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Another Time, Another Contagion

June 9, 2020

By Jim Rhodes

The year was 1793. The place was Philadelphia. It was an unusually hot summer.

Philadelphia was the largest city in America with a population of about 30,000. It was the intellectual and cultural center of the five-year-old nation, of which it was also the seat of the national government.

Just a few months earlier, Philadelphians had witnessed George Washington’s oath of office for his second term as president.

Several thousand European refugees had recently arrived in Philadelphia from the French West Indies. They were fleeing from insurrections and pestilence in the islands. It is most likely that the ships also brought mosquitoes carrying the virus that causes yellow fever.

The first death was reported on August 19. Dr. Benjamin Rush, the city’s most prominent physician, diagnosed the cause correctly as yellow fever.

Infections and deaths multiplied quickly. Symptoms included jaundice (which causes yellowing of skin and eyes), hepatitis, internal hemorrhaging, vomiting blood, shock and multisystem organ failure leading to death, which usually occurred within a couple of days after the symptoms appeared.

Panic spread. It was said that over half the population fled the city. The exodus included President Washington, Thomas Jefferson (just recently appointed as Secretary of State), and the U.S. Congress, which adjourned to Germantown.

Dr. Rush was one of the first to recognize that the disease was not spread by human-to-human contact. Not everyone in Philadelphia believed him. Infected and dying people were often put out into the streets or abandoned in their homes by citizens fearing the risk of exposure to the sick.

At the peak of the epidemic, hundreds were dying every day. Bodies decayed in abandoned homes and in the streets. The smell of death lay over the city. A witness said that a man in good health one day would be buried the next. The number of deaths is virtually impossible to determine since so many bodies were interred quickly without identification in mass graves, but it has been estimated to have been in the range of 6,000 – nearly 50 percent of the population left behind after the exodus of fleeing families.

Absalom Jones, a black minister who founded the first African Methodist Episcopal (AME) Church, recounted: “A woman died, we were sent for to bury her, on our going into the house and taking the coffin in, a dear little innocent accosted us with, mamma is asleep, don’t wake her, but when she saw us put her in the coffin, the distress of the child was so great that it almost overcame us; when she demanded why we put her mamma in the box? We did not know how to answer her but committed her to the care of a neighbor.”

More about the yellow fever epidemic in a minute, but first a few words about Dr. Benjamin Rush, a singular figure in America’s formative years.

In addition to being the country’s foremost physician, Dr. Rush was a philosopher, essayist, classicist, scientist, politician, author, patriot, literary figure, and a valued friend of America’s founding fathers, including Thomas Jefferson, a fellow polymath. Benjamin Franklin, another Renaissance man, was his mentor.

He was the youngest-ever graduate from Princeton University at 14 and was said to have translated Hippocrates’ Aphorisms from the Greek at 17. He wrote America’s first-ever chemistry textbook and taught some 3,000 medical students at what became the University of Pennsylvania.

An ardent patriot, he was a delegate to the Continental Congress and was one of the youngest signers of the Declaration of Independence. During the Revolutionary War, he served as a top physician in the Continental Army’s medical corps.

By 1793, Dr. Rush was firmly established as America’s foremost medical expert and one of the first citizens of Philadelphia. A deeply religious man, he saw his medical vocation as a divinely inspired mission.

It was reported that Dr. Rush was only one of three practicing physicians who remained in the city during that summer of 1793 to care for the many thousands of sick and dying people. When friends urged him to flee he wrote: “I have resolved to stick to my principles, my practice and my patients to the last extremity.”

When he was infected by the virus, he managed his own cure with the help of his assistants.

Dr. Rush believed he had discovered what he called the “unitary principle of fever.” All fevers are alike, he proclaimed, and are caused by an imbalance in the body’s fluids. The treatment, he felt, was “depletion” — in short, purging and bleeding. Dr. Rush claimed that his aggressive program of draining blood, purging, and administering various medicinal dosages saved hundreds of patients during the yellow fever epidemic. While that claim sounds suspicious to our modern sensibilities, there’s considerable evidence in the historical record that he saved many lives.

He came to believe that one causal factor behind yellow fever’s spread was the appalling sanitation conditions that prevailed in late 18th century cities. While his conclusion was incorrect, it was close to the truth, in that stagnant water is the breeding ground for mosquitoes. He devoted enormous energy to orchestrating cleanup programs for raw sewage, leaky privies, stagnant pools, polluted wells, and garbage rotting in the city’s streets. He was an untiring advocate of laws to enforce civic cleanliness. Following the epidemic, his efforts helped to bring about the construction of America’s first public waterworks.

Finally, October brought relief. Early frosts froze the stagnant ponds killing the virus-bearing mosquitoes. Almost overnight, the epidemic died out.

Dr. Rush died in 1813. The cause of death was reported as typhus.

A final footnote … During the Spanish-American War, more than a century after the Philadelphia epidemic, yellow fever killed thousands of U.S. soldiers in the tropics. Major Walter Reed, a military surgeon, was appointed to head a study commission in 1900. His experiments proved that the disease was caused by the bite of female Aedes Aegypti mosquitoes, and measures were adopted to mitigate the danger.

The first vaccines for yellow fever were discovered in the 1930s.