respected that he was known as ‘the Pennsylvania Hippocrates’ and is still the only physician to have had a statue erected in his honour in Washington DC by the American Medical Association. His prolific career had allowed him to persuade an entire generation of doctors of the benefits of bloodletting, including the three doctors who had attended General Washington. For Rush had served with Dr Craik in the Revolutionary War, he had studied medicine with Dr Brown in Edinburgh, and he had taught Dr Dick in Pennsylvania.
Dr Rush certainly practised what he preached. His best-documented bloodletting sprees took place during the Philadelphia yellow fever epidemics of 1794 and 1797. He sometimes bled 100 patients in a single day, which meant that his clinic had the stench of stale blood and attracted swarms of flies. However, William Cobbett, who had a particular interest in reporting on medical scandals, was convinced that Rush was inadvertently killing many of his patients. Cobbett began examining the local bills of mortality and, sure enough, noticed an increase in death rates after Rush’s colleagues followed his recommendations for bloodletting. This prompted him to declare that Rush’s methods had ‘contributed to the depopulation of the Earth’.
Dr Rush’s response to this allegation of malpractice was to sue Cobbett for libel in Philadelphia in 1797. Delays and distractions meant that the case dragged on for over two years, but by the end of 1799 the jury was ready to make a decision. The key issue was whether Cobbett was correct in claiming that Rush was killing his patients through bloodletting, or whether his accusation was unfounded and malicious. While Cobbett could point to the bills of mortality to back up his case, this was hardly a rigorous analysis of the impact of bloodletting. Moreover, everything else was stacked against him.
For example, the trial called just three witnesses, who were all doctors sympathetic to Dr Rush’s approach to medicine. Also, the case was argued by seven lawyers, which suggests that powers of persuasion were more influential than evidence. Rush, with his wealth and reputation, had the best lawyers in town arguing his case, so Cobbett was always fighting an uphill battle. On top of all this, the jury was probably also swayed by the fact that Cobbett was not a doctor, whereas Rush was one of the fathers of American medicine, so it would have seemed natural to back Rush’s claim.
Not surprisingly, Rush won the case. Cobbett was ordered to pay $5,000 to Rush in compensation, which was the largest award ever paid out in Pennsylvania. So, at exactly the same time that George Washington was dying after a series of bloodletting procedures, a court was deciding that it was a perfectly satisfactory medical treatment.
We cannot, however, rely on an eighteenth-century court to decide whether or not the medical benefits of bloodletting outweigh any damaging side-effects. After all, the judgement was probably heavily biased by all the factors already mentioned. It is also worth remembering that Cobbett was a foreigner, whereas Rush was a national hero, so a judgement against Rush was almost unthinkable.
In order to decide the true value of bloodletting, the medical profession would require a more rigorous procedure, something even less biased than the fairest court imaginable. In fact, while Rush and Cobbett were debating medical matters in a court of law, they were unaware that exactly the right sort of procedure for establishing the truth about medical matters had already been discovered on the other side of the Atlantic and was being used to great effect. Initially it was used to test a radically new treatment for a disease that afflicted only sailors, but it would soon be used to evaluate blood letting, and in time this approach would be brought to bear on a whole range of medical interventions, including alternative therapies.
Scurvy, limeys and the blood test
In June 1744