BENJAMIN RUSH AND HIS INSANE SON* T EN days before

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BENJAMIN RUSHAND HIS INSANE SON*

ERIC T. CARLSON, M.D., AND JEFFREY L. WOLLOCK, M.A.Section of the History of Medicine and the Behavioral Sciences

New York Hospital-Cornell Medical CenterNew York, N.Y.

T EN days before Christmas I807, Dr. Benjamin Rush sat down towrite another letter to his good friend, the former president of

the United States, John Adams. After-a few paragraphs devoted tovarious intellectual and political matters, Rush turned to some sadpersonal news. "My whole family," he writes, "were deeply afflictedfor a few days with an account of a duel fought by my son John atNew Orleans." They were reassured, however, by "the history of itscause published in our papers, and several letters from our son andone from a physician formerly my pupil. . ..'

John, Rush's eldest child, was 30 years of age, single, and a careernaval officer holding the rank of lieutenant and the command ofGunboat No. i8 stationed at New Orleans. His fellow officer andclose friend Benjamin Turner commanded a similar gunboat. Lt.Turner, who had joined the Navy in i 8oo, was apparently an excellentofficer with a distinguished record, particularly at Tripoli. Whenchallenged to a duel by another officer, however, Turner had declined.His associates thereupon had branded him a coward and ostracized him,driving him to increasing despair. John Rush was one of the few whodefended Turner's behavior as appropriate for an officer and a gentle-man. It was ironic, then, that Turner, yearning for renewed acceptanceby his mates, took a "light and thoughtless remark"2 of John Rushamiss and demanded satisfaction on the field of honor. Rush acceptedthe challenge, but with mixed feelings. He found a moral solution inresolving deliberately to miss his aim; after all, his opponent had shownno enthusiasm for dueling either. On the day of the encounter, Octo-ber i, 1807, however, Turner insisted he would "kill or be killed."

*Presented at a meeting of the New York Psychiatric Society held at the CenturyAssociation, New York, N.Y., January 6, 1975.

This research was supported in part by Public Health Service Research GrantLM-00919 from the National Library of Medicine.

Bull. N. Y. Acad. Med.

BENJAMIN RUSH AND HIS INSANE SON

Rush, preferring the latter alternative, aimed true, and killed him.Although dueling was illegal in many states, it was not uncommon

on the American scene. The most famous duel in United States historyhad occurred just three years earlier, when Aaron Burr killed AlexanderHamilton at XWeehawken, N.J. Many other prominent figures-suchas John Randolph of Roanoke, Henry Clay, Andrew Jackson, andThomas H. Benton-also were to lend their prestige to the code ofthe duello. In spite of what the law might say, for gentlemen of allclasses, except ministers, dueling was still an acceptable way of settlingdifferences and in some circumstances was almost compulsory. Hamil-ton, for example, had no taste for dueling at the time of Burr's chal-lenge-his own son Philip was killed in a duel three years earlier-but it is said that he lacked the courage to defy public opinion byrefusing. Claypoole's Daily Advertiser for June 12, I800, for example,noted that 2i duels had been fought in the United States within thepreceding six weeks, resulting in six dead and I I wounded.

Even greater importance was attached to the dueling code in thearmed services. The attitude in the navy was well expressed by Com-modore Stephen Decatur: a man who made arms his profession wasnot at liberty to decline an invitation from any person socially andprofessionally his equal. Decatur himself was killed in a duel in 1820.Ten years later, when President Andrew Jackson placed a prohibitionon duels between officers and civilians, he made sure to affirm that hehad no intention of interfering in duels between officers, since theirprofession was fighting and they were trained in arms.

Charles Paullin, in his valuable study, Dueling in the Old Navy,found that the custom was most common in the lower ranks. "Themiddies, not having much rank, were wonderfully jealous of whatlittle they had, and woe betide the careless shipmate who cast ashadow of offense upon it. Crowded together in the narrow quartersallotted to them on shipboard, they found ample opportunity forquarreling. For what trivial reasons they fought each other a fewexamples will show: Midshipman Redick offends Midshipman Barry-more by entering the messroom with his hat on his head; MidshipmanKerr applies the opprobrious epithets of 'boot-lick' and 'curry-favorer'to Midshipman Barney; one midshipman objects to the opening of acoal-scuttle by another.. . ."3 Thus it happened that within the firstso years of the old navy, 1798-I848, at least 36 men were killed in

Vol. 51, No. 11, December 1975

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E. T. CARLSON AND J. L. WOLLOCK

duels-two thirds of the mortality which resulted from naval warsduring the same period.

But while it still met with considerable social approval, dueling wasstrongly condemned by the reforming spirits of the age and, as usual,Benjamin Rush was in the vanguard. Long before the custom struckhim personally, he called dueling "private murder." When he dis-covered that two of his students were planning a duel in FebruaryI803, Rush reported them and had them arrested. Just three monthsearlier, his lawyer-brother Jacob delivered an impassioned lecture"On Duelling," in which he bemoaned the fact that "dueling has be-come a fashionable vice in our country," and called the custom illegal. . .immoral . . . irrational . . . and impious." He also published anabstract of the 1794 Pennsylvania Vice and Immorality Act, Sectioni o of which provided for the punishment of dueling by fine orimprisonment.4

After the unfortunate duel, John Rush's behavior was reported asexemplary. Two days after the duel, on October 3, 1807, he receiveda letter from his superior officer, Lt. James Leonard, ordering him toconsider himself under arrest and to report to the commander ofGunboat No. i5.5 In a report of the ensuing inquiry, Lt. Leonardreferred to the duel as an "unavoidable occurrence." ApparentlyRush was soon cleared, for on October 25, 1807 he was ordered totake command of another gunboat and fit her for service. After threeweeks he was sent up the Mississippi River to retrieve some navalmateriel left at Natchez. Six months later, in April i8o8, he was en-trusted with the responsibility of taking William Claiborne, governorof Louisiana, down river to Fort Plaquemines and back. Evidentlyhe had not lost the confidence of his commanding officers.

But within the next few months Rush apparently suffered somesort of breakdown, for his sister Julia wrote in a cheering letter ofSeptember 30, i8o8, "We are all extremely happy to hear that yourhealth is in great measure re-established." John was in more troublethan his sister realized, for on September I9 he had received a letterfrom Lt. Daniel Patterson informing him that several charges had beenmade against him, which, under orders from Commandant DavidPorter, a committee of three would investigate. Rush was accused ofnot following the rules of discipline of the navy in several unspecifiedinstances, and of disobeying an order. He was also charged with neg-


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lecting to report "two of his men who were fighting in the boat whilegoing on shore for him, as was his duty." More serious were thecomplaints of two local planters that "two muskets were fired fromGun Vessel No. 20 on their Negroes who were harmlessly going tomarket yesterday morning in a small boat with a few articles to sellfor their own use." In addition, Rush had failed in his responsibility toinspect passing merchant vessels, sending his "servant boy or steward"in his place.We have no information as to what happened to John Rush in the

immediate weeks that followed, but we learn from a passing referencein a note written a few months later, quoted below, that in OctoberI8o8 he suffered a brief "attack of insanity," including perhaps anattempt at suicide, although he recovered in a few days. In Decemberhis brother Richard wrote him an encouraging letter, and urged himto hold on to his commission. He admitted that there was a good dealof unrest among naval officers, but reminded his brother that thecountry was approaching a crisis. (Presumably, Richard referred to theBritish impressment of American seamen, already a serious grievance,which would eventually bring about the War of 1812.) He ended witha plea that John be "patient and resolute," and assured him that hewould achieve his goals and perhaps even reach the rank of admiral.

Clouded and fragmentary as it is, the story clearly indicates thatall was not well with John Rush. But things then moved into sharperfocus. On December 15, I8o8 Commandant Porter suddenly issuedhim an order. "You will on receipt of this settle your accounts withthe Purser on this station and repair to the city of Washington, whereyou will report yourself to the Honorable Secretary of the Navy."But it was too late. That day, to use the rather blunt terminology ofthe time, John Rush had gone insane.

On February 20, I 809 Dr. Samuel D. Heap of the U.S. Naval Hos-pital in New Orleans wrote a letter to his teacher, Dr. John SyngDorsey of Philadelphia, a graduate of the University of Pennsylvaniain i802, who, after further training in London and Paris, had returnedto his alma mater as adjunct professor of surgery.

Dear Doctor,You will I hope excuse the liberty I take in soliciting you

to perform a task which to a mind benevolent as your own mustbe painful. Desirous of conveying information of a distressing


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nature to an amiable and respectable family in a manner thatwill cause the least possible unhappiness, I know of no personI could select for this purpose so well as yourself.

Our fellow student John Rush has since the i5th of Decem-ber been insane, has made several attempts to destroy himself.The present is the third time I have had him under my caresince my arrival at this place. In October last he had an attacksimilar to the present. He however recovered in a few days.The great uncertainty of his recovery from the present attackinduces me to wish he might be sent to Philadelphia in orderthat he might derive the advantages of his Father's attention.Our hospital is by no means calculated for persons in Mr.Rush's situation....

Dorsey passed this letter on to Benjamin Rush, but soon thereafter theworried father received a more ominous letter from CommandantPorter, dated March 7, i809:

The situation of your son is at present the most deplorable. Heis now and has been for some time past in a state of insanity;and in consequence of his having made several attempts on thelife of the Surgeon, and others in the hospital, it was foundnecessary to confine him, and every search was made in orderto deprive of such weapons as might enable him to injure him-self and others (many of which were found secreted in hisapartment). This search was not effectual; he found means toconceal a razor with which he this morning attempted his life,and it is with the utmost concern that I am compelled to stateto you that it is quite uncertain whether he will survive theinjury he has done himself.

Not a medical man, Porter was probably overstating the serious-ness of John's injury. In a subsequent letter to Dorsey, Heap describedit as a four-inch slit on the left side of the throat which bled veryprofusely, but without the severing of any arteries.

On March 27, i809 both Porter and Heap wrote Benjamin Rushto reassure him that his son was not only recovering physically, butthat his mental condition was better than it had been for months. ByJune 3, i809 Heap could write hopefully to Rush that John would sailfor Philadelphia on the following day. But once again misfortune


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struck. On its way out of the harbor the ship lost its mizzen mast andhad to return for repairs. By the time these were done the captain wasno longer willing to take John, even though it was reported that "thestate of his mind is the same."

In the meantime Benjamin Rush continued to receive delayed andvacillating messages. Communications between New Orleans and Phila-delphia were slow and uncertain. In distress, he wrote Adams on July26th that John was on his way home, and then triumphantly onAugust I4th wrote, "I have great pleasure in informing you that myson John has recovered from his late attack of insanity and is nowdoing duty in the Navy. A gloom still, I have heard, hangs upon hisspirits. This I fear must be the case as long as memory and friendshipretain their places in his mind."7 Two weeks later Dr. Heap wrote thatevery attempt to find passage for John had been in vain, but thata vessel was now being prepared to take Commodore John Rodgers andhis family back to Maryland, and that John and he would accompanyit. They hoped to sail in October.

By January I8Io John had reached Washington and a CaptainThomas Tingey was in touch with Benjamin Rush. The problem nowwas that he could not find anyone to take John to Philadelphia andtime was of the essence: "I believe speedy medical aid might soonrestore his mental faculties." Tingey suggested that John's brother,Richard Rush, be sent down with a servant; Richard would have"sufficient authority to prevent any excesses; for I am informed that attimes, if John chance to get a little liquor, he wants more, and italways makes him worse." This was not the first suggestion thatalcohol had played some part in the disintegration of John Rush'smind. There exists a bill for one month's lodging at New Orleans forRush and his boy which, besides the usual room and board charges,includes three bottles of porter, four bottles of brandy, and six sep-arate purchases of gin by the half pint.

The father responded immediately by sending not Richard, but ayounger son, Benjamin Jr., then i9 years old, along with a servant,Black William. Captain Tingey had feared that John would be difficulton the journey, but he was not. Father Rush wrote to his son James,then studying medicine at Edinburgh, that John had arrived at laston February 3, i8i0 "in a deep state of melancholy. Neither theembraces nor tears of your mother, father, sister, nor brothers could


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obtain a word nor even a look from him."8 Later, writing to JohnAdams, he added further details. "His appearance when he entered hisfather's house was that of the King of Babylon described in the oldtestament. His long and uncombed hair and his long nails and beardrendered him an object of horror to his afflicted parents and family."9In a letter to Thomas Jefferson, he wrote further of John's "Raggedclothes, disheveled hair, long nails and beard and a dirty skin, with adejected countenance accompanied with constant sighing and an un-willingness to speak or even to answer a question, and an apparentinsensibility to the strongest expressions of parental and fraternalaffection. . . ."'O For three days the Rush family tried to make contactwith John and to clean him up, but without much success. They thentook him to the Pennsylvania Hospital.

Before examining what happened to John Rush after his hospitaliza-tion, we should stop to briefly review his earlier life and personality.In the winter of 1776-I777 it was feared that the British might soonoccupy Philadelphia. Benjamin Rush therefore took his wife Julia tothe home of a relative in Cecil County, Md., at the end of Demember,and left her on about January 20 to attend Congress in Baltimore, thenew temporary capital of the United States. At some time in MarchI777 he moved Julia, now five months pregrant, to Rush Hill, I I milesfrom Philadelphia, where his mother and sister were staying. On March24 he returned to Philadelphia. Julia came to visit him briefly in Aprilbefore going back to her relatives in Maryland. Finally, Rush left forMaryland on July I4, where three days later Julia gave birth to a son.After staying a week with her, Rush returned to Philadelphia, joiningthe army in the field a short time later."1 During the next I4 months itwould appear that he was able to visit his wife and baby only occa-sionally-at Christmas 1777,12 for example, and in the spring of 1778's-but it was not until August I778 that he could bring them back toPhiladelphia and begin a normal family life.

Mrs. Rush was a "devout, self-effacing woman,"14 the object of herhusband's lifelong respect and admiration. She bore him 13 children,of whom nine reached adulthood, and she herself lived to the age ofgo. Unfortunately, we know few details of her relation with John.

Benjamin Rush, if we may judge from the numerous references toJohn and his other children which occur in his letters, appears to havebeen an affectionate and attentive father-to John he was perhaps too


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attentive. Rush believed in the special importance of primogeniture."5This is reflected even in the name he chose for his firstborn son. Thename John had been borne not only by Rush's great-grandfather,founder of the American line, whose revolutionary activities underOliver Cromwell were held in veneration, but also by his father, whohad died when Benjamin was only five years of age.

From his earliest childhood Rush spoke of John as a "promisingboy." In 1784, when John was seven, his father already dreamed ofsending him to Edinburgh to study medicine."' Two years later Rushfrequently took the boy with him on medical rounds at the Pennsyl-vania Hospital. On one occasion the nine-year-old boy stood by hisfather and "saw a painful and bloody operation performed . . . with-out an emotion." A few days later, during a visit to an insane womanwho was chained to the floor in one of the cells, John at first reactedas though petrified-then he asked a flood of questions about madness,its cause and cure; these were followed by a discussion of medicine asa career. Young Rush concluded with the declaration: "I shall benothing but a doctor."'17 The father wrote further to his wife of John'sgood judgment and memory, but added, ominously, that John pos-sessed "a vivacity bordering upon folly."'18

At I I years of age, John Rush acted out a role which presaged theother half of his ambivalent career: as part of the Independence Daycelebration in Philadelphia on July 4, I788, he played the part of ayoung midshipman on board the good ship Union.19

In a letter to his wife, Rush speaks of John's "quick temper," hiswillfullness, and the need to "maintain government" over him.20 Rushis well known for his opposition to capital and corporal punishmentand he practiced what he preached; however, he was a great advocateof psychological punishment. "My eldest son, who is now near I2 yearsold," he wrote to Enos Hitchcock on April 24, 1789,21 "has more thanonce begged me to flog him in preference to confining him. 'The dura-tion of the confinement, and the disagreeable circumstances that areconnected with it are proportioned to the faults that are committed. Ihave in once instance confined my two eldest sons in separate roomsfor two days."

Space does not permit a review here of Rush's concepts of child-rearing, which are a subject for another study, but a few commentsshould be made about father Rush's personality as it relates to John.


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Julia Rush had likened her husband to Martin Luther and he sawhimself as a Jeremiah, a man of strife and contention.22 He was fre-quently embroiled in controversy, struggling with great energy anddedication for the acceptance of his ideas. Often angry and given toimpulsive outbursts, Benjamin Rush sometimes had cause to regrethasty words or letters, but there is no evidence that he ever lost physi-cal control of himself. He was proud and sensitive, nursing hurt andbitterness. His forgiveness came slowly if at all. In his younger dayspeople had commented on his verbal volubility (critics called him anincessant talker) and his enthusiasm. John Rush apparently shared inthese traits, but had less control than his father. It is undoubtedly sig-nificant that the actions which led him into trouble were preciselythose which his father had explicitly forbidden: gambling, the use offirearms, idleness, and the more than casual use of alcohol.

One final incident in John's younger life further highlights thefather-son relation as a breeding ground of implacable consc ence andoverwhelming pride. Rush sent John to Princeton in May 1792 but wasclearly apprehensive of trouble. He arranged for the boy to lodge ina private house with the family of Walter Minto, a professor at theschool. In several notes to Minto, Rush laid down the strictest disci-pline for John-he was to study constantly, was not to associate withother students any more than absolutely necessary, and was never togo to the college except for lessons, because "college life and collegesociety to boys of his age [are] alike fatal to morals and manners." 2aOne senses that the father's watchful eye was always upon the son.

D. F. Hawke suspects that Rush's fears may have derived from hisown days at Princeton, from experiences which had scarred him insome way. We can only guess what these might have been. In plan-ning his own college many years later, Rush spoke of "The bad con-sequences of crowding young men (whose propensities are generallythe same) under one roof . . . vices of the same species attract eachother with the most force."23 At any rate, there are grounds for believ-ing that Rush's anxiety created a kind of self-fulfilling prophecy. Thedraconian regimen on which he insisted meant that John would beentirely left out of the society of his peers-a devastating situation fora 15-year-old boy, especially if his father clearly was the sole causeof the ostracism. What happened afterward is therefore not surpris-ing. In September Rush and three other boys created a scandal-they


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were caught playing cards on the Sabbath. The four were requiredto make public confession, to return all gambling proceeds to eachother, and to pledge never to repeat the transgression.

The reaction of John's father was severe. Lamenting the "publicdisgrace" and the "depravity of his mind," convinced that "he cannever recover his character so as to appear to advantage either with hismasters or among his fellow students," Rush immediately took Johnout of Princeton. The paternal justice, it would seem, was far morestern than the institutional, for the other boys remained.24

In John's subsequent life we find quite a few incidents of ill health,aggressive acts, and erratic changes of plan. In September 1794 he be-came a medical apprentice to his father. Two years later "an obstinateslow intermittent [fever] which threatened consumption"25 determinedJohn to sign on as surgeon to an Indiaman bound for Calcutta. Uponhis return to Philadelphia he found a great controversy raging overthe methods of treatment which his father had used during a recentyellow fever epidemic. An unfavorable article appeared in a local news-paper; the Rushes angrily attributed it to a Dr. Andrew Ross, andin October 1797 the 2o-year-old John Rush forthwith challenged himto a duel. Ross repeatedly refused to have anything to do with the"impertinent puppy," but John was implacable, finally attacking himon the streets of Philadelphia, knocking him down, and bruising himabout the face. In truth, the article had been written by Dr. WilliamCurrie, not Ross.26

In May 1798 John enlisted in the fledgling U.S. Navy as a surgeon.He served on the U.S.S. Ganges and Adams in the quasi-war withFrance. In the fall of 1798 he was back at the Marcus Hook navalstation near Philadelphia treating yellow fever patients, but shortlyafterward he entered a dispute with a fellow officer, Lt. McElroy, andchallenged him to a duel. McElroy refused and spoke to John's father;Benjamin Rush also received complaints from McElroy, Sr. John de-fended himself in a petulant and rather self-justifying letter to hisfather.

In March i8oo John suddenly "set off in the mail stage for NewYork to obtain satisfaction of [William] Cobbett,"27 the poison-pennedsatirist, probably the most dangerous of all Rush's enemies. The fatherimmediately made contact with a lawyer friend in New York, whocombed the streets looking for John. He eventually found him in a


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theater and with great difficulty restrained him from going to Cobbett.Even so, young Rush had a deputy deliver his challenge to Cobbett,who flatly refused to honor it. John had to satisfy himself with a longself-justification in the New York Commercial Advertiser.28

On September 20, i8oo John drafted a rather peculiar letter, prob-ably to Benjamin Stoddert, secretary of the navy. While its meaningis not entirely clear, the gist is that John was living beyond his meansand needed more money. A year later we see that he wanted to resignfrom the navy and join the merchant service, but could not do so asyet because he was in debt to the navy. On January 25, 1802 BenjaminRush wrote to the new secretary of the navy, Robert Smith, askingpermission for John to resign in order to take a berth on an Indiaman.It is not clear whether John went to India again, but at any rate hesucceeded in getting out of the navy. In December he returned to hisfather's house to resume the study of medicine. Rush quoted him assaying, "he would supply the place of one of my men servants, andeven clean the stable rather than continue to follow a sea life."

In i804 he took his medical degree at the University of Pennsyl-vania with a thesis, ironically, on The Causes of Sudden Death and theMeans of Preventing It. Later that year he published a paper which hehad read before the Philadelphia Medical Society titled Elements ofLife, or the Laws of Vital Matter. Dr. George Corner has given theopinion that "the materialistic implications of the paper went far be-yond anything Benjamin Rush would knowingly have supported."29Upon graduation John was elected to the staff of the Philadelphia Hos-pital but declined. We do not know why, but once again we can sensethe hand and eye of the father perhaps coming a bit too close forcomfort.

Soon after graduation, John lost his health again and accompaniedhis father's friend, Maj. Pierce Butler, to Charleston, S. C., in Octoberi804, "where he will probably settle, and he says with far better pros-pects than he left in Philadelphia." Lyman Butterfield comments, "Lit-tle is known of this venture,"30 but one thing we have established isthat in May John took a trip to Havana.

In September 1805, against his father's wishes, John re-enlisted inthe navy, and took command of various gunboats, first in the Bostonarea and then in New Orleans. Thus, we have returned to the timeand place of the fatal duel, but perhaps to see it in a somewhat different


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light; not as a single inexplicable act, but as part of a pattern, in keep-ing both with John Rush's personality and the standards of conductwhich were accepted in the navy at that time. We recall that he wascleared of blame almost immediately after the duel. It is clear, too, thatremorse was not his only problem: he was beset with financial worries.On December I5, 1807 his mother wrote to him: "Let me my dear sonagain entreat you, not to cherish chagrin or irritation against your bestfriends, or the world; rouse you like a strong minded man, and resolvethat you will be independently limitting your expenses to your income,let that be what it may, and here let us drop this subject. . . ." Richardwrote on December 3, i8o8, just two weeks before his final break-down: "I will not pursue any futher the subject of our late letters. Iput the one last received from you into the hands of my Mother andFather and it must be for them to decide upon it. The necessity ofproperty and the difficulty of procuring it are such, that it forms themost fruitful subject of disputes. Upon this, or any other subject, Ihope never to have a dispute with a brother...

When John Rush was admitted to the Pennsylvania Hospital onFebruary I0, I8I0, he entered the oldest hospital in British NorthAmerica. In agitating for its establishment, Benjamin Franklin hadspoken of the need to relieve the sufferings of the insane. His wish wasgratified, for when the hospital opened its doors in I752 one of thetwo patients admitted was a lunatic. By the time Benjamin Rush wasappointed in 1789, there were 24 psychiatric patients in the hospital,and this number grew to 49 by 1804. Rush is well known for his re-forms there. As a result of his efforts to improve the accommodationsfor the insane, the west wing was reconstructed in 1796. It was thisarea, located in a semi-basement, that became home for John Rush.Each room had light and sufficient ventilation, although adequate heatwas still a problem.31

John Rush was one of 66 new patients admitted during that fiscalyear. At the start of the period there were i6 patients still hospitalized,the most senior having been admitted as far back as I778. The hospitalrecords included a rough form of classification. Almost all of the pa-tients, including John, were listed as lunatics; but there was one caseeach of nervous complaint, epileptic fits, amaurosis, hysteria, hypochon-driasis, and insanity from intemperance.32

With a father celebrated for his work with the insane, one question


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inevitably arises: Did Benjamin Rush take charge of his son's treat-ment? We have no direct evidence on this question, but there are somesuggestions. He had not seen John when he wrote to Adams, "I feelthis affliction in a most sensible manner."33 Faced in person with hisson's unkempt appearance and indifference to the family, Rush reactedmore strongly. Nearly a year later he confided to Jefferson. "Judgeof the distress of every member of [the family]! For some time I wasin a degree unfitted by it for study or business. In this depressed stateof mind I was unable to discharge my usual epistolary obligations tomy friends. Time has lessened the distress I have described, and I haveagain resumed my intercourse with them."34 From the fact of his son'sovert rejection and the strength of Rush's reaction, we might expectclinical acumen to have dissuaded him from taking direct care of John.On the other hand, as the leading physician of Philadelphia, a manknown for his dynamic and assertive personality, it seems unlikely thathe ever could have been far in the background. Other medical meninvolved in the case assumed that Rush would take charge. Dr. Heapwas anxious to have John return to Philadelphia "in order that he mightderive the advantages of his father's attention," and Dr. Amos A. Evans,another naval surgeon at New Orleans, wrote Rush on June i6, i809,"Your acquaintance with the 'anatomy of the human mind' will enableyou to do more for him than any man on earth could."

In keeping with his unitary concept of disease, Benjamin Rushviewed mental illness as a psychosomatic problem. He thought all ill-ness was caused by irregular motions in the arteries; hence his vigorousand somewhat infamous treatments, with heavy reliance on bloodlet-ting. Causation of an illness, therefore, was to be found in the organi-zation of the body, its responsiveness, and the types and strengths ofstimuli in the environment, including all types of psychological factors.Rush believed, for example, in the role of heredity, and even reportedalmost simultaneous and similar emotional illnesses in a pair of separatedtwins. If we look for hereditary factors in the Rush family, we findno evidence for any previous clearcut mental illness, but there is a faintsuspicion in the history of Benjamin Rush's eldest brother James, who"had been much afflicted with a nervous disease, for which his physi-cians advised a sea-life. He was perfectly cured by it, but died at seain the 2 ISt year of his age of a yellow fever taken a few days before inthe Island of Jamaica."35


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But Benjamin Rush saw the cause of John's illness much more inthe circumstances of his life and behavior. In his view it was the duelitself and its unfortunate outcome that were to blame. As Rush said,"The distress and remorse which followed this event deprived him ofhis reason. ..."36 Benjamin Rush announced quite early that the un-fortunate duel was the cause of his son's insanity. "Could the advocatesfor duelling and the idolators of the late General Hamilton peep intothe cell of my poor boy, they would blush for their folly and madnessin defending a practice and palliating a crime which has rendered apromising young man wretched for life and involved in his misery awhole family that loved him."-37 There is obviously much truth in this,and as a result of his son's tragedy Rush involved himself in the legis-lative effort against dueling on at least two occasions. In late 1809 heasked John Connelly, an old friend from Princeton, to introduce aresolution in the Pennsylvania legislature that a committee be appointedto review the i8o6 "Act to restrain the horrid practice of duelling;"and in January i8 ii he hinted to Jefferson that the Virginia assemblymight have something to learn from his son's example.38

This public stance was the background to a private claim. Rushstrongly believed that the Navy Department owed John compensation;that is, John should be entitled to continued pay as a naval officer, "theproperty of his country." "This disease," he wrote to Paul Hamilton,secretary of the navy, on February 28, i8io, "was contracted in theservice of his country. It is true it was not from the ordinary causesof disease, but from a cause-more imperious and irresistible (from thefalse maxims of honor which govern military men) -than those whichusually fill our military hospitals." Judging by the navy's quasi-officialadvocacy of dueling, as expressed by influential naval officers such asStephen Decatur, Rush's point seems well taken. After John had beengiven a certificate of insanity, the navy did agree to keep him on thepayroll for some time.

How would Dr. Rush have classed his son's illness? We find someclues in his letters, but we must remember that these were written inordinary social intercourse, not as medical diagnoses. He wrote at firstof an attack of insanity and of gloom, but after John's arrival at homeRush described him as being in a "state of deep melancholy and con-siderable derangement,"39 which he later condensed to "melancholy de-rangement." In Rush's pioneering book, Medical Inquiries and Observa-


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tions upon the Diseases of the Mind, published in i812, there is nodiagnostic category for melancholia as such.40 In general, Rush's classifi-cation follows his psychological theory of the faculties of the mind.4Almost half of his book is devoted to what he calls intellectual derange-ment, both partial and general. The partial intellectual derangements aresubdivided into two types, one accompanied with pain and distress, theother with pleasure. The first subsumes what we might consider melan-cholia. Rush calls it hypochondriasis, for it is often accompanied withbodily distress and what we would today call delusions. "Partial de-rangement consists in error in opinion, and conduct, upon some onesubject only, with soundness of mind upon all, or nearly all other sub-jects."42 This condition is accompanied by despair and, worst of all, "Itsometimes creates such a disgust of life, as to make the subjects of itwish to die."43 He suggests a new name, tristimania, for this condition;the term, however, was not adopted by others.

General intellectual derangement, on the other hand, is the tradi-tional mania, whether acute or more or less chronic. The most chronicRush calls manalgia-"that state of general madness, in which a uni-versal torpor takes places in the body and mind."44 Rush's descriptionof manalgia matches that of his son on his arrival home. The fact thathe once again cites Nebuchadnezzar as an authentic case only confirmsthis. We are left, then, with a mixed diagnosis, which bothered Rushnot one whit; for, in terms of his unitary approach, any given personcould exhibit a wide variety of symptoms, apparently passing from onederanged state to another. His son undoubtedly did have a melancholyderangement; today we would probably speak of it as a schizo-affectiveillness.

For treatment of these conditions Rush discusses a number ofmodalities, dividing them into two basic categories-those intended toact directly on the body and those intended to act indirectly upon thebody through the medium of the mind. Under the first heading, inaddition to bleeding, he mentions purges, emetics, and a reduced, non-acid diet; as improvement sets in, he recommends stimulating ailments,drinks, and medicines, including warm madeira or sherry, tea, weakcoffee, iron tonics mixed with ginger and black pepper, tar, garlic, and,above all, laudanum. Other remedies he recommended included warm

baths, cold baths, frictions, exercise, pain-particularly mustard on thefeet, mercury to induce salivation, and blisters and issues.


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Treatments intended to affect the body through the mind includethe destruction of old associations, employment, certain amusements,music, committing passages to memory, reading the Bible, mentioningthe name of a loved one, terror, traveling, and even matrimony. Inspeaking of the desirability of destroying old associations, Rush makesa comment which clearly relates to his son: "Even change his personas much as possible. Long nails, a long beard, and uncombed hair, oftenbecome exciting causes of a paroxysm of this disease. They shouldtherefore be carefully prevented or removed."45

In a remarkable passage Rush describes his visit to "a young gentle-man in our hospital, who became deranged from remorse of consciencein consequence of killing a friend in a duel":46

His only cry was for a pistol, that he might put an end tohis life. I told him, the firing of a pistol would disturb the pa-tients in the neighbouring cells, and that the wound made by itwould probably cover his cell with blood, but that I could takeaway his life in a more easy and delicate way, by bleeding himto death, from a vein in his arm, and retaining his blood in a largebowl. He consented at once to my proposal. I then requestedDr. Hartshorn, the resident physician and apothecary of thehospital, to tie up his arm, and bleed him to death. The doctorinstantly feigned a compliance with this request. After losingnearly twenty ounces of blood, he fainted, became calm, andslept soundly the ensuing night. The next day, when I visitedhim, he was still unhappy; not from despair and a hatred of life,but from a dread of death; for he now complained only, thatseveral persons in the hospital had conspired to kill him. By thecontinuance of depleting remedies, this error was removed, andhe was soon afterwards discharged from the hospital.

What happened to John Rush after he was hospitalized? By theend of April, according to Rush, John was "much improved, not onlyin his appearance, but in the health of his mind. Though still gloomy,he submits to be shaved and dressed, and walks out daily in the gardenof the Hospital. At times he converses in the most lucid and agreeablemanner. It is possible he may recover, but it is too probable he willend his days in his present situation."47 By early May-after threemonths of hospitalization and treatment-Rush wrote to James that"Your brother John is much better, though still depressed in his spirits."


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He continued, "We expect shortly to remove him from the Hospitalto a country situation near Darby, where he will have pure air, ruralexercises, and pleasant domestic society."48 A month later another letter:"Your brother John is still in the Hospital, but much better. He is de-ranged at present upon but one subject only. He fancies himself to bepossessed of a great estate in New Orleans."49 Another month passedand the father wrote: "Your brother John continues stationary. Hestill believes himself to be a man of great estate and is still cold in hisbehavior to all the members of his family. We are however consoledwith a belief that he is now free from all suffering both of body andmind."50 Near the end of the summer it was decided to allow John toleave the hospital on a trial basis. The only information that has comedown to us is a laconic entry in Benjamin Rush's Commonplace Book:"This day [September 2, i8 io] my son John came home from thehospital somewhat better, but not well. He returned six days afterwards,much worse."51 This poignant experience is one familiar to all psychia-trists, and was an ominous forecast of John's future.

Writing to Jefferson early in i8 I I, Rush notes: "My son is better.He has become attentive to his dress, now and then opens a book, con-verses with a few people, but still discovers, with a good deal of melan-choly, alienation of mind upon several subjects, particularly thosewhich associate with the cause of his derangement. He is now in acell in the Pennsylvania Hospital. ..." and here Rush repeats whathe had said the previous April ". . . where there is too much reasonto believe he will end his days."52

Benjamin Rush never knew the outcome of his son's case, for hedied on the i9th of April, I813. John Rush, as his father predicted,never left the hospital, and died there, after a residence of 27 years,on August 9, I 8 3 7.We do have a small amount of additional information about him

during those last years. Morton, in his History of the PennsylvaniaHospital, says that from admission "he was a case of melancholia,rejecting all companionship and all friendship, and was at times verymorose. He was a most confirmed peripatetic, walking the floor, to

and fro, every day and almost all day, until the planks of the wardflooring and of a certain place upon the board-walk of the yard were

worn into deep gutters; these were always called 'Rush's walk.' 53

In the Autobiography of Samuel D. Gross (Philadelphia, i887)


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BENJAMIN RUSH AND HIS INSANE SON I 3 2 9

Dr. Saul Jarcho discovered a passage which also relates to John Rush.In the summer of 1828 the famous American actor, Edwin Forrest(i8o6-i872), who was studying the part of King Lear, went with Dr.Gross to observe John Rush. Benjamin Rush would have understoodthis well, for he had cited King Lear as an example of manalgia.54 Grosswrites: "At the time of our visit the insane were confined in thebasement story of the building, and Rush was in the habit of pacingto and fro in the corridor, with his hands behind his back, engaged inincoherent mutterings. . . . He was then an old man, although he wasstill erect, with a handsome, open, manly countenance. Through thegrating in the heavy iron door of the corridor Forrest stealthily studiedthe conduct of the demented duellist. He visited the hospital a numberof times, and finally came away perfectly convinced of the madnessof Lear.... Forrest thenceforth made a special study of the character,and how faithfully he delineated it is too well known to require com-ment."55

Thus John Rush sat, year after year, alone in his cold cell at thePennsylvania Hospital dreaming of a vast property at New Orleans.Perhaps this imaginary estate was for John Rush a more tangible re-ward than the real but nebulous satisfaction of preserved honor. Undersuch pathetic circumstances the preservation of honor must have seemedalmost beside the point, yet the question was to persist for the restof his life. One day, as Samuel Coates relates, "The barber on combinghis hair pleasantly remarked to him that it was becoming quite grey,'but never mind,' added he, 'grey hairs are honourable, you know.''Yes,' replied the patient emphatically, 'and sometimes honour makesgrey hairs.' "56

NOTES AND REFERENCES

1. Butterfield, L. H., editor: Letters ofBenjamin Rush. Princeton, Amer. Phil.Soc., 1951, vol. 2, p. 959.

2. Morton, T. G.: The History of thePennsylvania Hospital, 1751-18.95. Phil-adelphia, Times Printing House, 1895,p. 152.

3. Paullin, C. 0.: Dueling in the old navy.U.S. Naval Inst. Proc. 35: 1155-57, 1909.

4. Rush, J.: Charges, and Extracts ofCharges. New York, for J. Weeden,

1804. pp. 150, 159, 181.5. Benjamin Rush Manuscripts: John Rush

Papers, vol. 32. Library Co. of Phila-delphia, courtesy of Edwin Wolf, II,librarian. All information on John Rushnot otherwise cited comes from thissource.

6. Officers' Letters. Ms. Office of NavyRecords, U.S. Nat. Archives, vol. 3,No. 88, 1807, cited in Paullin, loc. cit.

7. Butterfield, op. cit., pp. 1012, 1014.


I 3 3 0 E. T. CARLSON AND J. L. WOLLOCK

8. Ibid., p. 1035.9. Ibid., p. 1042. The biblical reference is

to Daniel 4.33: ". . . and his body waswet with the dew of heaven, till hishairs were grown like eagles' feathers,and his nails like birds' claws."

10. Ibid., 1074.11. Hawke, D. F.: Benjamin Rush, Revolu-

tionary Gadfly. Indianapolis, Bobbs-Merrill, 1971, pp. 175, 182, 192, 202.

12. Ibid., pp. 178, 190.13. Rush's second child, Anne Emily

("Nancy") was born January 1, 1779;thus, she was conceived the previousspring.

14. Hawke, op. cit., p. 141.15. Butterfield, op. cit., p. 512.16. Ibid., p. 328.17. Ibid., pp. 394-95.18. Ibid.19. Ibid., p. 469.20. Ibid., p. 601.21. Ibid, p. 572.22. Hawke, op. cit., p. 5.22.a Butterfield, op. cit., p. 613.23. Ibid., pp. 18-19.24. Butterfield, op. cit., pp. 622-23.25. Ibid., p. 778.26. Neilson, W. and Neilson, F.: Verdict

for the Doctor. New York, HastingsHouse, 1958, p. 209.

27. Butterfield, op. cit., p. 817.28. Clark, M. E.: Peter Porcupine in

America. Philadelphia, 1939, pp. 164-65.29. Corner, G. W., editor: The Autobiog-

raphy of Benjamin Rush. Princeton.Amer. Phil. Soc., 1948, p. 370.

30. Butterfield, op. cit., p. 890.31. Morton, op. cit., 78, pp. 113-14.32. Pennsylvania Hospital Patient Summa-

ries, vol. 7, April 22, 1809-April 28,1810.

33. Butterfield, op. cit., p. 1012.34. Ibid., p. 1074.35. Corner, op. cit., pp. 27-28.36. Butterfield, op. cit., p. 1041.37. Ibid., p. 1042.

38. Ibid., p. 1074.39. Ibid., p. 1042.40. Rush, B.: Medical Inquiries and Ob-

servations upon the Diseases of theMind. Philadelphia, Kimber & Richard-son, 1812; New York, Hafner, 1962.

41. Carlson, E. T. and Simpson, M. J.:The definition of mental illness. Amer.J. Psychiat. 121:209-14, 1964.

49. Rush, Medical Inquiries . ., p. 74.43. Ibid., p. 96.44. Ibid., p. 141.45. Ibid., p. 117.46. Ibid., p. 129. Rush gives the date of

this case as 1803; otherwise we mightwell suspect the patient to have beenhis son. Dr. Joseph Hartshorne (1779-1850) of Alexandria, Va., was residentapprentice and apothecary from July1801. He attended lectures as well,graduating in 1805. (Stone, R. F.:Biography of Eminent American Phy-sicians and Surgeons. Indianapolis,1898, p. 204.)

47. Butterfield, op. cit., p. 1042.48. Ibid., p. 1044.49. Ibid., p. 1052.50. Ibid., p. 1057.51. Corner, op. cit., p. 294.52. Butterfield, op. cit., p. 1074. After all

this, it seems almost incredible that an-other of Rush's sons, Richard, fought aduel on March 11, 1811, with Peter A.Browne, deputy attorney-general. Butin another sense it is quite understand-able: in taking precedence over thestrongest counter-claims of law, fam-ily, and common sense, the code ofpersonal honor would appear all themore honorable.

53. Morton, op. cit., p. 152.54. Rush, Medical Inquiries . . ., p. 219.55. Jarcho, S.: The psychotic son of Ben-

jamin Rush. Bull. N.Y.A.M. 43:609-10,1967.

56. Morton, op. cit., p. 152.


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BENJAMIN RUSH AND HIS INSANE SON* T EN days before