Sarah E. Naramore skilfully argues that Benjamin Rush earned his seat in the pantheon of America's founders because he dedicated his life not only to health, but also to public service and the creation of the new nation's ideals, citizenry and institutions. Thanks to a methodological approach that relies on a sample of approximately 3,350 letters and manuscripts produced between 1768 and 1813, Naramore redefines our understanding of Rush and his legacy by orienting him within the histories of medicine and republicanism.

Naramore's work is divided into two four-chapter parts: ‘Making an American system’ and ‘Using an American system’. Part I is foundational to understanding where and why Rush developed his medical and ideological beliefs and Part II explains why he put them into conversation with the American experiment. The first half of the book offers its readers an understanding of how the American Revolution, the professional communities he was involved in and his career as a medical practitioner in Scotland and America – not to mention the mentorship and financial support he received from figures like William Cullen, John Gregory, Benjamin Franklin and his mother – became the crucible of his beliefs and future interventions. The second half of the book is a portrait of a dynamic, national figure who applied what Naramore calls ‘the Rush system’ in his attempt to understand America's race, gender, health, organization and connectivity.

Rush believed that America's future was ordained and that its celebrated character would produce good citizens who were healthy, engaged and civic-minded, but that success required work. Rush believed, Naramore notes, ‘Citizens were not born but constructed. Cities and towns required constant supervision and correction analogous to the care required by the bodies that inhabited them’ (p. 230). Additionally, Naramore explains that Rush believed that governmental and civic success depended on a citizenry that embraced republican ideals, benefited from dynamic institutions operating within healthy communities and fostered a population of men and women who produced families that would make the republic thrive. ‘With education Rush believed citizens could become “republican machines,” healthy and naturally oriented to enjoy freedom and contribute to the improvement of their country’ (p. 235). Mind and body, for Rush, were linked individually and to the republic.

Rush was not one to sit on the sidelines. He was a founding member, with Benjamin Franklin, of the Society for Promoting Political Inquires. The membership believed that science could guide the development of national institutions and political trends by dismantling and reconstructing government to understand and improve it. Domestically, he was also a member of dozens of civic, medical and secular clubs and organizations and he worked to improve the American medical system by advocating for clean air and water and for desirable construction materials to prevent the circulation of disease in hospitals. Internationally, he contributed to the Enlightenment movement through England's Philosophical Society of Manchester, the Royal Humane Society and the Philosophical Society at Preston. Rush was a lifelong learner and scholarly investigator who strategically operated within a network of thinkers, former and current patients, friends and fellow professionals who regularly shared ideas, trends and emerging theories. Naramore writes that these shared ideas were ‘gleaned from a variety of sources – in many cases uncredited Black and Indigenous sources – and filtered through networks of doctors, soldiers, or travelers to reach individuals and institutions at the nation's center’ (p. 76).

The republican Rush saw the individual as a citizen who operated like a little republic, but when the ‘republic’ faltered, people suffered (pp. 131–3). For example, during the Yellow Fever epidemic of 1793, he estimated that somewhere between four thousand and six thousand people died – instability and a ‘revolutionary atmosphere’ were the cause of death. Naramore explains Rush's belief that ‘the biggest challenges [to a population] occurred when the delicate system of bodies, environments, and societies broke down, resulting in epidemic disease’ (p. 166).

It is unfortunate that only two dozen of the letters of Julia Stockton Rush – his wife and the mother of thirteen children, only nine of whom survived their first year – remain because it would be interesting to learn more about their relationship and how their family unit embodied Benjamin's republicanism. But, to her credit, Naramore succeeds in bringing Julia to life and casting her as an energetic, intellectual partner.

From Rush University and the Rush University Medical Center in Chicago, to a memorial in Washington, DC and the College of Physicians of Philadelphia and the Arts Academy at Benjamin Rush High School in Philadelphia, Dr Benjamin Rush's legacy endures. But his contribution to the United States is more than bricks and mortar celebrating his life; his true impact is woven into the fabric of the republic he loved, a legacy that Benjamin Rush effectively explains. Naramore gives her readers an energetic portrait of a domestically and internationally engaged, and hopeful, founding father. Rush attempted to define and create what it was to be a good citizen. Rush was a man of energy, optimism, civic duty and connectivity within a uniquely American space. Sarah E. Naramore's Benjamin Rush, Civic Health, and Human Illness in the Early American Republic is an engaging journey into Rush's mind, beliefs and quest to use American medicine and its institutions, government and citizenry to shape and grow a new and dynamic republic.