“Dr. Benjamin Rush, one of the signers of the Declaration of Independence, was the first member of the (American) medical community to write about alcoholism and suggest it might be an illness… a ‘disease process’”. (The Roundtable of AA History, Silkworth.net) This was fully one hundred years before the disease concept of alcoholism was fully developed and articulated in the 1870s.
Rush was born on January 4, 1746, on a plantation, a dozen miles outside of Philidelphia. “His interest in alcohol and alcohol-related problems sprang from personal as well was professional experience. Rush’s father was an alcoholic whose drinking led to his parents’ divorce, and his mother’s second husband was a distiller who abused her.” (Silkworth.net) His biological father died when the future founding father was five or six.
At the age of eight, Rush was put under the tutelage of his uncle, the Reverend Samuel Finley, who would later become president of the College of New Jersey, which later became Princeton. There was some thought of his becoming a lawyer, but after graduating with a B.A. from the College of New Jersey, Rush began an apprenticeship as a physician’s assistant to Dr. John Redman.
In 1766, he went to study at the University of Edinburgh, where he completed an MD degree in 1769. While in Europe studying and touring, the young Pennsylvanian became fluent in French Italian and Spanish. Returning to America, Rush set up a medical practice and became North America’s first ever chemistry professor, when he began teaching the subject at the College of Philadelphia’s medical department. He taught more physicians than any other educator of his era.
Upon his return to America, Rush also became active as a publisher of tracts lobbying for the elimination of slavery. His social activism eventually branched into other areas. He opposed slavery, advocated for free public schools, sought improved education for women and a more enlightened penal system.
“Rush was a prolific writer and social activist. If a health or social issue arose during this period, Benjamin Rush was likely to be in the middle of the debate. He was often called the ‘father of American Psychiatry’ and was unquestionably the first American authority on alcohol and alcoholism.” (Slaying The Dragon – The History of Addiction Treatment and Recovery in America, William L. White, Second Edition, p. 2)
During the Revolutionary War, Rush was in the field with the colonial military. In this capacity, the physician’s first professional recognition of the problem of alcohol involved the level of drunkenness among soldiers of the Continental Army – an issue of concern to George Washington as well.
In 1777, Rush issued a strong condemnation of the use of distilled spirits that was published and distributed to all soldiers.This was followed in 1782 with a newspaper article entitled ‘Against Spirituous Liquors,’ in which Rush recommended that farmers cease the practice of providing daily rations of liquor to their laborers… Two years later, in 1784, Rush published a pamphlet entitled “An Enquiry into the Effects of Spirituous Liquors Upon the Human Body, and Their Influence Upon the Happiness of Society”. This 36-page tract was reprinted by the thousands and stands as the most influential piece of early American writing on alcohol and alcoholism.” (Dragon, p. 2)
Some Injudicious Criticisms
Dr. Rush seems to have been an outspoken man, possibly lacking in political savvy. While representing Philadelphia at Pennsylvania’s own Constitutional Convention, he aroused controversy and some antipathy when he criticized the new Pennsylvania Constitution.
During the early stages of the Revolutionary War, the Army Medical Service was in disarray as the result of the high level of military casualties and deaths due to typhoid, yellow fever and other camp illnesses. There were also political conflicts, and inadequate supplies.
Then surgeon-general of the middle department of the Continental Army, Rush sided with John Morgan in criticizing a one-time mentor William Shippen Jr., for misappropriating supplies. When their complaint to George Washington was referred to Congress, and they then sided with Shippen, Rush resigned in disgust.
The early prosecution of the war did not go well for the colonials, and many were critical of the generalship of George Washington. Some sought to have him replaced. Rush penned two letters of criticism that he wanted communicated orally to Washington, leaving Rush’s reproaches conveyed, but anonymous. Washington saw the letters, recognized the doctor’s handwriting, and Rush was compelled to sever himself completely from the war effort.
In later years, Rush deeply regretted his criticisms of the national hero, and issued statements of great praise of the military leader.
Abolition, Indiscretion, and inconsistency
Dr. Benjamin Rush vociferously opposed slavery, and argued scientifically that Negroes were not, by nature, intellectually or morally inferior. Unfortunately, he went into greater detail. “In 1792, Rush read a paper before the American Philosophical Society which argued that the ‘color’ and ‘figure’ of blacks were derived from a form of leprosy. He argued that with proper treatment, blacks could be cured and become white.” (Racial Formation in the United States, M. Omi and H. Winant, 1986)
The physician’s conclusions were based, at least in part, by his review of the case of Henry Moss, a slave who had lost his dark skin color, probably due to vitiligo.
“Despite his public condemnation of slavery, Dr. Rush purchased a slave named William Grubber in 1776. To the consternation of many, he still owned Grubber when he joined the Pennsylvania Abolition Society in 1784.” (African American Lives, Clayborne Carson, p. 119)
Rush the Physician
Rush thought that illness was the result of imbalances in the body’s physical system and was caused by malfunctions in the brain. He stressed diligence in personal hygiene, and a clean environment. The colonial doctor was overly enamored of bleeding and purges using calomel and other toxic substances. The forced blood loss was thought to relieve pressure to the brain.
The Yellow Fever epidemic of 1793 brought great acclaim to the physician. He was seen as courageous for remaining in town, and treating up to 100 patients per day. Unfortunately, a great number of these patients died. In fairness to Benjamin Rush, this was an era in which the healer was often more dangerous than the affliction.
Not all were enthralled by his efforts. Journalist and pamphleteer, William Cobbett attacked Rush’s extreme use of bloodletting, a practice increasingly being abandoned by many of his fellow physicians on the scientific grounds of its danger and ineffectiveness.
Cobbett accused Rush of killing more patients than he saved. Rush sued and won a judgment of $8,000, his victory in part possibly being due to his complainant being a controversial figure, and an openly British sympathizer. Cobbett soon fled to New York, then Halifax, and back to England, still owing the lion’s share of the penalty.
Notwithstanding this “moral victory”, Rush’s practice waned as he continued to advocate for leeches and purges, much to the chagrin of his friend Thomas Jefferson.
Conception of Drunkenness
Rush first suggested that chronic drunkenness was a progressive medical condition… He called the process through which the drunkard became progressively addicted to and finally destroyed by alcohol a ‘disease of the will.’ Rush further recognized that the tendency toward drunkenness was transmitted intergenerationally within families.
Rush’s belief that distilled spirits were the cause of most drunkenness was so strong that he miscalculated the potential for similar effects from wine and beer…. (His) essay, which suggested that alcoholism should be viewed as a self-contained disease, broke from the traditional view that excessive drinking was either a reflection of moral depravity or a cause or symptom of mental illness.
Disease references helped buttress the move toward total abstinence from alcohol…
Rush referred to the disease of drunkenness as “suicide perpetrated gradually” – an idea that Dr. Karl Menninger would revive and elaborate on 152 years later… some people’s drunkenness sprang from a hidden desire for self-injury…” (Dragon, pp. 3-4)
Cottons in Their Ears
Cautions regarding the dangers of distilled spirits seems to have found an audience with cotton in their ears, and corn liquor jugs at their mouths. Considerable segments of the population were drinking, and at a pace that continued a startling escalation.
At a time when the newly born nation “was reveling in its newfound freedom, Rush challenged in his tract that ‘a nation corrupted by alcohol can never be free’”. (Dragon, p. 3) The citizens of the new republic continued to run up this “corruption” to unprecedented levels. By 1810, the per capita consumption of pure alcohol per person was almost double the 1792 figure, and by 1830, it was triple.
This 40 year period of the highest alcohol consumption in America’s history brought with it a variety of social problems, and prompted a strengthening of the countering forces of temperance. The forces of temperance reacted surprisingly well to the “disease concept”. Without surrendering their basic “Satan and sin” message, the disease idea buttressed the move toward total abstinence from alcohol.
Treatment of Drunkards
As did other physicians of the day, Dr. Rush “believed that health and disease were determined by the relative balance or imbalance of the body’s four humors (fluids): blood, phlegm, black bile and yellow bile… re-establishing the balance… by sweating, bleeding (via lancing or leeches), purging… blistering the skin, or ingesting various drugs… Many of his ‘heroic’ methods were clearly harmful”. (Dragon, p. 4)
The refusal to alter his aggressive treatments led to a collapse of his practice, and financial disaster was averted by his appointment as Treasurer of the US Mint in 1797, a position he held until 1813, the year of his passing.
On the plus side, he “was the first American physician to posit that continued abstinence from alcohol was the only hope for the confirmed drunkard”. (Dragon, p. 4) This idea did not gain a broad acceptance until the “AA era” was firmly established.
In one case, Rush produced a “cure” by inducing vomiting through an emetic mixed with alcohol, essentially inventing “aversion therapy” 156 years before Dr. Walter Voegtlin. He also had some success with what would much later be called “occupational therapy”. Those assigned menial daily tasks did better in their recuperation than those left idle.
At a time when drunks, unwed mothers, STD sufferers were seen as agents of their own misfortune, unworthy of community hospital care, Rush pushed for the creation of a “Sober House” where inebriates could be medically treated and rehabilitated. It was a visionary proposal.
The Weird and the Wonderful
Perhaps the majority of human beings are a mix of the weird and the wonderful, the stories of those in “high profile” remaining in the public consciousness. “A wildly popular and much beloved man, he was nonetheless a fallible character.” (ushistory.org) That he practiced extensively among the poor, and lobbied for the general betterment of the working class, he was, to some extent, a champion of the masses. This was the man risking his own life to help others, in the 1793 Yellow Fever epidemic.
He made clear political errors. Both Benjamin Franklin and John Adams had some harsh observations to make about Rush. He had a reputation for gossip, and he was quick to pronounce judgments on others. While he considered himself scientific, he clung tenaciously to the old ideas of medical practice that others saw as obsolete.
He was supremely confident of his own opinion and decisions, yet shallow and unscientific in practice.” (ushistory.org)
His resolute abhorrence of distilled spirits, possibly rooted in unpleasant experiences with a liquor-producing step-father, tempered his call for drunkards’ “total abstinence”, sometimes prescribing wine, beer, cider and opium as replacements.
He lobbied for blacks to not be seen as inferior, but theorized that their “negroidism” was a curable disease.
He was an abolitionist who owned a slave.
America’s most famous physician’s practice was so diminished that his acceptance of a political appointment was, at least in part, motivated by economic considerations. Nonetheless, in some circles he remained much admired. Several of his students established Rush Medical College in Chicago, naming it in his honor.
Two notable graduates were the very entrepreneurial Leslie Keeley, and a lanky Vermonter, Robert Holbrook Smith.
The Disease Concept
His advocacy for viewing inebriety as an illness was a brave one. A religious man himself, he understood the dangers of lobbying for the medical treatment of “sin”.
”I am aware that the efforts of science and humanity, in applying their resources to the cure of a disease induced by a vice, will meet with a cold reception from many people.”
The modern disease/not disease debate is a complex one based largely on technicalities and terms of definition. The debate of Rush’s time was disease vs. “moral depravity.” The AA era moves forward in a now much easier battle.
The wisdom gleaned from William White’s four decades of experience emerges in these words: “We have both an individual and collective need for this concept to be ‘true,’ regardless of its scientific status… Science is unlikely to destroy the popularity of the disease metaphor, but a better metaphor could.” (Dragon, p. 512)
As the first American physician to challenge the old, intractable metaphor of dysfunctional drinking as “moral degeneracy”, Dr. Benjamin Rush merits a nod from AA.
About the Author
Bob K. lives in the Metropolitan Toronto area, and has been a sober member of Alcoholics Anonymous since 1991, and an out-of-the-closet atheist for that entire time. He has been a regular contributor to the AA Agnostica website for almost 5 years, and in January, 2015, published Key Players in AA History In 2013, he co-founded the Whitby Freethinkers meeting.