1793 Philadelphia yellow fever epidemic

The Arch Street wharf, mistakenly thought to be the source of the outbreak.

The Yellow Fever Epidemic of 1793 is believed to have killed several thousand people in Philadelphia, Pennsylvania, United States.

Beginnings

In summer of 1793 the on-going Haitian Revolution forced many French refugees to flee, and many of them landed in Philadelphia. Given their ordeal, that many were ill did not alarm Philadelphia doctors. Dr. Benjamin Rush blamed them for a summer influenza epidemic. In retrospect it seems likely that the yellow fever epidemic that soon struck the city was also brought by the refugees. During the months of August and September low coastal areas in the United States, even in the northeast, were considered the "sickly season," and fevers were prevalent. Newcomers especially had to undergo a "seasoning" and their dying of fevers did not surprise natives. The first two people to die of yellow fever in early August were both recent immigrants. However, by the third week of August several natives of the city began to die of a violent fever. Recalling the yellow fever epidemic the city experienced in 1762, Dr. Rush alerted his colleagues that the city faced an epidemic of the "highly contagious, as well as mortal... bilious remitting yellow fever." Adding to the alarm was that, unlike most fevers, the principal victims were not the very young or very old. Many of the early deaths were teenage boys and breadwinners for families in the dockside areas.

Although the largest city in the US with around 50,000 residents, Philadelphia was relatively compact with most houses within 7 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, but then there were soon cases in Kensington The end of August was not traditionally a busy time in the city. Many families who could afford it or who had relations in the countryside were rusticating during that hot month. However, 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. Founded by the Quaker William Penn, and still very much the center Quaker life in America, the Yearly Meeting of the Society of Friends was to be held in the third week of September. The governor of the state was in charge with policing the health of the port and he asked the port physician, Dr. James Hutchinson, to assess conditions there. He found that 67 of about 400 residents near the Arch Street wharf were sick, only 12 had malignant fevers However most of his colleagues responded to Dr. Rush's call for a meeting of a medical society he helped organize called the College of Physicians, and they published a letter, 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 the amount of oxygen. Everyone should avoid unnecessary contact with the sick. Between that publication on August 25 and the death of Dr. Hutchinson from yellow fever on September 7 panic increasingly spread throughout the city.

The response of the various levels of government in the city varied. When the son of the doorkeeper of the State Assembly was found dead of fever on the State House steps, the state assembly adjourned. After signing decrees forbidding the landing of emigrants, always feared as harbingers of disease, Governor Mifflin left While the Federal government had no powers to respond to the epidemic, President Washington's cabinet continued to meet to address a crisis in US relations with the new French government and the reception of its new ambassador. 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 19. Employees of the Treasury Department who collected customs and did those things necessary to keep the country's financial system from grinding to a halt worked throughout the epidemic, nor did the post office close. The city's banks remained open. The Mayor of the city Matthew Clarkson, who was selected by his fellow city council members, organized the city's response to the epidemic even as most of his fellow city council members fled. Crews were immediately sent to clean wharves, streets and the market which cheered those remaining in the city Americans then were accustomed to forming ad hoc committees in response to a crisis. Clarkson summoned fellow citizens interested in organizing to cope with the epidemic. On September 14 a large number responded and committees were formed to organize a fever hospital to care for the sick, to arrange visits to the sick and feed those unable to take care of themselves. The markets held Wednesday and Saturday continued but the committee found it necessary to arrange for the baking and distribution of bread

Re-elevating the morale of the city

A source of contention in the Philadelphia College of Physicians was Dr. Benjamin Rush's claim to having found a cure. Doctors of the time believed in vis medicatrix naturae, "the healing power of nature." This was the belief that the body would in its own due course rid itself of any illness or poisons and that it was the doctor's job simply to help this natural process along. Rush saw that nothing was coming from this practice and decided more drastic measures needed to be taken. He tried many treatments (with no results) that included: administering shaved tree bark with wine, brandy, and aromatics such as ginger or cinnamon; sweating the fever out by coating a patient's body with a thick salve of herbs and chemicals; and wrapping the whole body in a blanket soaked in warm vinegar. Finally, after hours of reading for an answer, Dr. Rush came upon John Mitchell's published letter concerning a yellow fever outbreak fifty years prior in Virginia. Mitchell noted that the stomach and intestines filled with blood and that these organs had to be emptied at all costs. He urged doctors to be blunt and to forget any "ill-timed scrupulousness about the weakness of the body."

Last used during the American Revolutionary War, "Ten-and-Ten" was an intense purge of the body produced through administering 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). Both substances, being highly toxic, would create the desired elimination that Dr. Rush was looking for. To accelerate the process, he increased the dosage to ten-and-fifteen and administered it three times a day, in effect poisoning his patients to rid the body of waste. Rush also believed in bloodletting, as did virtually every doctor of the time. He removed copious amounts of blood from a patient with the thought that it would cleanse the body. Many at the time believed the body held about twenty-five pounds of blood, but in reality, it holds less than half that, and many of Rush's patients passed out because they were bled so radically. However drastic were Rush's methods, he saw signs of improvement, claiming that eight out of ten patients had gotten better with a single treatment, and that the next day nine out of ten were over the fever.

Nevertheless, success came with criticism. Most doctors believed he was poisoning his patients instead of curing them. Dr. Jean Devèze publicly criticized Rush saying: "He, I say, is a scourge more fatal to the human kind than the plague itself would be." Other doctors suggested treatments of their own, but no one claimed to have the cure as fervently as Rush did. He continued to face criticism until he himself fell ill with the fever. He had a servant administer the cure to him and fully recovered within five days. It wasn't until that point that many people sought him out for his cure; afterwards, over one-hundred fifty people came to him for help. Still, most of Philadelphia's physicians condemned his technique, calling him the "Prince of Bleeders."

Although the College of Physicians came to no agreement about the illness, they did provide a list of precautions and measurements to be delivered to the citizens of Philadelphia. The list included cleaning the streets, hospitalization for victims, avoiding fatigue, limiting the intake of beer and wine, placing patients in airy rooms, removing soiled clothes and linens often, putting strong smelling substances such as vinegar on handkerchiefs to place over the mouth, using gunpowder to purify the air, and to stay away from people with the disease. The list, however, did not offer a cure.

In response to the list, the citizens of Philadelphia created a feeling of panic. One citizen, Mathew Carey noted, "Acquaintances and friends avoided each other in the streets, and only signified their regard by a cold nod." Immediately people began evacuating the city to country homes and relatives far away, leaving behind the poor who could not afford such luxuries. Mayor Clarkson became increasing concerned over this because the poor were swiftly becoming poorer. As the middle and upper class people began closing their shops, many poor people lost their jobs, and could therefore not pay for food, medicine, a physician, or a nurse. A militia company from nearby Fort Mifflin began hauling a cannon around the streets, firing off gunpowder to calm the citizens that were left in the city. This was just one unsuccessful precaution taken to re-elevate the mood of the city.

Another unsettling fact was the low number of government officials that kept showing up for work. Only ten out of eighteen senators and thirty-six out of seventy-two representatives showed up at the state legislature to deal with the crisis. These numbers dropped even lower after the doorkeeper Joseph Fry died of the fever one night.[11] On September 10 George Washington left saying he wanted to keep his wife safe, and would be gone briefly for fifteen days, but his return kept being put off.[12] Other jobs in the city were going undone as well: such as burying the dead bodies, and cleaning the streets and the docks; measures that were supposed to help stifle the fever. Farmers refused to bring food into the city for fear of contracting the disease. This made the cost of available food in the city go up two or three times as much as when the fever was not occurring.

One more increasing concern of Mayor Clarkson's was the almshouses being at maximum capacity. Not only were the homeless on the streets scaring people, and providing an additional opportunity to transmit the fever, but they were also receiving no care. A prestigious Pennsylvania hospital turned away fever victims because they feared the disease would spread rampantly through the wards due to the close conditions of the patients and workers. One solution was to turn Ricketts' Circus building into a place for the excess homeless. Seven yellow fever victims were placed in the abandoned Circus and left to die there. The ones that were still alive were only moved when neighbors complained about the smells and sounds, to Bush Hill, an illegally seized building. However, Bush Hill was no better for the victims: it was described as "limited, crude, and insufficient."

Bush Hill

For the majority of the epidemic, Bush Hill remained overcrowded and understaffed. "The sick, the dying, and the dead were indiscriminately mingled together," eyewitness Mathew Carey reported. "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." It was not until Mayor Clarkson, in despair, organized a committee that the institution changed. Two members, Peter Helm, a barrel maker, and Stephen Girard, a very wealthy merchant and shipowner, decided to volunteer to personally manage the interim hospital.

In days, the hospital was running more smoothly, and the patients' morale increased. The first thing Helm and Girard did was to split up the work. Helm took the chores that were concerned with the outside of the building. He established an area where coffins were to be constructed, provided decent housing for staff members of the mansion, had the barn converted into rooming space for those recovering from illness so that they would not be affected from the newly ill, found sufficient areas for storage supplies, and had the property's water pump repaired so that fresh water would be available to patients for the first time. He also took on the daunting task of creating a system for receiving new patients and effectively carting away the dead.

Stephen Girard took the assignment of making sure everything was running efficiently inside the building. His first action was to clean every room of every floor from top to bottom. He then categorized the one hundred and forty current patients and placed them in separate rooms; the dying in one room, the "very low" in an additional room, and so on. He assigned each room and hallway a nurse, hired the French doctor Jean Devèze, who was critical of Rush, and placed a doorkeeper at the entrance to keep track of entrances as well as to prevent delirious patients from going out. In addition to managing those responsibilities, Girard found the time to personally help the patients, as one bystander describes:

"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."

Israel Israel

Another prominent figure from Mayor Matthew Clarkson's organization was forty-seven-year-old Israel Israel. A reserved merchant and tavern keeper, Israel became a saint of the epidemic. He was put in charge of many jobs, first to find housing, care, and support for the escalating number of orphans in the city. Not only did he rent a home, hire a matron, and have provisions carted to the door of the new home, but he provided all of these amenities to over one-hundred ninety-two orphans. Israel Israel also went where no sane man would go, to the potter's field, from which noxious odors were wafting, though many believed it the source of the epidemic; there he inspected burial procedures. He was also the one who arranged for the harvesting of grain at Bush Hill, and headed the Committee of Distribution who handed out food, firewood, and clothes to the city's rising number of disadvantaged families. It was also Israel who went to the Almshouse to persuade the keeper to open its doors to the poor once again.

Germantown

President Washington attempted to return to Philadelphia in early November, but was directed to Germantown, at that time a town some ten miles outside the city. 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". Members of his cabinet joined him in the suburb, waiting out the epidemic until they could safely return to Philadelphia. Polly Lear, the young wife of his secretary Tobias Lear, was an early victim.

End to the fever

As November edged closer, frost caused the cases of yellow fever to diminish (until the next summer). People began returning to their homes as the fever subsided, but what they found was a completely changed city. The streets were astonishingly clean; the trash and garbage had been swept away along with the removal of cats, dogs, birds, and pigs. The beggars and homeless children were also nowhere in sight. They found the survivors "exhausted and haggard looking", smelling strongly of vinegar and camphor. The skin of many still had a yellow tinge to it, and those who had taken Rush’s mercury purge had "unsightly black" teeth and were constantly spitting to rid their mouths of the foul taste.

Legacy

President's House, Philadelphia. Washington left the plague-ridden city for Mount Vernon on September 10, but was detoured to Germantown when he returned in November, and didn't reoccupy the President's House until December.

Everyone's lives were affected by the fever. For instance, Dolley Payne Todd's husband and newborn baby died of the fever. She took herself and her two-year-old son to a farm, and even became infected themselves. Then after the fever abated they returned to the city and ran a boarding house. However Dolley did not spend her life living in the past, and eleven months after her husband John Todd's death she remarried a Virginia congressman and future U.S. president, James Madison.

The Colonial government also found itself changed, both on the state and colonial level. Because many thought it was unconstitutional to meet outside of Philadelphia (this based on the fear of a future autocratic president, like the king of France at Versailles), the Congress didn't meet in the time of the plague, when its nation needed it the most. To avoid any future problems, congress granted the president the power to move a meeting in a time of grave danger and threat.

Philadelphians' hopes of permanently retaining the national capital were dashed. There were smaller yellow fever outbreaks through the 1790s, and during the summer of 1798 John Adams's administration evacuated to Trenton, New Jersey. As scheduled, the federal government moved to the District of Columbia in November 1800. By then, Philadelphia had also lost its position as the state capital: in 1799, Pennsylvania's legislature moved from Philadelphia to Lancaster, before permanently settling in Harrisburg in 1812.

Transformation also came to the city, where people agreed that foul smells were the cause of disease. Public health codes were strengthened and enforced, and in 1799 the United States' first urban water system, designed by Benjamin Latrobe, was constructed in Philadelphia. Curiously, the water system did indirectly affect the risk of yellow fever, by reducing the barrels and cisterns of standing water in which mosquitoes breed. It encouraged Elizabeth Drinker, one of America's most prominent and faithful diarists, to take a bath after waiting twenty-eight years.

In a later epidemic in 1802, yellow fever shaped the fate of the United States. Napoleon I of France sent thirty-three thousand soldiers to America with the purpose of reinforcing French claims to New Orleans. Twenty-nine thousand of these soldiers died of yellow fever, forcing Napoleon to sell the claims to Thomas Jefferson for unreasonably low prices, saying that they were too difficult to maintain. These claims became the Louisiana Purchase, more than tripling the United States land at the time.

Death total

Since most record keepers of the time, ministers, sextons, and city officials, either fled the city, or became ill that late summer in 1793, no real total of how many deaths occurred is available. However estimates have been produced and put the number between four and five thousand people. Yet even though the total doesn't begin to rival that of the original population of the city, the time span of two months that these deaths were incurred and the fear and panic they created remains unmistakably significant.

See also

• Arthur Mervyn, a novel about the epidemic by Charles Brockden Brown published in 1799
• Fever 1793, a historical novel about the epidemics published in 2000
• 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 04-12-2008. {{cite web}}: Check date values in: |accessdate= (help)
• 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.
• 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.
• Yount, Lisa (2000). Epidemics. San Diego: Lucent Books. ISBN 1560064412.
• "The Yellow Fever epidemic". Africans in America. PBS Online. 1998. Retrieved 04-12-2008. {{cite web}}: Check date values in: |accessdate= (help)

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)