The Benjamin Rush lecture notes (Ms. Coll. 225) is a collection of notebooks kept by medical students at the University of Pennsylvania between roughly 1783 and 1810. These documents present readers with that era’s most advanced understandings of medical theory, and reflect the highest quality of medical education available in late eighteenth and early nineteenth century America. The careful, handwritten notes faithfully transcribe the words of Dr. Benjamin Rush, a socially prominent and professionally revered physician who taught courses in Chemistry, the “Institutes of Medicine and Clinical Practice” and the “Theory and Practice of Medicine” at the University from 1769 to 1813. The notebooks describe topics ranging from anatomy to epidemiology, as well as the causes, symptoms and treatments for dozens of medical conditions including rheumatism, asthma, gonorrhea, cancer, ring worm, scurvy, ulcers, tetanus, morning sickness, malaria and… love.
If somehow conjured into the twenty-first century, I suspect Dr. Rush would reject the hard line that is often drawn between emotional and somatic experience in medicine today. Within a long list of diseases and disorders -chronic and acute, local and systemic, infectious and non-transmissible- Rush instructed his students at length on the “Passions,” or what we might (disparagingly?) call “feelings” today. He explains that “the Passions most subject to physical influence are Love, Grief, Fear, Anger, & to these I shall add lust.” Rush presents the simultaneously physiological and psychological nature of the Passions, informing his students that
“They contribute to the Circulation of the Blood. They promote all the Secretions. Moral evil I believe has its seat in the Body as well as in the Soul… The Cultivation of the Understanding moderates them. The Passions are as nearly contagious as the small Pox or Measles.”
Rush’s conviction in the capacity of the Passions to pervade multiple dimensions of human life is evident in this passage as he describes their effects, which alternate between mundanely corporeal and unexpectedly spiritual.
The first Passion* to which Rush directs his students’ attention is Love, a malady that his pupils should identify in their future patients by a “great irritability of the System, constant talk or silence of the Object of the Passion, &c.” As to this Passion’s origin, Rush notes, “The Remote causes are Idleness & reading of Novels, or Romances. The Proximate cause is an excess of motion in the Brain & action in the Heart.” While prompted by something as seemingly innocuous as reading fiction, Rush believed that “Unsuccessful Love” had grave health consequences: “Melancholy, Hysteria, Hypochondriasis, death, &c.” Perhaps unsurprisingly then, the doctor recommends a fairly aggressive therapeutic approach to the affliction, claiming, “Where there is fever, Sighing or difficult Respiration – Bleeding, Cathartics & Blistering are proper.” By these three treatments, Rush is referring to bloodletting (one of his personal favorites), the administration of drugs to induce vomiting, and the production of blisters through the application of heat or a caustic chemical- all were considered viable remedies for a wide range of conditions.
The Passions and their decidedly psychosomatic character were not Rush’s own idea or discovery, nor was his enthusiasm for this topic eccentric among his colleagues. Rather, the presence of the Passions in this collection of lecture notes reflects not only the prevailing medical theory of the day, but also the accumulated wisdom of several centuries worth of medical experts. Rush’s debt to his forebears for his knowledge of the Passions is revealed in a piece advice he bestows upon his audience. He suggests, “to know when a fever is occasioned by [Love], the Pulse should be felt when the name of the Person beloved is mentioned & by what changes take place in it.” In other words, since a high body temperature can be caused by any number of indispositions, Rush tells his students to carefully observe a patient’s response to the name of his or her sweetheart- a quickening heart rate might suggest that Love is behind the febrile condition. Though he doesn’t divulge the history of this clever trick, the device is not original to Rush. On the contrary, the technique was developed millennia prior, famously employed by the physician Erasistratus in the third century BCE to unveil the lovesickness of Antiochus I Soter, and illustrated in a case study in Galen’s De Praecognitione, from the second century CE. While this diagnostic method may seem offbeat from our contemporary perspective, it was extremely well established in Rush’s time.
Rush didn’t think love itself was bad, he just recognized the strong and direct effect that it –and fear and anger and grief- could have on a person’s experience of well-being or malaise. I think Rush considered it his responsibility, as a doctor, to administer to the needs of his patients, whether they were suffering from the pain of a broken wrist or a broken heart. Rush’s focus on the Passions may appear to be an early instance of medicalization, the impulsion of a normal bodily experience or phenomenon into the realm of specialized health care. But I think that in the medical lectures he delivered on the Passions, Rush was simply acknowledging what his wide-ranging experience had taught him: the line between feelings and physiology can be very fine.
*Rush’s discussions of the other Passions feature some amusing anecdotes, such as this one regarding Fear: “It has a singular effect upon the hair, making it stand erect; I have heard of one man whose hair became grey in one night, by the fear of some Rats, wh[ich] tormented him.”