1793 Philadelphia yellow fever epidemic: Difference between revisions

The Arch Street wharf, where the first cluster of cases were identified.

During the Yellow Fever Epidemic of 1793 in Philadelphia, Pennsylvania, there were 4044 people listed in the official register of deaths between August 1 and November 9. The vast majority of them died of the fever, making the epidemic in the city of 50,000 people one of the most severe in United States' history.

Beginnings

In the summer of 1793, as French colonial refugees from the slave revolution in Saint-Domingue crowded the port of Philadelphia, a summer yellow fever epidemic began in the city. It is likely that the ships and refugees carried the yellow fever virus and the mosquitoes that transmit it. The medical community and others in 1793 did not understand the role of mosquitoes in the transmission of yellow fever and other diseases. Survivors of the epidemic wrote extensively about it in the effort to learn from it. Many of their accounts are now available on-line. This short history of the epidemic draws from their accounts.

In the ports and coastal areas of the United States, even in the northeast, the months of August and September were considered the "sickly season," when fevers were prevalent. In the South, planters and other people wealthy enough usually left the Low Country during this season. Natives thought that newcomers especially had to undergo a "seasoning" and were more likely to die of what were thought to be seasonal fevers. The first two people to die of yellow fever in early Augustin Philadelphia were both recent immigrants. Letters describing their cases were published in a pamphlet a little over a month after they died. An Irish woman, Mrs. Parkinson, had severe head and back pains, great thirst, offensive stools, much vomiting, delirium, red spots on face and breast, blindness, sore throat, hiccuping and then she died. The young doctor sent by the Overseers of the Poor to treat the immigrant was perplexed and could do nothing to save her.

After two weeks Dr. Benjamin Rush, who had been a doctor's apprentice during the city's 1762 yellow fever epidemic, saw the pattern in the increasing fever cases and recognized that yellow fever had returned. In a lengthy account of his efforts to understand the epidemic written shortly after the epidemic ended, Rush recalled those early cases. On 7th he treated a young man for headaches, fever and vomiting, and on the 15th treated his brother. On the same day a woman he was treating turned yellow. On the 18th a man in the third day of a fever had no pulse, was cold, clammy, and yellow, but he could sit up in his bed. He died a few hours later. On the 19th a woman he visited died within hours. Another physician said five had died within sight of the woman's door. None of those victims was a recent immigrant. Rush alerted his colleagues that the city faced an epidemic of "highly contagious, as well as mortal... bilious remitting yellow fever." Adding to the alarm was that, unlike with most fevers, the principal victims were not the very young or very old. Many of the early deaths were teenagers and heads of families in the dockside areas.

Then the largest city in the US with around 50,000 residents, Philadelphia was relatively compact and most houses were within seven blocks of the Delaware River. Docking facilities extended from Southwark south of the city to Kensington to the north. Cases of fever clustered at first around the Arch Street wharf, and Rush blamed "some damaged coffee which putrefied on the wharf near Arch Street" for causing the fevers. Soon cases appeared in Kensington. The Pennsylvania governor, Thomas Mifflin, was charged with protecting the health of the port, as it was critical to the economy. He asked the port physician, Dr. James Hutchinson, to assess conditions. He found that 67 of about 400 residents near the Arch Street wharf were sick, but only 12 had malignant fevers. Alarmed by what Rush and others told him, Mayor Matthew Clarkson asked the city's medical society, the College of Physicians, to meet and advise the city's government and citizens how to proceed.

The College published a letter in the city's newspapers, written by a committee headed by Rush suggesting 11 measures to prevent the "progress" of the fever. They warned citizens to avoid fatigue, the hot sun, night air, too much liquor, and anything else that might lower their resistance. Vinegar and camphor in infected rooms "cannot be used too frequently upon handkerchiefs, or in smelling bottles, by persons whose duty calls to visit or attend the sick." They outlined measures for city officials: stopping the tolling of church bells and making burials private; cleaning streets and wharves; exploding gunpowder in the street to increase the amount of oxygen. Everyone should avoid unnecessary contact with the sick. Crews were sent to clean the wharves, streets and the market, which cheered those remaining in the city. Many who could left the city.

Like all hospitals of that time, the Pennsylvania Hospital did not admit patients with infectious diseases. The city's Guardians of the Poor moved victims into Ricketts' Circus, an open-air arena on 12th Street, far from the infected areas of the city. Seven yellow fever victims were placed there, two died. People in the neighborhood complained, so on August 29 the Guardians took over Bush Hill, a 150-acre estate farther outside the city, whose owner was away in England for an extended stay. Vice President John Adams had recently rented the main house, so yellow fever patients were placed in the outbuildings. Nurses were hired to treat patients, under orders by young physicians, who were to visit on a daily basis.

The end of August was not traditionally a busy time in the city. Many families who could afford it or who had relatives in the countryside were rusticating during that hot month. Beginning in September, fall goods shipped from Britain arrived. In 1793, the Federal Congress was not scheduled to be in session until November, but the Pennsylvania Assembly met in the first week of September. the city was founded by the Quaker William Penn and was still very much the center of Quaker life in the United States. The Yearly Meeting of the Society of Friends was scheduled to be held in the third week of September.

But, between the College's advisory on August 25 and the death of Dr. Hutchinson from yellow fever on September 7, panic spread throughout the city, and many who could left. The publisher Matthew Carey, who left the city for almost the entire month of September, estimated that 17,000 of the 50,000 resident left. Between August 1 and September 7, 456 people died in the city. On September 8, 42 deaths were reported. The daily death toll remained above 30 until October 26. The worst 7-day period was between October 7 and 13, when 711 deaths were reported.

Carey described changes in the life of the city:

"Those who ventured abroad, had handkerchiefs or sponges impregnated with vinegar of camphor at their noses, or smelling-bottles full of the thieves’ vinegar. Others carried pieces of tarred rope in their hands or pockets, or camphor bags tied round their necks.... People hastily shifted their course at the sight of a hearse coming towards them. Many never walked on the foot path, but went into the middle of the streets, to avoid being infected in passing by houses wherein people had died. Acquaintances and friends avoided each other in the streets, and only signified their regard by a cold nod. The old custom of shaking hands fell in such general disuse, that many shrunk back with affright at even the offer of a hand. A person with crape, or any appearance of mourning, was shunned like a viper."

The African-American nurses

The College of Physicians' advisory implied the fever was contagious and people should avoid contact with its victims, although "duty" required that they be cared for. Yet in families, when the person with the fever was a mother or father, they could forbid their children from coming near them. Rush knew of Dr. John Lining's observation during the 1742 yellow fever epidemic in Charleston, South Carolina, that African slaves in the city did not get the fever; he suggested they had immunity. Writing a short letter to the newspapers under the pseudonym "Anthony Benezet," a Quaker who provided schooling for African Americans, Rush recalled that supposed immunity to fever and asked the city's African Americans if that "exception... which God has granted you does not lay you under an obligation to offer your services to attend the sick to help those know in distress." Richard Allen and Absalom Jones recalled their reaction to the letter in a memoir they published shortly after the epidemic:

"Early in September, a solicitation appeared in the public papers, to the people of colour to come forward and assist the distressed, perishing, and neglected sick; with a kind of assurance, that people of our colour were not liable to take the infection. Upon which we and a few others met and consulted how to act on so truly alarming and melancholy occasion. After some conversation, we found a freedom to go forth, confiding in Him who can preserve in the midst of a burning fiery furnace, sensible that it was our duty to do all the good we could to our suffering fellow mortals. We set out to see where we could be useful. The first we visited was a man in Emsley's alley, who was dying, and his wife lay dead at the time in the house, there were none to assist but two poor helpless children. We administered what relief we could, and applied to the overseers of the poor to have the woman buried. We visited upwards of twenty families that day - they were scenes of woe indeed! The Lord was plentiful to strengthen us, and removed all fear from us..."

"In order the better to regulate our conduct, we called on the mayor the next day, to consult with him on how to proceed, so as to be the most useful. The first object he recommended was a strict attention to the sick, and the procuring of nurses. This was attended to by Absalom Jones and William Gray; and, in order that the distressed might know where to apply, the mayor advised that upon application to them they would be supplied. Soon after, the mortality increased, the difficulty of getting a corpse taken away, was such, that few were willing to do it, when offered great rewards. The black people were looked to. We then offered our services in the public papers, by advertising that we would remove the dead and procure nurses. Our services were the production of real sensibility; - we sought not fee nor reward, until the increase of the disorder rendered our labour so arduous that we were not adequate to the service we had assumed."

In a September 6 letter to his wife, Rush said that the "African brethren... furnish nurses to most of my patients." Despite Rush's assurances, most of the city's African Americans were no immune to the fever. Many of the slaves in Charleston in 1742 could have gained immunity before being taken in chains from Africa. Allen and Jones estimated that almost 250 blacks died during the epidemic.

Controversy over treatment

Given the limited resources and knowledge of the times, the city's response was creditable. The medical community did not know the natural history of yellow fever, a viral infection spread by the Aedes aegypti mosquito. Efforts to clean the city did not defeat the spread of the fever as that mosquito breeds in clean water. Philadelphia's newspapers continued to publish during the epidemic, and through them doctors and others tried to understand and combat the epidemic. On September 7, Dr. Adam Kuhn advised patients to treat symptoms as they arose: for nausea, "a few bowls of camomile tea" and if it continued "saline draught in a state of effervesence, elixir of vitriol [a dilution of sulphuric acid], and, if necessary, laudanum [an opium compound];" for stomach pains, apply "mint, cloves, or any other spice with wine or spirits to the pit of the stomach" and then "20 drops of elixir of vitriol" taken every 2 hours "in a cup full of strong cold camomile tea, and if [Peruvian] bark can be obtained, two drachms of the best pale bark in substance are to be taken given 2 hours, alternately with the elixir of vitriol;" if the bark brings on diarrhea then "give 10 or 15 drops of laudanum after every stool." Kuhn advised drinking wine, "at first weaker wines, such as claret and Rhenish; it these cannot be had, Lisbon or Madeira diluted with rich lemonade. The quantity is to be determined by the effects it produces and by the state of debility which prevails, guarding against its occasioning or encreasing the heat, restlessness or delirium." He placed "the greatest dependence for the cure to the disease, on throwing cool water twice a day over the naked body. The patient is to be placed in a large empty tub, and two buckets full of water, of the temperature 75 or 80 degrees Fahrenheit's thermometer, according to the state of the atmosphere, are to be thrown on him." The water treatment was also advocated by Dr. Edward Stevens, who wrote to the newspaper explaining how it cured Alexander Hamilton of the fever.

Rush claimed that he tried Kuhn's and Steven's stimulating remedies and his patients still died. Rush searched the medical literature for other approaches. Benjamin Franklin had given him letters sent by Dr. John Mitchell related to treating patients during a 1741 yellow fever outbreak in Virginia. (Franklin never published the letters.) Mitchell noted that the stomach and intestines filled with blood and that these organs had to be emptied at all costs. "On this account," he argued, "an ill-timed scrupulousness about the weakness of the body is of bad consequences in these urging circumstances.... I can affirm that I have given a purge in this case, when the pulse has been so low that it can hardly be felt, and the debility extreme, yet both one and the other have been restored by it."

After experimenting, Rush decided that a powder of ten grains of calomel (mercury) and ten grains of the cathartic drug jalap (the poisonous root of a Mexican plant, Ipomoea purga, related to the morning glory, which was dried and powdered before ingesting) would create the desired elimination he was seeking. Since the demand for his services was so great, he had his assistants make as many of his powders in pill form as they could.

On September 10, he published a guide to treating the fever: "Dr. Rush's Directions for Curing and Treating the Yellow Fever," outlining a regimen of self medication. At the first sign of symptoms, "more especially if those symptoms be accompanied by a redness, or faint yellowness in the eyes, and dull or shooting pains about the region of the liver, take one of the powders in a little sugar and water, every six hours, until they produce four or five large evacuations from the bowels..." He urged that the patient stay in bed and "drink plentifully" of barley or chicken water. Then after the "bowels are thoroughly cleaned," it was proper to take 8 to 10 ounces of blood from the arm if, after purging, the pulse was full or tense. To keep the body open he recommended more calomel or small doses of cream of tarter or other salts. If the pulse was weak and low, he recommended camomile or snakeroot as a stimulant, and blisters or blankets soaked in hot vinegar wrapped around the lower limbs. To restore the patient he recommended "gruel, sago, panada, tapioca, tea, coffee, weak chocolate, wine whey, chicken broth, and white meats, according to the weak or active state of the system; the fruits of the season may be eaten with advantage at all times." The sick room should be kept cool and vinegar should be sprinkled around the floor.

Rush's therapy was generalized as purge and bleed, and as long as the patient remained debilitated, Rush urged further purging and bleeding. Not a few of his patients became comatose. The calomel in his pills soon brought on a state of constant salivation which Rush urged patients to attain to assure a cure. A characteristic sign of death was black vomit and which salivation seemed to ward off. Since he urged purging at the first sign of fever, other doctors began finding patients with severe abdominal distress. Autopsies after their death revealed stomachs destroyed by the purges.

The hope offered by these treatments was soon dashed when it became clear that they did not cure the disease, and the doctors' competing claims were demoralizing to patients. Rush's trumpeting that his remedies cured 99 out of 100 patients have led to historians and modern doctors ridiculing his remedies and approach to medical science. Some contemporaries also attacked him, and in 1799 Rush won a $5,000 libel judgment against the newspaper editor, William Cobbett. He had attacked his therapies and called him a "Sangrado," after a character in Gil Blas, who bled patients to death. In his 1794 account of the epidemic, Matthew Carey noted that other doctors claimed to have used calomel before Rush and that "its efficacy was great and rescued many from death." Carey added that the "efficacy of bleeding, in all cases not attended with putridity, was great." Rush taught the African-American nurses how to bleed and purge patients. Allen and Jones wrote that they were thankful that "we have been the instruments, in the hand of God, for saving the lives of hundreds of our suffering fellow mortals." Rush's heroic brand of medicine became the standard American treatment for fevers in the 1790s and was widely used for the next 50 years.

Bush Hill

The response of the various levels of government in the city varied. The Federal government had no authority to respond to the crisis. Congress had not been in session since June. President Washington's cabinet continued to meet until Washington left the city on September 10 for his scheduled vacation, which included officiating at the laying of the cornerstone of the US Capitol in the City of Washington on September 18. Employees of the Treasury Department, who collected customs and worked to keep the country's financial system from grinding to a halt, worked throughout the epidemic; the post office also stayed open. The state legislature cut short its September session after a dead body was found on the steps of State House. Governor Mifflin became ill and was advised by his doctor to leave. The city's banks remained open. But, banking operations were so slowed by the inability of people to pay off notes because of disruptions from the epidemic that banks automatically renewed notes until the epidemic ended.

Matthew Clarkson, the Mayor of the city, selected by his fellow Common Council members, organized the city's response to the epidemic. Most of the Common Council members fled. Americans were accustomed to forming ad hoc committees in response to a crisis. On September 12, Clarkson summoned fellow citizens interested in helping the Guardians of the Poor. They formed a committee to take over from the Guardians and address the crisis. On the 14th Clarkson was joined by 26 men who formed committees to reorganize the fever hospital, arrange visits to the sick, feed those unable to take care of themselves, and arrange for wagons to carry the sick to the hospital and the dead to Potter's Field. On the 17th a Committee member reported that 15-month-old twins had been made orphans by the epidemic. On the 19th the Committee identified a house to accommodate the growing number of orphans. Richard Allen and Absalom Jones offered the services of members of the Free African Society to the Committee.

When the Mayor's committee inspected the Bush Hill fever hospital, they found the nurses unqualified and arrangements chaotic. "The sick, the dying, and the dead were indiscriminately mingled together. The ordure and other evacuations of the sick, were allowed to remain in the most offensive state imaginable... It was, in fact, a great human slaughter-house." On September 15, members of the Mayor's Committee, Peter Helm, a barrel maker, and Stephen Girard, a merchant and shipowner born in France, volunteered to personally manage the hospital.

The Minutes of the Mayor's Committee give an outline of the rapid improvements they made at the hospital. They had bbedsteads repaired and more sent from the prison so patients would not have to lie on the floor. A barn was adapted as a place for convalescing patients. On the 17th, the managers hired 9 female nurses and 10 male attendants, as well as a female matron. They assigned the 14 rooms to separate male and female patients. With the discovery of a spring on the estate, workers arranged to have clean water pumped into the hospital. The managers informed the committee that they could accommodate more than the 60 patients then under their care, and soon the hospital had 140 patients.

Girard found that having four young physicians come out from the city to see patients added to the confusion. He hired Jean Deveze, a French doctor with experience treating yellow fever in Saint-Domingue (now Haiti). Deveze cared only for the patients at the hospital, and he was assisted by French apothecaries. Deveze was gratified to see Girard's fearlessness in his devotion to the patients. In his memoir written shortly after the epidemic, Deveze lauded Girard's services:

"I even saw one of the diseased...[discharge] the contents of his stomach upon [him]. What did Girard do? ...He wiped the patient's cloaths, comforted [him]...arranged the bed, [and] inspired with courage, by renewing in him the hope that he should recover. ---From him he went to another, that vomited offensive matter that would have disheartened any other than this wonderful man."

News that patients treated at the hospital were recovering, encouraged many people to believe that medicine was acquiring control of the fever. Unlike other doctors, Deveze did not offer advice in the newspapers. He discussed his treatment in his memoir which included 18 case studies and descriptions of several autopsies. While he deprecated Rush's harsh purgatives and heroic bleeding, he moderately bled patients and also used medicines to evacuate the bowels. Like Rush, he thought poisons had to be "abstracted" in severely debilitated patients. Instead of purges, he used blisters to raise welts on the skin. Unlike Kuhn, he did not favor baths. He preferred to apply heat, using hot bricks on hands or feet. He strongly discounted the traditional treatment for severe fevers, which was to wrap patients in blankets, give them camomile tea or Madeira, and try to bring on sweats. He preferred "acidulated" water to the use of Peruvian bark. Many patients found the bark distasteful. He thought the use of opium very helpful. Soon it became apparent that mortality at the hospital remained high; about 50% of those admitted died.

The Selfless and the Selfish

In his account of the epidemic Mathew Carey contrasted the sacrifices of men like Joseph Inskeep, a Quaker who volunteered for the Mayor's committee and visited the sick, with the selfishness of others. When Inskeep got sick he asked for the assistance of a family that he attended when several members of the family were sick. They refused and he died. The city's Quaker community was scandalized when a grandfather refused to take in the children orphaned by the death of his daughter and her husband.

Carey collected rumors of rapacity especially by landlords who threw convalescing tenants into the street. He also singled out black nurses for charging exorbitant fees and stealing from those they watched. That elicited a quick response from Allen and Jones who defended the black nurses. They recounted that "the great prices paid did not escape the observation of that worthy and vigilant magistrate, Matthew Clarkson, mayor of the city, and president of the committee. He sent for us, and requested we would use our influence to lessen the wages of the nurses. But on informing him of the cause, i. e. that of the people over-bidding one another, it was concluded unnecessary to attempt any thing on that head; therefore it was left to the people concerned." Allen and Jones pointed out that white nurses also profited and stole from their patients. "We know that six pounds was demanded by and paid to a white woman, for putting a corpse into a coffin; and forty dollars was demanded and paid to four white men, for bringing it down the stairs." Many black nurses served without compensation: "A poor black man, named Sampson, went constantly from house to house where distress was, and no assistance, without fee or reward. He was smitten with the disorder, and died. After his death his family were neglected by those he had served. Sarah Bass, a poor black widow, gave all the assistance she could, in several families, for which she did not receive any thing; and when any thing was offered her, she left it to the option of those she served."

The Mayor's committee was the focal point of those who wanted to lessen the cities suffering. At the peak of the epidemic, the first week of October, eight members formed a Committee of Distribution to distribute food that was donated to the committee by outlying communities. They found 46 volunteers to oversee distribution in each of the city's wards. Other volunteers collected and cared for 192 children made orphans by the epidemic.

The Lord is among us

The continuation of church services also helped keep up the city's morale. Rev. Henry Helmuth who led the city's German Lutheran Congregation wrote A Short Account of the Yellow Fever in Philadelphia for the Reflecting Christian. He also left a diary. On September 16 he reported that his church was "very full" the day before. In one week in October 130 members of his congregation were buried. On October 13, he wrote in his diary: "Preached to a large gathering about Jes.26,1. I showed that Philadelphia is a very blessed city - the Lord is among us and especially in our congregation. I proved this with examples of dead and still living people. Baptized a child. Announced that I could not be with the corpses, that the sick should be reported to me in the morning so that I could visit them in the afternoon."

One hundred members, most of them coming from outside the city, attended the Yearly Meeting of the Society of Friends at the Arch Street Meeting House not far from where the epidemic started. In it Yearly Epistle, the members attending explained that to change the time or place of the meeting would be a haughty attempt to escape "the rod" of God from which there was no escape. The death of one attendee, John Todd, had ramifications. His widow Dolley Payne Todd's who escaped the epidemic at a Todd family farm outside the city subsequently married a Virginia congressman and future U.S. president, James Madison.

Fear and Quarantines: Other Cities React

As the death toll in the city rose, authorities in neighboring communities as well as major port cities like New York and Baltimore began doing all they could to keep people fleeing the epidemic as well as goods sent from Philadelphia away. New York established a "Committee appointed to prevent the spreading and introduction of infectious diseases in this city," which set up citizen patrols. People who did not leave Philadelphia before the second week in September could leave the city only with great difficulty and faced road blocks, patrols, inspections and quarantines. Stage coaches from Philadelphia were not allowed in many cities. Havre de Grace, Maryland, for example, tried to keep anyone from Philadelphia from getting south of the Susquehanna River. While neighboring cities wanted to keep refugees from Philadelphia away, they did send food supplies and money, including $5000 from New York City, to the Mayor's committee.

Other cities did receive refugees from Philadelphia including Woodbury and Springfield, New Jersey, Chester, Pennsylvania and Elkton, Maryland. President Washington corresponded with members of his cabinet on where to assemble if the epidemic prevented Congress from meeting as scheduled in December. Washington decided to meet his cabinet in Germantown, at that time a town some ten miles outside the city, in early November. He first lodged at the Dove House, on the campus of Germantown Academy, and then rented the house on Germantown Avenue still known as the "Germantown White House".

End of the epidemic

Doctors, preachers, and laymen all looked to the weather to end the epidemic. First hopes were placed in the onslaught of an "equinoctial gale" as hurricanes were then called. None came and heavy rains in late September only seemed to make the epidemic worse. The last hope was frost, which long experience had demonstrated ended fall fevers. During the first two weeks of October, gloom pervaded the city and those outside confronted the prospect that the epidemic would not soon end. Most church services finally ended. The post office moved out of the area mostly severely afflicted. The market days continued and bakers continued to make a distribute bread. Several members of the Mayor's Committee died. African American nurses began dying of the fever. The carts continued to take victims to Bush Hill and also to burial grounds. Due to their death and sickness, fewer doctors could visit patient. Three of Rush's apprentices, as well as his sister died, and Rush himself was too sick to leave his house. News of this cast doubts on Rush's methods, but as Rush knew none of those victims submitted to his harsh medicines.

The refugees from Haiti used the streets with impunity, but few others did. Those who did not escape the city at the beginning of the epidemic, now waited out the epidemic in their homes. However, members of the Mayor's Committee appreciated nuances of the epidemic and tried to make them plain. It commissioned a quick census of the dead which showed that the majority of victims were poor people who died in the alleys behind the healthier main streets where most of the business of city was conducted.

On October 16, after temperatures cooled, a newspaper reported that "the malignant fever has very considerably abated." On the 25th stores began to reopen, many families returned, the wharves were "once more enlivened," as a London ship came up to unload. The Mayor's Committee still advised people outside the city to wait another week or 10 days before coming back in. It published directions for cleaning houses that had been closed up. They should be aired out for several days with all windows and doors open. "Burning of nitre will correct the corrupt air which they may contain. Quick lime should be thrown into the privies and the chambers whitewashed." On the 31st a white flag was hoisted over Bush Hill with the legend "No More Sick Persons Here." However, after some warm days, the fever returned. The white flag had to be struck. On the 7th a woman who had stayed in the city marveled at the streets "full of people and waggons loaded with furniture." One returnee found the city "beautifully clean, nothing lying on the streets or gutters." On the 13th stages north and south were running. A merchant reported that the streets were "in an uproar and rendered the wharves impossible by reason of the vast quantities of wine, sugar, rum, coffee, cotton & c. The porters are quite savvy and demand extravagantly for anything they do." On the 14th the Mayor's committee announced that while houses still had to be purified and infected clothing and bedding "washed, baked, buried or destroyed," anyone could come to the city "without danger from the late prevailing disorder."

Controversy over causes and prevention

President's House, Philadelphia. Washington left the plague-ridden city for Mount Vernon on September 10. He and his cabinet reassembled in Germantown in early November. On November 11, Washington visited the city before the official all clear on November 14, but didn't reoccupy the President's House until December.

The end of the epidemic did not end the controversy between the city's doctors. Hearing rumors that some of his colleagues were going to try to get him expelled from the College of Physicians, Rush resigned and formed a new medical society that many of the city's younger doctors joined. Although Rush's shrill promotion of his remedies and attacks on other remedies was the main bone of contention, his arguing that the fever was engendered in the filth of Philadelphia and was not imported from the West Indies was also alarming. Merchants did not want the port's reputation stained permanently. Even some who used Rush's remedies would not embrace his etiology of the disease. On the other hand, some who deprecated his therapies like Dr. Deveze agreed that the fever was not imported and arose from local conditions. Deveze was on the ship which many of those arguing for importation of the disease and he recalled the ship as being healthy. The Governor chose to accept the positions of both sides: the city would be kept scrupulously cleaned and the port better policed to keep infected ships away until they went through a period of quarantine. The city's yellow fever epidemics in 1797, 1798, and 1799 kept this controversy alive.

The city's religious community also weighed in on the causes of the disease.arguing that the epidemic was a judgment from God. Led by the Quakers the religious community petitioned the state legislature to outlaw theatrical presentations in the state. Such entertainment had been banned during the Revolution and had only recently been authorized. After an extensive debate in the newspapers, the State Assembly denied the petition.

The almost annual return of deadly fevers kept discussions about causes and prevention going until the end of decade. Civic improvements like a municipal water system probably came sooner because of the epidemics. While the recurring epidemics were demoralizing, since other major ports also had epidemics beginning with Baltimore in 1794, New York in 1795 and 1798, and Wilmington in 1798, what appeared to be Philadelphia's unique problem in 1793 became a national crisis. In retrospect, New York doctors finally admitted that they had an outbreak of yellow fever in 1791 that killed over 100 people. All the cities that suffered epidemics continued to grow rapidly. None suffered a comparative disadvantage. The widespread recognition that the epidemics were centered along the waterfront meant that cities grew more rapidly away from the waterfront. Families that could afford it made arrangements to be outside areas prone to infection. During the epidemic of 1798, Benjamin Rush commuted daily from a house just outside of the city, near what is now 15th and Columbia Streets, to the new city fever hospital where he treated fever victims.

Coping with the epidemics did not lead to a discovery of their cause. However, Carlos Finlay, the Cuban doctor who in 1881 correctly argued that mosquito bites caused yellow fever, credited Rush's published account of the 1793 epidemic for giving him the idea. On page 108 of his lengthy account, Rush noted: "Mosquitoes (the usual attendants of a sickly autumn) were uncommonly numerous...

Lists of the Dead

An official register of deaths listed 4044 people as dying between August 1 and November 9. City officials, medical and religious leaders and newspaper publishers did not conceal the city's woe. The minutes of the Mayor's Committee were published in the newspapers and the number and names of victims were reported. In the appendix of the edition of Minutes now on-line, the names of all the patients admitted to Bush Hill are listed alphabetically as well as the disposition of their cases. While Deveze did not reveal the names of the patients whose treatments he described, Rush used the names of his patients in his memoir as he described his struggle against the epidemic. The publisher Mathew Carey had a history of the epidemic out just weeks after the epidemic ended. One reason it became an instant best seller was because he listed all the names of the dead at the back of the book.

Histories of the Epidemic

In first week of September 1793, Dr. William Currie published a description of the epidemic and an account of its progress during August. The publisher Mathew Carey had an account of the epidemic for sale in the third week of October, before the epidemic had ended. Currie's work was the first of several medical accounts published within a year of the epidemic. Dr. Benjamin Rush's was over 300 pages long. Two French doctors, Jean Deveze and Nassy, published shorter account. Carey's impressionistic popular history grew rapidly. The fourth version was out in December. The Reverends Richard Allen and Absalom Jones published an account correcting Carey's attack on the black nurses. Other clergymen published accounts the most notable by the Lutheran minister Helmuth. In March 1794, the Mayor's committee published its minutes. In addition letters written during the epidemic which in some cases expressed the last sentiments shared by victims were preserved by many families.

However, the first history of the epidemic taking advantage of that wealth of first hand accounts, J. H. Powells Bring Out Your Dead, was not written until 1949. The rapid succession of other yellow fever epidemics in Philadelphia and elsewhere in the northeastern United States engendered many more accounts of the efforts to contain, control and cope with yellow fever. Rush wrote accounts of the 1797, 1798, and 1799 epidemics in Philadelphia. They were not as long as his account of the 1793 and must have been problematical for historians of that era. Indeed Rush revised his account of the 1793 epidemic to eliminate reference to the disease being contagious. He varied his cures, and in 1798 he was the chief doctor at the fever hospital. The mortality rate then was roughly the same as that at Bush Hill despite the radical difference between therapies employed. The civic response to the 1798 epidemics in Philadelphia and New York were more complex than the simple efforts of the Mayor's committee to inspect, coordinate and succor the needy. In Philadelphia there were forced evacuation of neighborhoods and the concentration of refugees in regimented camps. There were mandatory inspections of all houses in the city after the epidemic and destruction of what was deemed unhealthy.

Noah Webster, better known then as a New York newspaper publisher than a lexicographer, joined two doctors in publishing the Medical Repository and magazine that collected accounts of fever epidemics throughout the nation much of which became part of the data Webster used to argue that the nation was being subjected to a wide spread "epidemic constitution" in the atmosphere that might last 50 years and make deadly epidemics almost certain. Yellow fever seemed a national crisis the history of which would have to wait until it ended. In 1855 when a French doctor published a 813 page history of yellow fever, the experiences of Philadelphia in 1793 filled only a few pages.

Popular culture

Several novels have depicted the epidemic including:

• Arthur Mervyn, a novel about the epidemic by Charles Brockden Brown published in 1799
• The Red City by Silas Weir Mitchell
• Fever 1793, a historical novel about the epidemics published in 2000

See also

• Philadelphia Lazaretto, built in 1799 in response to the 1793 epidemic
• Stubbins Ffirth

Bibliography

• Allen, Richard (1794). A Narrative of the Proceedings of the Black people, During the Late Awful Calamity in Philadelphia in the Year 1793. Philadelphia: Franklin's Head. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Arnebeck, Bob (January 30, 2008). "A Short History of Yellow Fever in the US". Benjamin Rush, Yellow Fever and the Birth of Modern Medicine. Retrieved 4 December 2008.
• Barnard, Bryn (2005). Outbreak! Plagues That Changed History. New York: Crown Publishers. ISBN 0375829865.
• Garret, Laurie (1994). The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Farrar, Straus and Giroux. ISBN 0140250913.
• Jacobs Altman, Linda (1998). Plague and Pestilence: A History of Infectious Disease. United States: Enslow Publishing Inc. ISBN 0894909576.
• Common Council, Philadelphia (1794). Minutes of the Proceedings of the Committee Appointed on the Date of 14 September to Alleviate the Suffering of the Afflicted. Google E-Book. Retrieved January 27, 2012.
• Murphy, Jim (2003). An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793. New york: Clarion Books. ISBN 0395776082. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
• Powell, John Harvey (1993). Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793. Philadelphia: University of Pennsylvania Press. ISBN 0812214234.
• Rush, Benjamin (1794). An Account of the Bilious Remitting Yellow Fever as it appeared in the City of Philadelphia in 1793. Google E-Book. Retrieved January 27, 2012.
• Yount, Lisa (2000). Epidemics. San Diego: Lucent Books. ISBN 1560064412.
• "The Yellow Fever epidemic". Africans in America. PBS Online. 1998. Retrieved 4 December 2008.

External links

• PBS American Experience program website
• PBS Africans in America program website
• Mathew Carey's A short account of the malignant fever, lately prevalent in Philadelphia (1793)