Bleeding by the numbers

Benjamin Rush

Andrew G. Shuman, MD, Marc Edelman, JD, MA, and Joseph J. Fins, MD

Dr. Shuman (AΩA, University of Michigan, 2004) was/ British journalist in post- America. Cobbett’s is a fellow in the Division of Medical Ethics at Weill Cornell literary foil and adversary was none other than the famous Medical College. He is currently assistant professor of physician and patriot, , who inad- Otolaryngology-Head and Neck Surgery and faculty in the vertently became the focus of one of the earliest applications Center for Bioethics and Social Sciences in Medicine at the of biostatistics in the history of medicine. University of Michigan Medical School. Mr. Edelman is asso- During the 1793 Philadelphia epidemic, Rush ciate professor of Law at Zicklin School of Business, Baruch made liberal and publicly-touted use of , which College, City University of New York. Dr. Fins (AΩA, Weill Cobbett argued was both dangerous and did not reduce the Cornell Medical College, 2011) is the E. William Davis Jr. MD death rate. After losing a libel suit to Rush, Cobbett defended Professor of Medical Ethics; chief of the Division of Medical himself with a novel weapon—data—and unwittingly opened Ethics; professor of Medicine, Public Health, and Medicine in the door to the modern concept of public health epidemiology. at Weill Cornell Medical College; and adjunct fac- Despite having the numbers and facts on his side, Cobbett’s ulty at the Rockefeller University. legacy is largely relegated to a historical footnote, whereas Rush’s continued support of bloodletting likely contributed to he emergence of statistics within the field of medicine many preventable deaths well into the nineteenth century. The is commonly traced to the French physician Pierre story is further enriched by its historical setting and political Charles Alexandre Louis, who, beginning in the 1820s, climate, challenging freedom of the press while the ink on the appliedT a “numerical method” to determine whether bloodlet- Bill of Rights was still moist. ting effectively treated infections and fevers.1 A surprising predecessor to Louis was , a rabble-rousing

10 The Pharos/Autumn 2014 Rush versus Cobbett Bleeding by the numbers

Illustration by Erica Aitken William Cobbett

The protagonists president. He gained further notoriety when disease invaded Dr. Benjamin Rush remains one of the best known Philadelphia. American physicians of his time. The son of a local gun- In 1793, a virulent yellow fever epidemic wreaked havoc on smith, Rush signed the Declaration of Independence and Philadelphia, killing up to one-tenth of the city’s population. A later served as Chief Physician of the Revolutionary Army, disease with a variable clinical course and no definitive treat- and enjoyed international acclaim and esteem as a physician ment even today, physicians at the time were nearly helpless. and educator.2 After graduating from the College of New The etiology, a mosquito-borne virus, along with effective pre- Jersey (now ), Rush apprenticed with vention strategies, would not be discovered for over a century. a local physician before graduating from medical school in In the absence of scientific evidence, public health debates be- 1768 with the financial assistance of .3 came intertwined with politics—“contagionists” believed yellow According to one student, Rush had a “voice, sweeter than fever was a communicable disease and generally sided with the a flute, [that] fell on [one’s] ears like droppings from a sanc- Federalists such as and , while tuary . . . with his earnest, most sincere, most persuasive “anti-contagionists,” on the other hand, favored environmental accents, sunk so deep into my heart that neither time nor etiologies and tended to be Jeffersonian Republicans.5 change could eradicate.” 4 Rush was reform-minded, peti- Rush combated the yellow fever epidemic with his char- tioning for the abolition of slavery, education of women, acteristic fervor, converting his home into a hospital and and improvement of . He was also a prolific writer seeing over a hundred patients daily.3 The idea for aggressive who authored the first essay in American history advocat- bloodletting, the crux of his treatment, was based on a medical ing for an entirely public school system, and boasted about publication from the given to him by none other than his writing the first article promoting for patron, Benjamin Franklin.6 By trial and error, Rush settled on

The Pharos/Autumn 2014 11 Benjamin Rush by Richard W. Dodson. © Stapleton Collection/CORBIS

a treatment regimen involving “depletion theory,” consisting of aggressive bleeding coupled with a mercury-based purgative.7 Convinced of its effectiveness, he publicized his treatment in newspapers and in impassioned pleas to medical colleagues, and intensely criticized physicians who spoke out against his ideas. The professional debate was relayed in communica- tions between , Secretary of War, to President Washington: “The different opinions of treatment incite great inquietude . . . But Rush bears down all before him.” 7 Doctor practicing bloodletting on a patient by artist James As both mercury-based purgatives and bloodletting were Gillray. © Historical Picture Archive/CORBIS very much a component of standard medical practice, it was these therapies’ applicability to yellow fever, the concordant use of aggressive emetics, and the sheer volume of blood removed physician himself, offered less than generous appraisals of that set Rush apart from his peers.8 A partial explanation for Rush’s contributions to the field: “In the whole vast compass the aggressiveness of Rush’s regimen involves his gross miscal- of medical literature, there cannot be found an equal number culation of the normal adult human blood volume, which he of pages containing a greater amount of utter nonsense and projected at twice the correct figure.6 unqualified absurdities.” 12 In fact, Rush applied his anecdotal Empiric study would eventually bring into question the prac- experiences with bleeding as a panacea for yellow fever widely, tice of routine bloodletting. To Rush’s credit, however, he did espousing the theory that all significant illnesses resulted from make substantive advances in the realm of public health with increased vascular tension that could be resolved with aggres- respect to yellow fever. His assertion that the disease was not sive bloodletting.10 This fallacy, popularized by his spirited transmitted among humans and his willingness to remain with rhetoric and prolific writings espousing the dangerous practice, the infirm served as a powerful example of medical profession- spread significantly throughout the global medical community, alism; moreover, while the insect vector would not be identified and was applied by his trainees along the eastern seaboard as until the twentieth century, his efforts to improve hygiene have late as the 1840s.10 been lauded.9 Rush urged the mayor of the city to establish William Cobbett, a British ex-marine and journalist resid- hospitals for management of the indigent.7 His memoir of the ing in Philadelphia, was an unlikely opponent. Cobbett had epidemic provided a personal and riveting account of the ill- received little formal education, but taught himself grammar ness and its effect upon the population.10 In addition, his sheer and literature.13 After the , Cobbett settled determination and work ethic throughout the epidemic of 1793 in Philadelphia and assumed the pseudonym Peter Porcupine, were highly praised.11 writing the popular Porcupine’s Gazette. A loyal Briton active in Even though there were few satisfactory alternatives to American politics, Cobbett bitterly opposed the Republicans, Rush’s practice of bloodletting to treat yellow fever, some con- lending grudging support to Alexander Hamilton and the tend that Rush managed to “severely retard medical progress for Federalists.14 Cobbett’s writings were popular as both enter- almost fifty years after his death.” 4 Elisha Barlett, a renowned tainment and a source of news. Abigail Adams appreciated his

12 The Pharos/Autumn 2014 Portrait of William Cobbett by J.R.Smith. © Bettman/CORBIS

work, commenting that Cobbett’s “shafts are always tipt with of his many barbs, Cobbett continued the Biblical metaphor: wit, and his humor is such as frequently to excite more of good “The Israelite slew his thousands, but the Rushites have slain than ill.” 15p8–9 Meanwhile, George Washington also offered their tens of thousands,” 20p131 followed by “The times are omi- guarded praise, despite his concern that the works contained nous indeed,/When quack to quack cries, Purge and bleed.” 20p167 “strong and coarse expressions” and “a want of official informa- In another broadside, Rush was given unholy company: “a mus- tion on many facts.” 15p18 quito, a horse-leech, a ferret, a pole cat, a weazel: for these are Cobbett ultimately chose Benjamin Rush as his main tar- all bleeders and understand their business full as well as Doctor get. While not the first to criticize Rush (Knox, Hamilton, and Rush does his.” 21pp288–89 others had already done so), Cobbett may have been the most The pamphlets were influential. In a personal letter in which acerbic. In Cobbett’s words, Rush “seized, with uncommon he disclosed his intent to file a legal suit, Rush admitted that alacrity and address, the occasion presented by the Yellow “Their design proved successful. They lessened my business, Fever, the fearful ravages of which were peculiarly calculated to and they abstracted so much of the confidence of my patients dispose the minds of the panick-struck people to the tolerance, as to render my practice extremely difficult and disagreeable and even to the admiration, of experiments, which, at any other among them. To put a stop to their injurious effects upon time, they would have rejected with disdain.” 16p53 As Rush con- my business and the lives of my patients, I commenced civil tinued to espouse his techniques of bloodletting during further action.” 22pp72–73 While the case awaited trial, Rush instructed yellow fever outbreaks in the late 1790s, Cobbett mounted a local newspapers to refrain from publishing further inflamma- systematic counterattack. tory quotes by Cobbett, while he persisted in employing this Adding both credence and support to his arguments, medium in defense of his practice.18 The stage was set for battle. Cobbett was joined by other physicians who were also troubled by Rush’s aggressive treatment regimen.17 The political climate The libel suit of the time was dominated by vitriolic rhetoric, and Cobbett The case did not come to trial for over two years. Some established a strong track record of ferociously attacking the contend that the delay was due to the plaintiff awaiting a more Republicans and defending the Federalist political agenda.18 sympathetic jury.23 Ultimately, Cobbett was forced to defend In fact, the debate over the appropriate treatment of yellow his statements before Chief Justice Thomas fever was also tied to political affiliations, with the Republicans McKean—the very judge whom he had dubbed a “corrupt, hen- (including Rush and ) bitterly opposed by pecked alcoholic.” 24p41 To add insult to injury, Cobbett asserted, the Federalists (including Hamilton), despite a widely varying in a pamphlet dedicated solely to McKean’s immorality, that “he (and frequently minimal) degree of medical experience on both beats his wife, and his wife beats him.” 25p23 sides.10 Rush himself was not above mixing medical debate with In their opening statements, the lawyers for the two men political barbs, sardonically noting that “Hamilton’s remedies traded blood-tinged metaphors. Mr. Hopkinson, counsel for the are now as unpopular in our city as his funding system is in plaintiff, noted that “Dr. Rush is as well known for his peace- Virginia or North Carolina.” 19p692 ful habits and his amiable manners, as William Cobbett is for Branding Rush “The Bleeding Physician of Philadelphia,” his disocial malignant disposition and inveterate hate.” 26p8 He Cobbett’s attacks were biting, popular, and downright entertain- characterized the libel against Rush as “of the most deadly and ing, selling thousands of pamphlets to an eager public. Rush was violent kind that malice could invent, or abandoned deprav- known to refer to mercury as the “Samson” of medicine. In one ity execute—He is accused of , or destroying the lives

The Pharos/Autumn 2014 13 Bleeding by the numbers

of his fellow citizens, in a time of dreadful calamity.” 26pp10–11 acts of which a man can be guilty, none is so mean, none is so Hopkinson went on to note the capriciousness of a physician’s base, none is so truly detestable, as that of seeking, through the reputation, which he called “a fabric delicate as air, the slightest law, vengeance for a literary defeat.” 30p408 Cobbett did not abate gust of popular prejudice or caprice dissipates it, even suspicion his criticism of Rush, retorting that “nothing provokes me but destroys it; if he is distrusted he is ruined.” 26p13 Mr. Harper, the thought of such a whining republican rascal putting 5,000 another attorney for Rush, argued that Cobbett’s attack was dollars in his pocket.” 31p1216 malicious, and not simply based upon a disagreement with his In the months after a ruling was rendered against him, medical theory. He even encouraged the jury to return a verdict Cobbett published a series of new pamphlets called the Rush- for Cobbett if they believed that his writings were only intended Light, in which he defended his actions and further denounced to attack Rush’s controversial medical practice, contending that his adversary. He explained that “When I determined to dis- Cobbett was also bent on destroying Rush as an individual.26 continue the publication of Porcupine’s Gazette, I intended to Rush’s attorneys based their case on Cobbett’s writings, remain, for the future, if not an unconcerned, at least, a silent coupled with the testimony of three individuals who claimed spectator of public transactions and political events; but, the that Cobbett had a personal vendetta against Rush. Meanwhile, unexpected and sweeping result of a lawsuit, since decided Cobbett’s representatives admitted that all of the submitted against me, has induced me to abandon my lounging inten- evidence attributed to their client was indeed written or en- tion.” 16p1 Cobbett’s arguments were reasoned and structured, dorsed by Cobbett himself, and did not dispute the facts of the much more so than his attorneys’ performance at trial. Among case. They contested the charges mostly by arguing that there other tactics, he used one of the more obvious, questioning the was no personal malice behind any of his writings, and that impartiality of both the judge and jury. they simply reflected his low opinion of Rush’s medical skills, Cobbett told the story of Dr. Glentworth, a friend and col- as supported by other physicians. They argued that “A good, league of Rush, who contracted yellow fever and sought care skilful, laborious, honest physician, is a very valuable member under Rush in 1793. of society. But, on the contrary, an unskilful, avaricious, indolent physician deserves, not only public disapprobation, but, public Dr. Glentworth told me, besides (and he will tell the same to contempt.” 26p26 Neither plaintiff nor defendant used medical, any one), that Rush attended him in the yellow fever of 1793; scientific, or epidemiologic facts in their legal strategy. that he bled him till he was extremely weak, and ordered The case was ultimately heard by Judge Shippen, a close several other bleedings which Glentworth’s knowledge made friend and colleague of Judge McKean.27 Judge Shippen es- him omit, without, however, telling Rush of the omission; sentially told the jury that the judgment should be in Rush’s that he came one day, and finding his patient sitting up in the favor, given both the nature of the comments as well as the bed, ran to him, squeezed him by the hand, called his “dear defendant’s lack of evidence supporting the veracity of Cobbett’s Glentworth,” and congratulated him on the salutary effects of statements. The court went so far as to suggest that the mon- his bleeding system; “but,” said he, “my dear friend, you must etary award against Cobbett should be substantial. lose a little . . . MORE BLOOD.”—”Lose more blood!” replied Pennsylvania’s defamation law at the time was less favor- Glentworth, “when I am so faint I can hardly support my- able to Cobbett than it would be today, as the state’s common self!”—Upon this, Rush started from the bed-side, caught up law placed the burden of proof on the defendant.28 In addition, his hat, called his “dear friend” an assassin, told him he was eighteenth-century medical debates and arguments among leagued with [one of his critics] to ruin his reputation, and doctors frequently strayed into the lay press, particularly con- ran down the stairs bawling out: “you’re a dead man! you’re a cerning the diagnosis and management of virulent, untreatable dead man! you’ll be buried . . . before to-morrow night!” 32pp12 epidemics with massive social and economic implications. After a two-hour deliberation, the case was decided in favor Cobbett also criticized Rush for exclusively consulting his of Rush in the amount of 5000, one of the largest libel awards friends and other doctors supporting his treatments. “If the in American history at the time. In a classic example of histori- opinions of all physicians were settled, and were all the same, cal irony, the verdict arrived on December 14, 1799, the same there could be no use in calling a consultation.” 32p14 Rush in fact day President Washington lay on his deathbed, being bled dry denounced even the physicians who agreed with the tenets of by a colleague and pupil of Rush’s, as was then the customary his regimen, but whom he perceived overly conservative with practice. the quantity of blood removed.7 In an open letter to Elisha Dick, the Rush disciple who cared The aftermath for George Washington on his deathbed, Cobbett implicated Despite the favorable outcome for Rush, the publicity ruined Rush as partially responsible for the former president’s fate: his medical practice. His connections proved useful, however— “poor Fate had much less to do in the business than you and he was subsequently named treasurer of the your colleagues. . . . P.S. Don’t you think it would be a good Mint by President John Adams. Cobbett estimated that his thing, Doctor, if the names and places of abode of all Rush’s total losses, including the settlement, legal fees, property loss, pupils were published? If you don’t, I do.” 16p86 and loss of printed works, totaled 8,000.29 Cobbett’s general Disillusioned with America, Cobbett set sail for , opinion on the case was, naturally, contemptuous: “Of all the where he noted that “neither the moths of Democracy nor

14 The Pharos/Autumn 2014 the rust of Federalism doth corrupt, and where thieves do was easily demonstrable that the more the bleeders bled, the not with impunity break through and steal five thousand dol- more the victims died.” 15 Even President Adams, who named lars at a time.” 33p72 In an autobiography written near the end Rush treasurer of the U.S. Mint, retorted that Rush was “too of his life, he was even blunter: “That I was most unjustly much of a Talker to be a deep Thinker.” 8 A historical review of and basely treated in the American States, and by two of the Rush’s career and reputation concluded that he had a “clever but Governments of that country, is a fact pretty well known . . . I not really a critical mind.” 11p551 Jacquelyn Miller contends that hate the United States and all their mean and hypocritical sys- Rush’s impassioned treatment of yellow fever can be considered tem of rule.” 29p84 Despite the bitterness, Cobbett had the last an anachronism of his unyielding political and social stances.6 laugh—the publicity surrounding the case and the popularity of the Rush-Light yielded a significant profit in pamphlet sales, Lessons for today and some estimate that Cobbett pocketed 10,000 in revenue Whether involving Federalists, Jeffersonian Republicans, or prior to returning to London.34 members of Congress in the twenty-first century, vitriolic at- tacks solely based upon political affiliations have the potential Biostatistics: A fine legacy to distort issues, prevent healthy discourse, and deadlock prog- Lest we forget what is arguably the most important result ress. Such displays of unyielding devotion to dogma revealed of the Rush-Cobbett saga, let us turn to the numbers. In the the inherent arrogance of our protagonists, which, in hindsight, February 28, 1800, edition of the Rush-Light,16 Cobbett used benefited neither them nor their contemporaries. Yet while municipal records to prove that Rush’s interventions did not clearly fallible, both Cobbett and Rush were consummate pro- decrease the death rate from yellow fever. He presented data fessionals. Cobbett wielded his pen to expose perceived injus- on mortalities during the 1793 yellow fever epidemic; there was tices in the true spirit of journalistic freedom. Rush, for all of his an average of sixty-seven deaths daily for the month following flaws, never once abandoned his patients, and even his enemies Rush’s implementation and advertisement of his treatment, recognized the zeal and passion with which he attempted, often much higher than the prior month. Rush claimed that his treat- in vain, to help and to heal. ments were successful by referencing surviving patients, to Cobbett’s nascent application of medical epidemiology which Cobbett argued that proof that “everyone he touched did heralded a revolution in which biostatistics framed the relative not die” 16p62 was not a valid defense of medical practice. Rush value of all medical interventions. It would certainly be a stretch published a list of twenty-two surviving patients who were bled to consider Cobbett the father of evidence-based medicine, but greater than fifty ounces, which Cobbett cited as proof of his his precocious line of logic heralded a paradigm shift that would awful results, since Rush treated and bled many more—up to evolve in the coming century. The saga of Cobbett and Rush one hundred individuals daily during the epidemic. Moreover, reminds doctors, journalists, and politicians alike of their legal, Rush claimed a greater than ninety percent survival rate, moral, and professional responsibilities, none of which are any whereas the data of a doctor with whom he worked suggested less important today than they were at the birth of our nation. that Rush had a fifty-six percent mortality rate during the yellow fever epidemic in 1797.16 Unfortunately, the incomplete histori- Acknowledgments cal record precludes a retrospective attempt to apply modern Thanks to the William L. Clements Library at the University of comparative statistics to prove the lack of efficacy (and direct Michigan for assistance with archival research. harm) that bloodletting afforded, but in a sense, the numbers that Cobbett himself assembled truly speak for themselves. References Although Cobbett’s failure to use biostatistics in his defense 1. Porter TM. The Rise of Statistical Thinking 1820–1900. Princ- at trial may seem to be an oversight from our modern perspec- eton (NJ): Princeton University Press; 1986. tive, his use of data in his later writings was ahead of his time. 2. Hawke DFW. Benjamin Rush: Revolutionary Gadfly. India- Francis Bacon had first developed the basis of the scientific napolis: Bobbs Merrill; 1971. method nearly two centuries earlier, but empiric study of sci- 3. Woodruff AW. Benjamin Rush, his work on yellow fever and ence and medicine were slow to emerge thereafter. Pierre his British connections. Am J Trop Med Hyg 1977; 26: 1055–59. Charles Alexandre Louis’s use of the “numerical method” to dis- 4. Toledo AH. The medical legacy of Benjamin Rush. J Invest prove the efficacy of bloodletting for pneumonia was published Surg 2004; 17: 61–63. in the 1820s, and was groundbreaking at the time.1 Medical sta- 5. Estes JW. Introduction: The Yellow Fever Syndrome and Its tistics as a discipline would not emerge until the 1830s, and only Treatment in Philadelphia, 1793. In: Estes JW, Smith BG, editors. A basic attempts at quantifying survivorship and death (mostly Melancholy Scene of Devastation: The Public Response to the 1793 with regard to smallpox) had been made throughout the eigh- Philadelphia Yellow Fever Epidemic. Canton (MA): Science History teenth century in Europe.35 A legal historian commented that Publications; 1997: 1–18. “Cobbett’s statistical research was an epidemiological tour de 6. Miller JC. Passions and Politics: The Multiple Meanings of force that would have done a modern scholar proud.” 36 Benjamin Rush’s Treatment for Yellow Fever. In: Estes JW, Smith BG, In the words of historian L. H. Butterfield, “Cobbett the lay- editors. A Melancholy Scene of Devastation: The Public Response to man must be credited with a suggestion of scientific importance the 1793 Philadelphia Yellow Fever Epidemic. Canton MA: Science that never seems to have occurred to Rush the physician. . . . It History Publications; 1997: 79–96.

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7. Kopperman PE. “Venerate the Lancet”: Benjamin Rush’s yel- 22. Rush B. A Memorial containing Travels Through Life or Sun- low fever therapy in context. Bull Hist Med 2004; 78: 539–74. dry Incidents in the Life of Dr. Benjamin Rush etc. Lanoraie (Quebec): 8. Clark RB. Bleedings, purges and vomits: Dr. Benjamin Rush’s Louis ; 1905. republican medicine, the bilious remitting yellow-fever epidemic of 23. Smith E. William Cobbett: A Biography. London: Sampson 1793, and the non-origin of the law of informed consent. J Contemp Low, Marston, Searle & Rivington; 1879. Health Law Policy 2008; 24; 209–50. 24. Cobbett W. Peter Porcupine in America: Pamphlets on Re- 9. Brodsky A. Benjamin Rush: Patriot and Physician. New York: publicanism and Revolution. Wilson DA, editor. Ithaca (NY): Cornell St. Martin’s Press, 2004. University Press; 1994. 10. Rush B. An Account on the Bilious Remitting Yellow Fever, as 25. Cobbett W. The Republican Judge: Or the American Liberty it Appeared in the City of Philadelphia in the Year 1793. Philadelphia: of the Press, as Exhibited, Explained, and Exposed in the Base and Thomas Dobson; 1794. https://archive.org/details/2569009R.nlm. Partial Prosecution of William Cobbett etc. London: J. Wright; 1798. nih.gov. http://books.google.com/books?id=Ex1XAAAAcAAJ&pg=PR1&d 11. Shryock RH. The medical reputation of Benjamin Rush: Con- q=william+cobbett+republican+judge&hl=en&sa=X&ei=gxqjU9e trasts over two centuries. Bull Hist Med 1971; 45: 507–52. aGIq2yAS294KIAg&ved=0CB4Q6AEwAAv=onepage&q=alcoho 12. Saffron MH. Benjamin Rush: Patriarch reconsidered. NY State lic&f=false. J Med 1979; 79: 1449–52. 26. Carpenter TA. Report of an Action for a Libel, Brought by 13. Cobbett W. The Last Confession and Dying Speech of Pe- Dr. Benjamin Rush against William Cobbett. Philadelphia: WW ter Porcupine, with an Account of His Dissection. New York; 1797. Woodward; 1800. https://archive.org/details/2182034R.nlm.nih.gov. http://books.google.com/books?id=MCtcAAAAcAAJ&pg=PA1&dq= 27. Waters R. How to Get On In the World, as Demonstrated the+last+confession+and+dying+speech&hl=en&sa=X&ei=KSijU6f by the Life and Language of William Cobbett. New York: James W. LMcvqoAS38ILoCQ&ved=0CB4Q6AEwAAv=onepage&q=the20 Pratt; 1883. https://archive.org/details/howtogetoninworl00wate. last20confession20and20dying20speech&f=false. 28. Philadelphia Newspapers v. Hepps, 475 U.S. 767 14. Pernick MS. Politics, Parties and Pestilence: Epidemic Yellow (1986). http://caselaw.lp.findlaw.com/scripts/getcase. Fever in Philadelphia and the Rise of the First Party System. In: Estes pl?court=US&vol=475&invol=767. JW, Smith BG, editors. A Melancholy Scene of Devastation: The Pub- 29. Cobbett W. The Progress of a Plough-Boy to a Seat in Parlia- lic Response to the 1793 Philadelphia Yellow Fever Epidemic. Canton ment. Reitzel W, editor. London: Faber and Faber; 1834. MA: Science History Publications; 1997: 119–46. 30. Cobbett W. Libel Law; July 1808. In: Cobbett JM, Cobbett 15. List KK. The Role of William Cobbett in Philadelphia party JP. Selections from Cobbett’s Political Works: Being a Complete press, 1794–1799. Journalism Monographs 1983; 82. Abridgment of the 100 Volumes which Comprise the Writings of 16. Cobbett W. The Rush-Light. 1800 Feb 28. https://archive.org/ “Porcupine” and the “Weekly Political Register.” Volume II. London: details/rushlight1718cobb. Ann Cobbett: 402–15. 17. Watson JS. Biographies of John Wilkes and William Cobbett. 31. Butterfield LH, editor. Appendix III: The Cobbett-Rush Edinburgh: W. Blackwood and Sons; 1870. Feud. In: Butterfield LH, editor. Letters of Benjamin Rush. Volume 18. Stewart DH. The Opposition Press of the Federalist Period. 2. Princeton (NJ): Princeton University Press, 1951. Albany (NY): State University of New York Press; 1969. 32. Cobbett W. The Rush-Light. 1800 Feb 15. https://archive.org/ 19. Rush B. Letter to Elias Boudinot, 2 Oct 1793. In: Butterfield LH, details/rushlight1718cobb. editor. Letters of Benjamin Rush. Princeton NJ: Princeton University 33. Bowen M. Peter Porcupine: A Study of William Cobbett, Press; 1951: 692. 1762–1835. New York: Longmans, Green; 1936. 20. Cobbett W. Gazette Selections, Tuesday, 19 September 1797 34. Schweizer KW, Osborne JW. Cobbett in His Times. Leicester In: Cobbett W. Porcupine’s Works; Containing Various Writings (UK): Leicester University Press; 1990. and Selections, Exhibiting a Faithful Picture of the United States of 35. Rusnock AA. Vital Accounts: Quantifying Health and Popu- America etc. Volume VII. London: Cobbett and Morgan; 1801. http:// lation in Eighteenth-Century England and France. New York: Cam- books.google.com/books?id=wmwFAAAAQAAJ&printsec=frontco bridge University Press; 2002. ver&dq=porcupine’s+works&hl=en&sa=X&ei=uv2iU4z_KYSl8QH 36. Lachman JA. Knowing and showing economics and law. Yale XrIHgAg&ved=0CDQQ6AEwBAv=onepage&q=porcupine’s20 Law J 1984; 93: 1587–1624. works&f=false. 21. Cobbett W. Gazette Selections, Tuesday, 14 November 1797 In: Address correspondence to: Cobbett W. Porcupine’s Works; Containing Various Writings and Selec- Andrew G. Shuman, MD tions, Exhibiting a Faithful Picture of the United States of America etc. University of Michigan Health System Volume VII. London: Cobbett and Morgan; 1801. http://books.google. 1904 Taubman Center com/books?id=wmwFAAAAQAAJ&printsec=frontcover&dq=porcupi 1500 E. Medical Center Drive ne’s+works&hl=en&sa=X&ei=uv2iU4z_KYSl8QHXrIHgAg&ved=0CD Ann Arbor, Michigan 48109 QQ6AEwBAv=onepage&q=porcupine’s20works&f=false. E-mail: [email protected]

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