1793 Philadelphia yellow fever epidemic

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

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 "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, and Rush blamed "some damaged coffee which putrefied on wharf near Arch Street" for causing the fevers. 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. 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 people deaths were reported.

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 18. 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. On September 12 Clarkson summoned fellow citizens interested in organizing to cope with the epidemic. On September 14 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 mayor's committee met daily during the epidemic at city hall. The markets held Wednesday and Saturday continued but the committee found it necessary to arrange for the baking and distribution of bread. The Committee arranged a house to care for the growing number of children made orphans by the epidemic.Under a mistaken belief that African Americans were immune to yellow fever, that community's religious leaders Richard Allen and Absalom Jones enlisted their parishioners to collect the dead and nurse those afflicted with the fever.

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 flee the epidemic before the second week in September could leave the city only with great difficulty 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.

Re-elevating the morale of the city

Given the resources and knowledge of the times, the city's response was creditable. The natural history of yellow fever, a viral infection spread by the Aedes Egypti mosquito, was unknown and, as bad luck would have it, efforts to clean the city did not defeat the spread of the fever. That mosquito breeds in clean water. Philadelphia's newspapers continued to publish during the epidemic and through them doctors and others endeavored 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."

Rush announced his remedy which he boasted brought the fever under the control of medicine. Current medical theory dictated the use of stimulating medicines to combat debilitating diseases. Frustrated by the failure of that regimen, Rush searched the medical literature for other approaches. Benjamin Franklin had given him letters sent by Dr. John Mitchell on his experiences 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 some brief 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 that Dr. Rush was looking for. When those depleting remedies failed to raise the pulse of patients he prescribed bleeding. 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 this guide to self medication to treat 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..

However, 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 eventually urged patients to attain to assure a cure. Since he urged purging at the first sign of fever, other doctors began finding patients with severe abdominal distress.

The hope offered by purported effective treatments to choose from was dashed when it became clear that the various treatments did not cure the disease, and doctors' controversies were demoralizing. Rush's amazing claims of the success of his remedies, 99 out of 100 cured, have disposed historians and modern doctors to ridicule 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, who ridiculed his therapies and called him a Sangrado, after a character in Gil Blas who relentlessly bled patients to death. However, 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

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."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==Hamburger

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.

An official register of deaths listed 4044 people as dying between August 1 and November 9. Benjamin Rush lost his mother, sister, and three of his assistants. Several members of Mayor Clarkson's committee died. 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 Federal government returned to the city in November and despite fears that Congress might have to meet somewhere else, Congress convened on schedule in December. Although a new capital city was being built in Washington, many Philadelphians' hoped it would fail and Philadelphia were permanently retain the national capital. If the 1793 epidemic were no enough to dash those hopes, there were also epidemics in 1797, 1798 and 1799. Philadelphia 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.
• Rush, Benjamin (1794). [<a href="http://books.google.com/books?id=crA_AAAAcAAJ&pg=PA90&dq=%22an+account+of+the+epidemic+bilious+remitting+fever%22&hl=en&sa=X&ei=hU0fT6HqIsKv0AHsvNEG&ved=0CDcQ6AEwAA"> An Account of the Bilious Remitting Yellow Fever as it appeared in the City of Philadelphia in 1793]. Google E-Book. {{cite book}}: Check |url= value (help); Cite has empty unknown parameter: |1= (help)
• 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)