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New York 1795 Part Two

Elihu Smith

Anderson prescribed Rush's remedies by rote. He would never challenge the health committee's interpretation of events. Two doctors who had more experience than he were on the committee. Another young New York doctor, 24 year old Elihu Smith, also kept a journal. His experiences during the epidemic showed how Rush's new theories inspired those in the next generation who were ambitious to become leaders of the medical profession. Or rather, inspired such an ambition in Smith, because it was the beauty of Rush's theories, the simplicity of his therapies, and the moral force of his example that drew Smith to the war against yellow fever.

It was a fight from which the young man could easily have walked away. He was having serious doubts about his career as a doctor. Since coming to New York in 1793, he had been taken aback by the difficulty of starting up a medical practice. At that moment he had one patient, a venereal complaint. He had not completely given up the idea of making a history of medicine his crowning achievement, but a book store, literary magazine or working in his father's apothecary shop in Litchfield, Connecticut, were more likely projects. And it was thoughts about those projects rather than Treat's death and the alarms along the wharves that filled the monologues in his journal, despite his treating one of the first yellow fever patients. His cousin's ship had been near the William at Fitch's wharf, and, along with four sailors, he had gotten a bad fever. Thanks, Smith thought, to his ministrations of purges then bark, the cousin survived. The four sailors, heavy tipplers, died. But Smith thought little about all that until he re-read Rush weeks later. Even after Dr. Amasa Dingley, Harvard '85, described by Smith as having "enterprise, intrigue," and a "good medical mind...," told him on September 7 that "the prevailing fever" was the same that "desolated Philadelphia," Smith, Yale '86, was still bored by the threat. He included Dingley's visit as an after thought in his journal devoted mainly to the tea-sodden perambulations of a literary chap busy writing the libretto for an opera and smitten with the idea of the perfectibility of man, or at least of his sisters back in Connecticut.

After writing in his journal about Dingley's visit, Smith couldn't get to sleep in his rented room on Pearl Street, due to "restlessness, heightened by the buzzings and bitings of musquitoes." On the 8th Smith spent the day walking along the Battery with a friend, reading Condorcet, and discussing "the propriety of... showing civilities to people for the sake of inducing them to purchase commodities of us, or otherwise advance our pecuniary interest." Smith argued that such behavior was "wrong."

At Bellevue four patients were admitted that day, including William Dewitt, a baker on Whitehall Street across from the Battery away from the supposed limits of the contagion. He was delirious and nothing Anderson did could stop it. Early the next morning Anderson found Dewitt had escaped and lay naked inside a nearby summer house. He was dying yet that afternoon had the strength to chase other patients with a club. It took three men to subdue him and push him into a little room where he died two hours later.

For the next two days, judging by his journal, Elihu Smith kept busy with philosophy and hiding under the bed clothes at night to escape mosquitoes. Finally on the 11th he wrote that the heat was "very oppressive," which made "exertion disagreeable and unproductive." He worried that the city's health was "sensibly and dangerously affected." Still he seemed more interested in the rumors swirling around Secretary of State Randolph's resignation for allegedly taking bribes from the French government. Then that night, Smith bumped into his brother-in-law Thomas Mumford who confessed to being unwell the past two days with a headache and pain in the bowels.

Mumford's wife was in Connecticut, so Smith spent a night with him and was pleased to find the purge he gave "operated kindly." Mumford seemed better, but didn't get well. To and from the literary salon of a Mrs. Lovegroves, Smith dropped in on his patient. He tried to induce a sweat only to come back and find Mumford had puked instead. Smith got him to sleep, and in the morning Mumford imprudently tried to walk about. He suffered a serious relapse and on the 16th Smith's "whole day" was "spent with Mumford, or in running backward and forward for him." Smith didn't smell the burning tar barrels that a band of youths had set afire in the streets around Peck Slip, but finally the young aesthete condescended to describe the terror:

"This whole city is in a violent state of alarm on account of the fever. It is the subject of every conversation, at every hour, and in every company; and each circumstance of terror acquires redoubled horror, from every new relation. In reality there is reason to be alarmed. I am told that 24 persons died, yesterday.... It is true, however, that of the number who are sick, and who die, there are few of the natives and long residents of this place. Far the greater part are emigrants, poor Irishmen; who, coming from a cooler country, in crowded vessels; changing a vegetable, for an animal diet, and in the worst season of the year; living in narrow and nasty streets, on the border of our worst slips and docks; in cellars; or half-underground rooms; nasty, ill-provided with food, and the little they have bad, and badly cooked; hard laborers and hard drinkers, fall the first and most numerous victims to disease. It is very evident, that these circumstances of themselves are enow to convert what would otherwise be only a simple remittent, to what is now denominated a malignant fever."

Not that Smith had occasion to see the poor in their hovels the way, say, a Catholic priest did. Father O'Brien actually saw the "subterraneous apartments, which admitted no light, but from their hatch-doors; so that when shut down at night, it might literally be said of them that they were buried alive." Smith probably learned about the plight of the emigrants from talking with some one on the health committee, for they too blamed emigrants. On the 9th, in response to seven dying the day before, it ordered the inspection of all vessels with passengers from Europe, and two were approaching the port. The committee began publishing a daily toll of the dead, 11 on the 17th, 14 on the 18th, but added this explanation to alleviate apprehensions: "a large proportion of the deaths hitherto reported have fallen among emigrants lately from Europe, strangers, and other transient persons."

The committee tried to hide evidence that the epidemic had revived. It chastised gravediggers for opening more graves than the committee ordered. It tried to keep down the numbers sent to Bellevue by sending the sick to city physicians. It admonished the boatmen who took patients to Bellevue to stop acting so hastily, charging them with removing patients without warning. It sent a committee out to investigate Anderson's methods at Bellevue, suspecting he might be causing the increase in the number of deaths.

New York newspapers didn't report on the panic in the city. Letters to Philadelphia papers chronicled that. "My God! what a change.... The fever is spreading fast," exclaimed a letter dated the 17th. "Forty three persons have died with it in 3 days; agreeably to the report of the committee, and how many more God only knows. My family are gone to Long Island. I shall remain till a stop is put to business." A letter written the 21st recounted a week of terror. Until the 15th those who died were of that class of people not generally known. "On that day names began to be mentioned, and those names were in different parts of the city; ...People were panic struck - they quitted town in all directions, and it is said three hundred families crossed Long Island ferry in one day."

Smith thought the number of people who had fled the city "cannot be less than 12 or 15,000." He had planned to go home to Litchfield that week, but decided he had to stay. His friends might get sick and his leaving might be cited as desertion of the city by its physicians. He had been in the lecture hall in 1791 when Rush urged his students never to disgrace the profession by fleeing from the plague. That day Smith saw a crowd gawking at a load of coffins in Maiden Lane. "In one shape or other the fever is constantly brought into view; and the soul sickens with the ghastly and abhorred repetition." That night Smith re-read Rush's account of '93.

The epidemic stopped being a social embarrassment and became an intellectual challenge. He joined Dingley on his rounds, and saw the cracks in the establishment slant on what was happening in the city. "According to him," Smith wrote of Dingley on the 20th, "the health committee are but partially informed, and the disease is spreading rapidly. For five days past, he thinks not less than 40 a day have died." As they walked Dingley asked a black woman in the streets about a baby saved after his father, mother and grandmother had died, and learned, to his shock, that the baby was dead. Smith had just received a letter from his friend Charles Brockden Brown who was inspired by the return of yellow fever to write a tale (that was never published) about the suffering it had visited on Philadelphia. As they finished their rounds, Smith told Dingley about Brown's story and was "surprised to see the tears trickle down Dingley's cheeks; and to find him, for several minutes, unable to make a reply." Part of the emotion must have arisen from Dingley's relief that an artist would write about the suffering that committees and editors seemed so bent on denying or explaining away as part of the bad odor of being Irish.

New York editors did their best to remain upbeat. Rain, winds and cooler temperature on the 21st prompted the hope that "the city will be clear of sickness in a few days.... Broad street, Broad way, all the north of the city, and many other parts, are as healthy as usual." In July and August to allay fears that fevers on the waterfront would spread, they insisted the fever was not contagious. Now that it was spreading they still insisted it was not contagious. One letter to Philadelphia described physicians, "called emphatically the contagious doctors," as "terrorists" who "contributed not a little to the excessive alarm that has gone forth. Unfortunate indeed is the transient lodger, or the poor man, that is taken with it; the one is instantly obliged to quit his lodging - the other is immediately carried to Bellevue. In short, the dread and alarm people are under is inconceivable, and many I believe actually die of fright."

The committee enlarged the facilities at Bellevue and sent out a 24 year old doctor, William Johnson, to help Anderson. Still it tried to make clear that sending patients to Bellevue was not from fear of direct contagion. Fresh air would help recovery and removing the patient removed another source of mephitic air from the city. Then the new doctor got the fever. Against the express orders of the committee, Dingley brought him to town the next day, where he recovered slowly. Dingley and Elihu Smith were disgusted at the committee proclaiming that the fever was not contagious while secretly acting as if it was. Smith knew it wasn't contagious. "Where the rooms are properly ventilated, and the patient kept cool and clean, I have no apprehension that it can be infectious," he wrote to a colleague. "I have mingled, like other practitioners, with the sick in every part of the city, at every stage of the disorder; sat by them, conversed with them, assisted, and watched with them, this without any dread, and without any bad effect perceivable, after a lapse of more than five weeks. Neither have I heard of two well-authenticated instances of the disease's having been propagated by intercommunication."

Merchants in New York recognized that if the fever was not contagious, than no other city could fear that it could be spread to other ports by ships from New York. Philadelphia was not impressed. On September 18 a citizens' meeting was held at the State House to organize watch committees in each ward to make sure refugees from New York did not slip into the city. The governor's earlier proclamation had only quarantined ships. The citizens' committee asked stage companies to make passengers from New York leave the stage five miles from the city where they could conduct business via letters sent to the city.

Rush did not participate in the citizens' meeting. During September ten members of his household were sick with a "remitting fevers." Rush credited his use of the lancet for preventing them from developing into something serious. All told he took blood 24 times, twice from himself in one day, and even 6 week old Samuel Rush was likewise "bled twice, and thereby rescued from the grave." He certainly felt prepared to save the city if the fever struck, but he offered no quick prescriptions on how the city should react to the New York epidemic.

In practice, in his bones, he believed a healthy person should avoid people and houses infected with yellow fever. But he knew that his theory of the local origin of the disease could not survive the supposition that yellow fever was highly contagious like influenza. Even he had blamed flu epidemics on sick travelers. Finally a week after the citizen's meeting that banned stages from New York, Rush allowed the Philadelphia Gazette to extract a page from his yet to be published memoir of the 1794 epidemic which discussed measures a city should take to limit the spread of a malignant fever. First all physicians must be compelled by law to report cases of malignant fever. A committee of doctors should investigate. If the fever seemed to have come from a ship, the offending ships must be cleaned and her cargo carried out of the city. If it seemed to be of local origin, the offending putrefying matter must be removed, covered or destroyed. Meanwhile the infected area should be chained off and all citizens removed, and then nature's way of killing contagion should be imitated by bringing fire hoses and drenching the streets with water. The object was to enhance "the improbability of the sick creating a reflected atmosphere of contagion." (In a portion of the book not excerpted Rush suggested that all fevers had varying degrees of contagiousness and he ranked yellow fever below small pox, measles, influenza, and plague.)

A week after his letter on public health, Rush addressed the issue he was vitally interested in at that moment. The Philadelphia Gazette printed several passages from the work on bloodletting that he had not yet sent to the printers. He instructed physicians on how to tell if more bleeding was necessary by looking at the blood already drawn. The six indicators were blood that was "dissolved," of a scarlet color, had "crassementum" or blood clots that were dissolved, sank, or floated, and "sizy blood, or blood covered with a buffy coat." (One modern commentator notes that most of the variations arise from exposure to air and impurities in whatever was used to collect the blood.) He also argued that when more bleeding was indicated it must be profuse. He cited the commonly accepted estimate that the body contained between 25 and 28 pounds of blood. (It contains about 11 pounds.) He also argued that blood was quickly replenished citing a case in Germany in which a man lost "75 pounds of blood in ten days" from hemorrhoids.

He hoped the extract would help doctors in New York, and that they, in turn, would boost his theories. "Do inform me immediately," he wrote to one, "what are your remedies? If bleeding and purging, to what extent do you use them? How many patients do you lose in a given number, and what is the practice of the other physicians in New York? An answer to these questions by the post (so accurate as to bear the public eye) will much oblige me and all the other friends of reason and of the lancet in Philadelphia."

New York physicians made a conscious effort during the epidemic to prove that they were in control. They sought to prevent the spectacle of physicians accusing one another of killing patients which demoralized the nation in 1793. The physicians continued to meet, a program of dissections was pursued at Bellevue, and a consensus formed on the value of purges, although calomel was not used by all. Glauber's salt was a more popular purge. Dr. David Hosack used snakeroot tea in lime juice. A few used calomel to induce salivation. Everyone gave Rush due credit. In a letter to Philadelphia William Smith lauded the "justly celebrated Rush" for showing the need for purging when the stomach was in a highly inflamed state. "His work on this subject," Smith added, "will be useful when all jealousies sleep in the silent grave."

Bleeding was less popular. David Hosack found in the New York hospital that in the majority of cases when bleeding was used "the disease terminated fatally." Yet there was no acrimony among doctors over the procedure. The venom came from laymen. A tailor named Alexander Cuthill breached the newspapers' ban on medical controversy by buying an advertisement "challenging the physicians of New York, to give their reasons publickly for their using the Lancet, Calomel, Bark, and Cantharides, or Spanish Flies, in the present prevailing sickness." He offered to cure "as Buchan [a British author on home remedies] recommends in a common cold" with a purge of castor oil. Cuthill threatened to indict Dingley, the principal exponent of bleeding in the city, for murder unless he defended his methods. Among Dingley's friends Cuthill was known as the "crazy tailor," and one promptly lampooned him in the press. Cuthill was persistent and, according to Smith's diary, began "going, whenever he hears D[ingley] has a patient, & telling the sick man that he will kill him."

Seeing first hand the kind of persecution Rush went through in 1793, Elihu Smith was moved by Rush's dispassionate observations on the blood of yellow fever victims. After reading the article, he rededicated himself to serving his city by proving the superiority of Rush's methods. "Do I not see ignorance, pride, stupidity, carelessness, & a superstitious veneration for foreign writers, & a mean jealousy of an illustrious writer of our own country, go hand in hand, & as it were, conspire, against the lives of men?" he asked himself in his journal. "I think I do. I think I have had sufficient opportunity to determine that his principles & practice are equally & certainly sound. I think I should apply them, in nearly all their extent." So he resolved to be useful and go forward like Rush, "animated by a sacred love of truth, & filled with an ardent humanity & tender zeal for the welfare of my fellow creatures."

Smith based his confidence on Rush's methods on his own experience with two patients and his visits to a handful of Dingley's patients. Smith saw Dingley draw two pounds of blood from a man in two days, "with great advantage." Then when one of his own patients had a serious relapse with feeble pulse and severe fever, Smith brought out his lancet. "I determined to bleed him," he wrote in his journal. "He tottered out to a chair in the yard. I took away 18 oz. He rose, & walked, with a steady step, to the end of the yard; & after a discharge, returned; went down stairs, & returned to his room."

His next case was not so happy. He joined Dingley in trying to cure the apothecary Nathan Webb with bleeding and purges. Their patient suffered one of the worst side effects of venesection. "We were near an hour employed in attempting to stop a bleeding which took place from a vein which had been opened before," Smith wrote in his journal. "The blood was entirely destroyed in its texture; the man stupidly insane; the house deserted; a negro nurse only remaining; except a drunken relation of the landlord, who with oaths & imprecations, refused to allow our moving the sick man, from an apartment five feet wide by twelve long, into an unoccupied, airy room. We did it however - & exerted every thing in our power to restore sensibility & hope to a man, thus forlorn, & without relation or friend near him, to yield any assistance."

A week before Smith was amused to find his hairdresser suddenly shy about working on Sunday. The Society for Aiding and Assisting the Magistrates in the Suppression of Vice and Immorality on the Lord's Day was making noise about enforcing blue laws. "This is a rich season for superstition," he had fumed in his journal, "a fine opportunity for the priests to play upon the terrors of the ignorant.... At this moment, a Methodist, who dwells in the house opposite, is beseeching the Deity, with nasal twang: & praying him to remove his judgments, from New York." Now Smith wrote in his journal: "If prayers were ever of any avail, it would be worth the while to clap to, in Yankee dialect, all hands, & pray for cold weather after this rain." When they called the next morning they found Webb dead.

Meanwhile the health committee continued to orchestrate, through the newspapers, a calming message flattering to the city's reputation. Dr. William Smith gave scientific proof that the epidemic would soon end. The thermometer dropped to freezing on September 21. From the city's experience in 1791 and 1794, he thought that would effectively kill any contagion. Judging from a letter Alexander Anderson got from his brother, who remained in the city, the freeze didn't kill off mosquitoes. They were plentiful enough to still keep people awake at night.

At the peak of the epidemic in late September, as the health committee recorded 32, 31, and 29 deaths on the 25th, 26th and 27th, several prominent men had the fever, including Rev. John Rodgers (the doctor's father,) and Rev. John McKnight (whose brother was a doctor.) Still, officially the point was made that only those in the low lands along the East River died. When Rodgers and McKnight survived, the health committee broke down the 380 deaths it recorded in September by profession, and was careful to note that the one preacher who died did not belong to a respectable denomination. (He was a Methodist.) Of the 269 white adult males who died, 106 were "strangers and persons employ unknown," 21 were seamen and 28 were laborers. Only 17 were merchants and merchants clerks, and of those, "only 5 or 6 [were] well known and established merchants." Not one practicing attorney died; the only physician, a young man who worked at the dispensary for the poor.

In Philadelphia the Committee's identifying the poor as the principal victims opened the flood gates of charity. Not in New York. While the city's system of poor relief was overburdened, the city government asked for no donations so as not to increase the panic. Of the $8,837 collected for the poor, $7,000 came from the city council of Philadelphia.

The epidemic did not end as predicted, Amasa Dingley told Elihu Smith on October 10 that the epidemic was "no better, & that those who are now taken sick, are more violently seized." The city remained "entirely deserted," explained another report dated the 9th, "no business of any kind going on. Every day has the appearance of a Sunday." The arrival of ships with fall goods had not brought merchants back to town.

On October 23 the health committee announced the virtual end of the epidemic. On November 4 the committee published a long letter congratulating itself for "undeviating veracity" which subdued the terror despite "falsehoods [that] have been propagated from the basest, meanest, and most despicable motives." (to see the letter and a list of the dead) The official count of fever deaths was 730, only 150 were "citizens," and "nearly one half the city has either wholly escaped, or experienced only here and there a scattered case."

However, unlike the 1791 and 1794 epidemics in New York this one was too big to be swept under the rug. Not that many in the city didn't try to do just that. On November 9, James Kent, a law professor at Columbia, wrote to his brother that the fever had been forgotten. Unlike in Philadelphia in 1793, there was no crusade to make the city remember and reform. At one of the sermons during the requisite day of thanksgiving proclaimed by the governor, Rev. William Linn subordinated the epidemic to the campaign to support the Jay Treaty and assure peace with Britain. Between war, famine and pestilence, Linn argued, the last was the least evil. He had enjoyed the evenings "on which we assembled to pour our hearts to God, that he would 'stay the hand of the destroying angel.'" He wept for victims but "In common years there have been more... tokens of mourning seen among us."

Not an alarmist by nature, Elihu Smith wanted to agree with those conclusions, but compelled by the example of Rush's memoir of the 1793 epidemic, he climbed Bunker's Hill to survey the low lying areas where the fever prevailed. A week later he toured the infected streets. He was in no position, since he had so few patients, to trumpet the virtues of bleeding. But he understood that New York presented a laboratory for proving Rush's theories on the origin of the fever.

For Rush's purposes Smith was an ideal convert. Unlike the young Baltimore physician Drysdale, Smith had not seen that much of the fever. His handful of cases didn't excite new observations; meticulous journalist though he was, he didn't write one case study. Prepared by his literary pursuits to be inclined to intellectual games, he was content to tie the simple New York epidemic to the epochal battle in Philadelphia that Rush had dissected. Better still for Rush, Smith inspired his friend Noah Webster to join him.

Like Smith, Webster was a Yale graduate and transplant from Connecticut. His spelling book and grammar had been published a decade before. Those works sought to stamp certain phenomena as distinctly American. In 1794 he published a New York newspaper which, though pro-Federalist, tempered its support for Britain with unabashed nationalism. In 1789, he had observed first hand the progress of the influenza epidemic that swept the nation. That gave him an abiding interest in epidemics. During the 1795 epidemic he was frequently out of the city, but Smith talked with him at length about the fever. While Smith was enticed by the scientific puzzle presented by the Philadelphia, New Haven, Baltimore, and New York epidemics, Webster grasped, even more than his fellow nationalist Rush, that they were harbingers of a threat to the whole nation. Webster decided to use the New York fever as the centerpiece for a national debate on the nature of the threat yellow fever posed to the new nation, and on the reforms that might save America.

There was no instant history of the New York epidemic from any New York journalist. Instead Webster wrote an open letter to the physicians of Philadelphia, New York, Baltimore, Norfolk and New Haven, asking them to send him information which would help determine if yellow fever was of domestic origin, and if it was contagious. Answering those questions was "equally interesting to every part of the United States, and one that deeply affects the happiness of families and the general property of the country." He didn't limit his inquiries to the big ports. After alluding to the bad fevers experienced that year along the Hudson, in the Genesee country, and in swampy districts in central New England like Sheffield, Massachusetts, he called for physicians anywhere with information on malignant fevers to send papers to him for eventual publication. Once the threat was identified and understood measures could be taken to stop importation or neutralize local causes for the disease. It was perilous to let the disease become rooted in America. "Our latitudes are the same as those of many countries in Asia, where the plague rages; and perhaps our climate, which formerly resisted the progress of fatal epidemics, is assimilating itself annually to that of Smyrna and Constantinople."

More discerning physicians understood that by equating the yellow fever of the Atlantic ports and the bilious remittents of places like Sheffield, Massachusetts, just as Rush had done, Webster skewed the debate in Rush's favor. William Currie never responded to Webster. In a November 29 letter, Rush told Webster that he was glad that "philosophical gentlemen had taken up the subject of yellow fever." He assured Webster that "the truths" he was after were "obvious" to any man of "candor." Rush's upcoming book would prove "in the most irrefragable manner" that yellow fever was indigenous, and that contagion was not its "essential character" but was influenced "by season, habit and some other accidental circumstances."

While Rush hinted that he already had all the answers, he appreciated having Webster as an ally. While Webster made no pretence that he understood Rush's theories, he appreciated Rush's efforts to theorize with modern sensibilities in mind. As a newspaper editor he was quite familiar with the hoary nostrums an epidemic elicited. For example in the midst of the New York epidemic, "Philo-Salutis" urged people to wear a piece of sulphur or brimstone next to their skin. That would neutralize the fever inducing effluvia exhaled by insects, "not only great quantities that are visible, but smaller and smaller, ad infinitum," that infected the air in "low marshy countries, in cities, country and towns, where much filth and moisture abound."