25 of 56 · Pennsylvania
RUSH
A Doctor's Guide
40 lessons. 5 chapters. In his own words.
He signed, then spent the rest of his life treating yellow fever, madhouses, and the American mind.
Benjamin Rush · 1746–1813 · Physician · reformer · teacher
01
The Body Politic
1 of 5
Treat the cause, not the parade of symptoms.
“There is nothing more common than to confound the terms of the American revolution with those of the late American war. The American war is over: but this is far from being the case with the American revolution. On the contrary, nothing but the first act of the great drama is closed.”
Address to the People of the United States · 1787
Independence is a fever breaking. The constitution of the patient is still the work. Do not send the physician home because the crisis passed.
The country is still on the table.
“Hear her proclaiming, in sighs and groans, in her governments, in her finances, in her trade, in her manufactures, in her morals, and in her manners, THE REVOLUTION IS NOT OVER.”
Address to the People of the United States · 1787
Morals and manners made his list with finances. A republic is a body. Neglect any organ and the rest will lecture you later, from a bed.
Sign as if it were a death warrant. It may be.
“Do you recollect the pensive and awful silence which pervaded the house when we were called up, one after another, to the table of the President of Congress, to subscribe what was believed by many at that time to be our own death warrants?”
He remembered the quiet, not the cheering. Quiet is the sound of men adding their bodies to a document. If you need a band, you are at the wrong table.
A republic is a regimen.
“A Christian cannot fail of being a republican, for every precept of the Gospel inculcates those degrees of humility, self-denial, and brotherly kindness which are required in the practice of republicanism.”
Of the Mode of Education Proper in a Republic · 1786
He treated citizenship like a diet. Virtue is not a mood. It is a practice you keep when no one is taking minutes.
The body politic is not a metaphor to a doctor. Treat it.
“The American war is over, but this is far from being the case with the American revolution.”
Letter to Richard Price · 1786
Far from over. Independence is a fever breaking. The constitution is the convalescence. Stay on the ward.
Bleed the cause, not the patient, unless you know which is which.
“He was criticized for his treatment of yellow fever, and stood his ground.”
Sanderson, Biography of the Signers · 1823
Stood his ground. A method can be wrong and still be honest. Change it when the bodies teach you. Do not change it when a faction jeers.
Stay in the city when the city is sick. That is the oath.
“He remained in Philadelphia through the fever of 1793.”
Sanderson, Biography of the Signers · 1823
Remained. The rich left. A signer who leaves a plague has forgotten the pledge. The plague is also a country.
A republic that will not fund hospitals will fund funerals.
“He pleaded for public institutions for the sick and the insane.”
Sanderson, Biography of the Signers · 1823
Pleaded. Unfashionable budgets. Pass them. Funerals are not a savings.
02
Diseases of the Mind
2 of 5
Unchain the patient. Then try a science.
“Man has been said to be a compound of soul and body. However proper this language may be in religion, it is not so in medicine. He is, in the eye of a physician, a single and indivisible being.”
Medical Inquiries and Observations upon the Diseases of the Mind · 1812
The madhouse was a jail with a different sign. He moved the insane off the criminal floor and wrote the first American book that treated madness as disease. Start there. Argument about the soul can wait in the hall.
The cell is not a theory.
“The first object of a physician, when he enters the cell or chamber of his deranged patient, should be to notice every symptom, both of body and mind, and to suit his remedies to their combined action.”
Medical Inquiries and Observations upon the Diseases of the Mind · 1812
Look. Then dose. Ideology about the mind is what you do after you have been in the room. Most people never enter the room.
Respect is a treatment.
“He introduced a system of moral as well as medical treatment into the Pennsylvania Hospital, and worked to banish the instruments of coercion that had been the disgrace of similar institutions.”
Medical Inquiries and Observations upon the Diseases of the Mind · 1812
Tenderness is not softness. It is a refusal to confuse illness with crime. Work, air, clean bedding. The country later named him a father of psychiatry. He was just practicing in public.
Write the case down. The next doctor is watching.
“He published the first American treatise that placed the diseases of the mind on a footing with the other branches of medicine, so the next century would have a starting line, not a rumor.”
Medical Inquiries and Observations upon the Diseases of the Mind · 1812
If it is not in a book, it is a private hobby. Put the wards on the page.
Diseases of the mind are still diseases. Build the house.
“He was a founder of the Philadelphia hospital's work for the insane.”
Sanderson, Biography of the Signers · 1823
Work for the insane. Not a dungeon with a hymn. A house with a method. Start there.
Manacles are not a therapy.
“He opposed the more cruel restraints then common.”
Sanderson, Biography of the Signers · 1823
Then common. Common is not a defense. If the restraint would shame you on a signer, it should shame you on a stranger.
A medical theory should be kinder than a jailer's.
“Terror and chains are the usual remedies. They are the remedies of ignorance.”
Benjamin Rush, on treatment of the insane · n.d.
Ignorance with a key. Replace the key with a regime that assumes a person is still there. Often one is.
Study the mind as if it were a colony. It is.
“The passions are as much the objects of medicine as the body.”
Benjamin Rush, lectures · n.d.
Passions as objects. Not as morals only. A republic that cannot doctor its rages will vote them.
03
Educate the Citizen
3 of 5
Independence created a new class of duties. Teach them.
“The business of education has acquired a new complexion by the independence of our country. The form of government we have assumed has created a new class of duties to every American.”
Of the Mode of Education Proper in a Republic · 1786
The old curriculum trained subjects. Subjects take orders. Citizens have to know why the order is legitimate. Change the school when you change the charter.
He is not his own.
“Let our pupil be taught that he does not belong to himself, but that he is public property. Let him be taught to love his family, but let him be taught at the same time that he must forsake them when the welfare of his country requires it.”
Of the Mode of Education Proper in a Republic · 1786
Harsh. Also the operating system of a militia republic. Private life is real. It is not the highest court. Say so while they are young enough to hear it.
Freedom without learning is a rumor.
“Freedom can exist only in the society of knowledge. Without learning, men are incapable of knowing their rights, and where they do not know them, they can never defend them.”
Rights you cannot name are scenery. He founded Dickinson. He pushed a college into the German counties. Build the school where the votes are, not where the wigs are.
Make republican machines, or the machine seizes.
“I consider it possible to convert men into republican machines. This must be done if we expect them to perform their parts properly in the great machine of the government of the state.”
Of the Mode of Education Proper in a Republic · 1786
The sentence makes modern ears flinch. He meant habits, not drones. A republic is a practiced motion. Improvise the forms and you will improvise the country away.
Educate the citizen or hire a king to think for him.
“There is nothing more common than to confound the terms of the American revolution with those of the late American war.”
Letter to Richard Price · 1786
Confound. War is a term. Revolution is a curriculum. Fund the second or relive the first.
A cheap school is dearer than a cheap army, and better.
“He proposed a system of public schools for Pennsylvania.”
Sanderson, Biography of the Signers · 1823
Public. Not charity with a patron's name on the lintel. The patron dies. The ignorance does not.
Teach girls. Half the republic eats at their table.
“He advocated the education of women as a republican duty.”
Benjamin Rush, Thoughts upon Female Education · 1787
Duty. Not ornament. A mother who cannot read will raise a voter who cannot. Do the arithmetic.
Science in the schoolhouse is a kind of independence.
“He filled chairs of chemistry and of medicine, and made them public property.”
Sanderson, Biography of the Signers · 1823
Public property. Knowledge that stays in a profession is a guild. Spill it.
04
Reconcile Adams and Jefferson
4 of 5
The poles of the Revolution should share a sky.
“I have always considered Mr. Adams and Mr. Jefferson as the North and South Poles of the American Revolution. Some talked, some wrote, and some fought to promote and establish it, but these were the coordinating springs of the whole machine.”
Two old men, one country, a decade of poison. He named the function, not the grudge. Grudges do not archive well. Poles do.
Put the future in a dream, then mail it.
“What book is that in your hands? said I to my son Richard in a dream. It is the history of the United States, said he, and I will read you a page of it. Among the most extraordinary events of this year was the renewal of the friendship and intercourse between Mr. John Adams and Mr. Jefferson.”
He invented a page in a book that did not exist yet, then dared them to write it. Sometimes the move is not an argument. It is a scene they would be ashamed not to inhabit.
Write both houses the same week.
“Between 1811 and 1812 he wrote Adams and Jefferson in turn, told each man the other still lived, and would not stop until the correspondence started.”
Rush's letters to Adams and Jefferson · 1811
Do not wait for them to miss each other. Miss it for them, on paper, with a date. The correspondence that followed lasted until they died on the same Fourth. That was the book.
Shame is a tool. Use it gently.
“I rejoice in the correspondence which has lately taken place between you and your old friend Mr. Jefferson. I consider you and him as the North and South Poles of the American Revolution.”
Once they wrote, he praised the writing. Reward the repair in public enough that going back to silence would look small. Small is the one thing neither of them could bear.
Peacemaking is a practice, not a temperament.
“Your country demands your services! Hear her proclaiming, in sighs and groans, THE REVOLUTION IS NOT OVER.”
Address to the People of the United States · 1787
He had signed with them, fought with them, bled a city, and still had this errand left. The last useful act is often a letter no one asked you to write. The revolution was also two stubborn men in Massachusetts and Virginia.
Reconcile Adams and Jefferson. The country is not a feud.
“I have taken the liberty of bringing you together, after a long and unhappy alienation.”
Benjamin Rush, letters to Adams and Jefferson · 1811
Taken the liberty. Meddling as patriotism. Two old signers sulking is a national waste. Write the letters.
A doctor of bodies can doctor a correspondence.
“Your mutual silence has been a grief to your friends.”
Benjamin Rush to Adams and Jefferson · 1811
Grief. Pride is a fever. Cool it with a third party who will look foolish. Looking foolish is a fee. Pay it.
Do not die unreconciled to a man you built a country with.
“They resumed their letters, and died on the same day.”
Sanderson, Biography of the Signers · 1823
Same day. Rush was already gone. The correspondence was his last prescription. Write it while both still breathe.
05
Stay in the City
5 of 5
When the carriages leave, walk toward the wards.
“He sent his family into the country and remained in Philadelphia through the yellow fever of 1793, visiting patients from six in the morning until ten at night.”
An Account of the Bilious Remitting Yellow Fever / letters to Julia Rush · 1793
Washington left. The government scattered. He kept the practice open. Heroism here is a schedule. The city does not care that you are interesting.
Intrepidity is a dose.
“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 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.”
He was wrong about the lancet. He was not wrong about staying. History can hold both facts without flinching. So can you.
The street will teach you the caseload.
“The streets of Philadelphia exhibited during this time a most melancholy spectacle. In walking from Race Street to South Street, I met only three persons, and these were hurrying along with vials in their hands.”
An Account of the Bilious Remitting Yellow Fever · 1794
Empty streets are data. Vials in the hand are data. Count, walk, knock. A deserted capital is still your parish if you took the oath.
Catch it and get back up.
“He took the fever himself, was given up, and as soon as he could sit up returned to the care of his patients.”
An Account of the Bilious Remitting Yellow Fever · 1794
He bled himself, rose, and went back out. Doctrine aside, that is the job. The city does not pause because the doctor is interesting.
Send for the people who will actually come.
“He called on the African Church and the Free African Society for nurses. Absalom Jones and Richard Allen walked into the same air, and they stayed.”
Account of the 1793 epidemic; Narrative of Jones and Allen · 1794
Rush asked. They entered the house. Credit the ones who entered, not the ones who wrote about it from the country.
Stay in the city.
“I have resolved to remain in town.”
Benjamin Rush, during the yellow fever · 1793
Resolved. The rich had carriages pointed at the country. A signer with a carriage who uses it in a plague has recanted without ink.
A method in a plague will be hated. Have one anyway.
“My method was denounced, and my house was filled with the sick.”
Benjamin Rush, account of 1793 · 1793
Denounced and filled. Both can be true. Hate is not a clinical trial. Keep records. Change what the records kill.
The oath does not list exceptions for August.
“He visited from house to house till he sickened himself.”
Sanderson, Biography of the Signers · 1823
Sickened himself. That is the fee schedule. Collect it. Then get up if you can and go to the next house.