Dr. Gustavus Richard Brown: George Washington's Physican

Rich Hill Plantation 
3 May 2023
Photo by Michael Mazzeo
Friends of Rich Hill

Dr. Gustavus Richard Brown was born 17 October 1747 at Rich Hill near what is now Bel Alton. His father, Gustavus Brown, who was also a physician, died in 1762 leaving his son a plantation in Nanjemoy known as Middleton. Four years later, the younger Brown entered the University of Edinburgh Medical School, from which he graduated in 1768. One of his classmates was Benjamin Rush of Philadelphia.

Brown spent a few months after graduation working in hospital wards in London. He then returned to Maryland and set up a medical practice at his Nanjemoy plantation. He remained there until around 1780, when he purchased Rose Hill near Port Tobacco. He planted a large botanical garden at Rose Hill using many of the plants for medicinal purposes. Brown also established a small medical school at Rose Hill, teaching about 10 young men at a time. According to tradition he had a brick building on the property that served as his office and, which had a dissecting room in the basement.

 

Rose Hill the home of Dr. Gustavus Brown
1933 HABS Photographic

Benjamin Rush
Thomas Sully, 1812
National Portrai Gallery
Washington, D.C.

During the Revolutionary War both Brown and his former classmate Benjamin Rush served as physicians. Rush was appointed Surgeon General until he ran afoul of George Washington and resigned. Gustavus Richard Brown, according to some sources, replaced Rush in 1778. However, other sources claim that his nephew William Brown (1748-1792) replaced Rush. William, who was a physician in Alexandria, Virginia, was a friend of Washington and was also a graduate of the University of Edinburgh.

 After the war Dr. Gustavus Brown returned to Charles County, where he continued to practice medicine. He was married to Margaret Graham before the war. They had at least five children. Eleanor (who died as a baby) and Elizabeth were born before the war. The three youngest children, Gustavus, Gustavus Richard, and Margaret were probably born at Rose Hill. Brown’s life after the war was one of a country physician. Then on 14 December 1799, he was called across the Potomac River to attend George Washington on the night he died.

Gustavus Brown continued to practice medicine until he died on the 27 September 1804. His estate probate inventory (dated 22 October) includes a list of the books in his library, which give us insight into the education and interests of this late eighteenth-century physician. Brown’s library contained works by 45 authors that comprised 124 volumes, an additional 21 volumes of bound literary periodicals with pieces by multiple authors, and a “parcel of pamphlets.” The contents of the books may be generally divided into ancient history and literature, general history, literature, poetry, philosophy, mathematics, and natural philosophy (as science was then known).

Title Page of Thomas Short's Observations

Natural philosophy volumes listed in the inventory are the most intriguing as they offer a window into Brown’s medical philosophy. There are only 9 works in this category and only one is directly associated with disease. This single volume, listed in the inventory as “Shearts Observations” is probably the 1750 edition of Thomas Short’s New Observations, Natural, Moral, Civil, Political, and Medical, on City, Town, and Country Bills of Mortality. Short was known for his work on demographics or population theory and this particular volume discussed how diseases affect and alter populations.

The parcel of pamphlets listed in the inventory are not described, however, it is possible that they included medical treatises as well as Brown’s own notes from courses he had attended at Edinburgh. Four of his notebooks are currently held by the Bernard Becker Medical Library Archives at the University of Washington in St. Louis. These notebooks include lectures by William Cullen on physiology, Cullen’s practice of physic, and Dr. Thomas Young’s lectures on midwifery. The lectures on physic (or the practice of medicine) and midwifery were clinical lectures given in the Royal Infirmary in Edinburgh. Another of the items within the parcel may have been Brown’s dissertation, entitled De ortu animalium caloris (about the origin of heat of animals). The title indicates that it considers humoral medicine in light of the Roman physician Galen’s vital heat theory which identified life with innate heat. Health depended on the lungs and respiration maintaining the right degree of vital heat so that the balance between the four humors was maintained.

The four humors as described by Hippocrates and Galen were Black Bile (Earth), Phlegm (Water), Blood (Air), and Yellow Bile (Fire). Each patient had a unique humoral makeup. When the humors were in balance they were in a state of eucrasia, or a normal state of health. Dyscrasia occurred when there was imbalance in the humors, which resulted in pain and discomfort. The duty of the physican was to return the patient to eucrasia. A change in the properties of the humor - hot, cold, wet, or dry - caused an imbalance. Despite the fact that Robert Boyle’s Sceptical Chymist (1661) denied the validity of the classical four elements, humoral medicine was still based on this view of the world. It should be noted that none of Boyle’s books were included in Brown’s library.

Title Page of Gustavus Richard Brown's 
 1768 Dissertation

Dr. Brown’s holdings in botany include volumes by the Roman authors Pliny the Elder and Marcus Terentius Varro. Pliny’s 37 book Naturalis Historia is generally printed as 10 volumes by modern printers (including those of the eighteenth century). The inventory does not say which of the volumes are included in Dr. Brown’s library but the two most likely to have been part of his holdings were modern volumes V and VI which cover Pliny’s books 12 through 32. The subject matter of these two volumes is primarily botany and medicinal plants, with additional information about agriculture and horticulture. Brown also owned 2 volumes of Varro’s Rerum Rusticarum Libri Tres (Three Books of Rural Topics or On Agriculture). Varro warned about the dangers of miasmas rising out of low places and swamps, there he wrote “…are bred certain minute creatures which cannot be seen by the eyes, but which float in the air and enter the body through the mouth and nose and cause serious diseases.” In some ways Varro prefigured germ theory. This miasma theory was still prevalent during the eighteenth century and it often prevented physicans from understanding the true causes of diseases such as yellow fever. This was particularly the case in the first decade of the nineteenth century when yellow fever ravaged Philadelphia, Baltimore, and Washington. Dr. Brown’s classmate Dr. Benjamin Rush believed that miasmas or foul orders arising from the city wharves caused the fever. What he failed to recognize was that the mosquitoes prevalent in the city that summer were the carriers of the deadly disease. The further away from the city one went, the fewer the mosquitoes and the less likely one was to be infected.

Bloodletting Instruments
L’Encyclopédie ou Dictionnaire raisonné des sciences,
des arts et des métiers
Denis Diderot 1751 and 1772
The National Library of Medicine
Bethesda, Maryland

In the 1780s there was a shift in medical practice in the Americas. “Heroic Medicine” practices began to emerge that included intensive courses of bloodletting, emetics, laxatives, sweating and blistering, cupping and massive dosing of calomel (which is mercury based). Brown’s classmate Dr. Benjamin Rush was a major proponent of this course of treatment. And as Rush was one of the founders of the University of Pennsylvania medical school it was incorporated into the course of study. Heroic medicine was then spread across the United States by his students and was in use well into the nineteenth century. 

Dr. Elisha Cullen Dick (1750-1825), who was one of the three physicians attending Washington on the night of his death, was one of Rush’s students. The other physician Dr. James Craik (1730-1814), studied medicine at the University of Edinburgh and was, like Gustavus Brown and Benjamin Rush a student of Dr. William Cullen. 

Heroic Medicine was likely the cause of Washington’s death. Desperate to save Washington’s life, the three physicans bled him frequently over a 9 to 10 hour period. The total amount of blood drawn was between 124 and 126 ounces, or almost 8 pints, which “led to preterminal anemia, hypovolemia, and hypotension.” He was also given “Vapors of vinegar and water...” which were inhaled, as well as “ten grains of calomel…succeeded by repeated doses of emetic tartar.” He probably went into shock before he died late on Saturday evening, 14 December 1799. Whatever his throat complaint had been, Washington didn’t survive the treatment.

Library of Congress, Washington, D.C.