If Benjamin Rush was certain of anything, he was certain of the cause. “I sit down at a late hour,” he wrote to his wife Julia from Philadelphia on the evening of August 21, 1793, “to inform you that a malignant fever has broken out in Water Street. . . . It is supposed to have been produced by some damaged coffee which putrefied on one of the wharves near the middle of the above district. The disease is violent and of short duration.”
It had been a tumultuous year for Philadelphia, then the nation’s capital. The beginning of George Washington’s second presidential term had been marked by escalating political conflict within his cabinet that reflected the partisan passions igniting among the citizenry. While Thomas Jefferson and Alexander Hamilton furiously debated whether the United States should join Revolutionary France in a war against Great Britain, the city’s residents (wearing hats whose black or colored cockades respectively identified them as Federalists or Republicans) brawled in the streets and threatened, as John Adams later recalled, “to drag Washington out of his House, and effect a Revolution in the Government.”
Pandemonium hadn’t always characterized Philadelphia. In fact, it had cultivated a reputation as a major center of culture and learning, housing not only the American Philosophical Society but the College of Physicians of Philadelphia, one of the first American medical associations. “From Philadelphia there will proceed rays of knowledge and federal sentiments . . . that shall irradiate the whole United States,” Rush had proclaimed when pitching the city as a seat for the federal government to Adams in 1789. “Here the human mind is in a state of fermentation. . . . Here the people and their rulers will be alike. . . . Here learning, manufactures, and human improvements of every kind thrive and flourish.” Rush was confident that Philadelphia would propel the young republic to a brilliant future where Enlightenment rationality suffused politics, guided technological development, and guaranteed human progress. Four years later, a virulent epidemic illuminated just how hollow that certainty had been.
Rush realized that the malady he was confronting bore similarities to “yellow fever” that he had treated as a doctor’s apprentice in 1762. Revisiting his notes from that period “with anticipating horror,” he found that the symptoms—headache, nausea, delirium, and a yellowish tinge to the eyes and skin—and timeline (“few survive the fifth day”) were nearly identical. The disease was known to kill 20 people daily at its peak. 38 had died in the week since his first alarming letter to Julia.
In what historian Mark A. Smith characterized as “one of the earliest appeals by an American government to a medical organization,” Mayor Matthew Clarkson called on the College of Physicians to identify the plague’s origins and devise policies to contain it. The organization quickly produced an 11-point plan. It advised Philadelphians to avoid those who appeared ill, mark the houses of the infected, clean the city’s streets, and erect a hospital dedicated to the treatment of yellow fever patients. It also recommended the silencing of bells. As Rush explained in his Account of the Bilious Remitting Yellow Fever, As It Appeared in Philadelphia, negative emotions—namely fear and grief—were believed to make individuals more susceptible to illness. “[Fear] debilitates, only because it abstracts its antagonist passion of courage,” Rush noted, invoking the language of equilibrium. “In many people the disease was excited by a sudden paroxysm of fear.” As bells customarily signaled funerals in the city, the College thought it would be best to muffle them lest they scare Philadelphians to death.
The College’s decisive recommendations were a credit to its mission to diffuse modern knowledge, but the united front fell apart once its members began debating the fever’s origins. Most physicians in the 18th century believed that disease occurred when external forces, either environmental or emotional (like a prolonged state of terror), imbalanced the body. An impassioned argument developed between the opposing camps of “localists” such as Benjamin Rush, who blamed a concentration of malignant air in the city for the fever’s spread, and “contagionists” such as Adam Kuhn, who contended that the epidemic had accompanied the recent influx of refugees fleeing rebellion in the French colony of Saint Domingue. In a way, they were both right—the culprit was the Aedes aegypti mosquito, which had originated in the West Indies but thrived in Philadelphia’s summer climate and passed infected blood between victims—but this etiology would only be confirmed by Cuban and American doctors a century later.
Vitriol grew as the dispute moved from cause to cure. Rush recommended a system of “bleeding and purging,” which, though brutal, he believed was so straightforward that a 12-year-old could learn how to administer it in a few hours. Rush’s republican optimism had embittered him towards the medical academy whose internecine squabbles rendered them impotent in previous crises, and he argued that it was “time to take the cure of pestilential fevers out of the hands of physicians, and to place it in the hands of the people.” Kuhn explicitly rejected Rush’s approach, which he and his fellow contagionists considered “murderous,” and instead advocated for a complicated regimen of teas, weak wines, and Spanish bark coupled with cold baths. His prescription incensed Rush. “Kuhn’s publication has done immense mischief,” he angrily scribbled to his wife. “Many doctors will follow him, and scores are daily sacrificed to bark and wine. My method is too simple for them. They forget that a stone from the sling of David effected what the whole armory of Saul could not do.”
With the medical community fracturing along political lines, Philadelphia’s newspapers followed suit. John Fenno’s Federalist Gazette of the United States exclusively printed directions from Alexander Hamilton’s personal physician, who echoed Kuhn’s recommendations. Andrew Brown’s Federal Gazette attempted to serve as an impartial forum, but as Smith has detailed it ended up overwhelmingly publishing Rush’s notes as the number of infections exploded. The laity meanwhile flooded publications with letters containing their own folk remedies, which ranged from diffusing tobacco smoke to mixing a solution known ominously as “Vinegar of the Four Thieves.” Though some hoped to profit from the catastrophe by advertising their concoctions, others were simply trying to navigate the devastating uncertainty generated by the medical establishment’s indecision. “No circumstances has added more distress to the present calamity, than the disagreement of the physicians about the disease” fretted an anonymous author at the suitably titled Independent Gazetteer.
As doctors feuded, government leaders fled the capital along with 20,000 Philadelphians. In response to the loss of leadership Clarkson organized a governing committee of two dozen citizen volunteers who agreed to remain in the city to supervise the public hospital (located in an abandoned mansion known as “Bush Hill”) and coordinate resources to manage the crisis. It is hard to overstate the daunting task they faced. Even if 18th century medicine misunderstood fear’s role in affecting physiological health, terror certainly exacerbated yellow fever’s weakening of Philadelphia’s body politic. Refusing to abandon his patients, Rush grimly chronicled how the virus frayed familial bonds, recalling scenes of children pushing parents out of their homes at the first sign of illness and spouses abandoning each other in their gravest hours. Streets that had once been bustling with commercial activity lay desolate, save for looting of shuttered shops and the carting of “solitary corps[es]” to burial. Neighbors who wore mourning bands were shunned as potential vectors for the pestilence. By the end of September, Rush estimated that graveyards were admitting 100 new occupants a day. The city that promised to be a beacon of human accomplishment was rapidly turning into an exhibition of humanity’s corruption.
Nevertheless, the chaos produced unlikely heroes. Jean Devèze, one of the refugees held under suspicion by the contagionists, was a French-trained doctor who had experience treating yellow fever in Saint Domingue. He received an appointment at Bush Hill, which was under the direction of Stephen Girard, a fellow French immigrant who had settled in Philadelphia at the outbreak of the American Revolution. Devèze espoused a medical philosophy that contrasted sharply with both Rush and Kuhn’s sensibilities. Rather than trying to wrangle symptoms to submission through a general, unyielding formula, Devèze believed in treating each patient individually, carefully negotiating between letting “nature” run its course in “destroying the morbific cause” and intervening “when nature is inactive.” As he concluded in his own tract on yellow fever, “Any one who, seduced by the brilliancy of a system, will force nature by the rules of the method he has adopted, he, I say, is a scourge more fatal to the human kind than the plague itself would be.” While the Bush Hill hospital did not promise a miracle cure, Girard and Devèze’s reasonable protocols and clean, orderly facilities turned it into a symbol of hope for the suffering city.
Aiding physicians at Bush Hill and across the rest of Philadelphia were members of the city’s free black community. Under the mistaken conviction that individuals of African descent were immune to the fever, Clarkson and Rush had written to the Free African Society begging that they stay in the city to nurse the sick. Absalom Jones and Richard Allen, clergymen of the African Church of Philadelphia, took the initiative to organize assistance. In addition to tending to victims, black men and women took over other essential public functions, transporting ill patients to hospitals, organizing funerals, monitoring shopfronts to prevent robbery, and rescuing orphaned children. In the process, they served on the front lines of the battle against fear. In their own account of their organization’s experience during the epidemic, Jones and Allen described how black Philadelphians prevented a white man from beating his neighbor to death in a panic-induced rage after he discovered that she was recovering from the fever. In another episode, black volunteers stood their ground when a white man threatened to shoot them for collecting bodies that had piled in the street. “We buried him three days after,” they stoically concluded.
What ended the horror was neither bleeding, bark, nor baths, but frost. The November cold killed off the virus’s mosquito hosts, allowing Philadelphians to cautiously reclaim their desolated city. Yellow fever had decimated their population, killing roughly five thousand citizens. It had also shattered the Panglossian expectation that Philadelphia would seamlessly midwife the new world order promised by Rush and other leaders of the early Republic.
Attempts to derive meaning from the carnage emerged even before the epidemic had fully abated. Building on the prevailing theory of how disease infiltrated the body, writers often centered on the political, moral, and economic imbalances that plagued Philadelphia prior to the fever’s onslaught. In mid-October, the National Gazette (run by Jefferson acolyte Philip Freneau) published an anonymous op-ed that identified the “creep” of “aristocratic sentiments” in American society as proof of civic enervation that drove individuals in fear to embrace despotism. Lutheran minister Justus Christian Henry Helmuth faulted the arrival of a circus theater in the city, which he believed eroded morals and warranted punishment from God. Others blamed Philadelphia’s growing industrialization and the crowded urban planning that drew citizens away from agricultural lifestyles considered physically and spiritually healthier. Rush even stretched divine correction to include landlords who overcharged on rent: “They have been one of the procuring causes in my opinion of the late judgment of God upon our city.”
But perhaps the greatest source of disequilibrium was the very notion that the United States could, through reason and certainty alone, master the human condition. In Feverish Bodies, Enlightened Minds: Science and the Yellow Fever Controversy in the Early American Republic, Thomas Apel outlines how yellow fever studies published at the end of the 1790s reluctantly refuted the expectation that the American republic could escape the cyclical ravages of disease that characterized most of history. For example, the educator Noah Webster, an American nationalist, exhaustively surveyed case studies of previous epidemics in hopes of identifying a discernible pattern that could help arrest future outbreaks in the country. In the end, he was forced to admit that America’s unrelenting urbanization made future scourges inevitable. Unwilling to part with the Enlightenment belief in a universe “governed by uniform laws,” however, Webster argued that plagues were actually an intervention by “the great AUTHOR” to check society’s destabilizing hubris and reorient it towards virtue.
These were all very American responses to a catastrophe. But none better exemplified the early Republic’s ideals than the voluntary associations that stepped in to offer structure and succor as other institutions failed in Philadelphia. When the federal government faltered and animosity immobilized members of the medical academy, Clarkson’s citizen’s committee, the immigrant-run Bush Hill hospital, and members of the Free African Society did what they could to save their city from being eaten alive by fear. The minutes of the citizen’s committee particularly read like a reassuring register of normalcy against an apocalyptic background, noting gradual improvements at Bush Hill, distributions of food and supplies, relocated orphans, and detailed lists of those whom the plague killed and spared. They also recorded the steady stream of donations that arrived from towns and cities across the United States, often denoted specifically “for the use of the poor.” If there was one immutable law governing all epidemics, it was (in Rush’s words) that “the poor are everywhere the principal sufferers.” To this he could have appended the truism that no good deed goes unpunished—Jones and Allen spent much of the 1790s refuting outlandish but predictably racist claims that the Free African Society had inflated nursing wages during the calamity.
While this diverse cast of ordinary men and women succeeded in preserving Philadelphia, the city did not return to its former stature. It had never meant to stand as the capital for long anyway (Jefferson and Hamilton having bargained its removal to the Potomac a few years prior), but as historian Eve Kornfeld has argued the fever played a unique role in destroying Philadelphia’s “unified intellectual community, supreme confidence, and developing cultural primacy.” Nevertheless, the wreckage of Philadelphia’s intellectual infrastructure inspired buds of new medical and philosophical associations that rooted themselves from Massachusetts to South Carolina, along with a rich literature on the study of pestilence. Although the United States demonstrated that it was not immune to the ravaging effects of fear and disease, it succeeded in sustaining a culture of inquiry and civic responsibility that would do more in coming years to mitigate public health emergencies than any of Rush’s romantic proclamations. It had just learned to better respect the limits of human knowledge, appreciate the stores of its civic capital, and to live with the weight of uncertainty. Even so, it is an albatross that will never sit comfortably on the shoulders of our republic, which longs so deeply to be exceptional.