Dr. Benjamin Rush

CHAPTER 1

The Making of a Physician

FREEDOM’S FIRES HAD lit the souls of his ancestors for five generations, beginning with Captain John Rush, Oxfordshire’s legendary “Old Trooper,” who led a troop of horse in Oliver Cromwell’s army against King Charles I.

“He was once ordered out with command of a reconnoitering party,” Philadelphia physician Benjamin Rush recounted the family history to his children. “Soon afterward his mare came into camp without him.

“‘Poor Rush is no more,’ Cromwell sighed. ‘He has not left a better officer in my army.’ But then the Old Trooper came in covered with mud and was received with joy. His mare had fallen into a ditch and thrown him off. The enemy thought him dead and pursued his mare… [while] he rose from the dead and returned to camp.”

After exposure of a Protestant plot to kill Charles III, John Rush, his wife, six sons, and a daughter climbed aboard a boat crowded with fellow Quakers fleeing the king’s wrath and followed William Penn to America in 1683, settling by the Delaware River near Philadelphia.

“I know nothing of his family in the part of England from which he came,” Benjamin Rush continued his tale to his children, who sat at his feet enraptured by their father’s warm, rich voice. “It is sufficient gratification to me to know that he fought for liberty and migrated to a remote wilderness in the evening of his life to enjoy the privilege of worshiping God according to the dictates of his own conscience.”¹

Although one of the Old Trooper’s relations in England had begged him to leave at least one grandchild behind before leaving, he refused. “‘No! No! I won’t,’” the Old Trooper responded, according to Rush. “‘I won’t leave even a hoof of my family behind me.’ He had been persecuted for his religious principles and left his native country in a fit of indignation at its then intolerant government.… He and his whole family were Quakers.…

“I am the eldest son of the fifth generation descended from him,” Rush smiled at the sixth generation seated on the floor before him.²

Benjamin Rush greeted life on January 4, 1746, in a comfortable stone house on his Quaker father’s prosperous, ninety-acre farm in Byberry, Pennsylvania, twelve miles from Philadelphia on the Delaware River. “Before the house flowed a small, but deep creek abounding in pan-fish,” Rush recalled. “Behind the house… an orchard planted by my father… bore fruit. My family were pious people,” he said, “chiefly Quakers and Baptists whose conversations centered on wolves and bears and snakes in the first settlement of the farm… [later] cows and calves and colts and lambs… [then] reapers and mowers and threshers… and at all times, prayers.”³

Benjamin Rush was only five when his father died. Four years later, when he turned nine, his mother, Susanna, also of English ancestry, sent Benjamin and his younger brother Jacob to West Nottingham Academy, an academically demanding preparatory school for the College of New Jersey (later Princeton University). Founded and run by Susanna’s brother-in-law, the renowned Presbyterian minister Samuel Finley, Nottingham Academy offered what was then a traditional classroom curriculum—writing, mathematics, geometry, algebra, astronomy, physics, history, logic, rhetoric, Latin, Greek, English, French, and German. In addition, Finley prepared his boys for frontier life with instruction in “hunting and gunning.” Although Rush disapproved of both as “a risk to morals and health,”⁴ he embraced the rest of Finley’s curriculum, as well as the man himself.

“Few men,” Rush said of Finley, “have ever possessed or displayed greater talents as a minister of the Gospel and scholar… as a teacher of an academy and as a master of a family. His government over his boys was strict but never severe nor arbitrary.… The instrument with which he corrected was a small switch… he struck the palm of the hand… never more than three times.… He took pains to promote good manners among his scholars.… Many of my schoolmates filled important stations and discharged the duties of useful professors with honor to themselves and benefit to their country.”⁵

In 1759, Rush turned fifteen and enrolled at Finley’s alma mater, the College of New Jersey at Princeton. Although he was admittedly “idle, playful, and mischievous” at times, he discovered “some talents for poetry, composition, and public speaking… [and] a love of knowledge.”⁶

Rush earned his bachelor of arts after two years, and his degree earned him an apprenticeship in medicine under Princeton alumnus Dr. John Redman, Philadelphia’s leading physician. “In addition to preparing and compounding medicines,^* visiting the sick and performing many little offices of a nurse to them,” Rush explained, “I took charge of his [Redman’s] books and accounts.… I read all the books in medicine that were put into my hands by my master or that I could borrow.… I kept a commonplace book [journal] in which I recorded everything that I thought curious or valuable.… I studied Dr. [Herman] Boerhaave’s^† lectures upon physiology and pathology with the closest attention.”⁷

Rush passionately embraced the British school of medical thought of Dr. Thomas Sydenham and the Dutch school of Boerhaave. The thinking of both was eminently logical; both believed they had solved the mysteries of disease and sickness. Sydenham said that all diseases were simply “fevers”—in effect, they were all one and the same—transmitted by airborne pollutants, or “miasma,” which invaded the body through the respiratory system and worked its way into the bloodstream. Normally, the vascular system automatically responded by trying to expel infected matter through the stool, sweat, or sputum, but if the disease remained in the blood, a doctor needed to extract it by cutting into a vein with a lancet.

Boerhaave broadened the scope of Sydenham’s thinking, systematizing clinical observation and expanding bloodletting and purging into what he called “depletion therapy”—adding emetics and purgatives to supplement bloodletting as a means of reducing inflammation caused by disease. In an era more than a century before cellular microscopy, Rush found the logic self-evident. Embracing Sydenham’s work with passion, Rush spent all but two weeks of the next five years learning and practicing his new craft.

In the midst of Rush’s apprenticeship, Philadelphia’s Dr. William Shippen, Jr., announced plans to teach the first anatomy course in America—to medical students, of course, but also to entertain “any gentlemen who may have the curiosity to understand the anatomy of the Human Frame.”⁸ To demonstrate human anatomy in his course, Shippen paid professional grave robbers to steal cadavers from graves of slaves or paupers. Like Redman, Shippen boasted impeccable credentials, having graduated from both the College of New Jersey at Princeton and Scotland’s University of Edinburgh Medical School. Rush joined ten other medical students who enrolled in Shippen’s course—only to have an angry mob block the alleyway and smash the windows of Shippen’s lab to protest his mutilation and desecration of human cadavers. Whenever the mobs appeared, Shippen and his students fled and hid, but he continued buying bodies and teaching his lucrative course for much of his life.

In 1765, the penultimate year of Rush’s apprenticeship, Britain’s Parliament outraged him and many other American colonists by passing the first direct tax ever imposed in America—a stamp tax to help pay costs of military protection against continuing Indian attacks along the frontiers. In effect for decades in England, the stamp tax required consumers, producers, or merchants to purchase one or more revenue stamps to affix on each of fifty-five articles, including legal documents, periodicals and such student essentials as textbooks, diplomas, and college degrees. Parliament’s tax on usually penniless students incensed Rush, who raged at having to buy a £5 stamp from the government to get a degree he had earned and paid for during years of hard work. With other students, Rush leaped into the “public commotions” against the tax and embraced the growing political movement for American sovereignty.

“An effigy of our stamp officer has been… affixed to a gallows,” Rush effused to a friend. “Our merchants have… entered into an association to import no more goods from London… which in my opinion promises more for us than anything hitherto attempted.”⁹ The Stamp Act not only frayed Rush’s political loyalty to England, it inspired a newfound allegiance to individual liberty.

As Rush was completing his apprenticeship, Dr. Redman urged him to complement his bachelor of medicine degree with a doctorate—preferably at the University of Edinburgh medical school, then considered the finest in the English-speaking world. Rush agreed and, in September 1766, he put American political troubles behind him and set sail for England to begin two years of study in Edinburgh. He arrived on October 22, took a coach to Edinburgh, and following the custom of Pennsylvania travelers to Britain, he wrote to Benjamin Franklin, Pennsylvania’s agent in London, in case he needed official help during his stay.

“As I have the happiness of being born in the province where you have resided many years,” the twenty-year-old wrote to Franklin, “I was anxious to come under your patronage, as I well know your great love and partiality to the Province of Pennsylvania would readily induce you to favor any one of its natives even though unknown to you.”¹⁰ Franklin, who enjoyed befriending visiting Americans, sent Rush a gracious reply, wrote letters of introduction to prominent friends in the arts and sciences, and, because of his interest in science, began what would become a lifelong correspondence and friendship with young Rush.

After Rush found lodgings in Edinburgh, he toured a city that was unlike any he had ever seen or imagined.

“Edinburgh is built upon a third less ground than Philadelphia,” he wrote to a friend in America, “but contains double the number of inhabitants… eighty thousand souls.

The University of Edinburgh had been founded in 1583 and the medical school a century later under a charter from King Charles II. Famed for its anatomy courses, the university suffered chronic shortages of cadavers, forcing students to compete with professional grave-robbers at night—extracting the dead from their graves and calling it “resurrection.”

In addition to anatomy, Rush studied chemistry, natural philosophy (physics), medicine, and “the practice of the infirmary.” In summer he studied higher mathematics and restudied Latin, which was the language of medical textbooks then. Repelled by the drunken orgies that marked Edinburgh night life, he used his evenings to “make myself master of the French language and acquire so much knowledge of the Italian and Spanish languages as to be able to read them.”¹² During his second year, he took advanced courses of first-year subjects and, on June 19, 1768, received his M.D., following a battery of examinations and publicly defending his thesis on “the digestion of food in the stomach”—a startlingly original study of his own vomitus.^*13

Rush then joined the Royal Medical Society, where recent graduates met with professors at informal weekly gatherings to discuss medical matters and cement social and professional ties. In addition, Benjamin Franklin’s friends invited Rush to salons and dinners where the newly minted physician’s modest ways and pleasing personality won the embrace of Britain’s intelligentsia.

“I had the pleasure of being domesticated in [visiting overnight] several very amiable private families in Edinburgh,” Rush recalled. “Some of them were persons of rank, but they were all distinguished more or less for learning, taste, or piety.”¹⁴

Some, such as Scottish historian/philosopher David Hume, Rush said, “distinguished themselves” with a quick wit and biting tongue. Indeed, Rush was dining with Hume when another guest asked Hume to recall a fact from his renowned six-volume History of England.^* Hume seemed puzzled, and his questioner persisted argumentatively, “But you mentioned it in your history!”

“That may be,” Hume snapped back, “but there are many things which I have forgotten—including you.”¹⁵

Rush met three other people in Edinburgh who made deep impressions. John Bostock, a Scottish medical student, claimed a forebear who, like Rush’s own ancestor, had commanded a company in Cromwell’s army.

“He declared himself an advocate for the republican principles for which our ancestors had fought,” Rush recalled. “Never before had I heard the authority of kings called in question. I had been taught to consider them nearly as essential to political order as the sun is to the order of the Solar System. For the first moment in my life, I renounced… the absurdity of hereditary power.”

After meeting Bostock, Rush concluded that “no form of government can be rational but that which is derived from the suffrages of the people who are the subjects of it.”¹⁶

Bostock gave Rush one of Cromwell’s swords and a leaf from Cromwell’s family Bible with a record of his marriage and the names and birth dates of his children “by his own hand.”¹⁷

Another meaningful encounter Rush experienced in Edinburgh was with Richard Stockton, an American lawyer from Princeton, New Jersey, and, like Rush, a graduate of both Samuel Finley’s Academy and the college at Princeton. By then a Princeton trustee, Stockton had come to invite Scotland’s renowned Presbyterian divine, Dr. John Witherspoon, to assume the college presidency. To Stockton’s deep disappointment, Witherspoon refused, citing his wife’s fear of ocean travel and distress at prospects of separating from friends and relations. With Stockton’s reluctant approval, Rush went to Witherspoon’s home in Paisley to plead with the divine.

“All America waits… for your answer,” Rush petitioned the Scottish priest. “Must poor Nassau Hall indeed be ruined?… Must that school of the prophets, that nursery of learning become a party to faction, bigotry, and party spirit?”

Predicting the college’s demise if Witherspoon did not assume its leadership. Rush tried flattering the clergyman, citing the widespread popularity of his sermons. “Recollect the pain you will give the friends of the college and the lovers of religion in America.… I tremble to think of the consequences of your refusal. Will you suffer your sun to set so soon?”

Rush turned to Mrs. Witherspoon and displayed what would develop into a gift for calming frantic patients by charming her with the tale of his own, joy-filled sea voyage from America. In fact, he had been seasick most of the way, but he now “obviated such of the objections as she had formerly made to crossing the ocean” and the great priest embarked for America with his family soon afterward.¹⁸

Although he could not know it at the time, coaxing Witherspoon to assume Princeton’s presidency would prove an enormous contribution to the college and to his country’s future. Beginning in 1768, Witherspoon transformed the College of New Jersey from a small religious school into one of America’s leading universities, on a par with Harvard and Yale. As president of Princeton, the Scottish cleric would influence the shape of the early US government more than any other single educator in American history. A proponent of the Scottish “common sense” school of philosophy, Witherspoon would teach James Madison, the father of the Bill of Rights and future President; future vice president Aaron Burr, Jr.; ten of the nation’s first cabinet officers; seventy-seven of the first US senators and congressmen; twelve future state governors; and three future US Supreme Court justices. And in 1776, he would be one of only eight foreign-born signers of the Declaration of Independence.

In September 1768, Rush left Edinburgh for London where he attended “lectures and dissection” by a famed Scottish surgeon, “saw an immense variety of diseases and practices,” and attended informal medical discussions with London’s most prominent physicians, including Sir John Pringle, the court physician. With the new year, Rush put his studies aside and presented himself at Benjamin Franklin’s London home. It proved an exhilarating step for the Pennsylvania farm boy.

“The doctor [Franklin] had acquired knowledge, reputation, and powerful connections,” Rush explained. “It was my peculiar happiness to be domesticated in his family. He introduced me to a number of his literary friends. He once took me to Court with him and pointed out to me many of the most distinguished public characters of the nation. I never visited him without learning something.” One by one, the “public characters” he saw and met filled Rush with a range of intellectual and political ideas that would convert him into one of America’s most brilliant thinkers.