“They were not terrified enough”: The Yellow Fever Epidemic in Philadelphia, 1793
Between early August and early November of 1793 almost ten percent of the population of Philadelphia died after contracting Yellow Fever. At that time Philadelphia was the capital of the young nation and with a population of approximately 50,000 inhabitants was the largest city in the United States. The epidemic was one of the worst in American history.
Philadelphia had experienced other epidemics in the past, including smallpox which occurred so frequently it had become endemic. Because Philadelphia was the country’s commercial center in those days, its port was a matrix of shipping which brought possibly infected people, rodents, and mosquitos from abroad.
In 1751 John Kearsley, a physician, politician, and philanthropist, published “A Letter to a Friend: Containing Remarks on a Discourse Proposing a Preparation of the Body for the Small-Pox: and the Manner of Receiving the Infection. With Some Practical Hints Relating to the Cure of the Dumb Ague, Long Fever, the Bilious Fever, and Some Other Fevers Incidental to this Province.”
Bilious fever was used to describe typhoid, malaria, and hepatitis. Kearsley’s intent was to challenge many of the precepts delineated by Dr. Adam Thomson in an address in 1750 before the Academy of Medicine of Philadelphia. This discourse serves as an example of the disagreements among medical doctors as to the causes, diagnoses, and treatment of victims of various febrile diseases. As an example: Thomson asserted that “Putrefaction is always occasion’d [sic] by too much Heat.” Kearsley responded:
It is an undoubted Mistake, to suppose Putrefaction is always occasioned by too much Heat….it is sufficiently known, that in a Deficiency of animal Heat, after large Evacuations in the Dropsy, &c. the worst Symptoms of a Gangrene, and a Putrefaction of both Solids and Fluids, have appeared: And it is also the Opinion of eminent Physicians, that those fatal Symptoms of Putrefaction attending the Plague, do arise from a Deficiency of animal Heat, being extinguished by the deleterious Miasms [sic] of the Disease, by which the Motion of the Blood is retarded, and the Humours do consequently putrify.
Mathew Carey, of Philadelphia, was a prominent publisher and frequent commentator and critic. In late 1793 he published “A Short Account of the Malignant Fever, Lately Prevalent in Philadelphia.” His account is compelling. He describes the conditions in the city and the emotional and social impact of the contagion.
Those who ventured abroad, had handkerchiefs or sponges impregnated with vinegar or camphor, at their noses, or else smelling bottles with the thieves’ vinegar. Others carried pieces of tar in their hands, or pockets, or camphor bags tied round their necks. The corpses of the most respectable citizens, even of those who did not die of the epidemic, were carried to the grave, on the shafts of a chair, the horse driven by a negro, unattended by a friend or relation, and without any sort of ceremony. People 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 into such general disuse, that many were affronted at even the offer of the hand.
Carey notes that more men than women were sickened and that for “tipples and drunkards, and men who lived high, and were of a corpulent habit of body, this disorder was very fatal.” Further, he appears to blame the impoverished for their suffering.
It has been dreadfully destructive among the poor. It is very probable, that at least seven eighths of the number of the dead, were of that class. The inhabitants of dirty houses have severely expiated their neglect of cleanliness and decency, by the numbers of them that have fallen sacrifices. Whole families I such houses have sunk into one, silent, undistinguished grave.
While praising the work done by Philadephia's black citizens in nursing the sick and burying the dead, Carey immediately made accusations against some of them.
The great demand for nurses afforded an opportunity for imposition, which was eagerly seized by some of the vilest of the blacks. They extorted two, three, four, and even five dollars a night for attendance, which would have been well paid by a single dollar. Some of them were even detected in plundering the houses of the sick.
The leaders of the black community subsequently rebutted his perspective.
While the medical professionals struggled with understanding the disease, critically its means of transmission, they were confronted with the enormity of the task of caring for the ill and disposal of the dead. Dr. Benjamin Rush, a pre-eminent physician, hospital founder, and signer of the Declaration of Independence, recruited free black men and women to nurse and to bury. In 1794 Absalom Jones and Richard Allen, two leaders of the Free African Society, published “A Narrative of the Proceedings of the Black People, During the Late Awful Calamity in Philadelphia, in the Year 1793: and a Refutation of Some Censures, Thrown upon Them in Some Late Publications.”
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.
This assurance was based on a specious belief that because the blacks came from the Caribbean region they had become immune because of extended exposure to the disease, but they were not, as it quickly evolved, immune. As more people became sick and more died, the black volunteers found themselves overwhelmed. Dr. Rush urged them on, providing instruction of when and how to bleed the patient, where to get proper medicines and how to administer them and to seek his advice when any questions arose. They did not get paid by the city nor usually by the patients or survivors. They were obliged to hire five men to just to do the burials. They were not compensated for this expense.
At first we made no charge, but left it to those we served in removing their dead, to give what they thought fit—we set no price, until the reward was fixed by those we served. After paying the people we had to assist us, our compensation is much less than many will believe.
We do assure the public, that all the money we have received, for burying, and for coffins which we ourselves purchased and procured, has not defrayed the expence [sic] of wages which we had to pay to those whom we employed to assist us.
There followed an itemized account of receipts and expenses.
Regarding Carey’s charge against the black citizens, Jones and Allen point out the accuser’s own behavior:
Had Mr. Carey been solicited to such an undertaking, for hire, Query, “what would he have demanded? but Mr. Carey, although chosen a member of that band of worthies who have so eminently distinguished themselves by their labours, for the relief of the sick and helpless—yet, quickly after his election, left them to struggle with their arduous and hazardous task, by leaving the city.
Carey was not alone in fleeing the contagion. It is likely that as many as 15,000 white Philadelphians left for safer places, including Dr. Rush. Jones and Allen also criticize Carey for making money from the epidemic.
That there were some few black people guilty of plundering the distressed, we acknowledge; but in that they only are pointed out, and made mention of, we esteem partial and injurious; we know of as many whites who were guilty of it; but this is looked over, while the blacks are held up to censure.—Is it a greater crime for a black to pilfer, than for a white to privateer?
The history of the services provided by black Philadelphians is a compelling story. As a whole, they provided care that few were willing to do, and often they suffered for it.
Most of the accounts of the 1793 Yellow Fever Epidemic were retrospective. An exception appeared in the New Jersey State Gazette, published in Trenton on November 6, 1793. The author reports from Philadelphia.
It is not my intention to enter into a complete history of the disorder that has for above two months past prevailed in our city. That will, I presume, be done in some time hence, by persons who have more means of information, and are more competent. All I propose, is, to give a slight sketch, to satisfy curiosity in the mean time.
He notes that in early August little was known or understood by the public and seems to imply that the authorities had not done an adequate job.
All was apathy and indifference. This has been the cause of our subsequent distress; for, had the public attention been early awakened, and decisive measures adopted to prevent the spreading of the disorder, and to separate the infected from the sound, it is probable that before now we should have been freed from this calamity.
He documents the actions being taken in places like New York City and Baltimore to protect themselves from refugees from Philadelphia.
About this time the alarm spread through the neighboring states. The 12th of September, the inhabitants of New-York had a meeting, and passed several resolves, to prevent the introduction of the disorder among them. One was, that no person from hence should be received into their city, until after an absence of fourteen days from Philadelphia, and even then, not without the examination of a physician, and proof of having enjoyed good health in the interim.
The abandonment of the city by many physicians, perhaps prompted by the number of their fellows who had become ill and died, drew public admonishment. When the College of Physicians published their report on the contagion, the Independent Gazetteer of Philadelphia ran an editorial on November 30, 1793, condemning one of the report’s signers, Dr. Shippen:
A Correspondent considers it as one of the autre things in human transactions, that the late report of the College of Physicians on the introduction of the Yellow Fever, should be signed by Dr. Shippen, who fled from his post on the first signal of danger….However the disease may have arisen, the public will certainly abate their confidence to men, who turned their backs upon their duty, and the miseries of their fellow-citizens.
Unlike Shippen, Dr. Jean Deveze, a francophone refugee from Haiti, remained in Philadelphia throughout the epidemic. He served at the Bush-Hill hospital, which had been established specifically to house Yellow Fever patients, and treated many people whose case histories he described in his publication “An Enquiry into, and Observations upon the Causes and Effects of the Epidemic Disease, Which Raged in Philadelphia from the Month of August till Towards the Middle of December, 1793.”
Dr. Deveze’s conclusions clashed with those of Dr. Rush. The debate was vivid at times and mirrors that which may occur among professionals in search of medical answers. Deveze used bleeding, as did Dr. Rush, but he did not follow all of the latter’s advice. He urged a specific diet which included
…gargle and lemonade….creamed [sic] of barley or rice, a light mucilaginious [sic] diet, such as sago, tapioca, and the like….If in the beginning of this unfortunate malady, recourse had been led to a similar treatment, I am convinced it would seldom have proved mortal….But an ill-directed public often act contrary to what is efficacious. The diseased were carefully shut up in close rooms, and covered with three or four blankets; their beverage was infusions of chamomile, Madeira wine, and other inflammatory liquors, which increasing the disease brought the patients to extremity, having produced mortification and over-charged the brain. After death, the victim of this fatal practice had a livid appearance, and the vessels of the head and brain were in the same state as those with a fit of the apoplexy.
The treatment Deveze disparaged was what Rush had promoted.
Because Dr. Rush was highly regarded for his skills and compassion, his “A Description of the City of Philadelphia during the Late Providence of the Yellow Fever” merits attention. An extract was published by the Philadelphia Gazette on July 12, 1794. It began:
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.
Rush laments the initial indifference to the disease and takes credit for raising the alarm.
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.”
Once Philadelphians understood the threat, Rush continues, the city was galvanized:
The streets and roads leading from the city were crowded with families flying in every direction for safety in the country. Business began to languish. Water-street between Market and Race-streets became a desert….
The contagion after the second week in September, spared no rank of citizens. Whole families were confined by it….
But a more serious source of the distress of the city arose from the dissentions of the physicians, about the nature and treatment of the fever….The newspapers conveyed accounts [of the conflicts among physicians] to the public, every day. The minds of the citizens were distracted by them, and hundred[s] suffered and died from the delays which were produced by an erroneous opinion of a plurality of diseases in the city, or by indecision in the choice, or a want of confidence in the remedies of their physician.
It would be more than 200 years before Dr. Walter Reed would correctly identify the vector for Yellow Fever. There would be more outbreaks. In Philadelphia that happened in 1797. In 1793 the epidemic was short in duration and powerful in its devastation. While many errors were made and social contracts threatened, there were countless instances of selflessness, sacrifice, and heroic actions in the face of an almost unimaginable horror.