A Different Kind of Expert

In the spring of 1813, Abigail Adams wrote to her friend Julia Rush inquiring after the death of Julia’s husband physician Benjamin Rush.¹ “[O]h how shall I address you. how offer the consolation I need for myself upon an occasion which has torn my heart in anguish, filled by Bosom with Grief, and so overwhelmed me by the magnitude of Bereavement, that I cannot utter my feelings.” Although separated by a considerable distance—Quincy, MA to Philadelphia, PA—the Adams and Rush families were close, and they expressed their mutual grief through letters after Benjamin’s demise from typhoid, typhus, or some other “low fever” on April 13, 1813. The raw emotion in Abigail’s first letter to Julia is full of sentiment and empathy for a friend. However, in their continued correspondence, emotion was accompanied by analysis of Benjamin’s final disease and a rational assessment of the failings of the human body.

Throughout my research on Benjamin Rush, his wife Julia has been an ever-present but often invisible force. Though married for nearly 37 years, records of their relationship are fragmented, surviving in a few mentions by friends and letters between the Rushes when they were infrequently apart. Few of Julia’s letters to Benjamin survive, and those that do are mostly from a few distinct periods: their courtship in 1776, the yellow fever epidemic of 1793, and occasional notes from summers or trips apart. Other snippets come from Benjamin’s autobiography (full of praise for Julia) and complementary depictions of her kindness and intelligence from other notable men, including physician Charles Caldwell, president of Princeton University Samuel Stanhope Smith, and Latin American revolutionary Francisco de Miranda.²

Too often, Julia’s voice is frustratingly missing. Nevertheless, we can learn about her by paying careful attention to those fragments, evidence not only of her social importance but often her medical knowledge. Married women were expected to be the primary medical caregivers in early nineteenth-century families, doing the day-to-day work of helping the sick recover, even when married to a physician. As a wife, mother, and reader of medical texts from Benjamin’s library, Julia seemed to have an informal but still sophisticated grasp of medical knowledge. Through her correspondence, Julia demonstrated that medical expertise, even narrowly construed, was not limited to men or physicians. Her observations challenge us to think more deeply about the expertise of women in general, and doctor’s wives in particular. When Benjamin died, it was Julia’s expertise that came to bear on her grieving process. Julia’s accounts and analysis took the place of similar assessments Benjamin made as a professional, communicating the details, causes, and consequences of illness to their mutual friends.

Julia’s initial response to Abigail was fairly short, conveying the shock of a husband’s sudden death. She expressed a self-defined lack of knowledge and the failure of her past experience, noting, “[i]n the early years of my marriage I had nurs’d him through [two] sever illnesses, and seeing none of the alarming symptoms which then appeared, I was lull’d into security, and having no knowledge of the pulse. I was till sunday evening flattering myself with a hope and expectation that we would soon be well.” In this passage, Julia noted her (perhaps misplaced) faith in experience and lack of technical knowledge about the presumed meaning of the pulse in cases of sickness (a diagnostic tool Benjamin found central to medical practice). But time altered Julia’s grief and assessment of her own conduct. The first letter was dated May 13, exactly a month after Benjamin’s death. By the summer, time, thought, and the continuation of the mourning process changed the nature of Abigail and Julia’s correspondence.

Julia’s next letter was written on June 23, in response to Abigail’s questions about Benjamin’s knowledge of his own demise—did he know it was his deathbed? Unlike the preceding short missives, Julia responded with a level of detail reminiscent of Benjamin’s own medical narratives. Both Rushes looked to long-term trends in their patients’ health and behavior to explain the course of illness. They also both had a keen memory for seemingly insignificant details that might prove useful. Though Benjamin died in April, Julia dated the beginning of his final illness to the previous November, when Benjamin “got his feet wet” at a funeral and developed a cough that he could not shake. Over the course of the winter, the couple disagreed about Benjamin’s diet. Julia thought he needed to eat more “generously” as he aged, while Benjamin opted for abstinence from all alcohol (even beer, a staple in this time period) and ate meat sparingly. He passed safely through the winter, if a little too thin for Julia’s comfort. She noted in an aside that could have come from a medical student, “I cannot but believe that this reduced state of his body previous to his illness, had no small effect in the sinking of his system [body] so soon under so little apparent disease.”

From this passage, it is clear that Julia both understood the body as a system interconnected with its surroundings and felt comfortable drawing medical conclusions from her observations. She described how, as soon as he felt a chill, she sent him to a warm bed with warm drinks. Julia also expressed her opinions on more “masculine” treatments like bloodletting; she disagreed with Benjamin on the topic and prevented the procedure early in his illness. She was backed up on her conclusions later by attending physicians, but she clearly took credit for her own knowledge in the letter.

For the first day of his illness, neither Julia, nor Benjamin, nor attending physician Dr. John Syng Dorsey were especially concerned—in fact Dorsey wasn’t called to see Benjamin, but to treat an injury of a Rush son. But soon afterwards, Benjamin’s pulse dropped suddenly, and a sudden course of stimulants could not reverse Benjamin’s demise. The end came both slowly and suddenly, allowing Benjamin to say goodbye and Julia to focus on palliative care and spiritual comfort. Julia ended her rational recounting of the events with a brief insight into her emotions, stating, “I have given you a plain unvarnished statements of the circumstances as they occured—my hand has trembled I fear too much to make what I have written legible and my tears have flown too fast to enable me to study the language I have used—but to a friend who was so much interested as to ask such a detail I am sure it is not necessary to apologize for the manner of its execution I cannot tell you how much I am gratified by the request.”

Julia may not have studied medical language, but we can appreciate the mix of sentiment and grief, with the technical terminology in her discussion of bloodletting, blisters, constitutions, and fever crises. Beyond the medical detail of the June 23 letter, facts seemed easier for Julia to relive than feelings. Before heading into the nitty-gritty of Benjamin’s sickness, Julia wrote: “A request from you dear Madam will ever with me have the force of a command, I will therefore at this time pass over that part of your letter in which with so much feeling you refer to my afflicting bereavement, and proceede to give you the particulars of the closing scene of our much loved frend.” Both women noted evidence of tears on the page of Julia’s letter, so emotion was not absent in the writing. Nevertheless, it was medical detail and analysis that dominated Julia’s long account of her husband’s death. While she did not consider herself a medical practitioner, Julia’s knowledge is valuable for us. It highlights the manner in which expertise is developed and challenges us to look for it in unexpected places.

Finally, with respect to illness and emotion, I keep returning to Julia saying that she included the detail as a courtesy to Abigail. Was this level of detail really just courtesy to Abigail? Or did Julia find comfort in factual knowledge that she could not in discussing her own bereavement? All we can do is speculate and appreciate the confidence Julia placed in her own medical expertise when so much else in her life felt adrift. She revisited her decisions as a wife and medical authority, and she found nothing wanting. Perhaps there was comfort knowing that she had not made a deadly mistake.

This kind of rational self-assessment in the face of a poorly understood illness has additional relevance at the moment. In the middle of a modern pandemic, where people turn to facts and news for some sort of comfort, I am more than ever inclined to believe that, more than 200 years ago, Julia Rush sought some solace in the recollection of facts too.

Sarah E. Naramore

Sarah Naramore is visiting assistant professor of history at Sewanee - The University of the South. Her current book project, Medical Independence: How Benjamin Rush Created American Medicine, 1769-1813 assesses the work of Philadelphia physician Benjamin Rush and his attempt to form a uniquely American medical profession and practice.

• Sarah E. Naramore

  https://nursingclio.org/author/sarah-e-naramore/

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