The Yellow Fever in Philadelphia, 1793

Thus far have I delivered the history of the yellow fever as it affected the human body with sickness and death. I shall now mention a few of those circumstances of public and private distress which attended it. I have before remarked, that the first reports of the existence of this fever were treated with neglect or contempt. A strange apathy pervaded all classes of people. While I bore my share of reproach for "terrifying our citizens with imaginary danger," I answered it by lamenting "that they were not terrified enough." The publication from the college of physicians soon dissipated this indifference and incredulity. Fear or terror now sat upon every countenance. The disease appeared in many parts of the town, remote from the spot where it originated; although in every instance it was easily traced to it. This set the city in motion. The streets and roads leading from the city were crouded with families flying in every direction for safety to the country. Business began to languish. Water-street between Market and Race-streets became a desart.

Thus far have I delivered the history of the yellow fever as it affected the human body with sickness and death. I shall now mention a few of those circumstances of public and private distress which attended it. I have before remarked that the first reports of the existence of this fever were treated with neglect or contempt. A strange apathy pervaded all classes of people. While I bore my share of reproach for “terrifying our citizens with imaginary danger,” I answered it by lamenting “that they were not terrified enough.” The publication from the College of Physicians1 soon dissipated this indifference and incredulity. Fear or terror now sat upon every countenance. The disease appeared in many parts of the town, remote from the spot where it originated,2 although in every instance it was easily traced to it. This set the city in motion. The streets and roads leading from the city were crowded with families flying in every direction for safety to the country. Business began to languish. Water Street between Market and Race Streets became a desert.

1. The College of Physicians of Philadelphia, the city’s society of doctors, founded in 1787. In late August 1793 it published advice to the public on avoiding the fever.
2. Rush traced the fever to a cargo of coffee rotting on a wharf near Water Street. He shared the common belief that disease spread through foul air from rot.

The poor were the first victims of the fever. From the sudden interruption of business, they suffered for a while from poverty, as well as disease. A large and airy house at Bush-hill about a mile from the city, was opened for their reception. This house, after it became the charge of a committee appointed by the citizens on the 14th of September, was regulated and governed with the order and cleanliness of an old and established hospital. An American and French physician had the exclusive medical care of it after the 22d of September.

The poor were the first victims of the fever. From the sudden interruption of business, they suffered for a while from poverty, as well as disease. A large and airy house at Bush Hill,3 about a mile from the city, was opened for their reception. This house, after it became the charge of a committee appointed by the citizens on September 14, was regulated and governed with the order and cleanliness of an old and established hospital. An American and French physician had the exclusive medical care of it after September 22.

3. A country mansion just outside the city, turned into a hospital for fever patients.

The contagion after the second week in September, spared no rank of citizens. Whole families were confined by it. There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physicians from the desertion of some, and the sickness and death of others. At one time, there were only three physicians who were able to do business out of their houses, and at this time, there were probably not less than 6,000 persons ill with the fever.

The contagion,4 after the second week in September, spared no rank of citizens. Whole families were confined by it. There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physicians from the desertion of some, and the sickness and death of others. At one time there were only three physicians who were able to do business out of their houses, and at this time, there were probably not less than 6,000 persons ill with the fever.

4. The idea that disease passed from person to person by touch, breath, or objects, long before anyone knew about germs.

During the first three or four weeks of the prevalence of the disorder, I seldom went into a house the first time, without meeting the parents or children of the sick in tears. Many wept aloud in my entry, or parlour, who came to ask for advice for their relations. Grief, after awhile descended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends, without shedding a tear, or manifesting any other of the common signs of grief.

During the first three or four weeks of the prevalence of the disorder, I seldom went into a house the first time without meeting the parents or children of the sick in tears. Many wept aloud in my entry, or parlor, who came to ask for advice for their relations. Grief, after a while, descended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends, without shedding a tear, or manifesting any other of the common signs of grief.

A chearful countenance was scarcely to be seen in the city for six weeks. I recollect once in entering the house of a poor man, to have met a child of two years old that smiled in my face. I was strangely affected with this sight (so discordant to my feelings and the state of the city) before I recollected the age and ignorance of the child. I was confined the next day by an attack of the fever, and was sorry to hear upon my recovery, that the father and mother of this little creature died, a few days after my last visit to them.

A cheerful countenance was scarcely to be seen in the city for six weeks. I recollect once in entering the house of a poor man, to have met a child of two years old that smiled in my face. I was strangely affected with this sight (so discordant to my feelings and the state of the city) before I recollected the age and ignorance of the child. I was confined the next day by an attack of the fever, and was sorry to hear upon my recovery that the father and mother of this little creature died a few days after my last visit to them.

The streets every where discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading, or driving a horse, with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city at every hour of the day, while the noise of the same wheels passing slowly over the pavements, kept alive anguish and fear in the sick and well, every hour of the night.

The streets everywhere discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder,5 or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man,6 leading or driving a horse with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city at every hour of the day, while the noise of the same wheels passing slowly over the pavements kept alive anguish and fear in the sick and well, every hour of the night.

5. Someone who drew blood from the sick. Bleeding and purging (causing vomiting and diarrhea) were standard treatments for centuries, meant to rid the body of disease; they are now known to weaken patients.
6. Many of the nurses and carters were free Black Philadelphians, organized by the ministers Absalom Jones and Richard Allen. Rush had urged them to help, wrongly believing that Black people could not catch the fever.

The number of deaths between the first of August and the ninth of November, amounted to four thousand and forty four.

The number of deaths between the first of August and the ninth of November amounted to four thousand and forty-four.

Baffled in every attempt to stop the ravages of this fever, I anticipated all the numerous and complicated distresses in our city, which pestilential diseases have so often produced in other countries. The fever had a malignity, and an obstinacy which I had never before observed in any disease, and it spread with a rapidity and mortality, far beyond what it did in the year 1762. Heaven alone bore witness to the anguish of my soul in this awful situation. But I did not abandon a hope that the disease might yet be cured. I had long believed that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy.

Baffled in every attempt to stop the ravages of this fever, I anticipated all the numerous and complicated distresses in our city, which pestilential diseases have so often produced in other countries. The fever had a malignity and an obstinacy which I had never before observed in any disease, and it spread with a rapidity and mortality far beyond what it did in the year 1762.7 Heaven alone bore witness to the anguish of my soul in this awful situation. But I did not abandon a hope that the disease might yet be cured. I had long believed that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence8 has not provided a remedy.

7. Philadelphia had suffered a yellow fever epidemic in 1762, when Rush was a young medical apprentice in the city.
8. God’s care for the world and plan for what happens in it.

I resolved after mature deliberation, to prescribe this purge. Finding ten grains of jalap insufficient to carry the calomel through the bowels, in the rapid manner I wished, I added fifteen grains of the former, to ten of the latter; but even this dose was slow, and uncertain in its operation. I then issued three doses, each consisting of fifteen grains of jalap, and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder, not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwithstanding some of them were advanced several days in the disorder.

I resolved, after mature deliberation, to prescribe this purge [of calomel and jalap]. Finding ten grains9 of jalap10 insufficient to carry the calomel through the bowels in the rapid manner I wished, I added fifteen grains of the former to ten of the latter; but even this dose was slow and uncertain in its operation. I then issued three doses, each consisting of fifteen grains of jalap and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwithstanding some of them were advanced several days in the disorder.

9. A small unit of weight. Ten grains is about two-thirds of a gram.
10. Jalap is the dried root of a Mexican plant; calomel is a compound of mercury. Both were strong purges. Large doses of calomel poison the body.

But I did not rely upon purging alone, to cure the disease. The theory of its proximate cause, which I had adopted, led me to use other remedies, to abstract excess of stimulus from the system. These were blood-letting, cool air, cold drinks, low diet, and applications of cold water to the body. I had bled Mrs Bradford, Mrs Leaming, and one of Mrs Palmer's sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had moreover, heard of a man who had been bled on the first day of the disorder, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type, and instead of tending to a crisis on the third, to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experience such sublime joy as I now felt in contemplating the success of my remedies. It repaid me for all the toils and studies of my life. The conquest of this formidable disease, was not the effect of accident, nor of the application of a single remedy; but, it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind, when I add a short extract from my note book, dated the 10th of September. "Thank God! Out of one hundred patients, whom I have visited, or prescribed for, this day, I have lost none."

But I did not rely upon purging alone to cure the disease. The theory of its proximate cause, which I had adopted, led me to use other remedies, to abstract excess of stimulus11 from the system. These were bloodletting, cool air, cold drinks, low diet, and applications of cold water to the body. I had bled Mrs. Bradford, Mrs. Leaming, and one of Mrs. Palmer’s sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had, moreover, heard of a man who had been bled on the first day of the disorder, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type and, instead of tending to a crisis on the third [day], to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experience such sublime joy as I now felt in contemplating the success of my remedies. It repaid me for all the toils and studies of my life. The conquest of this formidable disease was not the effect of accident, nor of the application of a single remedy; but it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind, when I add a short extract from my notebook, dated September 10. “Thank God! Out of one hundred patients whom I have visited or prescribed for this day, I have lost none.”

11. Rush believed that fevers came from too much tension or excitement in the blood vessels. His bleeding and purging were meant to lower it.