The noted Dr. Benjamin Rush, the best-known Philadelphia physician of his day, pompously declared in 1789 that he found all schemes bf physic (medicine) faulty, and that he was therefore evolving "a more simple and consistent system of medicine" 1 than the world had yet seen. The Rush hypothesis, it soon appeared, was based upon a belief that all diseases were one, and likewise that all treatments were thus reduced to one. Dr. Rush's declaration greatly impressed his contemporaries, and left its author nursing the delusion that he hail rendered medicine the same sort of service as the immortal Newton contributed to physics. To his believing students in Philadelphia, Rush further remarked:
"I have formerly said that there was but one fever in the world. Be not startled, Gentlemen, follow me and I will say there is but one disease in the world. The proximate cause of disease is irregular, convulsive or wrong action in the system affected. This, Gentlemen, is a concise view of my theory of disease. . . . I call upon you, Gentlemen, at this early period either to approve or disapprove of it now." 2
Most of his students did approve, and went out over the United States practicing the heroic techniques of purging and bleeding. These treatments were supposed to re-establish health by a process of exhaustion.
European physicians joined with fellow Americans in praising both Rush's theory and his practice. Dr. Lettsom, in London, said that Rush united "in an almost unprecedented degree sagacity and judgment." A Dr. Zimmerman in Hanover announced that not only Philadelphia but all humanity should raise a statue to the American prodigy. When Rush died in 1813, he was widely acclaimed the greatest physician his country had known.
Only thirty years later, however, Rush's medical philosophy was subjected to a re-evaluation. Elisha Bartlett, a prominent member of the profession in the 5840's, rather shockingly remarked of Rush's medical essays : "It may be safely said, I think, that in the whole vast compass of medical literature, there cannot be found an equal number of pages containing a greater amount and variety of utter nonsense and unqualified absurdity. . . ."4
Why was Rush lauded by one generation and repudiated by the next? Simply because far-reaching changes were taking place. Rush, one of the last leaders of the eighteenth century, was not entirely divested of medieval tradition. The newer generation witnessed the beginnings of the metamorphosis of the older art into modern science.'
Benjamin Rush was not the only notable in the healing art whose theory of disease failed to stand. Much of the history of medicine is devoted to the rise and fall of theories and systems. Indeed, how much of today's medicine was known to yesteryear? Further, what portion of accepted practice today will survive unaltered ? When you are ready to take the National Board examinations, you may be quizzed on aspects of chemotherapy or antimicrobial agents, the scant knowledge of which a short time before did not justify their consideration in lectures.
Further emphasis on the rapid changes in medical science in a speech to medical students who are trying desperately to get into step with this onward march would be sheer prolixity. There are other changes, however, occurring within the framework of modern man's social structure, which might well be considered by fledgling physicians as well as by seasoned members of the healing art.
When Rush occupied the chair of theory and practice of medicine at the University of Pennsylvania School of Medicine, a student could attend two terms of three to four months each (the second was a repetition of the first), present a not too erudite thesis, and have conferred on him the Doctor of Medicine degree. The premedical requirements at first were specific but limited—three years of apprenticeship under a reputable physician, and a knowledge of Latin and the natural sciences. As the decades of the nineteenth century came and went, less was said of preliminary requirements, and more emphasis was placed on the volume of students accommodated by the faculties in a rapidly increasing number of medical schools, not a few of which were little more than diploma mills.
Under little or no State regulations, American medical schools turned out thousands of M.D.'s, with only this meager formal medical training in addition to an apprenticeship. An even larger number sallied forth to practice without qualifying for the degree. Indeed, many a practitioner never saw an anatomy laboratory or hospital ward, or ever heard a formal lecture.
They were a vigorous lot, these general practitioners who succored the ills of the nation during its period of westward expansion. The relatively few who had a liberal education in many instances served their communities as preachers, judges, or lawyers.
Now the picture has changed. The frontier pioneer days passed with the turn of the century. Concurrently medicine gave birth to the specialties. The profession has encouraged State regulation of licensure, and has undertaken to establish and enforce standards of premedical and medical education.
In an effort to keep up with the rapidly expanding borders of science, medical education has tended to crowd everything out of the curriculum but science. The specialties which ought to be integrated for the better understanding and treatment of disease have too often divided mortal man into spheres of influence. Thus modern discoveries have broadened our frontiers to an almost unmanageable extent.
In medicine, one is bound to deal with human life as a whole. We can only agree with A. E. Clark-Kennedy, dean of London Hospital Medical School, that "a purely scientific education is inadequate for the profession of medicine, and medical education is losing touch with the humanities at a time when the power of medicine to prolong life, relieve pain, influence endocrine secretion and to some extent instinct, control birth, dominate the mind, and even change the structure of the brain and modify personality, has increased, is increasing, and is likely to increase still further."
Tremendous power is thus coming into the hands of medicine. The greater the power, the greater will be the moral and ethical issues. Is medical education, as it is now organized, producing suitable custodians of these forces? The founders of the College of Medical Evangelists were well aware that man does not live by bread alone; that the physician must deal with human personality, human hopes, human fears, and human failings—the things a the spirit.
Let not the sagacity of the founding fathers lead students of medicine and the affiliated schools to conclude that by lock-stepping through the curricula of this college, including its courses in religion, they will automatically emerge polished products "throughly furnished unto all good works."
The burden is on each of you individually to synthesize human suffering, material forces, and spiritual values into a large interpretation of your duty and responsibility to God and mankind. Unfortunately, you cannot enjoy during your years of medical training the fellowship of men and women training in the humanities. Such students would benefit from your influence, and you would extract from this association imponderable social and cultural values. Lacking this, beware the ease by which you may become a mere technician of medical science, rather than a cultured, spiritually minded member of the healing art.
Two other significant changes have occurred during the past century which bear directly upon medicine. First, our industrial age, with all its scientific development, including medicine, has had a profound effect upon the religious life of professed Christians. Science and technology have in a large measure taken the place of God in the lives of millions. Dr. D. Elton Trueblood, of Stanford, calls it "power culture." It is based upon the assumption "that civilization consists primarily in scientific, technical, and artistic achievements, and that it can reach its goal without ethical considerations."
Hitler and Mussolini carried this doctrine to its ultimate. The Western powers won the war, so they are not yet disillusioned. Nevertheless, the achievement of nuclear physics, with all that it implies is filling men's hearts with fear as they contemplate the possibilities of the future.
Such mental distress can but produce physical symptoms. Here medicine enters the picture.
This brings us to the second significant change —a long-overdue acknowledgment by medicine in recent years that mental factors, including things spiritual, are vital considerations in the diagnosis and treatment of disease. Unfortunately, there is still much froth in the field of psychotherapy, but medicine appears to be moving unmistakably into that middle zone, where it can be a unifying force in this troubled world.
At such a time as this, you are training in the College of Medical Evangelists, an institution the existence of which is amply justified if its idealism is fulfilled. The changing world and medical science have conspired to magnify the nobility and sacredness of medicine. The ground whereon you stand is holy.
1 David Ramsay, Eulogium on Benjamin Rush (Philadelphia: Bradford and Inskeep, 1813), p. 23.
2 Benjamin Rush, "Lectures on the Practice of Physic" (1796), I, No. 31 ; II, No. i (MSS, library of University of Pennsylvania) ; cited by Richard H. Shryock, The Development of Modern Medicine (Philadelphia : University of Pennsylvania Press, 1936), p, i.
3 J. C. Lettsom, Recollections of Dr. Rush (London: J. Nichols Sons and Bentley, '815), pp. 12, 15.
4 Elisha Bartlett, An Essay on the Philosophy of Medical Science (Philadelphia : Lea and Blanchard, 1844), p. 225.
5 For a critical estimate of Dr. Rush's place in medicine see Shyrock, op. cit., pp. 1-3.
6 Clark-Kennedy's small booklet is well worth the time of any medical student or physician: The Art of Medicine in Relation to the Progress of Thought, (New York: Macmillan Company, 1945).
7 The Predicament of Modern Man, (New York Harper and Brothers, 1944).