1793 Philadelphia yellow fever epidemic
During the 1793 Yellow Fever epidemic in Philadelphia, 5,000 or more people were listed in the register of deaths between August 1 and November 9. The vast majority of them died of yellow fever, making the epidemic in the city of 50,000 people one of the most severe in United States history. By the end of September, 20,000 people had fled the city, including congressional and executive officials of the federal government. Most did not return until after the epidemic had abated in late November. The mortality rate peaked in October before frost finally killed the mosquitoes and brought an end to the outbreak. Doctors tried a variety of treatments but knew neither the origin of the fever nor that the disease was transmitted by mosquitoes (this information was not verified until the late 19th century).
The mayor and a committee of two dozen organized a fever hospital at Bush Hill and other crisis measures. The assistance of the Free African Society was requested by the city and readily agreed to by its members. Parties mistakenly assumed that people of African descent would have the same partial immunity to the new disease as many had to malaria, which was typically the most common source of fever epidemics during the summer months.[2] Black nurses aided the sick, and the group's leaders hired additional men to take away corpses, which most people would not touch. But black people in the city died at the same rate as whites, about 240 altogether.
Some neighboring towns refused to let refugees in from Philadelphia, fearing that they were carrying the fever. Major port cities, including those in Baltimore and New York City had quarantines against refugees and goods from Philadelphia, although New York City sent financial aid to Philadelphia.
Beginnings[edit]
Back in the spring of 1793, French colonial refugees, some with slaves, arrived from Cap Français, Saint-Domingue in present-day Haiti. The 2,000 immigrants fled the slave revolution in the island's north.[3] They crowded the port of Philadelphia, where the first yellow fever epidemic in the city in 30 years began.[3][4] It is likely that the refugees and ships carried the yellow fever virus and mosquitoes. Mosquito bites transmit the virus. Mosquitoes easily breed in small amounts of standing water. The medical community and others in 1793 did not understand the role of mosquitoes in the transmission of yellow fever, malaria, and other diseases.[5]
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 wealthy people 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 in their early years in the region.[6] In 1793 Philadelphia was the temporary capital of the United States, and the government was due to return in the fall. President George Washington left the city for his Mount Vernon estate.[7]
The first two people to die of yellow fever in early August in Philadelphia were both recent immigrants, one from Ireland and the other from Saint-Domingue. Letters describing their cases were published in a pamphlet about a month after they died. The young doctor sent by the Overseers of the Poor to treat the Irish woman was perplexed, and his treatment did not save her.[8]
A 2013 book by Billy G. Smith, professor of history at Montana State University, makes a case that the principal vector of the 1793 plague in Philadelphia (and other Atlantic ports) was the British merchant ship Hankey, which had fled the West African colony of Bolama (an island off West Africa, present-day Guinea-Bissau) the previous November. It trailed yellow fever at every port of call in the Caribbean and eastern Atlantic seaboard.[9]
Controversy over treatment[edit]
Given the limited resources and knowledge of the times, the city's response was credible. 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 the mosquitoes breed in clean water as well as in dirty water. Philadelphia's newspapers continued to publish during the epidemic, and the doctors and others tried to understand and combat the epidemic. On September 7, Dr. Adam Kuhn, who had studied medicine at the University of Uppsala in Sweden, advised patients to treat symptoms as they arose.[28]
Rush claimed that he had tried Kuhn's and Steven's stimulating remedies but that his patients still died. He recommended other treatments, including purging and bloodletting, and published his theories. The hope offered by any of these treatments was soon dashed when it became clear that they did not cure the disease, and the doctors' competing claims demoralized patients.[29]
In his 1794 account of the epidemic, Mathew Carey noted that other doctors claimed to have used calomel (a mercury compound) 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."[30] 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."[31] Rush's brand of medicine became the standard American treatment for fevers in the 1790s and was widely used for the next 50 years.[32]
Dr. Mark Chesterfield also suggested training prisoners to perform the dangerous jobs of collecting the dead and transporting the sick, but the idea met with great controversy and was abandoned. Dr. Chesterfield later fell victim to the sickness and died as the result of excessive bloodletting at the hands of Dr. Benjamin Rush.
Rush's claim that his remedies cured 99 out of 100 patients has led historians and modern doctors to ridicule his remedies and approach to medical science. Some contemporaries also attacked him. The newspaper editor William Cobbett attacked Rush's therapies and called him a Sangrado, after a character in Gil Blas, who bled patients to death. In 1799 Rush won a $5,000 libel judgment against Cobbett.[29]
Reactions by other cities[edit]
As the death toll in the city rose, officials in neighboring communities and major port cities such as New York and Baltimore established quarantines for refugees and goods from Philadelphia. New York established a "Committee appointed to prevent the spreading and introduction of infectious diseases in this city", which set up citizen patrols to monitor entry to the city. Stage coaches from Philadelphia were not allowed in many cities. Havre de Grace, Maryland, for example, tried to prevent people from Philadelphia from crossing the Susquehanna River to Maryland.[34][43] Neighboring cities did send food supplies and money; for example, New York City sent $5000 to the Mayor's Committee.[44]
Woodbury and Springfield, New Jersey; Chester, Pennsylvania and Elkton, Maryland, were among towns that accepted refugees.[45]
Aftermath[edit]
The Governor created a middle path: he ordered the city to be kept clean and the port policed to prevent infected ships, or those from the Caribbean, from docking until they had gone through a period of quarantine. The city suffered additional yellow fever epidemics in 1797, 1798, and 1799, which kept the origin and treatment controversies alive.[76]
Some of the city's clergy suggested the epidemic was a judgment from God.[77] Led by the Quakers, the religious community petitioned the state legislature to prohibit 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.[78]
The recurrences of yellow fever kept discussions about causes, treatment and prevention going until the end of decade. Other major ports also had epidemics, beginning with Baltimore in 1794, New York in 1795 and 1798, and Wilmington and Boston in 1798, making yellow fever a national crisis. New York doctors finally admitted that they had had an outbreak of yellow fever in 1791 that killed more than 100 people. All the cities that suffered epidemics continued to grow rapidly.
During the epidemic of 1798, Benjamin Rush commuted daily from a house just outside the city, near what is now 15th and Columbia streets, to the new city fever hospital, where as chief doctor he treated fever victims.[79]
American doctors did not identify the vector of yellow fever until the late nineteenth century. In 1881 Carlos Finlay, a Cuban doctor, argued that mosquito bites caused yellow fever; he credited Rush's published account of the 1793 epidemic for giving him the idea. He said that Rush had written: "Mosquitoes (the usual attendants of a sickly autumn) were uncommonly numerous..."[80]
In the 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.[81]
The reverends Richard Allen and Absalom Jones of the Free African Society published their own account rebutting Carey's attacks; by that time Carey had already published the fourth edition of his popular pamphlet.[81] Allen and Jones noted that some blacks had worked for free, that they had died at the same rate as whites from the epidemic, and that some whites had also overcharged for their services.
Currie's work was the first of several medical accounts published within a year of the epidemic. Dr. Benjamin Rush published an account more than 300 pages long. Two French doctors, Jean Devèze and Nassy, published shorter accounts. Clergymen also published accounts; the most notable was by the Lutheran minister J. Henry C. Helmuth.[82] In March 1794, the Mayor's Committee published its minutes.
The rapid succession of other yellow fever epidemics in Philadelphia and elsewhere in the northeastern United States inspired many accounts of the efforts to contain, control and cope with the disease. Rush wrote accounts of the 1797, 1798, and 1799 epidemics in Philadelphia. He revised his account of the 1793 epidemic to eliminate reference to the disease being contagious. He varied his cures. In 1798 he was appointed as the chief doctor at the fever hospital. The mortality rate that year was roughly the same as it had been at Bush Hill in 1793, despite radical difference between the therapies used.
Noah Webster, then a notable New York newspaper publisher, joined two doctors in publishing the Medical Repository, a magazine that collected accounts of fever epidemics throughout the nation. Webster used this data in his 1798 book, suggesting that the nation was being subjected to a widespread "epidemic constitution" in the atmosphere that might last 50 years and make deadly epidemics almost certain.[83] Mortality was especially great in Philadelphia. This fact, along with the spread of the disease between Boston and Charleston between 1793 and 1802, made yellow fever a national crisis.[84] As Thomas A. Apel has written "Yellow fever constituted the most pressing national problem of the early national problem. [...] Yellow fever eroded public virtue, the cornerstone of a health republic."[85]
General 20th-century US histories, such as the 10-volume Great Epochs in American History, published in 1912, used short excerpts from Carey's account.[86] The first history of the epidemic to draw on more primary sources was J. H. Powell's Bring Out Your Dead (1949).[87] While Powell did not write a scholarly history of the epidemic, his work reviewed its historical importance. Since the mid-twentieth century, scholars have studied aspects of the epidemic, first in papers. For example, Martin Pernick's "Politics, Parties, and Pestilence: Epidemic Yellow Fever in Philadelphia and the Rise of the First Party System," developed statistical evidence to show that Republican doctors generally used Rush's therapies and Federalist doctors used Kuhn's.[88]
Scholars celebrated the 200th anniversary of the epidemic with the publication of papers on various aspects of the epidemic.[89] A 2004 paper in the Bulletin of the History of Medicine reexamined Rush's use of bleeding.[90]
Several novels and short stories have explored the Philadelphia epidemic, including the following: