 cream of tartar, and foxglove, hard labour  or exer-
 cise in such a degree as to produce fatigue, low diet,
 thirst, fasting, fear, a recumbent posture of the body,
 punctures.
    The remedies for atonic dropsies, or such  as arc
 accompanied with a feeble morbid action in the blood
 vessels, are all such stimulating substances as increase
 the  action of the arterial system, or determine the
 fluids  to the urinary organs. These are bitter  and
 aromatic substances of all kinds, exhibited in sub-
 stance or in infusions of wine, spirits, beer, or water;
 certain acrid vegetable, such as scurvy grass, horse
 radish,  mustard, water cresses, and  garlic;  opium;
 metallic tonics, such as chalybeate medicines of all
 kinds, and the mild preparations of copper and mer-
 cury; diuretics, consisting of alkaline salts, nitre,  and
 the oxymel of squills, and colchicum; generous diet,
 pressure, bandages bound tightly round the belly and
 limbs  sometimes  prevent the increase  or return of
 dropsical swellings.
    Frictions, heat applied either separately or com-
 bined with moisture in the form of warm or vapour
 baths,  has been often used  with success in dropsies
 of too little action.
    Exercise. This is probably as necessary  in the
 atonic dropsy as it is in the consumption, and  should
never be omitted, when a patient is able  to take it. 
37
   After  stating and illustrating the  two different
states of action in dropsies which have been  already
mentioned,  Dr. Rush observes, that " dropsies  are
often connected with a certain intermediate or mixed
action in the arterial system, analogous to the  typhoid
action which takes place  in certain fevers. In drop-
sies  of mixed action, where too much force  prevails
in the action of some, and too little in the action of
other of the arterial  fibres,  the remedies must  be
debilitating or stimulating, according to the greater
or less  predominance of tonic or atonic  diathesis in
the arterial system."
    The distinction of dropsies, as arising from dis-
tinct states of the system, first introduced by  Dr.
Rush, has been of great service in correcting the too
general practice of prescribing stimulating medicines
indiscriminately in every case of dropsy.
    Dr. Rush, having for many years been unsuc-
cessful  in all the cases except two, of internal dropsy
of the brain which came under  his care,  began to
entertain doubts of the common theory  of  this  dis-
ease, and to suspect that the effusion of water should
be considered only as the effect of a primary  dis-
ease in the brain.  He mentioned this opinion to  Dr.
Wistar in the month of June, 1788, and delivered it
the  winter following in his lectures. The year after-
wards he was  confirmed in it by  hearing  that the 
38
 same idea had occurred to Dr. Quin. He soon after
 procured and read Dr. Quin's treatise on the dropsy
 of the brain.  With this respectable aid and his own
 observations' and reflections,  he formed a connected
 theory, which led to a new and more successful mode
 of treating this disease.
    He observes, that " the  internal  dropsy of the
 brain is a disease confined chiefly to children,  and
 that in them the brain is larger in proportion to other
 parts of the body than it is in adults, and of course a
 greater proportion of blood is sent to it in childhood
 than in the subsequent periods of life.
    In  all febrile diseases there  is a preternatural
 determination of blood to the  brain. In fevers of
 every kind, and in every stage of life, there  is a dis-
 position to effusion in that part to which there is the
 greatest determination.  He then gives a description
 of the disease, chiefly taken from Dr. Quin, as accord*
 ing most with the ordinary phenomena of this disease
 in the United States, and enumerates the causes of it.
 These which  act directly on the brain are falls and
 bruises upon the head, certain positions of the body,
 and childish plays, which bring  on  congestion  or
 inflammation, and afterwards an affusion of water on
 the brain.
    The indirect causes of this disease are intermit-
tent, remittent, and continual fevers, and those which 
39
are attended with eruptions. The internal dropsy of
the brain appears to be  the  effect  of inflammation
of the brain. Having adopted this theory of the dis-
ease, he resolved upon such a change in his practice
as should accord with it.  The  first remedy indica-
ted by  it was blood-letting.  This was followed  by
purges, calomel, and blisters. The preceding theory
of this disease has been adopted by many respecta-
ble physicians in Philadelphia and  in other parts of
the United States, and led to the practice that has
been  recommended, particularly to copious blood-
letting, in consequence of which death from a dropsy
of the brain is not a more frequent occurrence than
from  any other of the acute  febrile  diseases of our
country.
    Dr. Rush carried bleeding  in apoplexy farther
than had been usual before his time.  He considered
the importance of the part  affected, and the urgency
of immediate danger, to warrant extraordinary losses
of blood in the most perilous disease.  In his own
energetic language,  he advised his pupils " to bleed
not only by ounces or in basins, but  by pounds and
by pailfuls; and that the head of the  patient should
be subjected to a stream of the coldest water, from a
pump or otherwise, till a bleeder was procured."  It
is well known in Philadelphia, that, in conformity to
these  ideas. Dr. Physick, at one bleeding, drew ninety 
                        40
 ounces, by weight (or nearly one fourth of the usual
 quantity of blood in the human body) from Dr. De-
 wees,  in a sudden attack of the  apoplectic state of
 fever,  and thereby restored him so speedily to health
 that he was able to attend to his business in three days
 afterwards.
    Dr. Rush has also greatly improved the treatment
 of the gout, by recommending bleeding in case of
 gout where there is great morbid action in the blood
 vessels and viscera.
    " The usual objections to bleeding, as a remedy,
 have been urged with more success in the gout than
 in any other disease.  It has been generally forbidden
 because the gout is said to be a disease of debility.
 This is an error.   Debility is not a disease:  it is
 only its predisposing cause. Disease is preternatural
 strength in the state of the system now under consi-
 deration, occasioned by the abstraction of excitement
 from one part, and the accumulation of it in another
 part of the body. Every argument in favour of bleed-
 ing in a pleurisy applies in the present instance,  for
 they both depend upon the same kind of morbid ac-
 tion in the blood vessels.  Bleeding acts,  moreover
alike in both cases,  by  abstracting the excitement
from the blood vessels and restoring its natural and
healthy equality to every  part of the system.
    " The advantages of bleeding in the gout, when
performed under the circumstances that  have been 
41
 mentioned, are as follow:  It removes or lessens pain:
 it prevents those congestions and effusions which pro-
 duce apoplexy, palsy, pneumonia  notha, calculi in
 the kidneys and bladder, and chalk stones in the hands
 and feet.
    " It shortens the  duration of a fit of gout  by
 throwing it not into the feet,  but out of the system,
 and thus prevents a patient's lying upon his back  for
 two or three months, with a writhing face, scolding
 a wife and family of children, and sometimes cursing
 every servant that comes near enough to endanger the
 touch of an inflamed limb. Besides preventing all this
 parade  of pain and peevishness,  it  frequently, when
 assisted with other  suitable remedies, restores a man
 to his business and society in two or three days."
    Dr. Rush has also improved the theory and prac-
 tical treatment of madness. He rejects the abdominal
 viscera, the nerves, and the mind, as the primary seats
 of madness, and gives reasons for his believing and
 teaching, that the cause of madness is  seated prima-
 rily in the blood vessels of the brain. In enumerating
 its various exciting and predisposing causes,  he ©b-
                                            •r
serves that  " single persons are more predisposed  to
 madness than married people.  Of seventy-two insane
 patients in  the Pennsylvania hospital, in the month of
 April, 1812, forty-two had never been married, and
                        r 
                       42
five  were widows and widowers at the time  they
became deranged.
   The absence of real and present care, which gives
to the mind leisure to look back upon past, and to an-
ticipate future and  imaginary evils; and the  inverted
operation of all the affections of the heart upon itself,
together with the want of relief in conjugal sympathy
from the inevitable distresses and vexations of life,
and for which friendship is a cold and feeble substi-
tute; are probably the reasons why madness  occurs
more frequently in single than  in  married people.
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 some-
times becomes a predisposing cause of madness.
   " The rich are  more predisposed to madness thai*
the poor, from their exposing a larger surface of sen-
sibility to all  its remote and exciting causes.   Even
where mental sensibility is  the  same in both those
classes of people,, the disease is prevented in the latter
by the constant pressure of bodily suffering from la-
bour, cold, and hunger.  These  present evils defend
their minds from such as are past and anticipated, and
these are the principal causes of madness."
   To the lunatics in the  Pennsylvania hospital Dr.
Rush paid, for many years, the  most pointed atten-
tion. From his own accurate observations,  and those 
43
which had been made by others in the old European
establishments of a similar nature, he deduced a the-
ory, " that the cause of madness is  seated primarily
in the blood vessels  of the brain, and that it depends
upon the  same kind of morbid and irregular actions
that constitutes other arterial diseases.   There is no-
thing specific in these actions. They are a part of the
unity of disease, particularly of fever, of which mad-
ness is a chronic form, affecting that part of the brain
which is the seat of the mind." In conformity to this
theory, he prescribes for the mental disease common-
ly called the hypochondriasis, but by him tristimania,
blood-letting, if the pulse be tense or full, or depressed
without either fullness or  tension;  and  also active
purgatives,  particularly aloes, jalap, and calomel, and
emetics.  These, by exciting the stomach and bowels,
often remove morbid excitement from the brain, and
thus restore the  mind to its healthy state.
    A reduced diet, consisting of food  and drinks
that contain but little nourishment.  After reducing
the action of the blood vessels to a par of debility
with the nervous system, he advises stimulating ali-
ments, drinks, and medicines. The  diet should con-
sist of solid animal food, with such vegetables  as are
least disposed to acidity, and both should be rendered
palatable  by condiments. 
44
    Frictions to the  trunk  of the body and limbs.
 Exercise, or rather labour in the open air. The ex-
 citement of pain.
    Salivation.—^Mercury acts in this disease:  1st, by
 abstracting morbid excitement from the brain to the
 mouth: 2d, by removing visceral obstructions;  and
 3d, by changing the cause of our patient's complaints
 and fixing them wholly upon his sore mouth. Blisters
 and issues.
    In addition to these remedies, intended to act di-
 rectly on the body, Dr. Rush recommends a variety
 of others which are intended to act through the me-
 dium of the mind.  These  are so various, as being
 adapted to the countless vagaries of this whimsical
 disease, that they cannot be abridged for the present
occasion. For them I therefore refer you to the book
itself.
   Dr. Rush divides general madness into three states:
Mania, Manicula, Manalgia.  In attempting the cure
 of mania, which is the highest grade, he recommends
to the physician, " when he enters the cell or chamber
 of his deranged patient, to catch his eye, and look him
 out of countenance.  The dread of the eye was early
 imposed upon every beast of the field:  the tiger, the
 mad bull, and the enraged dog, all fly from it. Now
 a man deprived of his reason, partakes so much of the
 nature of those animals, that  he is for  the most part 
45
easily terrified or composed by the eye of a man who
possesses his reason.  A great effect is produced by
looking the patient out of countenance,  with a mild
and steady eye, and varying its aspect from the high-
est degree of sternness down to the mildest degree of
benignity, for there are keys in the eye which should
be suited to the state of the  patient's mind."  This
experiment  has been long successfully tried by Dr.
Rush, and witnessed by hundreds of pupils, and se-
veral of the managers of the Pennsylvania hospital.
   " The countenance of a  physician should assist
his eye and voice in governing his deranged patient.
It should be accommodated to the state of the patient's
mind and conduct. There is something like contagion
in the different aspects of the human face, and mad-
men feel it in common with other people.
   " The conduct of a physician to his deranged pa-
tients should be uniformly dignified, if he wishes to
acquire their obedience and respect.  He should hear
with silence their rude or  witty answers to his ques-
tions, and  upon no account ever  laugh at them or
with them.
   " A physician should treat them with respect, and
with all the ceremonies which are due to their former
rank and habits of living, and endeavour to acquire
their obedience and affections by acts of kindness. 
                        46
    " If all the means that have been mentioned should
 prove ineffectual to establish  a government over de-
 ranged  patients, recourse should be  had to certain
 modes of coercion, such as confinement by means
 of a strait waistcoat or of a chair contrived for the
 purpose.
    " Privation of their customary pleasant food.
 Pouring cold water under the coat sleeve, so that it
 may descend into the armpits and down the trunk of
 the body.  The shower bath  continued for fifteen or
twenty minutes.  If all these modes of punishment
should fail of their intended effect,  it will be proper
to resort to the fear of death.  By the proper appli-
cation of these mild and terrifying modes of punish-
ment, chains will seldom, and the whip never be re-
quired to govern mad people."
   For the cure  of general  mania, Dr. Rush  pre-
scribes blood-letting,  " as this grade of madness is
an arterial disease of great morbid excitement, or in-
flammation in  the  brain.  The bleeding should  be
copious on  the first attack of the disease.  From
twenty to forty ounces of blood may be taken at once,
unless fainting be induced before  that quantity be
drawn.  It will do most service if the patient be bled
in a standing posture.  The effects of this early and
copious  bleeding  are wonderful in calming mad 
47
people.  It often prevents the necessity of using any
other remedy, and sometimes it cures in a few hours.
    " The quantity of blood drawn should be greater
than in any other organic disease.  This is indicated
by the strong and uncommon hold which the disease
takes of the brain.  In the progress of the disease he
recommends  solitude; darkness; an erect position of
the body;  low diet; purges;  emetics; nitre; blisters;
cold, in the form of air, water, and ice;  a salivation;
(too much cannot  be said in its  favour in general
madness);  opium;  digitalis;  camphor;  the shower
bath: this excellent remedy acts upon the head, by
the stimulus arising from the weight and momentum
of the water,  and by the reaction of the blood vessels
after the sedative effects of the water are over.   It
should be used two or three times a day."
    Dr. Rush also recommends another class of pre-
scriptions, which act upon the body through the me-
dium of the mind.
    The first remedy under this head is, "to divert
the ruling passion, or subject which occupies  the
mind, if it be one, and fix it upon some other.  No-
thing effectual can be done without great attention to
this direction.
    " Great care  should  be  taken by a physician to
suit his conversation to the different and varying
states of the minds of his patients in this disease. In 
                       48
its furious state they should never be contradicted,
however absurd their opinions and assertions may be,
nor should we deny their requests by our  answers,
when it is improper to grant them.
   " The cure of mental and bodily disease is to be
effected by the same means.  We first reduce the
system, then create revulsive actions, and finally re-
move subsequent debility or feeble morbid actions
by stimulating remedies.
   " The return of regularity and order in the ope-
rations of the mind will be much aided, by obliging
mad people to read with an  audible voice,  to copy
manuscripts, and to commit interesting passages from
books to  memory. By means of the first their atten-
tion will be more  intensely fixed upon one subject
than by conversation.
   " Terror acts powerfully upon the body through
the medium of the mind, and should be employed in
the cure of madness.   A fall down a steep ridge has
cured a mania of twenty years' continuance.
   " Manicula differs from mania as being accompa-
nied with a more  moderate degree of the same symp-
toms. The remedies for this grade of madness should
be the same in its inflammatory state as for mania,
but of less force.
    " The symptoms of manalgia, the third and last
form of general madness,  are taciturnity, downcast 
49
looks, a total neglect of dress and person, long nails
and beard, dishevelled or matted hair, indifference to
all surrounding objects, insensibility to heat and cold.
    " The remedies for it are cordial food and drinks.
The former  should be made savory and grateful to
the taste, and the stimulus from the pleasure impart-
ed by it should be increased by its variety.
    " The warm bath.—The water should be heated
above the  natural temperature of the body, in which
state it acts powerfully upon the arterial system.
    " The cold shower bath.—The impulse imparted
to the head by the descent of the water  upon it, adds
very much to its efficacy.
    " The cold shower bath in succession to the warm
bath.—This, by giving a most powerful shock to the
system, has restored reason.
    " A caustic applied to the back of  the neck, or
between the  shoulders, and kept  open for  months
or years.
    " A salivation.—This, when it can be effected,
seems to resuscitate the mind.   Two instances oc-
cured in the Pennsylvania hospital, in which a taci-
turnity of a year's continuance  was removed by it.
Speech was excited in one of them on the very day
on which  the mercury affected  the mouth, and the
>ise of reason followed in a few days afterwards,
                        o 
                       50
    " Exercise, or rather labour, which has several ad-
vantages over exercise, in being not only more stimu-
lating, but more durable in its effects,  whereby it is
more calculated to arrest wrong habits of action, and
to restore such as are regular and natural.
    " Errhines.—-These are suggested by the general
absence of secretion in the nose in mad people, and
by the relief which the discharge of a few drops of
tears affords in tristimania.
    " Opium: iron: the datura strammonium: strong
infusions of green tea and green coffee:  garlic:  vale-
rian: the nitrous oxyd, and electricity,  have all been
administered in the Pennsylvania hospital, and some
of them for several months, but never in a single in
stance with success when given alone. They may be
given as auxiliaries to those more powerful and ra-
tional remedies which agitate the whole body and
mind."
    On a review of the improvements made by Dr.
Rush, it appears that a free use of the lancet, in almost
every case,  and particularly  in some in which it had
rarely or never before been used, was one of his first
and most common prescriptions.  Let  us hear him
pleading his own cause in his ingenious and able de-
fence of  bleeding. This is founded on his theory of
fever.  Let us review them both as being fundamen-
tal to his system.   We will then view  his improve- 
51
 ments in the practice of physic as they ought to be,
 not as the effect of accident, but as resulting from
 principles  growing out  of accurate observations  of
 the animal economy, both in its sound and morbid
 state, carefully  combined and compared with  each
 other.  In his theory of fever, he premises, " that
 fevers of all kinds are preceded by general debility,
 natural or accidental.  From this a sudden accumu-
5 lation of excitability takes place, whereby a predispo-
 sition to fever is created.  Depression of the whole
 system follows,  and where the stimuli, whether mor-
 bid  or  natural,  are continued,  reaction is induced^
 and in this reaction, according to its  greater or less
 force and extent consist the different degrees of fever.
 It is of an irregular or a convulsive nature.  In  com-
 mon cases it is  seated primarily in the blood vessels,
 and particularly in the arteries,  which pervade every
 part of the body.
     "All diseases are preceded  by debility. There is
 but one exciting cause of fever, and that is stimulus;
 and that consists  in  a preternatural  and convulsive
 action of the blood vessels. All the supposed variety
 of fevers have but one proximate cause, and that is
 morbid excitement.  All ordinary fevers being seated
 in the blood  vessels, it follows, of course, that  all
 those local affections, we call pleurisy, angina, phre-
 hitis, internal dropsy of the  brain,  pulmonary con- 
52
 sumption, and inflammation of the liver, stomach,
 bowels, and limbs, are symptoms only of an original
 and primary disease in the sanguiferous system."
    The artificial division of fever into genera and spe-
 cies is rejected by our professor for the following rea-
 sons:  " Much mischief has been done by nosological
 arrangements of diseases—they erect imaginary boun-
 daries between things which are of a homogeneous
 nature—they degrade the human understanding, by
 substituting simple perceptions to its more dignified
 operations in judgment and reasoning—they gratify
 indolence  in a physician, by fixing his attention upon
 the name of a disease, and thereby leading him to ne-
 glect the varying state of the  system—they moreover
 lay a foundation for disputes among physicians—the
 whole materia medica is infected  with  the baneful
consequences of the nomenclature of diseases; for
 every article in it is pointed only against their names,
 and hence the origin of the numerous contradictions
 among authors who describe the virtues and doses of
 the same medicines.  By the rejection of the artificial
 arrangement of diseases a revolution must follow in
 medicine.  Observation and judgment will take the
 place  of reading and  memory,  and prescriptions will
 be conformed to existing circumstances."
    Dr. Rush remarks that "morbid action  in the
 blood vessels  constitutes fever, and that excess in 
53
the force and frequency in the pulsations of the arte-
ries has been  considered as the characteristic mark
of what is  called inflammatory fever. He then enu-
merates eleven usual effects of fevers or morbid ex-
citement in the blood vessels,  when not removed by
medicine, and also the following thirty-seven differ-
ent states of  fever. 1. The malignant. It constitutes
the highest grade of morbid diathesis. It is known by
attacking frequently without a chilly fit, by coma, a
depressed, low, or intermitting pulse, and sometimes
by the absence of pain, and with a natural tempera-
ture or coldness of the skin.
    2.  The gangrenous state of fever.  3. The syno-
cha, or the common inflammatory state of fever. 4.
The synochus state of fever, known by a full, quick,
and round pulse, without tension. 5. The synochula
state of fever, in which the pulse  is small but tense
and quick. The patient, in this  state of fever, is
seldom confined to his bed.
    6.  The synochoid state of fever, which inclines
more to the synocha  than what  is called the typhus
or chronic state of fever.
    7. The typhus state of fever is generally prece-
ded by all  those circumstances which debilitate the
system, both by the action and abstraction of stimuli.
The common name of this state of fever is the nervous
fever. This name is improper, for it invades the ner- 
54
 vous system much less than several other  states of
 fever. To prevent the absurd and often fatal associa-
 tion of ideas upon the treatment of this state of fever,
 it should be called, from its duration, the low chronic
 state of fever.
    8. The typhoid state of fever is composed of the
 synocha and low chronic states of fever.
    9. The  hectic state of fever  differs from  all the
other states of fever,- by the want of regularity in its
paroxysms,  in  which chills,  fevers, and  sweats are
included, and by the brain, nerves,  muscles, and ali-
mentary canal being but little impaired in  their func-
tions by it.
    10.  Intermissions.  The intermittent and remit-
ting states of fever are common to all the states of
fever which have been mentioned: but they occur
most distinctly  and universally in those which par-
take of the bilious diathesis.
    11. There is a state of fever in which the morbid
action of the blood vessels is so feeble  as scarcely to
be perceptible.  Like the hectic state of fever, it sel-
dom affects the brain, nerves, muscles, or  alimentary
canal. It is known in the southern states of America
 by  the name of inward fevers.
    These eleven states of fever may be considered
as primary in their nature. All the states  which  re-
main to be enumerated belong to some one of them, 
55
or they are compounds of two, three, or more of
them.
    12.  The  sweating  state of fever occurs in the
plague, in the yellow fever, in the small pox, the
pleurisy, the rheumatism,  and in the hectic and in-
termittent states of fever.
    13.  The fainting state of fever accompanies the
plague, the yellow fever, the  small-pox, and  some
states of pleurisy. It is the effect of great depression.
    14.  The burning state of fever has given rise to
what  has  been called  a species of fever. It is the
causus of authors.
    15. The cold and chilly state of fever differs from
a common chilly fit by continuing four or five days,
and to such a degree that the patient frequently can-
not bear his arms out of the bed.
    16.  The intestinal state of  fever. It includes the
cholera morbus, diarrhoea, dysentary, and colic. The
remitting bilious fever appears in all the above forms
in the summer months.
    17.  The  pulmonary state  of fever includes the
true and bastard pneumony in their acute forms; also
catarrh  from   cold  and influenza, and  the  chronic
form of pneumony in what is called pulmonary con-
sumption.
    18. The eruptive state of fever includes the small-
pox, measles, erysipelas, miliary fever, and chicken-
pox. 
                       56
    19.  The anginose state of fever includes all those
affections of the throat which are known by the names
of cynanche inflammatoria, tonsillaris, parotidea, ma-
ligna, scarlatina, and trachealis.
    20.  The rheumatic state of fever is confined
chiefly to the labouring part of mankind. The topical
affection is seated most  commonly in the  joints and
muscles.
    21.  The arthritic, or gouty state of fever, differs
from  the rheumatic in affecting, with the  joints and
muscles, all the nervous and lymphatic systems, the
viscera and the skin.
    22. The cephalic, in which are included the phre-
nitic,  lethargic, apoplectic, paralytic, hydrocephalic,
and maniacal states of fever.
    23.  The nephritic state of fever is often induced
by calculi; but it frequently occurs in the gout, small-
pox, and malignant states of fever. It is generally
accompanied with a full or  tense pulse,  great pain,
sickness, or  vomiting,  and a pain along the thigh
and leg.
    24.  The  hydropic state  of fever, in which are
included collections of water in the lungs, cavity of
the thorax, cavity  of the abdomen, and lower extre-
mities, and usually preceded and generally accompa-
nied with morbid action in the blood vessels. 
57
   25. The hemorrhagic state of fever, in which are
included discharges of blood from  the nose, lungs,
stomach,  liver,  bowels,  kidneys, and bladder, hae-
morrhoidal vessels, uterus, and skin.
   26. The amenorrhagic state of fever occurs more
frequently than  is suspected by physicians. A  full
and quick pulse,  headach,  thirst, and preternatural
heat often accompany chronic obstructions.
   27. The chronic hepatic state of fever.  The liver
disease of the East-Indies is nothing but  a bilious
fever translated from the blood vessels, and absorbed
or suffocated, as  it were, in the  liver. A chronic
hepatitis scarcely  ever exists but  as a symptom of
general or latent fever.
    28.  The haemorrhoids are frequently a local dis-
ease; but they are  sometimes accompanied with pain,
giddiness, chills,  and an active  pulse. When these
symptoms occur it should be considered as the hae-
raorrhoidal state of fever.
   29.  The opthalmia,  when  it occurs,  as it  fre-
quently does in sickly seasons, with a quick  and
tense pulse,  and pains diffused over the whole head,
may properly be called an opthalmic state of fever.
    30.  The toothach; and,
    31.  Earach, when  they arise from cold, and are
attended  with great heat, a quick and tense pulse,
and  pains in the  head,  are odontalgic and otalgic
states of fever. 
                       58
    $2.  The aptha, from the pain and fever which
attend them, are justly  entitled to the name of the
apthous state of fever.
    33.  The  symptoms of scrophula, as  described
by  Dr. Hardy, clearly prove it  to  be a misplaced
state of fever.
  34. The scurvy has lately been proved  by Dr.
Claiborne to arise from so many of the  causes, and
possesses so many of the symptoms of the  low chro-
nic  and petechial states of fever, that it may be con-
sidered as a state of fever.
    35.  The convulsive or spasmodic state of fever,
Convulsions, it is well known, often usher in fevers,
more especially  in  children:  but the  connexion
between spasmodic affections and fever in adults has
been less attended to by physicians. The same causes
which produced general fever and hepatitis  in the
East-Indies in  some soldiers, produced locked-jaw
in others. By means of blood-letting  and the other
remedies for the violent state  of bilious fever, the
convulsions in  this disease are  translated  from the
muscles to the blood-vessels, where  they immedi-
ately produced  all the common symptoms  of fever.
    36.  The hysterical  and hypochondriacal state of
fever. Both these states of the nervous system occur
frequently in the gout,  and in the malignant state of
fever. It is common to say in such cases that patients 
59
have a complication of diseases, but this is not true;
for the hysterical and hypochondriacal symptoms are
nothing but the effects of one remote cause, concen-
trating its force chiefly upon the nerves and muscles.
   37. The cutaneous state of fever. Dr. Sydenham
calls a dysentery a " febris introversa." Eruptions
of the  skin are often nothing but the reverse of this
introverted fever. They are a fever translated to the
skin,  hence we  find them  most common in  those
countries and seasons in which fevers are epidemic.
The prickly heat, the rash, and the essere of authors
are ail  states of misplaced fever.
    At the end  of  a long dissertation  of sixty-six
pages, explaining and defending his principles, Dr.
Rush " commits the whole to his pupils, to  be cor-
rected and  improved, and concludes with observing,
   " We think our fathers fools so wise we grow.
   Our wiser sons, I  hope, will think us so."
   His " Defence  of blood-letting as a remedy for
certain diseases," grounded on the  preceding theory
of fever, occupies eighty-six  pages in his fourth
volume.  He therein states, that "blood-letting,  in
violent fevers, when used at a proper  time, and  in
quantity  suited to the force of the disease, frequently
strangles a  fever,  when used in its forming state, and
thereby saves much pain, time, and expense  to a
patient; and that it  imparts strength to the body, by 
                       60
removing the depression  which is induced by the
remote cause of the fever.
   " It reduces the uncommon  frequency of the
pulse,  and renders  it more frequent when it is pre-
ternaturally slow;  checks the nausea and vomiting
which  attend the  malignant state  of fever; renders
the bowels, when costive, more  easily moved  by
purging physic; renders the action of mercury more
speedy and more certain in exciting a salivation; dis-
poses the body to sweat spontaneously, or renders
diluting and diaphoretic medicines more effectual for
that purpose; suddenly removes a dryness, and gra-
dually,  a blackness from  the  tongue; removes or
lessens pain in every part of the body,  and more
especially in the head;  removes or lessens the burn-
ing heat of the skin, and the burning heat in the sto-
mach, so common and  so  distressing in the yellow
fever; removes a constant chilliness, which sometimes
continues for several days, and which will neither
yield to cordial drinks nor warm bedclothes; checks
such sweats as are profuse without affording relief,
and renders such as are partial and moderate univer-
sal and salutary.  Blood-letting  sometimes checks a
diarrhoea and tenesmus, after astringent medicines
have been given to no purpose.  This has often been
observed in the measles. It suddenly cures the into-
lerance of  light  which accompanies many of  the 
                       61
inflammatory states of fever; removes coma; induces
sleep; prevents effusions of serum  and blood. Hae-
morrhages seldom  occur  where bleeding has been
sufficiently copious.  It prevents the chronic diseases
of cough, consumption, jaundice, abscess in the liver,
and  all the different states  of dropsy which so often
follow autumnal fevers.
   " Bleeding prevents the termination of malignant
in the gangrenous state of fever. It also prepares the
way  for the successful use of the bark and other tonic
remedies, by destroying, or so far weakening a mor-
bid action in the blood vessels, that a medicine of a
moderate  stimulus afterwards  exceeds it in force,
and thereby restores equable and  healthy action to
the system."
   But great and  numerous as the  advantages of
blood-letting are in fevers, there have been many
objections to it. Dr. Rush enumerates and  refutes
them as follows: blood-letting has been forbidden by
physicians by the following circumstances and states
of the system.
   " By warm weather, or being born and  having
lived in a warm climate." To  these he replies that
" he had  never,  in any  year of his practice, been
restrained by the heat  of summer in  the use of the
lancet, where the pulse indicated  it to be necessary,
and that he always found  the same  advantages from 
                       63
it  as when he had prescribed  it in the  winter  or
spring months; but at the same time concedes that
he does not defend its  use to the same extent, as to
diseases or to quantity, in the native and long settled
inhabitants of hot climates  as  in persons who have
recently migrated to them, or  who  live in climates
alternately hot and cold.
   Great  apparent weakness.  This, in  acute and
violent fevers is always from a depressed state of the
system. It resembles, in so many particulars, that
weakness  which is the  effect of the abstraction of sti-
mulus, that it is no wonder they have been confound-
ed by physicians. The same  symptoms sometimes
arise  from opposite states-of the system, and occur
equally from repletion and inanition. The natural re-
medy for  the former is depletion, and  no mode of
depleting  is so effectual or safe as blood-letting. When
a  fever of great morbid  excitement affects persons
of delicate constitutions, and such as have long been
subject to debility of  the chronic kind,  there is in
this state  of the system  the same morbid and pre-
ternatural action in the blood vessels that there is in
persons of robust habits, and the same remedy is ne-
cessary to subdue it  in both cases.  It is sometimes
indicated  in a larger  quantity in  weakly than in
robust people, by the plethora which is more easily
induced in their relaxed  and yielding blood vessels, 
63
and by the greater facility with which ruptures and
effusion take place in their viscera. Vomits, purges,
sweats, and other evacuating  remedies are preferred
to bleeding in weakly constitutions, by some physi-
cians;  but bleeding is not  only more effectual, but
more safe, in such habits, than any other depleting
remedy.
    Infancy and childhood. This is so far from being
an objection  to bleeding, that the excitable state of
the blood  vessels in those periods of life renders it
peculiarly necessary in their inflammatory diseases.
    Old age. The increase of appetite in old people,
their inability  to use  sufficient  exercise, whereby
their blood vessels become relaxed, plethoric, and ex-
citable, and above all, the translation of the strength
of the muscles to the arteries, and of  plethora to the
veins,  all  indicate bleeding  to be more  necessary,
in equal circumstances, in old than in middle aged
people.
    Pregnancy. The inflammation and distention in-
duced upon the uterus, directly, and indirectly upon
the whole system,  by pregnancy, renders bleeding
in the  acute states of fever then more necessary than
at other times.
    Coldness of  the extremities and of the  whole
 body.  This cold  state of fever, when it occurs early,
 yields more readily to bleeding than to  the most
cordial medicines. 
64
     The long duration of fever. Inflammatory diathe-
 sis is often protracted for many weeks in the chronic
 state of fever. It moreover  frequently revives after
 having disappeared from an accidental irritant affect-
 ing some  part of the body,  particularly the lungs
 and brain. The pulmonary consumption is often  the
 effect of a chronic fever terminating with fresh inflam-
 matory symptoms by effusions in the lungs. It may
 easily be prevented by forgetting the number of  the
 days of the patient's fever, and treating the pulmona-
 ry affection as if it were a recent complaint.
    Objections are made by some to bleeding after the
 fifth or seventh day in a pleurisy.  This prohibition
 was introduced into medicine at a time when a fear was
 entertained of arresting the progress of nature in pre-
 paring and expelling morbific matter from the system.
 Dr. Rush asserts,  from repeated experience, that
 " bleeding is safe in every stage of pleurisy in which
 there is  pain and a tense and oppressed pulse, and
 that it has, when used for the first time after the fifth
 and seventh days, saved many lives. Bleeding  has
 likewise been limited to a certain number of ounces
 in several states  of fever. If the force of the remote
 cause of a fever, its degrees of violence,  and  the
habits of the subject of it were always the same, this
rule would be a  proper  one; but  this not being the
case, we must be governed wholly by the condition
of the system, manifested chiefly by the state of the 
65
 pulse. To admit of copious bleeding in one state of
 fever, and not in another, under equal circumstances
 of morbid excitement, is to prescribe  for its name
 and to forget the changes which climate, season, and
 previous habits create in all its different states.
    The loss of a sufficient quantity of blood is often
 prevented by patients being apparently worse after
 the first or second bleeding. This  change  for  the
 worse, is occasioned by  the system rising suddenly
 from  a state of extreme depression,  to a state of
 vigour and  activity; but the symptoms consequent
 thereon are  so  far from  forbidding, that they most
 forcibly indicate a repetition of blood-letting, and can
 in no other way be so readily and effectually removed.
    Bleeding has been charged with being a weaken-
 ing remedy. It is  so, and  in this  its  merit chiefly
 consists. The excessive  morbid action  of the blood
 vessels must be partially subdued in a  fever,  before
 stimulating remedies can be given with safety or  ad-
 vantage. Now, this is usually attempted by depleting
 medicines, or it is left to time and nature, all of which
 are frequently either deficient or excessive in their
 operations.  On the contrary, bleeding,  by suddenly
 reducing the morbid action  of the blood vessels to a
 wished-for point of debility, saves a great and unne-
 cessary waste of excitability, and thus prepares  the
body  for the exhibition  of such cordial remedies as
                         i 
                        66
are proper to remove the debility which predisposed
to the fever.
    It has been said that bleeding renders the habitual
use of it necessary to health and life. This objection
to blood-letting  is founded upon an ignorance of the
difference between the healthy and morbid action of
the blood vessels. Where blood  is drawn in health,
such a relaxation is induced in the blood vessels as to
favour the formation of plethora,  which may require
habitual bleeding to remove it; but where blood is
drawn only in the inflammatory  state  of fever, the
blood vessels are reduced from a morbid degree o!
strength to that which  is  natural, in which  state no
predisposition to plethora is created, and no founda-
tion laid for periodical blood-letting.  But there are
cases which require even this evil to be hazarded, to
prevent a greater.
    Bleeding has been accused of bringing on an in-
termittent fever.  This is a new argument in its favour;
for when it produces that state of fever, it converts «
latent and perhaps a dangerous disease into one that
is obvious to the senses, and under the dominion of
medicine.
    It has been  said that bleeding, more especially
where it is copious, predisposes to effusions of serum
in the lungs, chest,  bowels, limbs, and brain.  In re-
plying to this objection, the eloquent professor Rush 
67
addressed his pupils in the following language: "Ask
the poor patients who come panting to the door of our
hospital, with swelled legs and hard bellies, every fall,
whether they have been too copiously bled, and they
will all tell you that  no lancet has come near their
arms.  Ask  the parents who still mourn the loss  of
children, who have died in  our city  of the internal
dropsy of the brain, whether they were destroyed by
excessive blood-letting?  If the remembrance of the
acute sufferings which  accompanied  their sickness
and death will  permit these  parents to speak, they
will tell you that every medicine except bleeding had
been tried to no purpose in their children's diseases.
Go to those families in which  I have practised for
many years, and inquire whether there is a living  or
a dead instance of dropsy having followed in  any one
of them the use of my lancet?  Let the undertakers
and grave-diggers bear witness against me if I have
ever, in the course of my practice, conveyed the body
of a single dropsical patient into their hands by ex-
cessive blood-letting?  No—dropsies  like abscesses
and gangrenous eruptions upon the skin, arise in most
cases from the want of sufficient bleeding in inflam-
matory diseases. Debility, whether induced by action
or abstraction,  seldom disposes to effusion. Who
ever heard of dropsy succeeding famine?  And how
rarely do we see it accompany the extreme  debility
of old age?" 
                       68
    " If ever bleeding kills**' says Botallus, either
directly or indirectly through the instrumentality of
other diseases, " it is not from its excess, but because
it is not drawn in a sufficient quantity,  or  a proper
time." And again says this  excellent  writer, " one
hundred thousand men perish from the want of blood-
letting, or from  its being used out of time, to one
who perishes from too much  bleeding prescribed by
a physician."
    Evacuating remedies of another kind have been
said to be more safe than bleeding, and equally effec-
tual in reducing  the inflammatory state of fever. Dr.
Rush enumerates each of these evacuating remedies,
and then draws a comparative view of their  effects
with blood-letting.  " They are—vomits, purges,
sweats, salivation, and blisters.
    Vomits have often been effectual in curing fe-
vers of a mild character, but they are  uncertain in
their operation, from the torpor induced by the fever
upon the stomach.  They are unsafe in many condi-
tions of the system, as in pregnancy, and a disposition
to apoplexy and ruptures.  They  are not subject to
the control of a physician, often operating  more  or
less than was  intended by him, or indicated by the
disease. They are often ineffectual in mild, and always
so in fevers of great morbid action. 
69
   Purges are useful in discharging acrid fasces and
bile from the bowels in fevers.  They act, moreover,
by creating an artificial weak part, and thus invite
morbid excitement  from the  blood vessels to the
bowels. But, like vomits, they are uncertain in their
operation, and from the same cause.  Many ounces
of salts and castor-oil,  and whole drachms of calomel
and  jalap have  often been given without effect,  to
remove the costiveness which is connected  with the
malignant state of fever.  They are not subject to the
direction of a physician with respect to the time of
their operation,  or the quantity or quality of matter
they are intended to discharge from  the bowels.—
They are  unsafe in the  advanced stage of fevers.
Death, in several instances, has succeeded a  plentiful
spontaneous stool in debilitated habits.
    Sweating was introduced into practice at a time
when morbific matter  was supposed to be the proxi-
mate cause of fever. It acts, not by expelling any
thing exclusively morbid from the blood, but by ab-
stracting a portion of its fluid parts, and thus reducing
the action  of the blood vessels.  But sweating reme-
dies are uncertain; large and repeated doses of them
being often given to no purpose. They are  slow and
disagreeable where they succeed  in  curing fever.
Like vomits and purges, they are not under the
direction of a physician, with respect to the quantity 
70
 of fluid discharged by them. They are sometimes,
 even when most profuse, ineffectual in the cure of
 fever.
    None of these objections to sweating remedies
 are intended to dissuade from their use, when nature
 shows a disposition to throw off a fever by the pores
 of the skin; but even then, they often require the aid
 of bleeding to render them effectual for that purpose.
    Mercury, the Sampson of the materia medica, has
 lately added to its reputation by overcoming the in-
 flammatory and malignant state of fever. When it acts
 by exciting a salivation, from half a pound to two
 pounds of fluid  are  discharged by it in a day. The
 depletion in this way is gradual,  whereby fainting is
 prevented. By exciting and  inflaming the glands of
 the mouth and throat, excitement and inflammation
 are abstracted from more vital parts. In morbid con-
 gestion and excitement in the brain, a salivation is of
 eminent service, from the proximity of the discharge
 to the part affected. But it ought not to be depended
 upon as an exclusive evacuant in the cure of fever.
 Because it is sometimes impossible by the largest
 doses of mercury to excite it when the exigencies of
 the system render it most necessary.  Because it is
 not so quick in its operation as to be proportioned to
 the rapid progress of the malignant  state of fever.
Because it is at all times a disagreeable and frequently 
71
a painful  remedy, more especially where the teeth
are decayed.  Because it cannot be proportioned in its
duration, or in the quantity of fluid discharged by it,
to the violence or changes in the fever.
   Blisters are useful in depleting from those parts
which are the seats of topical inflammation, but their
effects in reducing the morbid and excessive action
of the blood vessels are very feeble.  To depend upon
them in cases of great inflammatory action, is as un-
wise as it  would be to attempt to bale the water from
a leaky and sinking ship by the hollow of the hand,
instead of discharging it by two or three pumps.
   Abstemious  diet has sometimes been prescribed
as a remedy for fever. It can  bear no proportion in
its effects  to  the rapidity and violence of an inflam-
matory fever. In chronic fever, such as occurs in the
pulmonary consumption, it has often been tried to no
purpose.  Long before it reduces the  pulse, it often
induces such a relaxation of the tone of the stomach
and bowels as to accelerate death.
   Bleeding  has great advantages over every mode
of depleting  that has been mentioned.  It  abstracts
one of the exciting  causes, viz.—the stimulus  of
the blood  from  the seat of fever.  Blood-letting is
quick in its operation, and may be accommodated to
the rapidity of fever, when it manifests itself in apo-
plexy, palsy, and syncope. It is under the command 
                        72
 of a physician.  He may bleed when and where he
 pleases, and may suit the quantity of blood he draws
 exactly to the condition of his patient's system.  It is
 a more delicate depleting remedy than most of those
 which  have been  mentioned, particularly vomits,
 purges, and a salivation.  There  is no  immediate
 danger to life from  its use. Patients have  sometimes
 died under the operations of vomits and purges; but
 no instance can be produced of a patient's dying in a
 fainty fit, brought on by bleeding.  It is less weaken-
 ing, when used to the extent that is necessary to cure,
 than the same degrees  of vomiting, purging,  and
 sweating.  Convalescence is more  rapid,  and more
 perfect  after bleeding, than after the successful  use
 of any of the other evacuating remedies. By making
 use of ^blood-letting in  fevers,  we are not preclud-
 ed from the benefits of the other  evacuating  reme-
 dies.  Some of them are rendered more certain  and
more effectual by it, and there are cases of fever in
 which the combined or successive application of them
all is barely sufficient to save life.   To rely upon  any
one evacuating remedy to the exclusion of the others,
is like trusting to a pair of oars in a sea voyage, in-
stead of spreading every  sail of a ship.
    What quantity of blood may be taken with safety
from a patient in an inflammatory fever? In a person
of an ordinary size, there are supposed to be contained 
73
between twenty-five and  twenty-eight  pounds  of
blood. Much more  blood  may  be taken when the
blood vessels are in a state  of morbid excitement and
excitability, than at any other time. One of the uses
of the blood is to stimulate the blood-vessels, and
thereby to assist in originating and preserving animal
life. In a healthy state of the vessels, the whole mass
of the blood is necessary for this purpose, but in their
state of morbid excitability, a much less quantity of
blood than what is natural is  sufficient to keep up an
equal and vigorous circulation.
    An ignorance of the quantity of blood which has
been  drawn by design, or lost by accident, has con-
tributed  very much to encourage prejudices against
blood-letting.  Mr.  Cline  drew three hundred and
twenty ounces of blood in twenty days from a patient
in St. Thomas's hospital, who laboured under a con-
tusion of the head.  Dr. Haller mentions one person
who lost nine pounds of blood*,  a second twelve, a
third  eighteen, and  a  fourth twenty-two, from the ^
nose,  at  one time.  A fifth lost twelve  pounds  by  x
vomiting, in one night; and a sixth twenty-two from
the lungs. A gentleman at Angola lost between three
and four pounds daily from his nose;  to cure it he
was bled ninety-seven times in  one year. A young
woman was bled  one thousand and twenty times in
nineteen  years, to cure her of plethora,  which dis-
                        x 
                       74
posed her to hysteria. Another young woman lost one
hundred and twenty-five ounces of blood by a natural
haemorrhage every month; to cure it, she was bled
every day or every other day for fourteen months. In
none of these instances was death the consequence of
these great evacuations of blood. On the contrary,
all the persons alluded  to recovered. Many similar
instances of the safety, and even benefit of profuse
discharges  of blood, by nature and art,  might  be
mentioned from other authors.
    An ignorance of the rapid manner in which blood
is regenerated  when lost  or drawn, has  helped to
keep up prejudices against blood-letting.  A person
(Dr. Haller says) lost five pounds of blood daily from
the haemorrhoidal  vessels, for  sixty-two  days; and
another seventy-five pounds of  blood in ten days.—
The loss each day was supplied by fresh quantities of
aliment.
    These facts are sufficient to establish  the  safety
and advantages of plentiful blood-letting, in cases of
violent fever, and also to show the fallacy and danger
of that practice which attempts  the cure of such cases
of fever, by what is called moderate  bleeding.  It is
better not to bleed at all, than to draw blood dispro-
portioned in quantity to the  violence of  the fever. If
the state of the pulse be our guide, the continuance
of its inflammatory action, after the loss of even one 
                       75
hundred ounces of blood, indicates the  necessity of
more bleeding, as much as it did the first time a vein
was opened. In the use of this remedy, it may be truly
said, as in many of the enterprises of life, that nothing
is done while any thing remains to be done. Bleeding
should be repeated while the symptoms which first
indicated it continue, should it be until four fifths of
the blood contained in the body  are drawn away. In
this manner we act in the  use of other medicines.
Who ever leaves off giving purges in a colic attended
with costiveness, before the bowels are opened?
    In drawing blood, the quantity should be large
or small at a time, according to the state of the sys-
tem.  In  fevers and other diseases, which  run their
courses in a few days or hours, and which threaten
immediate dissolution,  there can be no limits fixed
to the quantity  of blood which may be drawn at once,
or in a short time;  but in chronic states of fever of
an  inflammatory type, small  and frequent bleedings
are to be  preferred to large ones. We use  mercury,
antimony, and diet drinks as alteratives  in  many
diseases with advantage. We do not expect to remove
debility by two or three immersions in a cold bath.
We persist with patience in prescribing all the above
remedies  for months and years before we expect to
reap the full benefits of them.  Why should not blood- 
76
 letting be used in the same  way and  have the same
 chance of doing good.
    Bleeding from an artery, commonly called arte-
 riotomy, would probably have many advantages over
 venesection, could it be performed  at all times with
 ease and safety.
    Besides  the  cases already mentioned,  there arc
 several others in which bleeding is proper.  It is
 generally so  in madness, which is the effect of a chro-
 nic inflammation of the brain, and it  is generally so
 in pregnancy and parturition.  In the latter case it not
 only lessens  the pains of delivery, but prevents after-
 pains, favours  the easy and healthy secretion of milk,
 prevents sore breasts, swelled legs, puerperile fevers,
 and all the distressing pain of anomalous complaints
 that often follow child bearing.
    Though  bleeding is so extensively useful, yet
 there are many cases in which it is improper. It is
 forbidden in  that state of fever,  as  well as in other
 diseases, in which there  is reason to believe the brain
 or viscera are  engorged with blood,  and the whole
 system prostrated below the  point of  reaction.  The
 pulse in these cases is feeble, and sometimes scarcelv
 perceptible,  occasioned  by the quantity of blood in
 the blood vessels being reduced,  in consequence of
the stagnation of large portions of it in the viscera. By
bleeding in these cases we  deprive the blood vessels 
77
of the feeble remains of the stimulus, which keep up
their action, and thus precipitate death.
    It is seldom  proper beyond the third day in  a
malignant fever,  if it  has not been used on the day
previous to it.  Even the tension of the pulse  is not
always a sufficient warrant to bleed, for in three days,
in a fever which runs its course  in five  days, the
disorganization of the viscera is  so complete  that a
recovery is scarcely to be expected from the lancet.
The remedies which give the only chance of relief in
this case are purges, blisters, and a salivation.
    Where  fevers  are  attended with  paroxysms,
bleeding should be omitted, or used with great  cau-
tion in the close of those paroxysms. Bleeding is for-
bidden, or should be used cautiously in that malignant
state of fever in which  a weak morbid action takes
place in the blood vessels.  It is known by a weak and
frequent pulse, such as occurs  in the typhus fever,
and is  often met with in the malignant sore  throat,
and occasionally in the pleurisy and yellow fever.
    It should be  used sparingly in the  diseases  of
habitual drunkards. The morbid action in such per-
sons, though often violent, is generally transient.  It
may be compared to a soap bubble. The arteries  by
being often overstretched by the stimulus of strong
drink, do not always contract with the diminution of 
                        78
 blood, and such patients often sink from this cause,
 in consequence of the free use of the lancet.
   It has been forbidden after the suppurative process
 has begun in local inflammation. It should be onrtted
 in pneumony after copious expectoration  has  taken
 place.  The lancet can only be required where great
 pain in coughing and a tense  pulse attend this last
 stage of the disease.
    It  may  be omitted (except when the blood ves-
 sels are insulated)  in those diseases  in which there is
 time to wait, without danger to life  or future health,
 for the circuitous operation of purging  medicines, or
 abstemious  diet.  It should be avoided when  it can
 be done without great danger to life, where there is a
 great and constitutional dread of the operation.
   There are cases in which sizy blood should not
warrant a repetition of blood-letting. In some  of the
fevers of our own country, we sometimes see sizy
blood followed by symptoms which forbid the repeat-
 ed use of the lancet, but which yield to other depleting
remedies, or to such as are of a cordial nature.
   Even a tense pulse does not always call for the
 repeated use of the lancet.  There are instances of in-
 curable consumptions, from tubercles  and ulcers in
the lungs, in which the pulse cannot be made to feel
the least diminution of tension by either copious or
frequent bleedings.  There are likewise cases of hepa- 
79
tic fever, in which the pulse cannot be subdued by
this remedy. This tense state of the pulse is the effect
of a suppurative process in the liver.  If a sufficient
quantity of blood has been drawn in the first state of
this  disease, there is little danger from leaving the
pulse to reduce or wear itself down by a sudden or
gradual discharge of the hepatic congestion.  The re-
covery in this case is slow, but it is for the most part
certain.
    Lastly—there  is sometimes a tension in the pulse
in haemorrhages, that will not yield to the lancet.
    We now dismiss this subject on which we have
dwelt  uncommonly long.
    Dr. Rush's  fondness for the lancet was objected
to him by many. But his friends consider it as a great
improvement in the treatment  of the serious diseases
most generally prevalent in the United States. On the
correctness of this opinion, his fame as an improver
of medicine, in a great degree,  must eventually rest.*
   * In one of his lectures, Dr. Rush contrasted the nosolo-
gical system of medicine with his simple system, by observing
that the former was like a housekeeper who had a large house
with numerous rooms and closets, and a distinct key for each
of them, while the latter was like a housekeeper who had a
house similarly circumstanced as to rooms and closets, but
with this difference, that he had one key which opened all its
rooms and closets. On the next day when he entered the lec-
ture room, he observed drawn on the wall by one of the class,
a good likeness of Dr. Cullen, with a bunch of keys  in bis 
80
 We have therefore for the most part  used his own
 words in the defence of this practice, though for the
 sake of brevity, we have omitted the  many pleasant
 anecdotes and striking cases by which he  illustrates
 his principles; and for the same reasons we have often
 omitted or shortened the  arguments he adduces in
 support of his principles.
    The year 1793 brought the theories and the na-
 tive strength of Dr. Rush's genius to the test.  Phila-
 delphia was in that year desolated by the yellow fever,
 after it had disappeared for thirty-one years.  This
 baffled the skill of the oldest and most judicious phy-
 sicians. They differed about the nature and treatment
 of it; but, in general, free evacuations were supposed
 to be improper from the depressed  state of the pulse,
 which was a common symptom.  The prevailing fever
 was considered by some as a modification of the influ-
 enza, and by others as the jail fever.  Its  various grades
 and symptoms were considered as so many different
diseases, all originating from different causes. There
was the same contrariety in the practice of the physi-
 cians that there was in  their principles.  This general
calamity lasted for about one hundred  days, extend-

 hands, labelled ClavicuU, and over it a picture of Dr.  Rush
 holding in his hand a lancet labelled Clavis.  The professor
 complimented the ingenuity of his pupil, as rightly compre-
 hending his system, and proceeded to his lecture. 
81
 ing from July till November.  The deaths in the whole
 of this distressing period were four thousand and forty-
 four, or something more than thirty-eight each day,
 on an average. Whole families were confined by it.
 There was a deficiency of nurses for the sick. There
 was likewise a great deficiency of physicians, from
 the desertion of some and the sickness and death of
 others.  At one time there were but three physicians
 who were able to do business out of their houses,
 and at this time there were probably not less than six
 thousand persons ill with the fever.
    A cheerful countenance was scarcely to be  seen
 for six weeks.  The streets every where discovered
 marks of the distress that pervaded the city. In walk-
 ing, for many hundred yards, few persons were met,
 except such as were in quest of a physician, a nurse,
 a  bleeder, or the men who  buried  the  dead.  The
hearse alone kept up the remembrance of the noise of
 carriages or carts in the streets. A black man leading
 or driving a horse with a corpse on  a  pair of chair
 wheels,  met the eye in most of the streets of the city
 at every hour of the day, while the noise of the same
 wheels,  passing slowly over the pavement, kept alive
anguish and fear in the sick and well, every hour of
the night.
    All the physicians, for some time after the com-
mencement of this disease, were unsuccessful in its
                        L 
                       82
 treatment.  Dr. Rush tried, in the first instance, the
 gentle purges used in the yellow fever of 1762; but
 finding them unsuccessful, and observing the disease
 to assume uncommon symptoms of great prostration
 of strength, he laid them aside about the 20th of Au-
 gust, and had recourse to ipecacuanha on the first day
 of the fever, and to the usual remedies  for exciting
 the action of the sanguiferous system, and  gave bark
 in all its  usual forms, and joined wine,  brandy, and
 aromatics with it.   He applied blisters to the limbs,
 neck, and head.  Finding them all ineffectual, he at-
 tempted  to rouse the system by wrapping  the whole
 body in blankets dipped in warm vinegar. He rubbed
 the right side with mercurial ointment, with a view of
 exciting  the action of the vessels in the whole system
 through the  medium of the liver.  None of these re-
 medies appeared to be of any service. Perplexed and
 distressed by his want of success, he waited upon Dr.
 Stevens,  an  eminent and worthy physician from St.
 Croix, who happened then to be in Philadelphia, and
 asked for such advice and information upon the sub-
ject of the disease as  his  extensive practice in the
 West Indies would naturally suggest.   He replied,
 that " he had long ago laid aside evacuations of all
 kinds in  the yellow fever;  that they had been found
 to be hurtful, and that the disease yielded more readi-
 ly to bark, wine, and, above all, to the use of the cold 
83
bath.  He advised the bark to be given in large quan-
tities and in every possible way, and pointed out the
manner in which the cold bath should be used so as
to derive the greatest benefit from it."  These reme-
dies were faithfully applied by Dr. Rush.  Bark was
prescribed by him in large  quantities and in various
ways.   Buckets full of cold water were frequently
thrown upon patients.  The bark was offensive to the
stomach, or rejected by  it  in every case. The cold
bath was grateful, and procured relief in several cases
by inducing a moisture on the skin. But three out of
four of the patients died  to whom the cold bath was
administered in addition  to the tonic remedies before
mentioned.
   The disease had a malignity and an obstinacy never
before observed, and it spread with a rapidity and mor-
tality far exceeding its ravages in the year 1762, when
the yellow fever had last visited Philadelphia.  From
thirty to seventy died every day, though one third of
the inhabitants of the city had  fled into the country.
In this dreadful state of  things, what reward would
be reckoned too great to  the man who should find out
and publish a remedy which would  generally cure
this wasting pestilence?  Heaven, in mercy to the af-
flicted inhabitants, raised up such a man in Dr. Rush.
Well  knowing the numerous  and complicated dis-
tresses which pestilential diseases had often produced 
                       84
in other countries, the anguish of his soul was inex-
pressible.   But he did not despair: he believed that
good was commensurate with evil, and that there did
not exist a disease for which the goodness of  Provi-
dence had not provided a remedy.  Under this im-
pression he applied himself with fresh ardour to in-
vestigate this novel disease. He ransacked his  library
and pored over every book that treated of the  yellow
fever.  The result of his researches, for a while, was
fruitless. The accounts of the symptoms and cure of
the disease, by the authors he consulted, were contra-
dictory, and none of them appeared altogether appli-
cable to the prevailing epidemic. He had among some
old papers a manuscript account of the yellow fever
as it prevailed in Virginia in the year 1741, which was
given to him by Dr. Franklin, and had been written
by Dr. Mitchell of Virginia. This was read with at-
tention. In it a remark was made, " that evacuation
by purges was more necessary in this than most other
fevers, and that an ill-timed scrupulousness about the
weakness of the body was of bad consequence in these
urging circumstances." Solid reasons were given in
support of this opinion, and it was added, " I can af-
firm that I have given  a purge in this case, when the
pulse has been so low that it could hardly be felt, and
the debility extreme; yet both one and the other have
been restored by it."  This single sentence was the 
85
groundwork  of Dr. Rush's subsequent successful
practice.
    From these words a new train of ideas suddenly
broke in upon his mind.  He was led to believe that
the weak and low pulse generally  observed in this
fever, which had hitherto deterred him from the use
of strong evacuating remedies,  was the effect of de-
bility from an oppressed state  of the  system.  His
reasoning powers taught him to distinguish between
this and an exhausted state.*  His fears from large
evacuations were in a moment dissipated.  He adopted
Dr. Mitchell's theory and practice, and resolved to
follow  them.  It remained now only to fix upon a
suitable purge to answer the purpose  of freely dis-
charging the contents of the bowels.   Calomel, in
doses of ten grains, quickened by ten or fifteen grains
of jalap, was preferred.  The effects of this  powder,
especially when repeated according to circumstances,
not only answered but far exceeded his expectations.
It perfectly cured four  out of the  first five patients
to whom he  gave it, notwithstanding some  of them
were advanced several days in the disease.

   * The clown who supposes the crooked appearance of a
 stick when thrust into a pail of water to be real, does not err
 more against the laws of light than that physician  who mis-
 takes the debility which arises from oppression for an ex-
 hausted state of the system, and attempts to  remove it by
 stimulating medicines.—Rush's works, vol. 4, pa$e ns. 
86
    After such a pledge of the safety and success of
 this new medicine, he communicated the prescription
 to such of the practitioners as he met in the streets.
 Some of them he found had been in the use of calo-
 mel for several days, but as they had given it in small
 and single doses only,  and had followed  it by large
 doses of bark, wine, and laudanum, they had done lit-
 tle or no good with it.  Pie imparted the prescription
 to the college of physicians on the third of  Septem-
 ber, and endeavoured to remove the fears of his fel-
 low citizens, by assuring them that the disease was
 no longer incurable.  The credit  it acquired brought
 him an immense accession of business. It continued
 to be almost uniformly effectual in nearly  all those
 cases which  he was able to attend, either in person or
 by his pupils. But he did not rely upon purging alone
 to cure the disease.  The  theory of it which he had
 adopted, led him  to use  other remedies to abstract
 excess of stimulus from  the system.  These were
blood-letting, cool air, cold drinks, low diet, and ap-
plication of  cold water to  the body.  He began bv
drawing a small quantity of blood at a time.  The ap-
 pearance of  it when drawn, and  its effects upon the
 system, satisfied him of its safety and efficacy, and en-
 couraged him to proceed.  Never did he experience
 such sublime joy  as he now felt in contemplating the
success of his remedies. It repaid him for all the toils 
87
and studies of his life. The conquest of this formida-
ble disease was not the effect of accident, nor of the
application of a single remedy, but it was the triumph
of a principle in medicine. In this joyful state of mind
he entered in his note-book,  dated the 10th of Sep-
tember—" Thank God!  out of one hundred patients
whom I have visited or prescribed  for this day, I
have lost none."
    Being unable to comply with the  numerous de-
mands which were made upon  him for the purging
powders, notwithstanding he had employed three per-
sons to assist his pupils in putting them up, and find-
ing himself unable to attend all the persons who sent
for him, he furnished the apothecaries with the  re-
ceipt for the mercurial purges,  together with printed
directions for giving them, and for the treatment of
the disease.  Had  he consulted his own interest he
would silently have pursued his own plans of cure
with his old patients, who still confided in him and
his new remedies; but he  felt  at this season of uni-
versal distress, his professional obligations to all  the
citizens of Philadelphia,  to be superior to private and
personal considerations, and therefore determined, at
every hazard, to do every thing in his power to save
their lives. Under the influence of this disposition he
addressed a letter to the  college of physicians, in
which he stated his objections to Dr. Stevens's reme- 
88
 dies, and defended those he had recommended. He
 likewise defended them in the public papers, against
 the attacks that were made upon them by several of
 the physicians of the city, and occasionally addressed
 such advice to the  citizens as experience had sug-
 gested to be useful, to prevent the disease.  In none
 of the recommendations of his remedies did he claim
 the credit  of  their  discovery.  On the contrary, he
 constantly endeavoured to enforce their adoption by
 mentioning precedents in favour of their efficacy from
 the highest authorities in medicine.  This controversy
 was encouraged merely to prevent  the greater evil of
 the depopulation of Philadelphia, by the use of reme-
 dies which had been prescribed by himself as well as
 others, not only without effect, but with evident injury
 to the sick.  The repeated and numerous instances of
 their inefficacy, and the almost uniform success of the
 depleting remedies, after awhile procured submission
 to the latter from nearly all the persons who were af-
 fected by the  fever.
    Many whole families, consisting of five, six, and
 in three instances, of nine members, were  recovered
by plentiful purging and bleeding.* These remedies

  * The  objections that have been made by some to Dr.
 Rush's principles and practice, as leading to an  indiscrimi-
 nate use of the lancet, mercurial purges, and consequent
 salivation, in the treatment of  the yellow  fever and other 
89
were prescribed, with great advantage, by several of
the physicians of the city.  But the use of them was
not restricted to the physicians alone; the clergy, the
apothecaries, many private citizens, several intelligent
women, and two black men prescribed them with great
success. Nay more, many persons prescribed them
to themselves. It was owing to the almost universal
use  of these remedies that the mortality of the disease
diminished  in proportion as the number of persons
who were affected by it increased. It is probable that
not less than six thousand of the inhabitants of Phila-

 dangerous diseases, are without foundation. His system re-
 probates all prescriptions, but those that are founded on their
 suitableness to the present circumstances of the patient. His
 treatment of the yellow fever in twelve successive years is
 distinctly laid down in his works, and is not precisely the
 same in any two years. In a letter dated October 15th, 1803,
 which  the author received from him, Dr. Rush  observes:
 " Our epidemic has been more tractable, than in some former
 years.  I have bled sparingly, purged freely, blistered early,
 (sometimes on the first day) sweated profusely,  with almost
 universal success. The last remedy was suggested to me by
 the moisture which I found upon touching the wrists in my
 frrst visits to my  patients. I have not found  it necessary to
 salivate in a single case. The violent pain and inflammation
 excited on the arms by the blisters,  was a substitute for a
 sore mouth, and happily saved the stomach and brain by a
 new and revulsive action on  the fourth and fifth days."  To
 those who charged Dr. Rush with using strong  mercurial
 medicines for ordinary complaints, he replied " that he was
 not in the habit of destroying musquetoes with  cannon bul-
 lets."
                           M 
                       90
delphia were  saved  from death,  by  purging  and
bleeding during the autumn of 1793.
    The  credit which this new mode of treating the
disease acquired in all parts of the city, produced an
immense influx of patients to Dr. Rush.  His pupils
were constantly employed; at first in putting up purg-
ing powders,  but after awhile only in bleeding and
visiting the sick.
    Between the 8th and the 15th of September Dr.
Rush visited and  prescribed for between a  hundred
and a hundred and  twenty patients  a day. In the
short  intervals  of business,  which he spent at his
meals, his house was filled with patients,  chiefly the
poor,  waiting for advice. For many weeks he seldom
ate without prescribing for numbers as he sat at ta-
ble. To  assist  him,  three of his pupils, Mr. Stall,
Mr. Fisher, and Mr. Cox, accepted of rooms in his
house, and became members of his family. Their la-
bours now had no remission. He employed every
moment in the interval of his visits to the sick, in pre-
scribing in his house for the poor,  or  in sending an-
swers to  messages from his patients. Unable to com-
ply with the numerous applications that were made
to him, he was obliged to refuse many  every  day.
His sister counted forty-seven applicants for medical
aid turned off in one  forenoon before eleven o'clock.
In riding through the streets  he was often forced to 
                        91
resist the entreaties of parents imploring a  visit to
their children, or of children to their parents.  He was
sometimes obliged to tear himself from persons who
attempted to stop him, and to urge his way by driving
his chair as speedily as possible beyond the reach of
their cries.  While he was thus overwhelmed with
business, and his own life endangered without being
able to answer the numerous calls made on  him, he
received letters from  his friends in the country press-
ing him in the strongest terms to leave the city.  To
one of these letters he replied,  " that he had resolved
to stick to his principles, his practice and his patients
to the last extremity."
    Dr. Rush's incessant labours of mind  and body,
by night and by day, nearly cost him his life; but by
bleeding  and purging, under the  direction of Mr.
Fisher, then one of his pupils, but now an eminent
physician of Columbia, in this state, his valuable life
was preserved for twenty-three years' further useful-
ness.
    We have been particular in describing the yellow
fever as it appeared in Philadelphia in 1793. This was
the most eventful year in the life of Dr. Rush.  It laid
a solid foundation for his fame, which will  last till
sin and sickness are no more.   Had the same events
taken place  in the early ages of the Pagan  world, he
would have  been deified; if in  the dark ages of  the 
                        92
 Christian era, he would have been  canonized, and
 worshipped as a saint. His friends in the nineteenth
 century prefer no farther claim on their countrymen,
 than that his meritorious and beneficial services be pro-
 perly appreciated and kept in grateful remembrance.
 But they indulge the hope and belief,  that unborn ge-
 nerations will point to his descendants and say, " there
 is a person in whose veins runs the blood of Dr.
 Rush."  Even in his lifetime, his name operated as
 a draft in favour of his children for the respect and
 civilities of well-informed strangers,  to whom they
 were known or introduced,  or among whom they
 sojourned. Of this we have seen an  instance in this
 city in 1798, when his eldest son landed in Charles-
ton, on his return from Calcutta.
    We now proceed to consider Dr.  Rush as an au-
thor.  His printed works consist of seven volumes, six
of which treat of  medical subjects, inclusive of the
volume of Introductory Lectures.  One is a collection
of essays, literary, moral, and philosophical.  Your
time will not permit our  review of these invaluable
writings, or even to recapitulate the subjects therein
discussed.* I shall therefore pass over this part of my
   * Dr. Rush's works, printed in his lifetime, treat on the
 following subjects:
   " An  inquiry into the natural history of medicine among
 the Indians of North America, and  a comparative view of
their diseases and remedies, with those of civilized nations. 
93
subject, only remarking, that his medical works are
so original, and so well adapted to our local situation,
that they should be carefully perused by every me-

   " An account  of the climate of Pennsylvania, and its influ-
ence upon the human body.
  " An account of the bilious remitting fever, as it appeared
in Philadelphia in the summer and autumn of the year 1780.
   " An account  of the scarlatina anginosa, as it appeared in
Philadelphia in the years 1783 and  1784.
   " An inquiry  into the cause and cure of the cholera in-
fantum.
   " Observations on the cynanche trachealis.
   " An account of the efficacy of blisters and bleeding in the
cure of obstinate intermitting fevers.
   " An account  of the  disease occasioned by drinking cold
water in warm weather, and the method of curing it.
   " An account of the efficacy of common salt in the cure of
haemoptysis.
   " Thoughts on the cause  and cure of pulmonary consump-
tion.
   " Observations upon  worms in the alimentary  canal, and
upon anthelmintic medicines.
   " An account of the external use of arsenic in the cure of
cancers.
   " Observations on the tetanus.
   " The result of observations made upon the diseases which
occurred in the  military hospitals of the United States, du-
ring the revolutionary war.
   " An account  of the influence of the military and political
events of the American revolution upon the human  body.
   " An inquiry into the relations of tastes and aliments to
each other, and upon the influence of this relation upon health
and pleasure.
   " The new method of inoculating for  the small-pox.
   " An inquiry into the effects of ardent  spirits  upon the
human body and mind, with an account  of the means of pre-
venting, and the  remedies for curing them. 
94
dical student; for they unfold true  principles,  which
will lead the physician of genius to correct, efficient,
and energetic  practice.  To the American student

   u Observations on the duties of a physician, and the me-
thods of improving medicine; accommodated to the present
state of society and manners in the United States.
   " An inquiry into the causes and cure of sore legs.
   " An account of the state of the body and mind in old age,
with observations on its diseases and their remedies.
   " An inquiry into the influence of physical  causes upon
the moral faculty.
   " Observations upon the cause and cure of pulmonary con-
sumption.
   " Observations upon the symptoms and cure of dropsies.
   " Inquiry into the cause  and cure of the gout.
   "Observations on the nature and cure of the hydrophobia.
   " An account of the measles as they appeared in Philadel-
phia in the spring of 1789.
   " An account of the influenza, as it appeared in Philadel-
phia in the years 1790 and 1791.
   " An inquiry into the cause of animal life.
   " Outlines of a theory of fever.
   " An account of the bilious yellow fever, as it appeared in
Philadelphia in 1793, and of each successive year till 1805.
   " An inquiry into the various sources of the usual forms of
the summer and  autumnal diseases in the United States, and
the means of preventing them.
   " Facts, intended to prove the yellow fever not to be con-
tagious.
   " Defence of blood-letting, as a remedy in certain diseases.
   " An inquiry into the comparative states of medicine in
Philadelphia, between the years 1760 and 1766, and  1805.
   " A volume of essays, literary, moral and philosophical, in
which  the following subjects are discussed:
   " A plan for establishing public schools in  Pennsylvania,
and for conducting education agreeably to a republican form 
95
they are  of incalculable value; for they convey that
practical knowledge of our climate, and peculiar dis-
eases, which will contribute more to his success than

of government.  Addressed to the legislature, and citizens
of Pennsylvania, in the year 1786.
   " Of the mode of education proper in a republic.
   " Observations upon  the study of the Latin  and Greek
languages, as a branch of liberal education; with hints of a
plan of liberal instruction without them, accommodated to
the present state of society, manners, and government, in the
United States.
   " Thoughts upon the amusements and punishments which
are proper for schools.
   " Thoughts upon female education, accommodated to the
present state of society, manners and  government, in the
United States of America.
   " A defence of the Bible as a school book.
   " An address to the ministers of the  gospel of every de-
nomination in the United States, upon subjects  interesting
to morals.
   "An inquiry into the consistency of the  punishment of
murder by death, with reason  and revelation.
   " A plan of a peace-office for the United Stales.
   " Information to Europeans who are disposed to migrate
to the United States of America.
   " An account of the progress of population, agriculture,
manners and government, in Pennsylvania.
   "An account of the manners of the German  inhabitants
pf Pennsylvania.
   "Thoughts on common sense.
   " An account of the vices peculiar to the Indians of North
America.
   " Observations upon  the influence of the habitual use of
tobacco, upon health, morals, and property.
   " An account of the sugar maple tree of the United States. 
96
any books he can import from foreign countries. His
miscellaneous essays deserve the serious attention of
every  member of our numerous legislative bodies.
His lecture on medical jurisprudence should be read,
not only by physicians, but by judges, jurymen, and
lawyers. This subject has never before been discussed
in this country, and very little can be  gleaned from
all who have written on it in Europe.
    Dr. Rush's volume of Medical Inquiries and Ob-
servations on the Diseases of the Mind, is the fruit of
accurate  observation  and long experience,  in  the
Pennsylvania hospital. It was his last contribution
to the  literature of his country.   Though  for many
years digested in his own mind, it was published only
six months before his death. Dr. Rush was a public
   " An account  of the life and death of Edward Drinker,
who died on the 17th of November, 1782, in the one hundred
and third year of his age.
   " Remarkable circumstances in the constitution and life of
Ann Woods, an old woman of ninety-six years of age.
   " Biographical anecdotes of Benjamin Lay.
   " Biographical anecdotes of Anthony Benezet.
   " Paradise of negro slaves—a dream.
   " Eulogium upon Dr. William Cullen.
   " Eulogium upon David Rittenhouse.
   " A volume of lectures, most of which were introductory
to his annual courses of lectures on the institutes and prac-
tice of medicine.
   " Medical inquiries and observations on  the diseases of
the mind." 
                       97
writer for forty-nine years, and from the nineteenth
to the sixty-eighth year of his age. It was a singular
opinion of his own, but in unison with his medical
system, " that ideas whether acquired from books or
by reflection, produced a plethora in the mind, which
can only be relieved by depletion from the pen or
tongue."  It is matter of wonder how a physician
who had so many patients to attend; a professor who
had so many pupils to instruct, could find leisure to
write so much, and at the same time so well. Our
wonder will cease when it is known that he suffered
no fragments of time to be wasted, and that he im-
proved every opportunity of acquiring knowledge, and
used all practicable means for retaining and digesting
what he had acquired.  In his early youth he had the
best instructors, and in every period of his life great
opportunities for mental improvement. He was gifted
from  heaven with a lively imagination,  a retentive
memory, a discriminating judgment, and he  made
the most of all these advantages.  From boyhood till
his last sickness, he was a constant and an indefatiga-
ble student. He read much, but thought  more. His
mind was constantly engrossed with at least one lite-
rary  inquiry, to which, for the time,  he devoted  his
undivided attention.  To make himself master of that
subject, he read, he meditated, he conversed.  It was
less his  custom to read a book through, than to read 
98
as milch of all the authors within his reach,  as bore
on the subject of his present inquiry. His active mind
brooded over the materials thus collected, compared
his ideas, and traced their relations to each other, and
from the whole drew his own conclusions.  In these,
and similar mental exercises, he was habitually and
almost constantly employed, and daily aggregated and
multiplied his intellectual stores. In this manner his
sound judgment was led to form those new combi-
nations which constitute  principles in science.*  He
formed acquaintances with his literary fellow citizens
and all well-informed strangers who visited  Philadel-

  * It was to Dr. Rush  as his meat and drink, to combine
facts, so as to deduce principles from them. " The learned
pigs," said he, " which are exhibited as shows in our country,
observe and think, but they cannot reason.  This  protracted
operation of the mind can be performed only by man. Should
we build facts upon facts until our pile reached the heavens,
they would soon tumble to pieces, unless they were cemented
by principles. Medicine without principles is an humble art
and a degrading occupation.  It reduces a physician to a level
with the cook and the nurse, who administer to the appetites
and weakness of sick people. But  directed by principles it
imparts the highest elevation to  the  intellectual and moral
character of man.  In  spite, therefore, of the  obloquy with
which they have been treated, let us resolve to cultivate them
as long as we live.  This, gentlemen, is my determination,
while I am able to totter to this chair, and if a tomb-stone be
afforded after my death, to rescue my humble name for a few
years from oblivion, I ask no further addition to it than that
; I was an advocate for principles in medicine ' "~Dr, Ru$h\
Introductory Lectures, fiage 362. 
99
phia, and drew from them every atom of information
he could obtain, by conversing on the subjects with
which they were best acquainted. He extracted so
largely from the magazine of knowledge deposited in
the expanded  mind of Dr. Franklin, that he men-
tioned to me many years ago, his intention to write a
book with the title of Frankliniana, in which he pro-
posed to collect the fragments of wisdom which he
had treasured in his memory, as they fell in conver-
sation from the lips  of this great original genius. To
Dr. Rush every place was a school, every one with
whom he conversed was a tutor. He was never with-
out a book, for when he had no  other, the book of
nature was before him, and engaged his attention. In
his lectures to his pupils, he advised them to ** lay
every person  they met with,  whether in a packet-
boat, a stage wagon, or a  public road, under con-
tribution, for facts on physical subjects."  What the
professor recommended to them, he practised him
self. His eyes and ears were open to see, hear,  and
profit by every occurrence.  The facts  he received
from persons in all capacities are  improved to some
valuable purpose.   He illustrates one of his medical
theories by a fact communicated by a butcher; another
from an observation made by a madman, in the Penn-
sylvania hospital. In his scientific work in the diseases
of the mind, he refers frequently to poets, and parti 
100
cularly to Shakspeare, to illustrate the history of mad-
ness, and apologizes for it in the following words.
" They (poets) view the human mind in all its opera-
tions, whether natural or morbid, with a microscopic
eye, and hence many things arrest their attention
which escape the notice of physicians."  It  may be
useful to students to be informed that Dr. Rush con-
stantly kept by him a note-book,  consisting of two
parts,  in one of which he entered  facts as  they  oc-
curred; in the other, ideas and observations as they
arose in his own mind, or  were suggested by others
in conversation.* His mind was under such complete
discipline,  that he  could read or write with perfect
composure, in the midst of the noise of his  children,
the conversation of his family, and the common in-
terrogatories ofhis visiting patients. Avery moderate
proportion of his time  was devoted  to sleep, and
   * In his lectures he recommends a similar practice to his
 pupils. His words are, " there should be no time allotted for
 recording facts and thoughts. It should be done directly or
 even indirectly, at all times, and  in all places.  Even where
 a pencil cannot be employed, a knot in a handkerchief will
 preserve an idea until it can be transplanted into a memoran-
 dum, or common-place book.  In short, there should be no
 day nor night to a student, and above all, to a student of me-
 dicine. He  should always, like a plant, be  in an  absorbing
 state.  Even his dreams should not be permitted to sport
 themselves idly in his brain. Useful inferences may be dedu-
 ced from them, by a person who has acquired habits of ob-
 servation."-—.Dr. Rush*s Introductory Lectures,page 355. 
                       101
much less to the pleasures of the table.  In the latter
case, sittings were never prolonged but in conversa-
tion on useful subjects,  and for purposes totally dis-
tinct from the gratifications of appetite. In the course
of nearly seventy years spent in this manner, he ac-
quired a sum of useful practical knowledge that has
rarely been attained by one man in any age or coun-
try.  It may  be useful to survivors, to be informed
that his incessant labours, both of mind and body,
neither shortened his life, nor impaired his health. In
a letter I received from him in 1803, he observes, "I
continue, through divine goodness, to enjoy, in the
fifty-ninth year of my age, uncommon good health."
In a letter written to his kinsman, our associate, Dr.
Finley  in  1809, he  observes: " in  my  sixty-fifth
year I continue to enjoy uncommon health, and the
same facility  in studying and doing business that I
possessed five and twenty years ago."  And again, in
another,  dated March 4th, 1813, about six weeks be-
fore his death, he  observes: " through divine good-
ness, I continue to enjoy uncommon health for a man
in his sixty-ninth year.  Now and then I am remind-
ed of my age  by light attacks of the tussis senilis,  but
they do not impair my strength nor lessen my facility
in doing business."
    Medical inquiries were the primary objects of Dr.
Rush's attention; but he took such a  comprehensive 
102
 view of his profession, that he made all branches of
 knowledge tributary to it.  From the philosophy of
 mind as connected with the body, he drew many use-
 ful hints respecting the functions and diseases of the
 latter. Theology;  metaphysics; natural and civil his-
 tory; philosophy,  natural, moral, and  political;  the
 principles and practices of agriculture; of the liberal,
 mechanical, and chemical arts; histories of voyages,
 travels, and of the lives of illustrious characters, and
 the nature of man  under all its varieties of age, coun-
 try, religion, climate, and form of government, were
 so far known to him as to furnish him with facts,  il-
 lustrations, and analogies, casting light on  medical
 subjects.  To politics, in  the earlier part of  his life,
 he paid great attention; but not to  the unimportant
 controversies stirred up by those who were contend-
 ing for the loaves  and fishes of government.  Three
 great political subjects, for the time being, engrossed
 his whole soul—the independence of his country—
 the establishment of good  constitutions for the United
 States, and for  his own particular state—to enlighten
 the public mind and to diffuse correct ideas. On these
important disquisitions he laboured night and day.
 Many were the productions of his pen, which, under
 a variety of names, issued through the medium of the
 press to dispel prejudices, obviate objections, correct
 erroneous impressions, and, in general, to dispose his 
103
fellow citizens to discern the true, extended, perma-
nent interest of their country, and to sacrifice to it all
minor considerations.  When these great national ob-
jects were secured he gradually retired from this field,
not a little disgusted with the selfish, crooked politics
of men of all parties, in their scramble for power and
office.   In the year 1798 he thus expressed himself,
in a letter to him who now addresses you: " I have
been  alternately called an aristocrat and a democrat.
I am now neither.  I am a  Christocrat.  I believe all
power, whether hereditary or elective, will always fail
of producing order and happiness in the hands of man.
He alone who created  and redeemed man is qualified
to govern him."*  His  first sanguine expectations,

   * The other parts of this letter are so benevolent and pious,
that no apology is necessary for inserting them in  a note.
They are as follows:  " I abhor war in all its forms, and I
have often wished a new  nomenclature could be invented to
designate all  its  business by more  appropriate names.  If
the capture of a town, by a  siege, were called  < national bur-
glary,' the  sacking of a  country «highway robbery,' and a
battle (murder,'  it would excite more general horror in the
minds of men. But, alas! these offences, < or military evils,'
must come.  < But wo unto them by whom they do  come.'
Never did the folly and wickedness of war appear in more
striking colours  than at  present.   On the one hand we be-
hold a great nation, under the banner of just principles, per-
petrating the most atrocious acts of fraud, oppression, and ra-
pine;  while on the other hand,  we behold the nations in Eu-
rope that are opposed to  her, committing equal acts  of vio-
lence and cruelty, in defence of their old and corrupted civil 
104
 from the excellent institutions  of our government,
 were very much diminished  by time.  But this did
 not lessen his respect for representative government
 as the best calculated to promote  human happiness,
 but impressed more forcibly on his mind the depravi-
 ty of the human heart,  and that all things, as far as
 they depend on man, tend to evil.  While his confi-
 dence and trust in  every  thing human abated, they
 increased towards  God.  As  he became  less of a
 politician, he became more of a  Christian.
    While he  was engaged in  the  bustle of politics
 his country, sensible of  his merit,  conferred sundry
 offices on him.  He was a member of  the congress
 which, in 1776, declared  these states free and inde-
 pendent.*  In this event he gloried,  and from it he

 and ecclesiastical establishments. Between  the two contend-
 ing powers, I believe all the liberty of our globe will be an-
 nihilated in a few years.  In the 25th chapter of Jeremiah,
 from the 15th verse to the end, you will find a picture of the
 aistress which awaits our world.  But let not Christians be
 discouraged by these events. They are intended, by produ-
 cing universal misery,  to produce universal prayers for the
 coming of that kingdom which is  described in the Old and
 New Testament, and whose Head has  been emphatically cal-
 led the ' desire of all nations'"
   * While attending his duty in congress,  Dr. Rush made
an observation which, probably, did not occur to any other
member.  It was as follows:  " The late judge Wilson, Dr.
Witherspoon, and Mr. John  Adams, were the  most copious,
methodical, and correct extempore speakers in the congress 
105
expected much good,  and that of no common kind.
While others counted  on the increase of commerce,
the influx of riches, the high rank among nations^
which awaited the new formed states, Dr. Rush's at-
tention was preferably  fixed on  the expansion of the
human mind likely to grow Out  of independence.
From the happy state of things which left every man
at liberty to think what he pleased,  and to speak what
he thought; to pursue his own interest and the impulse
of his mind iri any way he though  best* without! any
control from privileged orders, or" the restraints of ar-
bitrary government, he anticipated a great increase of
talents and knowledge.  The progress of eloquence,
of science,  and  of mind, in all its various pursuits,
was considered by him as the necessary effect of re-

6f the year 1776. They spoke" often and lotig,  but never re-
peated any thing. Now these gentlemen  had been in the prac~
tice of composing in the early part of their lives."
   This remark was introduced, after a short preface, by Dr.
Rush, tfoirty-thtfee years after k« date, in a lecture delivered
to his pupils in 1789, in which he recommended to them, by
way of improving their minds, to exercise themselves fre-
quently in cdrriposrtiotf; « for it has," said he, " many advan-
tages:" among others* he observes, "by habits of composi-
tion we enlarge the retentive powers of the mind and acquire
order, perspicuity, and correctness in speaking.
   The speech of an Indian sachem seldom contains more
than three or four ideas.  The same thing  may be said of
nearly all public speakers, however long they may remain
upon then* feet, who have not been in the habit of composing,
and thereby of multiplying and arranging their thought?.'5 
                       106
 publican constitutions, and in the prospect of them
 he rejoiced.  Nor was he disappointed, for in a lec-
 ture,  delivered in November 1799, he observes:—
 " From a strict attention to the  state of mind in this
 country,  before the year 1774 and at the present
 time, I am satisfied the rati6 of intellect is as twenty
 are to one, and of knowledge as an hundred are to
 one, in these states,  compared  with what  they were
 before the American revolution."
    Dr. Rush served his country in the capacity of
 physician-general,  in the middle department,  in  the
 revolutionary army. The observations he there made
 on our hospitals, army diseases,  and the effects of the
 revolution on the  army and  people,  are before  the
public. They constitute a valuable part of his works,
 and afford an ample testimony of his talent for accu-
rate observation.
    For the last fourteen years of his life, he was  the
treasurer of the national mint,  by appointment of pre-
 sident Adams.  This office was conferred as  an ho-
mage to talents and learning,  and did  equal honour
to  him who gave and to him who received  it.
   In the establishment and support of the many pri-
vate associations for the advancement of human hap-
piness which abound in Pennsylvania,  Dr.  Rush was
uncommonly active.  Of Dickinson college, in Car-
lisle, he may be said to be the father.  This, in point 
107
 of situation, bears the same relation to Philadelphia
 as Columbia to Charleston.  He saw the tide of po-
 pulation spreading westward, and the necessity of its
 being accompanied with the means of acquiring an
 education competent to the purposes of civil society.
 His influence was not only instrumental in establish-
 ing this western college, but particularly so in bring-
 ing from Scotland the Rev. Dr. Nisbet, of Montrose,
 to preside over it. Very few have crossed the Atlan-
 tic to settle in these states, whose literary attainments
 were equal to this gentleman's.   Dr. Rush's zeal in
 the cause of literature was  not  confined to colleges
 and universities, he eloquently  advocated the esta-
 blishment  of free-schools,  and  for conducting the
 education of the youth of the country, agreeably to
 its republican form of government.  " Let  there be,"
 he said, " free-schools established in every township,
 or in districts, consisting of one  hundred families.
 In these schools  let children be taught to read and
 write, and the use of figures. By this plan the whole
 state will be tied together by one  system of education,
 and become one  great and enlightened family."  He
 further  adds: " The independence of our country has
 created  a new class of duties to every American.  It
becomes us, therefore, to adopt our modes of teach-
ing to the peculiar form of our government." He ob-
serves,  " that an education in our own,  is  to be pre- 
108
ferred to an education in a foreign country. That the
only foundation for a useful education, in a republic,
is to be laid in religion.  Without this  there can be
no virtue, and without virtue there can be no liberty;
and liberty is  the object and life of all republican go-
vernments." He declares, if that he would rather see
the opinions of Confucius  or  Mahomed inculcated
upon our youth, than see them grow up wholly de-
void of a system of religious principles. But the reli-
gion he recommends is that of the New Testament."
He observes, " All the doctrines and precepts of the
Christian religion are calculated to promote the hap-
piness of society, and the  safety and well-being of
civil government. A Christian cannot fail of being a
republican.  The history of the creation of man, and
of the relation of our species to each other by  birth,
which is recorded in the Old Testament, is the best
refutation that can be given  to  the divine right of
kings, and the  strongest argument that can be used
in favour of the original  and  natural equality  of all
mankind.  A Christian cannot fail of being a republi-
can, for every  precept of the Gospel inculcates  those
degrees of humility,  self-denial, and brotherly  kind-
ness, which are directly opposed to the pride of mo-
narchy and the pageantry of a court. A Christian can-
not fail of being useful to the republic, for his religion
teacheth him that no man <  liveth to himself.'  And, 
                       109
lastly, a Christian cannot fail of being wholly inoffen-
sive, for his religion teacheth him, in all things, to do
to others what he could wish, in like circumstances,
they should do to him."
    He  recommends that  " next to the duty which
young men owe to their Creator,  a regard to their
country be inculcated upon them.  Let our pupil be
taught that he does not belong to  himself, but that
he is public property.  Let him be taught to love his
family;  but let him be taught at the same time that
he must forsake and even forget them, when the wel-
fare of his country requires it.  He must love private
life; but he must decline no station, however public
or responsible it may be, when ealled to it by the suf-
frages of his fellow citizens.  He must love popula-
rity; but he must despise it when set in competition
with the dictates of his judgment, or the real interest
of his country.  He must love character and  have a
due sense of injuries;  but he must be taught to ap-
peal only to the laws of the state to defend the one
and punish the other.    He must avoid neutrality in
all questions that divide the state; but he must shun
the rage and acrimony  of party spirit.   He must be
taught to love his fellow creatures in every part of the
world; but he must cherish with a  more intense and
peculiar affection the citizens of the United States.
He must be indulged  occasionally in amusements; 
                       110
 but he must be taught that study and business should
 be his principal pursuits in life.  He must love life,
 and endeavour to acquire as many of its conveniences
 as possible by industry and economy; but he  must
 be taught that this life  " is not  his  own" when the
 safety of his country requires it.  While we incul-
 cate these republican duties upon our pupil, we must
 not neglect  at the same time to inspire him with re-
 publican principles.   He must be taught that there
 can be no durable liberty but in a republic;  and that
government, like all other sciences, is of a progres-
sive nature.   To assist in rendering religious, moral
and political  instruction  more effectual upon the
minds of our  youth, it will be  necessary to subject
their bodies to physical discipline.  They should live
upon a temperate diet,  consisting chiefly of broths,
milk and vegetables.  They should avoid tasting spi-
rituous liquors.   They  should  also  be  accustomed
occasionally to work with their hands in the intervals
of study; and  in the busy seasons of the year in the
country.   Moderate sleep,  silence, occasional soli-
tude and  cleanliness,  should  be inculcated upon
them."  He hazards  the bold assertion  that " it is
possible to convert men into republican machines.
This must be done,  if  we expect them to perform
their parts properly in the great machine of the go-
vernment of the state.   That republic is sophistica- 
Ill
ted with monarchy or aristocracy that does not re-
volve upon the wills of the people, and these must be
fitted to each other  by  means of education,  before
they can be made to produce regularity and unison
in government.  Too much pains cannot be taken
to teach our youth to read  and write our American
language with propriety and elegance."  He asserts
that " eloquence is the first accomplishment in a re-
public, and often sets the whole machine of govern-
ment in motion.   Let our youth therefore  be in-
structed in this art.  We do not extol it too highly,
when we attribute as much to the power of eloquence
as to the sword in bringing about  the American re-
volution."
    He recommends that " a regular course of lec-
tures be given upon history and chronology—that our
youth be instructed in the history of the ancient re-
publics, and the progress of  liberty and tyranny in
the different states of Europe, and in the numerous
facts that relate to the origin and present state of com-
merce,  together with the  nature  and principles of
money."   He considers " commerce as the best se-
curity against the influence of hereditary monopolies
of land, and therefore the surest protection against
aristocracy, and as next to religion in humanizing
mankind, and as the means of uniting the different
nations  of  the world together by the ties of mutual 
112
wants and obligations.   In a young country, where
improvements in agriculture and manufactures are so
much  to  be desired, the cultivation of chemistry,
which explains the principles of both of them, should
be considered as an object of universal importance."
    " Let your youth be instructed in all the means
of promoting national prosperity and independence,
whether they relate to improvements in agriculture,
manufactures, or inland navigation.  Considering the
nature  of  our connexion with the United States,  it
will be necessary to make our pupil acquainted with
all the prerogatives of the national government.   He
must be taught wherein the obligations of individuals
and of states are the same, and wherein they differ."
He concludes by observing, that  he " can form no
idea of the golden age,  so much celebrated by the
poets, more delightful than the contemplation; of that
happiness  which it is now in the power of the legis-
lature of Pennsylvania to confer  upon her citizens,
by  establishing proper modes and places of educa-
tion in every part of the state."   With the same en-
lightened  zeal for the proper education of youth, Dr.
Rush pointed out the amusements and punishments
which  are proper for schools, and proposed an ex-
cellent plan for female education, accommodated to
existing circumstances in this country.  He was un-
commonly anxious that  the Bible should be used as 
                        113
 a school book.   On these several subjects this great
 patriot sowed good seed.  It has not yet  produced
 all its fruit;  but it is not lost, and the hope of bet-
 ter times  may  be confidently indulged.  The very
 circumstance of the great lustre which the death of
 the recommender of these important national mea-
 sures throws over his  now  established fame, may
 induce the legislators of Pennsylvania, and of other
 states, to reconsider the reasons why they have so long
 delayed to perform their full-orbed duty to the youth
 of our beloved country.
    The Philadelphia Dispensary, the first institution
 of the kind in the United States, owes its origin to
 the illustrious philanthropist whose death we lament.
 His pen demonstrated the advantages of such an in-
 stitution;  and when the public mind was favourably
impressed towards  it,  he preconcerted with Dr.
 Moyes, the blind philosopher, to give a public lec-
 ture,  the proceeds of which were to be appropriated
as the beginning of a fund to support this novel in-
stitution.  Curiosity, prompted by benevolence, drew
forth  a very large audience.  A handsome sum was
collected.  This formed a nucleus for private con-
tributions.  These flowed in  so profusely, that  the
institution was speedily organized, and from the year
1786  to this day, it has  been a great public blessing,
extending annually medical relief to  several hundreds 
114
 of the sick poor in their own houses.  The good ex-
 ample was speedily followed by Boston, Newyork,
 Baltimore, Charleston, and some other cities.
    The enlarged ideas which grew out of the Ame-
 rican revolution, were in unison with the  compre-
 hensive views of Dr.  Rush.  He reflected with hor-
 ror on the sanguinary punishments annexed to crimes
 by European, and consequently American legislators,
 which had no tendency to reform offenders.  To era-
 dicate prejudices, and to substitute in their place cor-
 rect ideas of the legitimate objects of penal laws, was
 an arduous labour, but essentially prerequisite to any
 reform.  To accomplish a revolution  in the public
 mind favourable to these views,  and to the principles
 of the new republican  system of government, a soci-
 ety was instituted in Philadelphia, for promoting po-
 litical inquiries.   This usually met at the  house of
 Dr. Franklin.   I have no precise information who
 was the first mover of these investigations; but  it is
 well known that Dr. Rush was an active member of
the society; and that in 1787, he  read before it his
 elaborate dissertation,  entitled "  An Inquiry into the
 effects of public  punishments on criminals and upon
 society."  This was intended to prepare the public
mind for a repeal of  an injudicious law, passed in
 1786, to introduce the punishment of hard labour for
some offences which, under the old system, had been 
115
capital.   The labour which the convicts, under this
new law, were to perform, was, however, to be pub-
lic; and they were accordingly chained to wheelbar-
rows, and were  employed to clean the streets and
repair the roads: as a mark of infamy their heads were
shaved and they wore a particular habit.   This  alte-
ration of the penal system, was far from having the
effect which the friends to humanity wished. Intoxi-
cation was daily seen among men who were expia-
ting their crimes by the deprivation of their liberty.
They became hardened against  shame: the various
degrees of vice were mixed in one mass:  so that the
reformation of criminals was completely defeated.
    In the paper read by  Dr. Rush, as above stated,
he exposed the errors and mischief of the penal law
that had been recently passed, and proposed that all
punishments should  be private, and that they should
consist of confinement, different kinds of labour, low
diet, and solitude, accompanied by religious instruc-
tion.  The principles  contained in  this  pamphlet,
were opposed with acrimony and ridicule in the news-
papers.  They were considered as the schemes of a
humane heart, but  wild and visionary imagination,
which it was impossible ever to realize.   Notwith-
standing a most powerful opposition, the law was re-
pealed, after it had,  by a continuance of three years,
proved  the correctness of the arguments which had
 been urged against it. 
                       116
    In 1788 Dr. Rush published a second pamphlet,
 entitled, " An Inquiry into the justice and policy of
 punishing murder by death," in which he denied the
 right of government to punish even the crime of de-
 liberate murder by death.   To this pamphlet a reply
 was written by the Rev. Mr. Annan, who chiefly de-
 rived his arguments from  Scripture.  Upon those
 texts Dr. Rush published a number of remarks, in-
 tended to prove that they all referred to the dispensa-
 tions of Noah and Moses,  and  that they were com-
pletely abrogated by the doctrines and precepts of the
 Gospel.  In the year 1793,  Mr. Bradford,  the attor-
 ney general of Pennsylvania, published an  " Inquiry
 how far the punishment of death is necessary in Penn-
 sylvania,"  calculated to enforce and  establish the
 principles and arguments  previously laid down  by
 Dr. Rush.  At the following session of the  legisla-
 ture, the punishment of death was abolished for all
 crimes except murder of the first degree. In all other
 cases,  solitary confinement and labour were substi-
 tuted in lieu  of corporal punishment and common
 imprisonment.  The result has been highly  gratify-
 ing to the friends of humanity.   Crimes have dimi-
 nished in  number.  Few reconvictions have taken
 place, though many offenders have been restored to
 society, and in several cases before the expiration of
 their sentence. Criminals have been restrained from 
                       117
a repetition of their  offences, while they were under
a discipline which often issued in their permanent re-
formation.  At the same time, the public  burdens
have been lessened,  for the labour of the confined
culprits overpaid all expenses, both of their main-
tenance and of the establishment."  This good ex-
ample, as in the case of the dispensary,  was success-
fully followed by several of the states, and bids fair
to become general throughout the United States.
    Dr. Rush's philanthropy was  manifested in his
great zeal to repress the immoderate  use of ardent
spirits and of tobacco.  His " Inquiry into the effects
of ardent spirits upon the human body and mind,"
has been  more read  than any of his works.  All the
medical philosophy that was pertinent to the subject,
was incorporated  with it.  Brilliant descriptions of
the personal  and family distress occasioned by that
vice, and of its havoc  on the minds, bodies, and es-
tates  of its unhappy votaries,  were given, and the
means of prevention and cure pointed out. ' '* It was
said that the following diseases are the usual conse-
quences of the habitual use of ardent spirits; viz.  a
decay of  appetite, obstructions of the liver, jaundice
and dropsy,  hoarseness and a husky cough, which
often terminate in  consumption;  redness  and erup-
tions on different parts of the body,  a  fetid  breath,
epilepsy, gout in all  its various  forms of swelled 
                      118
limbs, colic, palsy and apoplexy;  madness; and that
in one third of the maniacs in the Pennsylvania hos-
pital, this terrible disease had been induced by hard
drinking."  It was also observed, " not less destruc-
tive are the effects of ardent spirits upon the human
mind.  They impair the memory, debilitate the un-
derstanding, and pervert the moral faculties: and that
poverty and misery, crimes and infamy, diseases and
death, are all the natural and usual consequences of
the intemperate use of ardent spirits."  The whole was
illustrated by a scale, graduated like a thermometer,
showing, at one view, the effects of certain enume-
rated liquors on the body, the  mind,  and the condi-
tion in society of those who are addicted to them.
In the last year of Dr. Rush's life, he presented to
the general assembly of the Presbyterian church, in
the United States, one thousand copies of this popu-
lar pamphlet, to be given away among the people of
their respective congregations.  About the same time
that numerous and respectable body passed a reso-
lution, enjoining on their members to exert them-
selves in counteracting this ruinous vice.
    The increasing use of tobacco was, in like man-
ner, animadverted upon by  our  medical philanthro-
pist. In his " Observations upon the influence of the
habitual use of tobacco upon health, morals, and pro-
perty," he proves that tobacco impairs the appetite, 
119
prevents the early and complete digestion of die food,
and thereby paves the  way for the pulmonary con-
sumption;  that  it produces  nervous diseases; tjaat
when taken in the form of snuff, it impairs the voice
by obstructing the nose, and imparts to the com-
pleKion a disagreeable dusky colour; that it creates
an artificial thirst, and lays a  foundation for drinking
strong drinks, which often leads to drunkenness; that
it disposes to idleness, which is the root of all evil."
In this manner our professor employed his eloquent
pen in dissuading from practices which, though to a
certain extent harmless, insensibly grow into habits
productive of many unforeseen evils.
    Dr. Rush was a great practical physician.  In the
treatment  of diseases  he was eminently successful,
and  in describing their symptoms and explaining
their  causes, he was uncommonly accurate.  Nor is
this matter of wonder,  for he was minutely acquaint-
ed with the histories of diseases of all ages,  countries
and  occupations.  The annals of medicine cannot
produce an account of any great epidemic disease^
that has visited our earth in  any age or  country^
which is more minute, accurate, and completely  sa-
tisfactory,  than Dr. Rush's description of the yellow
fever of 1793, in Philadelphia.  Had he never wrote
another line, this alone would have immortalized  his
name.  He was a physician of no common cast. His 
120
 prescriptions were not confined to doses of medicine,
 but to the regulation of the diet, air, dress, exercise,
 and mental actions of his patients, so as to prevent
 disease, and to make healthy men and  women from
 invalids.   His preeminence as a physician,  over so
 many of his cotemporaries, arose from the following
 circumstances:
    He carefully studied the climate in  which he liv-
 ed,* and the symptoms of acute and chronic diseases
 therein prevalent, the different habits and constitu-
tions of his patients, and varied his prescriptious with
 their strength, age, and sex.  He marked the influ-
 ence of different seasons upon the same disease,  and
 varied his practice  accordingly.   He observed  and
 recorded  the influence of successive epidemic  dis-
 eases upon  each other, and the hurtful as well as sa-
lutary effects of his remedies, and thereby acquired
a knowledge of the character of the reigning disease,
in every successive season.  His notes and records
 of the diseases which have taken place in Philadel-
 phia for the last forty-four years, must be of incalcu-
lable value to his son and successor.   In attendance
 upon patients, Dr. Rush's  manner was  so gentle and
    * Dr. Rush's account of the climate of Pennsylvania, is
 a master-piece of its kind. Every physician should write
 such a one of the country  in  which he practises, at least
 for his own use. 
                       121
sympathizing, that pain and distress were less poig-
nant in his presence.  On all occasions he exhibited
the manners of a gentleman, and his conversation was
sprightly, pleasant and instructive.  His letters were
peculiarly excellent; for they were dictated by a feel-
ing heart, and adorned with the effusions of a bril-
liant imagination.  His correspondence was extensive
and his letters numerous; but  every  one  of themr,
as far as can  be known to an individual, contained
something original, pleasant, and sprightly.  I can
truly say, that in the course of thirty-five years' cor-
respondence  and friendly intercourse, I never recei-
ved a letter  from him without being  delighted and
improved,  nor left his company without  learning
something.   His observations were  often  original,
and when otherwise,  far from being insipid: for he
had  an uncommon  way of expressing  common
thoughts.   He possessed  in a high degree those ta-
lents which engage the  heart.   He took so  lively an
interest in every thing that concerned his pupils, that
each of them believed himself to be a favourite,
while his kind offices to all, proved that he was the
common friend and father of them all.   One of his
lectures was devoted to their instruction in the exer-
cise of their profession, so as to be most useful to
themselves and their country.   In it he particularly
recommends  to them so to arrange their business,
                       1 
                       122
" that it shall as little as possible interfere with acts
of public homage to the Supreme Being;"  as " the
neglect of this religious and social duty, generally
produces a relaxation either in principles or morals.'"
    He urges them " to improve the many opportu-
nities their profession gives them, to diffuse useful
knowledge of all kinds, and to take the lead in all
public improvements, and particularly to disdain an
ignoble silence upon public subjects." In their pro-
fessional visits, he advises them " never to appear in
a hurry, nor to talk of indifferent matters before they
have made the necessary inquiries into the symptoms
of their patient's disease—to avoid making light of
any case.  There is scarcely a disease so trifling, that
has not directly or indirectly proved an outlet to hu-
man life.   This consideration should make you anx-
ious and punctual in your attendance upon  every
acute disease, and keep you from risking your repu-
tation by an improper or hasty prognosis."
    " Do not  condemn or oppose unnecessarily the
simple prescriptions of your patients.  Yield to them
in matters of little consequence, but  maintain an in-
flexible authority  over them in matters that are essen-
tial to life.
    " Preserve, upon all  occasions,  a composed or
cheerful countenance in the room of your patients,
and inspire as much hope  of a recovery as you can, 
123
consistent with truth, especially in acute diseases.
The extent of the influence of the will over the hu-
man body, has not yet been fully ascertained.1 Does
the will beget insensibility to cold, heat, hunger and
danger?  Does it suspend pain, and raise  the body
above feeling the pangs of Indian tortures?  Let us
not then be surprised that  it should enable the system
to resolve a spasm, to open an obstruction, or to dis-
charge an offending humour.
    " Make it a rule never to be angry at any thing a   ,
sick man says or does to you.  Sickness often adds
to the natural irritability of the temper. We are there-
fore to bear the reproaches of our patients with meek-
ness and silence. It is folly to resent injuries at any
time; but it is  cowardice  to resent an injury from a
sick man.
    " Avoid giving a patient over in an acute disease.   \
It is impossible to tell in such cases where life ends,
and where death begins.   Hundreds of patients have
recovered, who have been pronounced incurable, to
the great disgrace of our profession.
    " Let the poor of every description be the objects
of your peculiar care.   Dr. Boerhaave used to say,
' they were his  best patients, because God was  their
paymaster.'  There is  an inseparable  connexion be-
tween a man's  duty and his interest.  Whenever you
are called, therefore, to visit a poor patient, imagine 
                      124
you hear the voice of the good Samaritan sounding
in your ears: ■ * Take care of him and I will  repay
thee."
- ; »For the further prosecution of their studies, and
the improvement of medicine, he recommends to his
pupils to open all the dead bodies they can, without
doing violence to the feelings of surviving friends, or
tile prejudices of the common people.  " Preserve a
register of the  weather, and of its influence upon the
vegetable productions of the year.  Record the epi-
demics of every season, their time of appearing and
disappearing, and the connexion of the weather with
each  of them.   Preserve, likewise, an account of
chronic cases.  Record the name, age, and occupa-
tion of your patient; describe his disease accurately,
and the changes produced in  it by  your remedies;
mention the doses of every medicine you administer
to him."
   He farther recommends to them the study of the
anatomy of the human mind, commonly called meta-
physics.   The reciprocal influence of  the body and
mind upon each other, can only be ascertained by an
accurate knowledge of the faculties of the mind, and
of their various modes of combination and action.
On this subject he advises them to study the writings
of Butler, Locke, Hartley, Reid, and Beattie. 
                      125
   He reminds them " that improvement in medicine
is not to be  derived only from colleges and universi-
ties.  Systems of physic are the productions of men
of genius and learning; but those facts which consti-
tute real knowledge are to be met with in every walk
of life.  Remember how many of our most useful
remedies have been discovered by quacks.  Do not
be afraid therefore of conversing  with them, and of
profiting by their ignorance and temerity in the prac-
tice of physic.  Medicine has its Pharisees as well as
religion.  But the spirit of this sect is as unfriendly
to the advancement of medicine, as it is to Christian
charity. By conversing with quacks we may convey
instruction to them, and thereby lessen the  mischief
they might  otherwise do to society.  In the pursuit
of medical knowledge, let me advise you to converse
with nurses and old women.  They will  often suggest
facts in the history and cure of diseases, which have
escaped the most  sagacious  observers  of nature.
Even negroes and Indians have sometimes stumbled
upon discoveries in medicine.  Be not ashamed to
inquire into them.   Converse with persons who have
recovered from indispositions without the aid of phy-
sicians.  Examine the strength and exertions of na-
ture in these cases, and mark the plain  and home-
made remedy to which they ascribe their recovery.
 If every man in a city or district could be  called upon 
                       126
to relate to persons appointed to receive and publish
his narrative, an exact account of the effects of those
remedies which accident or whim has suggested to
him, it would furnish a very useful book in medicine.
To preserve the facts thus obtained,  let me  advise
you  to record them  in a book  to be  kept for  that
purpose.
   " Give as few medicines as possible in tinctures
made with distilled spirits.   Perhaps  there are  few
cases in which it is safe to exhibit medicines prepared
in spirits, in any other form than in drops.   Many
persons have been innocently seduced into a love of
strong drink  from taking large or frequent doses of
bitters infused in spirits. Let not our  profession be
reproached, in  a single  instance, with  adding to the
calamities that have been entailed upon mankind, by
this dreadful  species of intemperance."
   He concludes by urging his pupils to pay  " par-
ticular attention to the  indigenous medicines of our
country.  Cultivate or  prepare as many of them as
possible, and endeavour to enlarge the materia medica,
by exploring the untrodden fields and forests  of the
United  States.   The ipecacuanha, the Seneka  and
Virginia snake-roots,  the  Carolina pink-root,  the
spice-wood,  the sassafras,  the butter-nut, the tho-
roughwort, the poke, and the stramonium, are but a
small part of the medicinal productions of America. 
127
There are many hundred other plants which now ex-
hale invaluable medicinal virtues in the  desert air.
Examine, likewise, the mineral waters which are so
various in their impregnation, and so common in all
parts of our country.  Let not the properties of the
insects of America escape your investigation.  We
have already discovered among  some of them a fly
equal in its blistering qualities to the  famous fly of
Spain. Who knows but it may be reserved for Ame-
rica to furnish  the world, from her productions, with
cures for some of those diseases which  now elude
the power of medicine? Human misery of every kind
is evidently on the decline. Happiness, like truth, is
a unit.  While the world, from the progress of intel-
lectual, moral, and political truth, is becoming a more
safe and agreeable abode for man, the votaries of me-
dicine should not be idle.  All the doors and windows
of the temple of nature have been thrown  open by the
convulsions of the late American revolution. This is
the time, therefore, to press upon her altars.  We have
already drawn from them discoveries in morals, phi-
losophy, and government; all of which have human
happiness for their object. Let us preserve  the unity
of truth and happiness, by drawing from  the same
source, in the present critical moment, a knowledge
of antidotes to those diseases which are supposed to
be  incurable." 
128
     In lecturing to his class, Dr. Rush mingled the
 most abstruse investigation with the most agreeable
 eloquence—the sprightliest sallies of imagination with
 the most profound disquisitions;  and the whole was
 enlivened with anecdotes, both pleasant and instruc-
 tive. His language was simple and always intelligible^
 and his method so judicious, that a consistent view of
 the subject was communicated, and the recollection
 of the whole rendered easy. His lectures were origin-
 ally written on leaves alternately blank. On the blank
 side he entered, from time to time, every new fact,
 idea, anecdote, or illustration, that he became possess-
 ed of, from any source whatever.  In the  course of
 about four years, the blank was generally so far filled
 up, that he  found it expedient to  make a new set of
 lectures. In this Way he not only lightened the various
 subjects on which it was his province to instruct his
 class, but the light which he cast on them, for forty-
four successive years, was continually brightening.
The instructions he gave to his pupils by lectures,
though highly valuable,; were less so than the habits
of thinking and observation he, in some degree, forced
upon them.  His constant aim was to rouse their minds
from a passive to an active state, so as to enable then*
to instruct themselves.  Since the first institution of
the medical school  in Pennsylvania, its capita^ Phi-
ladelphia, has been the very atmosphere of medicine, 
129
and that atmosphere has been constantly clearing from
the fogs of error, and becoming more luminous from
the successive and increasing diffusion of the light of
truth. A portion of knowledge floated about that hal-
lowed  spot, which was imbibed by every student
without his being conscious of it, and  had an influ.
ence in giving to his mind a medical texture. To this
happy state of things all the professors contributed.
Drs. Wistar,  Barton, Physick, Dorsey, Coxe,  and
James, the survivors of that illustrious and meritorious
body, will acknowledge, that their late colleague, pro-
fessor Rush, was not deficient in his quota. University
of Pennsylvania, your numerous sons sympathize with
yOU!__you have sustained a loss indeed! He who for
more than forty years has attracted pupils to your in-
stitution,  and with them wealth and  reputation to
Philadelphia,  is now numbered with the dead!  Those
lips which have long been advantageously employed
in uttering instructions to hundreds of young physi-
cians, are now closed in silence! May  Heaven grant
that the mantle of your ascended Elijah may fall on
some Elisha,  who will support, maintain and extend
the reputation of the university of Pennsylvania.
    We have  hitherto viewed Dr. Rush as an author,
a physician, a professor, and a philosopher; let us now
view him as a man.  From him we  may learn to be
good as well  as great.  Such was the force of pious 
                       130
 example, and religious education, in the first fifteen
 years of his  life, that  though he spent the ensuing
 nine in Philadelphia, Edinburgh, London, and Paris,
 exposed to the manifold temptations which are inse-
 parable from great cities, yet he returned, at the age
 of twenty-four, to his native country with the same
 purity of morals he brought with him from Notting-
 ham, the country scene of his  boyish years.  The
 sneers of infidels; the syren allurements of pleasure;
 the fascinations of diversions, had no power to divert
 him from the correct  principles and sober orderly
 habits  which had been  ingrafted  on his mind in early
 youth.  He came home from his travels with no ex-
 cessive attachment but to his books;  no other ambi-
 tion than that of being a great scholar;  and without
 any desire of making a stepping-stone of his talents
 and education,  to procure for him the means of set-
 tling down in inglorious ease, without the farther cul-
tivation and exertion of his talents. In a conversation
 which  he held with  the person  who now addresses
 this audience, thirty-five years ago, Dr.  Rush  ob-
 served, that as he stepped  from the ship that brought
 him home from Europe,  he resolved  that "no cir-
 cumstance of personal charms,  fortune or connexions
 should tempt him to perpetrate matrimony  (his  own
 phrase) till he had extended his  studies so far that a
 family would be no impediment to  his farther pro- 
131
gress.* To this resolution of sacrificing every grati-
fication to his love for learning, and his desire of ma-
king a distinguished figure in the republic of letters,
he steadily adhered.  For this he trimmed the mid-
night lamp: for this,  though young, gay, elegant in
person and manners, and possessed of the most insi-
nuating address, he kept aloof from all scenes of dis-
sipation, enervating pleasures, and unprofitable com-
pany, however fashionable, and devoted himself ex-
clusively to the cultivation of those powers which
God had  given him.   In a letter which I  received
from him at an early period of  my life, he describes
his situation  in  the  following  forcible language:—
11 Medicine is my wife; science is my mistress; books
are my companions; my study is my grave: there I lie
buried, the world ' forgetting, by the world forgot."
From his early youth he thus resolved to be a great
man, and a great man he  became.  Diligence con-
quers the hardest things.  Intense desire of knowledge
rarely fails of gaining its object.  This laudable am-
bition was a security against  vice and folly.  It was
also a fence placed round his virtues:  but there was
   * Dr. Rush did not marry till  he was thirty-two years of
 age.  The rule he generally laid down was, that  no female
 should  marry before she was  sixteen, nor male  before he
 was twenty-one; and the longer they both delayed matrimo-
 ny, after these periods, the better:  provided the delay in a
 female did not exceed twenty-four, or in a male thirtv. 
132
a Stronger one; an exalted sense of moral obligations,
founded on the system of divine truth as revealed in
the holy Scriptures.  Of this he gave a strong proof
in the conformity of his life to the precepts  of the
Gospel. For the Scriptures he had the highest reve-
rence, and often referred to them in his conversation
and letters,* and also in his lectures, and from them
drew several ingenious illustrations of his medical
opinions.  Of the Philadelphia Bible Society he was
vice-president, and very active in the discharge of his
duty.  In the year  1791 he wrote an able defence of
the use of the  Bible as a school-book. From these
oracles of divine truth, he was taught that the indivi-
duals of the human race were all related to each other,

   *  The reader will  be so much pleased with the following
extract from a letter addressed to the author when in trouble,
that his egotism in inserting it will be forgiven: " May your
past misfortunes  serve but to enhance the value of present
blessings.  The late Dr. Smith has happily said in one of his
sermons, ' were I to pity any man  abpve all the rest of the
human race, it should be that man who had never known af-
fliction.' In passing by the houses of our wealthy and pros-
perous citizens, who, perhaps, in the course of a long  life,
have  never known a loss in business, a death in their families,
the treachery of a friend, nor public or private slander, I am
disposed to say with the Pharisee,  <I thank God I am not in
the condition of those rich men.*  The most severe thing
that can be said of a man, is that he has had his «good things
in this life,' and the most comfortable thing that can be said
to a man who  has hopes beyond the grave, is that in  this
world ' he has had his evil things." 
133
as having a common Father and Redeemer, and, there*
fore, that the whole family of mankind should be em-
braced in the arms of an active benevolence. He was
there also taught to reduce this  divine principle to
practice, by doing all  in his power for the advance-
ment of the happiness of his fellow men.  To this, as
we have seen, his whole life was devoted.  His chari-  1/
ties were great.  In addition to ordinary contributions
for the relief  of distress,  clergymen, widows,  and
helpless women, could always command  his gratu-
itous professional services.  It is not less true than
strange, that he added to  the  list of his  pensioners,
the officers of our late revolutionary army.  Here
patriotism combined with benevolence!   He consi-
dered that a large debt of gratitude  was due from
their fellow citizens to these meritorious  men. They
had spent the most valuable part  of their lives in  se-
curing the independence of their country, for which
it had not made them adequate compensation. From
these liberal views, he rarely charged any of them
with the usual fees for his professional services.
    Piety to God was  an eminent trait in the charac-
ter of Dr. Rush. In all his printed works, and in all
his private  transactions, he expressed the most pro-  -
found respect and veneration  for the great Eternal.
At the close of his excellent observations on the pul-
monary consumption, he observes,  " I  cannot con- 
134
elude this inquiry without adding, that the author of
it derived from his paternal ancestors a predisposition
to the pulmonary consumption; and that, between the
eighteenth and forty-third year of his age, he has oc-
sionally been afflicted with many of the symptoms of
that disease, which he has described. By the constant
and faithful use of many of the remedies which he has
recommended, he now, in the sixty-first year of his
age, enjoys nearly an uninterrupted exemption from
pulmonary complaints.  In humble gratitude, there-
fore, to that Being,  who condescends to be called the
" preserver  of men," he thus publicly devotes this
result of his experience and inquiries, to the benefit
of such ofhis fellow creatures as may be afflicted with
the same disease, sincerely wishing that they may be
as useful to them as they have been to the author."
In his Introductory Lecture, delivered November 3,
1806, after giving a short retrospective history of the
medical school of Philadelphia, he offers up thanks
to " that Almighty  Being, who took the infant insti-
tution by the hand,  and conferred upon it its present
reputation and prosperity, and supplicates him to in-
spire  its teachers with wisdom and. knowledge,  and
its students with diligence, and all the virtues which
adorn the profession of medicine, till science  and
sickness, and time  and death shall be no more." In
his admirable account of the bilious yellow fever of 
135
1793, after acknowledging his obligations to his pu-
pils, messrs. Fisher, Coxe, and Woodhouse, he con-
cludes:  " but wherewith shall I come before the great
Father and Redeemer of men, and what shall I ren-
der unto him for the issue of my life from the grave?
                  Here all language fails—
     Come then, expressive silence, muse his praise."
    In his last work on the Diseases  of the Mind, he
begins as follows:  " In entering upon the subject of
the following inquiries and observations, I feel  as if I
were about to tread upon consecrated ground. I am
aware of its difficulty and importance, and I humbly
implore that Being,  whose government extends  to
the thoughts of all his creatures, so to direct mine in
this arduous undertaking, that nothing hurtful  to my
fellow citizens may  fall  from my pen,  and that this
work may be the means of lessening a portion of some
of the greatest evils of human life."
    It was not only by words, but in deeds, that he
expressed  his reverence for, the Deity. It was his   '<
usual practice to close the day by reading to his col-
lected family a chapter in the Bible, and afterwards
by addressing his Maker in prayer, devoutly acknow-
ledging his goodness for  favours received, and hum-
bly imploring his continued protection and blessing.
His respect for the Deity  led him to respect his
ministers, who acted consistently with their high calK 
136
ing.  He considered their office of the greatest impor-
tance to society, both in this world and that which
is  to come. He strengthened their hands, and was
always ready and willing to promote and encourage
arrangements for their comfortable support,  and for
building churches, and for propagating the  Gospel.
In an address to ministers of every denomination, on
subjects interesting to morals,  he remarks: " If there
were no hereafter, individuals  and societies would be
great gainers by attending public worship every Sun-
day.  Rest from labour in the house of God winds up
the machine of both soul and  body, better than any
thing else, and thereby invigorates it for the labours
and duties of the ensuing week." Dr. Rush made his
first  essay,  as an author, when an apprentice to Dr.
Redman, by writing an eulogy on the Rev. Gilbert
Tennent, who had been  the friend and fellow labourer
of the  celebrated George Whitfield, and an active,
useful, animated preacher of the Gospel, from 1725
till 1764. On the 27th of May, 1809, he wrote to his
cousin, Dr. Finley, of this city: " The General As-
sembly of the  Presbyterian church is now in session
in Philadelphia. It is  composed of many excellent
men, some of whom  are highly distinguished  by
talents and  learning  as well  as piety.  I have  had
some pleasant visits from a  number of them,  and
have been amply rewarded for my civilities to thera^ 
137
by their agreeable and edifying conversation.  They
remind me of the happy times, when their places in
the church were filled by your venerable father, and
his illustrious  cotemporaries  and friends, messrs.
Tennent, Blair, Davies and Rodgers."
    In these and several other ways, particularly by
his pen and his practice, Dr. Rush supported the cause
of morality and religion in our country, and  super-
added the character of a Christian to that of a scholar.
Such was the tenor of the life of our illustrious coun-
tryman, who is now no more! No more the ornament
of the first medical school in America!  No more the
instructor, the delight, and the admiration of that
portion of our youth which is destined to take care
of the healths and lives of their fellow  citizens! No
more the medical  luminary of our  western  world!
But he  has not ceased to exist. His soul at this mo-
ment, lives in some part of the universe; and his body,
though now mouldering in dust, Revelation assures
us, at some future time, will rise from the grave, and
commence a new and immortal life.  Let us therefore
be comforted.  Death is not an eternal sleep. Its ef-
fects are only temporary.  In due time they will all be
done away, as though they ne'er had been. A reunion
ofhis soul and body will constitute the same person,
and the identical Dr. Rush, whom we this day lament
as dead, will assuredly live again, and live forever and
                        s 
                       138
 ever.  In this world he sought for knowledge, as the
 thirsty traveller in a sandy desert seeks for water; and
 in his course of .nearly seventy years, he acquired am
 uncommon stock of it, and rejoiced in his success:
 but who can tell what will he the amount ofhis acqui-
 sitions and consequent pieasuise in the ensuing seven
 hundred years, seven thousand, or if you please, seven
 millions of years, blest with the beatific vision of the
 omniscient God? But I forbear,  the mind sinks be-
 neath the  weight of the sublime  and liappy destinies
 of those who are the reconciled friends of " the God
 of Knowledge."
    Gentlemen  of the  Medical Society, the great
 ornament of our profession is lost to the republic of
 medicine, and  by his  death,  an immense blank is
 made, not easy  to be filled.  It is our duty to douhle
 our diligence, to supply the loss of him who has been
 the preceptor of more than half  of  our society.  He
 has done much to illustrate the medical history of our
country, and to advance its literary fame; but much
still remains to  be done. No system of medicine can
be perfect while there exists a single disease which we
do not know or cannot cure. There cannot therefore
be a complete system of medicine  till our  country
has furnished descriptions and  cures for all its pecu-
liar diseases.  Let us therefore endeavour to supply
this defect, and to do all in our power to advance the 
139
healing art.  Our deceased fellow labourer in the field
of medicine, has recorded his opinion, " that the phy-
sician has lived to little purpose, who does not leave
his profession in a more improved state than he found
it."  Let us prevent that reproach from fastening on
us, and at the same time do honour to the great Ame-
rican reformer and improver of medicine, by following
his bright example.  That we may be fortified against
all temptations  to relax in our studies, or to make a
trade of our profession, let us frequently think of
Dr.  Rush. 
 
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