Physical medicine Rush was a leading proponent of
heroic medicine. He firmly believed in such practices as
bloodletting patients (a practice now known to be generally harmful, but at the time common practice), as well as purges using
calomel and other toxic substances. In his report on the Philadelphia yellow fever epidemic of 1793, Rush wrote: "I have found bleeding to be useful, not only in cases where the pulse was full and quick but where it was slow and tense. I have bled twice in many and in one acute case four times, with the happiest effect. I consider intrepidity in the use of the
lancet, at present, to be necessary, as it is in the use of mercury and
jalap, in this insidious and ferocious disease." During that epidemic, Rush gained acclaim for remaining in town and treating sometimes 100 patients per day (some through freed black volunteers coordinated by
Richard Allen), but many died. Even Rush acknowledged the failure of two treatments, sweats in vinegar-wrapped blankets accompanied by mercury rubs, and cold baths. Perhaps his greatest contributions to physical medicine were his establishment of a public dispensary for low-income patients (Philadelphia Dispensary), and public works associated with draining and rerouting
Dock Creek (eliminating mosquito breeding grounds, which greatly decreased
typhus, typhoid and
cholera outbreaks). Another of Rush's medical views that now draws criticism is his analysis of race. In reviewing the case of Henry Moss, a slave who lost his dark skin color (probably through
vitiligo), Rush characterized being black as a hereditary and curable skin disease. Rush wrote that the "disease, instead of inviting us [whites] to tyrannise over them [blacks], it should entitle them to a double portion of our humanity." He added that this "should teach white people the necessity of keeping up that prejudice against [miscegenation], as it would tend to infect posterity with … their disorder" and called for an "endeavour to discover a remedy for it."
Native American health Rush was interested in Native American health. He wanted to find out why Native Americans were susceptible to certain illnesses and whether they had higher mortality rates as compared to other people. Other questions that he raised were whether they dreamed more and if their hair turned gray as they got older. His fascination with indigenous peoples came from his interest in the theory that social scientists can better study the history of their own civilization by studying cultures in earlier stages of development, "primitive men". In his autobiography, he writes "From a review of the three different species of settlers, it appears that there are certain regular stages which mark the progress from the savage to civilized life. The first settler is nearly related to an Indian in his manners. In the second, the Indian manners are more diluted. It is in the third species only that we behold civilization completed. It is to the third species of settlers only that it is proper to apply the term of farmers. While we record the voices of the first and second settlers, it is but just to mention their virtues likewise. Their mutual wants to produce mutual dependence; hence they are kind and friendly to each other. Their solitary situation makes visitors agreeable to them; hence they are hospitable to a stranger."
False quote One bogus quote sometimes falsely assigned to Rush portrays him as a medical libertarian: Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship [. . .] To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic and have no place in a republic [. . .] The Constitution of this republic should make special privilege for medical freedom as well as religious freedom." The statement was probably not made by Rush and does not represent his actual position. No primary source for it has been found, and the words "un-American" and "undercover" are anachronisms, as their usage as such did not appear until long after Rush's death.
Mental health Rush published one of the first descriptions and treatments for psychiatric disorders in American medicine,
Medical Inquiries and Observations, Upon the Diseases of the Mind (1812). He undertook to classify different forms of mental illness and to theorize as to their causes and possible cures. Rush believed (incorrectly) that many mental illnesses were caused by disruptions of blood circulation or by sensory overload and treated them with devices meant to improve circulation to the brain such as a
centrifugal spinning board, and inactivity/sensory deprivation via a restraining chair with a sensory-deprivation head enclosure ("tranquilizer chair"). After seeing mental patients in appalling conditions in Pennsylvania Hospital, Rush led a successful campaign in 1792 for the state to build a separate mental ward where the patients could be kept in more humane conditions. Rush believed, as did so many physicians of the time, that bleeding and active purging with mercury(I) chloride (calomel) were the preferable medical treatments for insanity, a fact evidenced by his statement that, "It is sometimes difficult to prevail upon patients in this state of madness, or even to compel them, to take mercury in any of the ways in which it is usually administered. In these cases I have succeeded, by sprinkling a few grains of calomel daily upon a piece of bread, and afterwards spreading over it, a thin covering of butter." Rush followed the standard procedures of bleeding and treatment with mercury, he did believe that "coercion" and "restraint", the physical punishment, chains and dungeons, which were the practice of the time, were the answer as proven by his invention of the restraint chair and other devices. For this reason, some aspects of his approach could be seen as similar to
Moral Therapy, which would soon rise to prominence in at least the wealthier institutions of Europe and the United States. Rush is sometimes considered a pioneer of
occupational therapy particularly as it pertains to the institutionalized. Rush pioneered the therapeutic approach to
addiction. Prior to his work, drunkenness was viewed as being sinful and a matter of choice. Rush believed that the alcoholic loses control over himself and identified the properties of alcohol, rather than the alcoholic's choice, as the causal agent. He developed the conception of
alcoholism as a form of medical disease and proposed that alcoholics should be weaned from their addiction via less potent substances. Rush advocated for more humane mental institutions and perpetuated the idea that people with mental illness are people who have an illness, rather than inhuman animals. He is quoted to have said, "Terror acts powerfully upon the body, through the medium of the mind, and should be employed in the cure of madness." He also championed the idea of "partial madness," or that people could have varying degrees of mental illness. The
American Psychiatric Association's seal bears an image of Rush's purported profile at its center. The outer ring of the seal contains the words "American Psychiatric Association 1844". The Association's history of the seal states: ==Educational legacy==