May 11, 1751- Benjamin Franklin and Dr. Thomas Bond establish Pennsylvania Hospital
August 1769- Rush, upon returning to Philadelphia after medical training abroad, joins the medical team treating John Dickinson's friend Captain John Macpherson for mental illness
1783- Rush joins medical staff at PA Hospital, and begins treating some patients with mental illness and addiction: in staff lectures that year, he was already describing mental illnesses more medically, telling medical staff and students that depression was "a disease of the body as well as the mind," mania was a "disease of the brain" and both had "various causes" including "hereditary disposition."
1784- Publishes landmark pamphlet on addiction: “An Enquiry into the Effects of Spirituous Liquors upon the Human Body, and their Influences upon the Happiness of Society”
February 27, 1786- Rush delivers landmark lecture on mental health: “An Enquiry into the Influence of Physical Causes on the Moral Faculty” and publishes it as a pamphlet
Fall 1787- Rush put in charge of "maniacal" patients (mental illness and addiction) at PA Hospital and immediately begins reforms including heat for the “cells” where patients live, an end to the public being able to pay and observe the mentally ill, and the use of medical treatments and rudimentary talk therapy
1789- Rush's American mentor John Morgan dies & Rush becomes the top doctor in Philadelphia, stops lecturing about chemistry, and starts teaching clinical medicine; Publishes the first of many editions of his medical text "Medical Inquiries and Observation"
1791- College of Philadelphia and the University of the State of Pennsylvania combine into the University of Pennsylvania; Rush becomes head of the medical school
1794- At Rush's urging, PA Hospital begins a new building facing 9th Street which is only for treating patients with mental illness and addiction; in Paris, Philippe Pinel first reads his landmark paper “Memoir on Madness” and begins the process of trying to institute his ideas about "traitment moral" at the all-male Hospice de Bicetre which he runs
1796- PA Hospital's West Wing opens; William Touke opens York Retreat in England
Spring 1796- Rush corresponds with English psychiatrist Francis Willis, who treated King George III
1800- John Adams's son Charles dies from alcoholism
1804- Rush's first born son John graduates from the University of Pennsylvania medical school with a thesis on suicide prevention
September 27, 1807- William Pickering, son of Massachusetts senator Timothy Pickering, becomes mental health patient at PA hospital
October 1807- Dr. John Rush, while serving as a Navy surgeon in New Orleans, shoots his best friend in a duel, and soon after descends to madness
1810- John Rush is admitted in the mental health wing of Pennsylvania Hospital; Rush, in his commonplace book, lays out the first plan for Sober House, a separate asylum for people with addictions
1812- Rush publishes Medical Inquires Upon the Diseases of the Mind
In 1786, when John was 9, Rush had John accompany him to the basement to visit the mentally ill patients. He was asking his father questions about the cause of madness, whether madness could be cured, if people die from it, etc. That was when Rush knew John wanted to be nothing but a doctor.
In 1792, John was accepted to study at the College of New Jersey. After getting in trouble playing cards on a Sunday evening, John was withdrawn from Princeton, and began studying at the University of Pennsylvania under his parents' supervision.
John didn't finish college, and he was sent on a voyage as a surgeon on a British indiaman bound for Calcutta. Rush thought it was best for his son due to his health and behavioral problems.
In 1797, John returned from his voyage in India, and became his father's apprentice. During this time, John became upset over his father's long-time enemy, Dr. Andrew Ross, who he believed had attacked his father in an article. They ended up arguing in the street until Ross called him "an impudent puppy." John punched Ross, setting off a brawl.
A year later, John was made a navy surgeon at age 21 at the beginning of the Quasi-War with France. During his time there, he got into another argument, this time with Lt. Archibald McElroy. After the incident, John, either his choice or the navy's, stopped being a surgeon.
Another attack on Rush happened again, this time by William Cobbett who made an accusation that Rush was responsible for Washington's death. Cobbett also retold the story about John's brawl with Ross. John wanted to fight for his father's justice again, but this time, Rush's college friend Brock Livingston was told by Rush to stop John from going after Cobbett. John temporarily saved himself, and returned to his navy duties.
In 1803, John quit the navy and returned home to finish medical school. He graduated a year later at Penn, and wrote a thesis on "The Causes of Sudden Death and the Means of Preventing It," dedicating his father. He also wrote a second paper called "Elements of Life, or the Laws of Vital Matter." He was offered a staff position at the Pennsylvania Hospital, but John declined. He moved to Charleston, but it didn't go well for him since he didn't develop a practice as hoped. He even got injured from an argument. He ended up returning to the military.
Only known drawing of John Rush in uniform; Drawn by Benjamin Rush
In October 1807, John was in a duel with Lt. Benjamin Turner. John was helping Turner work through his feelings after being called a coward for refusing to duel. But then, Turner challenged John to a duel. The two fired simultaneously, and John's ball went through Turner's body, killing Turner. John was briefly kicked out from the navy, but he was cleared of wrongdoing. Turner was considered John's friend.
Once again, John got into trouble not only with his navy post, but also with his family. John thought the his parents were forcing him to live on his navy salary, and speculated that one of his sisters asked their father to change his will to benefit her. He reached out to a lawyer William Minot, who then turned to John's brother Richard, concerned about his obsession with their father. In the navy post, John committed minor infractions:
Since there were doctors who couldn't treat John's mental health, or was afraid to treat him, they thought it was best for him to return home, and be treated by his own father, who was his best hope. In January 1810, he was brought back to Philadelphia. He looked floridly psychotic; his hair, beard and fingernails grew out like a Biblical madman. He was immediately taken to PA Hospital where Rush hoped that his treatments for his son would work: warm and cold baths, wine, gentle purges, bloodletting, "low diet," and exercise.
The Pennsylvania hospital staff thought John's duel with Turner was a "sole cause" of his condition. But to Rush and Julia, they've been struggling with John's health for a long time. John was treated by Rush in the locked ward of Pennsylvania Hospital's new West Wing. He invoked his son's condition by asking Pennsylvania Hospital managers for more funds to treat mental illness. John's situation certainly inspired Rush's last book: Medical Inquiries and Observations Upon the Diseases of the Mind, the first American text on brain disease.
John was still in the hospital in the late winter of 1813, when Rush made what would be his final rounds to see the patients at PA Hospital. John spent the rest of his life there, then died there in 1837.
“... patients afflicted by Madness should be the first objects of the care of a physician ... Many of them might be Relieved by the use of remedies which have lately been discovered to be effectual in their disorder”
Rush made rounds around the Pennsylvania Hospital, starting from the second floor ward to the basement of the hospital. In the basement, Rush and his students observed the "Maniacs" in their locked ward.
'Some of them were extremely fierce and raving, nearly or quite naked; some singing and dancing, some in despair,' the visitor noted. 'Some were dumb and would not open their mouths; others incessantly talking.' He [Rush] found that it 'curious indeed to see in what different strains their distraction raged... [a] distressing view of what human nature is liable to.' (Fried, 265)
Rush felt that those "lunatics" living in the basement of PA Hospital was unacceptable. Rush and other young doctors were figuring out how to improve the living conditions in the cells, but Rush had something else in mind he wanted to solve: "to actually better understand what was wrong with those locked in the basement and even one day know how to treat them as patients, not as prisoners." (Fried, 268)
He had an idea about the physical roots of madness: blood flow in the brain:
Blood flow, he was coming to believe, was the key to understanding all disease, and pulse the key to understand blood... Pulse was one of the few things inside that physicians could easily measure from the outside -- and do something to change (Fried, 309)
Jacques-Pierre Brissot was a French writer who visited America, and spent some time with Benjamin Rush. He wrote his observations in the basement of PA Hospital in his book called New Travels in the United States of America.
Each patient, he noted, 'had his cell, with a bed, a table, and a convenient window with grates. Stoves are fixed in the walls, to warm the cell in winter.... These unhappy persons are treated with the greatest tenderness; they are allowed to walk in the court; are constantly visited by two physicians.... None of these fools were naked, or indecent... These people preserve, even in their folly, their primitive characteristic of decency.'
'What a difference between this treatment and the atrocious regulations to which we condemn such wretches in France! where they are rigorously confined, and their disorders scarcely ever fail to increase upon them.'
- Jacques-Pierre Brissot (1792)
“For many centuries ... mad people ... have been treated like criminals, or shunned like beasts of prey; or, if visited, it has been only for the purposes of inhuman curiosity and amusement ... Happily these times of cruelty to this class of our fellow creatures, and insensibility to their sufferings are now passing away. ... The clanking of chains, and the noise of the whip, are no longer heard in their cells. They now taste of the blessings of air, and light, and motion, in pleasant and shaded walks in summer, and in spacious entries, warmed by stoves, in winter ... the sexes are separated and alike protected from the eye of the visitors of the hospital.”
- Benjamin Rush
With the inspiration from his son, who was hospitalized after a duel, Rush invented the Tranquilizer Chair in 1810.
"In this state they often lie whole days and nights, and sometimes in a situation which delicacy forbids me to mention... To obviate these evils and at the same time to retain all the benefits of coercion."
- Benjamin Rush (Fried, 448)
So How Does it Work?
Rush would have someone strapped in an arm chair, sitting up straight that would allow access to the body for treatments. The seat was cut off for the person to use for waste. This would be important when a patient was taking purgatives. On top of the seat is a wooden box, and it was to put over the head to block visual stimulation. Rush tried it on patients with an extreme state of madness.
The Tranquilizer Chair
PA Hospital Today (South Wing)
PA Hospital East Wing 1783
PA Hospital West Wing 1796
Hannah Garrett Lewis was admitted to the PA Hospital around the same time Rush joined the hospital staff. She was in her late 60s at the time.
She was characterized as "under Great Indisposition of Mind" by her fellow Quakers at the Philadelphia Meeting House. Hannah was experiencing powerful delusions, and believing to be the eldest daughter of King George II and the rightful heir to his throne. She described her tiny one-windowed home a castle.
There were other instances of how insane she was: eating broiled mice and cats, tearing off heads or wings of mosquitoes and flies, and keeping them in a jar.
She had enough money, that was inherited from her father, to come to Pennsylvania Hospital as a paying patient. Most of the patients treated for mental illness were not considered as paying patients. Hannah was taken there by a fellow Quaker, and paid her "security," meaning patients weren't admitted unless someone agreed to pay their burial expenses if they died there.
Rush described in a case report as "grief induced madness... in middle life" triggered by "the loss of her husband." (Fried, 269) Her husband died in the 1740s. She was the first patient Rush and the others tried to really talk to her, and better understand her.
His friend Thomas Mifflin visited Rush at the PA Hospital, and recognized Hannah Lewis. They ended up having a feisty conversation.
In 1799, Hannah died in the hospital at age 87.
John Adams talked to Rush about his son Charles being in bad shape. Charles had been struggling with alcoholism for years. Rush tried to figure out where "drunkenness 'short of insanity' fit into the care he was giving at Pennsylvania Hospital." (Fried, 400) Charles refused treatment. His condition might've inspired Rush to create the "Sober House" for drunkards. In 1800, Adams received bad news that Charles was found dead in New York of cirrhosis of the liver.