The Benjamin Rush Prescription (Part 1)

Even today, archaeologists tracing the campsites used by Meriwether Lewis and William Clark in their historic expedition across the Great Plains from 1804 to 1806 can still rely on the relatively high mercury deposits to be found in the soil where the explorers dug their latrines.  According to Sam Kean and his excellent book, The Disappearing Spoon, not only did Lewis and Clark set out on 220px-Benjamin_Rush_Painting_by_Peale[1]their expedition armed with microscopes, compasses, three mercury thermometers, and other scientific instruments, they also carried more than six hundred mercury laxatives, each four times the size of an aspirin, to be used for any digestive problems that they might encounter along the way. 

The laxatives, marketed under the name of Dr. Rush's Bilious Pills, were supplied by Meriwether Lewis' chief medical advisor and the foremost health authority for the still-growing United States, Dr. Benjamin Rush. 

Born in 1746 near Philadelphia, Benjamin Rush was an excellent student who completed a Bachelor of Arts degree at the age of fifteen.  Going on to study medicine at the University of Edinburgh, he earned his medical degree and practiced in the United Kingdom before returning to the American colonies in 1769.   With a prosperous medical practice in Philadelphia and a position as professor of chemistry at what is now the University of Philadelphia, Dr. Rush also managed to find time to become increasingly active with the Sons of Liberty, including representing Pennsylvania at the Continental Congress and becoming one of the signers of the Declaration of Independence.   After the American Revolution began,  he became surgeon-general of the middle department of the Continental Army although this ended after only a year due to conflicts with other doctors in the service.  Dr. Rush  also became openly critical of George Washington, whom he blamed for worsening conditions for Continental troops and urged that he be replaced as commander-in-chief.   Although Rush would regret this criticism later, his post-war relationship with George Washington would never be the same as a result.

With the end of the American Revolution in 1783, Benjamin Rush was appointed to the staff at Pennsylvania Hospital and later appointed treasurer of the U.S. Mint in 1797.   He also became professor of Medical Theory and Clinical Practice at the University of Pennsylvania in 1791.  The yellow fever epidemic of 1793 help cement Dr. Rush's reputation as a medical hero as he rushed from bedside to bedside trying to stem the epidemic. Although his medical skill (including the copious use of bleeding) seemed open to question, even given the medicine of the time, he was still the fledgling union's most famous physician and few people dared question his methods.  One critic, William Cobb, rashly accused Rush of killing more patients than he saved.  While Rush later won a libel judgment against him for that remark, Cobb's criticism was likely true enough.  Even George Washington himself had cause to regret being treated by Rush-trained physicians during his final illness since it was likely the bleedings and mercury treatments that he received that hastened his death in 1799. 

Along with his fondness for bleeding,  Rush was also an advocate of prescribing mercury as a cure-all without any concern for possible toxic effects.  His favourite remedy was a mercury-chloride compound that he insisted patients take orally on a daily basis.  The fact that months of this sort of treatment led to patient hair and teeth falling out didn't stop him from marketing his cure-all as "bilious pills" (a.k.a. "thunderclappers for their laxative effect).   When Meriwether Lewis came to him for three months intensive training in field medicine as preparation for his expedition, he also received training in how to use the different patent medicines that Rush preferred.  This included opium for pain relief, calomel for stomach  problems, and the mercury chloride pills that have been such a boon to archaeologists.

As the United States' most prominent medical authority, Benjamin Rush's opinionated views on a variety of subjects almost carried the weight of scientific truth due to his reputation.  Although he was a fervent abolitionist (which likely antagonized friends and colleagues such as Thomas Jefferson), he was also a founder of the Philadelphia Bible Society and even urged the United States government to require using bibles as textbooks in public schools.  It was likely in matters relating to medicine that he had the greatest influence however.    His 1784 book, An Inquiry into the Effects of Spirituous Liquors, eventually sold 170,000 copies and described alcoholism as a biological illness.  In the book, Rush argued that "drink and democracy cannot mix" and that "Taste not, handle not, touch not" should  be inscribed upon every vessel that contains spirits in the house of the man who wishes to be cured by habits of intemperance".    He also advocated the creation of the first "rehabilitation center" for chronic alcoholics who he suggested be locked up in a special asylum that he called the "Sober House" where they could be held until deemed safe to reenter society.   In the fledgling Constitution, Rush advocated including bans on "gaming, drunkenness, and uncleanness" along with "habits of idleness and love of pleasure".  He also campaigned against taverns and "clubs of all kinds where the only business of the company is feeding (for that is the true name of a gratification that is simply animal) are hurtful to morals".    When the Bill of Rights was added to the Constitution, Rush wrote The Drunkard's Emblem to highlight the dangers of drinking.   While he was hardly the only temperance advocate around at the time, he was definitely one of the most influential.

Rush's concerns about the morality of the new nation wasn't just limited to alcoholism though.  He also wrote extensively on the dangers of rampant sexuality as well.  In 1788, he wrote that the culture of pleasure found in most cities had a "pernicious influence upon morals and thereby prepare our country for misery and slavery".    Although prostitution had been relatively tolerated prior to the American Revolution, that changed dramatically over the first twenty years of independence.   The first anti-vice organization, the Association of the District of Southwark for the Suppression of Vice and Immorality, was formed in Philadelphia in 1790.  Attacking brothels, gambling houses, dancing halls, and taverns,  the anti-vice movement gained strength with the formation of the Magdalene Society and the first Magdalene asylums in the United States.  Prostitutes and other "fallen women" were often forced into these asylums and banned from leaving for years at a time.  Since it represented the only way many women could receive treatment for venereal disease, it made them more reluctant than ever to report being infected.

As the premier medical authority in the United States, Benjamin Rush was in a good position to provide his own stamp on the backlash against "European immorality" that the new United States was expected to eradicate.  He wrote a series of influential sex manuals describing the medical dangers of excessive sex including "seminal weakness, impotence, hypochondriasis, loss of memory, and death".  That included masturbation although his arguments focused on moral persuasion rather than the elaborate anti-masturbation aids that would become so popular later in the 19th century. 

But his greatest influence was still to come.

To be  continued









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