Medical America in the Nineteenth Century: Readings from the Literature

On the Causes of Death in Diseases That Are Not Incurable

BENJAMIN RUSH ON THE CAUSES OF DEATH IN DISEASES THAT ARE NOT INCURABLE Editor's Note Benjamin Rush (1745-1813), one of America's most famous physicians, signer of the Declaration of Independence, medical writer and teacher, needs no introduction. His influence during the first decades of the nineteenth century was widely felt. Although the lancet and calomel purge that he favored so much doubtless caused much harm, his work for education, temperance, and the care of the mentally ill more than balanced the ledger. Rush, who was active in various religious causes, sometimes sounded more as if he were delivering a sermon than a medical school lecture. The sermonizing is apparent in the following essay, which also nicely illustrates his opinion of the efficacy of active treatment and his contemptuous dismissal of the "ill directed operations of nature." It was partly against views such as Rush's that some of the writers of a later generation reacted. The school of therapy that relied more on nature than on art received a considerable hearing just after the middle of the century.l Bibliographical Note Rush's monistic theory of disease causation is not well expressed in the essay which follows. It has been described by Professor Shryock in Medicine and Society in America, 1660-1860, New York: New York University Press, 1960, available in paperback reprint; and in his article "Benjamin Rush from the perspective of the twentieth century," Trans. Studies Coll. Phys. Phila. 14 (1946): 113-20, reprinted in Medicine in America, Baltimore: The Johns Hopkins Press, 1966, pp. 233-51. See also Nathan G. Goodman, Benjamin Rush, Physician and Citizen, 1746-1813, Philadelphia: University of Pennsylvania Press, 1934; Letters of Benjamin Rush, L. H. Butterfield, ed., 2 vols., Princeton: Princeton University Press, 1951; and George W. Corner, ed., The Autobiography of Benjamin Rush, Princeton: Princeton University Press, 1948. Sixteen Introductory Lectures (Philadelphia, 1811), pp. 65-87. This is Lecture III, delivered November26, 1793. 1 As Professor Shryock has pointed out, the condemnation of Rush at mid-century also reflected the influence of the Paris school on American medical thought. 90 BENJAMIN RUSH 91 Our city has again been afflicted by a malignant bilious fever. Its mortality has been much greater, in a given number of sick people, than in former years. In meditating upon the causes of this extraordinary mortality, I was led to contemplate the causes of death, not only in our late epidemic, but in other diseases which are not incurable, for the malignant bilious or yellow fever is not necessarily a mortal disease. In considering this subject, the first thing that occurred to my mind was the small proportion of people who die of diseases that are acknowledged to be incurable. In examining the bills of mortality, of all countries , how few people do we find die of aneurysms, epilepsy, internal cancers, and casualties, compared with the number of people who perish from fevers and other diseases which are admitted to be under the power of medicine. Perhaps the proportion of deaths from the former, compared with the deaths from the latter diseases, does not amount to more than one in a hundred. Ninety-nine persons, of course, die who might be cured by the proper application of remedies which are within the reach of reason and power of man. The business of the present lecture shall be to point out the various causes which render the means of saving life, that are known or attainable by us, thus abortive. The discovery of these causes will open a wide field for speculative truth, as well as practical virtue and happiness. In considering the causes of death in diseases which are not incurable, I shall mention: I. those which are derived from physicians; II. those which arise from the conduct of sick people; and HI. those which arise from the conduct of their attendants and visitors. 1st. Under the first general head, I shall first mention ignorance in a physician , arising from original incapacity or a want of proper instruction in medicine. But where there have been both capacity and instruction, there is sometimes an obliquity in the human understanding which renders it incapable of perceiving truth upon medical subjects. A mind thus formed, may acquire learning without knowledge, and it may even acquire knowledge upon all subjects except in medicine. But where there are talents that are in every respect equal to the profession (and these are by no means so rare as has been...