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Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Three

The difficulty Rush faced, the root cause of his controversial performance, the source of historical complexity which has made it so easy to distort his work was his inability to communicate the overriding importance of his deeply felt sense of duty. Stripped of its religious imagery, Rush's dedication and frustration are quite contemporary. Absurd as it is given the complexities of modern society, we still think of one man conquering disease whether it be Drs. Salk, Sabin, or Gallo. Rush created that expectation. His predicament in August 1793 was that then such heroics were viewed with suspicion.(1) Society was not accustomed to the rapid assimilation of a scientific discovery to better the human condition. It would be another five years before Jenner became the first great medical humanitarian.

There is little evidence that Rush himself really anticipated the idea of the individual scientist as hero; as an intrepid discoverer of nature's secrets like Harvey or nature's laws like Newton, yes, but not as a man who could virtually single handedly avert disaster. He anticipated that the coming revolution in medicine would arise from the group endeavors of American scientists, just as the American revolution had been the work of a dedicated group of men. Rush had been active in fostering that idea among his colleagues. Of course the Philadelphia College of Physicians was modeled on the Royal College of Physicians in London, which had been in existence over 200 years, but its seemingly inevitable formation came about in 1787 largely because of Rush's energy and persuasive abilities.(2)

He soon regretted his achievement, as the corporate opinion of his colleagues did not serve as a conduit to amplify his discoveries. Instead they tried to block them with the weight of tradition. Rush soon realized the importance of individuality in nurturing science and the need to collect a phalanx of true believers to join in the assault on tradition which was impregnable enough without jaded and jealous practitioners taking upon themselves the task of legislating scientific truth.

However, at first Rush managed to use the college to his satisfaction.(3) At the meeting Rush defeated Hutchinson's conceit that things really weren't so bad. In response to Hutchinson's claim that there were only 12 cases of malignant fever, Rush added his own cases with those of Foulke and Hodge, and showed that 12 people had died of malignant fevers in the last 12 hours.(4) Rush then presented his evidence that the fever was contagious. That it had spread along Water Street was not conclusive since everyone in the area had been exposed to the putrefying coffee. But relatives of the McNair boy, the Stephens family on 2nd and Chestnut, had the fever and while they had seen McNair before he died, they had not visited Water Street nor smelled the coffee. Sixteen days had passed between Mr. Stephen's last visit to McNair and his taking the fever, a sobering fact. No one could be sure they were free of possible contagion until 16 days after their last contact with it.(5) In addition the fever was spreading in Kensington a good half mile north of the Arch Street wharf. Rush was treating three seamen and Dr. Say had 40 cases there, and knew of 20 deaths.(6)

The College had 26 members who were the cream of the profession. Upwards of 80 people in Philadelphia, including Hannah Toy, listed themselves as physicians. (There was no system to license physicians as there is today.) The college had done nothing in the realm of public health save, at Rush's prodding, recommending that the legislature raise duties on imported liquor.(7) Yet it had no doubt about its duty in the face of a deadly contagious disease. Its model, the College of Physicians of London, had acted during the Great Plague of 1665. Its essential service was to lessen fear by publishing simple directions to guide people in coping with the epidemic, which didn't prevent 40,000 people from dying.(8)

The Philadelphia physicians appointed a committee of four, Rush, Say, Hutchinson and Caspar Wistar, a former student of Rush's, to draw up directions. The committee trusted Rush to write them.(9) In a sense he was prepared for the exercise. In his medical school lectures he listed 15 ways to prevent the spread of contagion. But what Rush did in his lectures and much of his early medical writing was merely collect ideas that he gleaned from the literature. He had told his students that it was said that Edinburgh and Madrid were uncommonly healthy because "the volatile alkali arising from putrefying human feces" helped rid the air of contagion.(10) However, opening outhouse doors was not on the list he penned to save his city.

His eleven measures to prevent the "progress" of the fever combined strictures gleaned from books on the plagues of Europe with modern medical appreciation of environmental and personal cleanliness. Rush warned citizens to avoid fatigue, the hot sun, night air, too much liquor, and anything else that might lower their resistance. He endorsed two age old preventatives, vinegar and camphor in infected rooms: "they cannot be used too frequently upon handkerchiefs, or in smelling bottles, by persons whose duty calls to visit or attend the sick." He outlined measures for city officials. Stopping the tolling of church bells and making burials private saved all from the gloom which disposed one to get the fever. Cleaning streets and wharves gave confidence to the healthy as it diminished the contagion which could arise from filth any where. Fires in the street, often mentioned in plague literature, had been proven by modern chemistry to vitiate the life giving properties of air. Exploding gunpowder, however, did increase the amount of oxygen.

And he addresed the issue of isolating patients, giving advice he would later regret. As a rule in America, where malaria was endemic, fever victims were not shunned. But this malignant fever was more than a mere "intermittent." Not only was the spread from the McNair boy to the Stephens family troubling, but the fever was spreading through the Stephens family. Rush advised "that unnecessary intercourse with the sick should be avoided," and "places should be marked where the fever is known to exist." Pains had to be taken to prevent the contagion from concentrating which would increase its virulence. The sick should be in large airy rooms and body waste immediately removed. The sick poor who lived in close unhealthy quarters should be taken to a special hospital.(11) (The Pennsylvania Hospital did not treat infectious disorders.)(12)

Compared to the usual mute reaction of American cities to epidemics, the college's directions were remarkable. But there was an element of civic posturing about them. In 1793 approximately 50,000 people lived in Philadelphia, most within six blocks of the waterfront. Today an alarm along the waterfront would inspire instant panic a mere six blocks away. But people then had an acute sense of altitude, and felt that just a few feet of height afforded better air and drainage. A student of Rush's, William Currie, in large part inspired by Rush's teachings, had just published a book on diseases in the United States. It did not hide the existence of intermittent, remittent and bilious fevers, but it used the testimony of doctors in all the 13 states to show that, especially with the rapid improvement of the land, fevers were increasingly becoming confined to certain low lying districts.(13)

The epidemic had begun in a low area of the city. Inspired by the plans for rebuilding London after the Great Plague in 1665 and the Great Fire in 1666, William Penn had the city's streets laid out on a grid.(14) Regularity that banished winding streets and cul de sacs would save the city from fires, fevers, and felons. The regular pattern of streets also meant that Philadelphians had a good sense of their proximity to the rest of the city. Their city was not infected, yet.

The evacuation of cities due to sickness is as old as civilization. Despite the imperative to always preserve the reputation of new cities in America, citizens had fled them with their leaders' blessings when smallpox or yellow fever claimed too many victims.(15) Yet the example of Boston in 1730 and Charleston in 1745 did not make leaving Philadelphia in 1793 any easier. In his book Currie had implied that recent improvements in Philadelphia, especially the covering of Dock Creek that had cut through the grid in the southern portion of the city serving as an open sewer, made epidemics a thing of the past.(16) Recent improvements had made optimism a birthright among city dwellers. There was by no means mass flight from the city, yet.

If Rush was indeed the happy go-lucky millennialist and by-the-book physician, the publication of the program he outlined, premised on the conviction that the epidemic could be controlled, should have energized him into publicizing and carrying out its prescriptions. But it didn't. In the first week of September the city tried to deal resolutely with the crisis, always in vain. Rush did not even comment on the tragi-comic goings-on.

Governor Mifflin would immediately ask the legislature, which was then sitting in Philadelphia, to give him power to quarantine ships from the West Indies to keep out yellow fever.(17) On September 2, the efforts of some Irish emigrants to escape from a sickly ship below the city prompted the mayor to authorize any citizen to apprehend the miscreants.(18) Of course such action was quite consistent with Rush's etiology and the college's advisories. It behooved the city, even with contagion so evidently in it, to keep any more contagion out. Every little bit made the situation worse. But there's no evidence that Rush expended any energy in that cause.

One of the stratagems proposed by Rush met a brutal defeat. The overseers of the poor chose Rickett's Circus, on the western outskirts of town, 13th and Market Streets, as the site for the fever hospital. Seven fever patients were placed there. While there were few people living near by, there were enough to fuel a small riot. Angry neighbors threatened to burn down the so-called hospital after three of the seven patients died. The overseers quickly agreed to shut down operations there.(19) Rush recorded no reaction to that, if indeed he even knew about it.

It's important to distinguish Rush's directions to check the spread of the fever with the public health measures he campaigned for later. His position after the epidemic would divide the community because he emphasized that local filth caused the disease. The directions he wrote for the college were generally welcomed as valuable guidance and as a way to check panic which would tarnish the city's reputation.(20)

He wasn't basing his suggestions on any particular theory of epidemics. Eventually Rush would deny that yellow fever was contagious, but that declaration was several years and several epidemics away. Unfortunately most historians conflate Rush's later view with his initial reaction to the epidemic. There was one consistent element. Although his assertion was often challenged, Rush always maintained that rotting coffee caused the epidemic. After Hutchinson's report to the governor impugned that theory, Rush once again traced all early cases to the smell and reminded his colleague, that "it is no new thing for the effluvia of putrid vegetables to produce malignant fevers. Cabbage, onions, black pepper, and even the mild patotoe, when in a state of putrefaction, have all been the remote causes of malignant fever."(21)

But Rush felt that, once fever gained a foothold in a city, it could spread by contagion, from person to person. Clearly in these early days of the epidemic Rush was not a dogmatist applying his theories. As a practiced polemicist, Rush knew how to promote new ideas. The college's directions were not fashioned to persuade. They merely sought to check the extremes of behavior so common in epidemics. They were aimed at those who heedlessly helped the sick and those who burdened themselves with useless precautions. The directions presented no really new ideas.

On Monday, the day before the newspapers printed the directions, Benjamin Smith wrote to his father that the disease was so putrid "that in some instances persons still living have been deserted by their assistants on account of the smell."(22) The college's directions did not suggest the need for avoidance of the sick to any one. That was ingrained in the culture, as was the use of aromatic preventatives.

Margaret Morris made "a plentiful use of vinegar, onions, and a little wine between whiles." She burned tar in her rooms and put camphor in her bosom, "and strew wormwood, tansy-rue, and other strong herbs, on he beds, tables and floor of our houses."(23) The strategy of prevention was simple. Counteract the smells. A certain odor was thought to be the disease itself. In his novel Arthur Mervyn, written in 1798 and set during the 1793 epidemic, Charles Brockden Brown described the sensation on first encountering an infected corpse: "... a vapour, infectious and deadly, assailed my senses. It resembled nothing of which I had ever before been sensible. Many odours had been met with, even since my arrival in the city, less supportable than this. I seemed not so much to smell as to taste the element that encompassed me. I felt as if I had inhaled a poisonous and subtle fluid, whose power instantly bereft my stomach of all vigour. Some fatal influence appeared to seize upon my vitals, and the work of corrosion and decomposition to be busily begun."(24)

Rush observed that a washerwoman's husband who came to the city from New Jersey had a bag of tar and a bag of camphor around his neck, "rue in his mouth and a roll of brimstone between his teeth."(25) The college's directions ridiculed the redundancy. There was no controversy over the fear that the disease entered the body by the inhalation of foul air.

There was some attention paid to the actual, though entirely unsuspected, sowers of the seeds of death. One newspaper correspondent suggested that fresh pennyroyal, a weed abundant along the Schuylkill, might ward off the fever because a sprig of it was so effective in keeping away mosquitoes (a virtue of the plant that had been known to the ancient Romans.)(26) Not that he blamed the mosquito for the fever. If pennyroyal was so powerful against that pest it "may be a good preventative against infectious disorders." Another correspondent suggested a way to kill mosquitoes so "distressing" to the sick: pouring a cup of oil in the casks behind most houses that were used to store clean water.(27) A most effective measure to control an epidemic spread by mosquitoes if done by everyone, evidently it wasn't. In his notebook Rush observed on August 26 that mosquitoes were very plentiful, but urged no measures to subdue them.(28)

Rush could have easily become a cheerleader for the measures the College had outlined. Many others did. Scavengers, as the official city street cleaners were then called, began cleaning up the docks. Officials saw to it that the Wednesday and Saturday markets were kept clean, especially the meat stalls.(29) Citizens cheered and instructed these efforts in their letters to the newspapers: dirty streets, "if not the cause, [have] very much contributed to the present unhealthfulness of the place;"(30) another argued that the supposed malignant fever was only the influenza made more malignant by Water Street's houses "half buried underground," its "sailor taverns and huxter's shops, which are the receptacles of all kinds of filth, dirt and nastiness;"(31) another writer urged that the scavengers hired by the city come more than once a week so households would not store "bones, with some flesh on them, the entrails of poultry, and many other corruptive matters in a barrel, in the yard, and in some cases in cellars, where they putrefy,... sowing the seeds of death."(32)

By week's end the official measures bolstered the confidence of many. Samuel H. Smith, a young Republican printer wrote to his sister, that "the force of the disease" had been spent. Everyone infected had contact with the Water Street victims. "Since proper precautions have been taken, the disease has assumed a much more harmless shape, and little, if any danger, can be rationally entertained, except where a person unnecessarily exposes himself to entering sickrooms, attending funerals, and touching or very nearly approaching the infected body." In the past two weeks only 8 people had been buried in the Arch Street church burying ground, hardly a high number for that time of year. Before 3 out of 4 victims had died, now 1 out of 3. Seventy had died and at that moment 70 had the disease. While it was true that people had fled, it was mostly families with children who could not be trusted to take proper precautions. Smith noticed "no visible diminution of the inhabitants."(33) Mayor Clarkson told the press that the number of deaths in August was quite in line with the usual number. The 40 who died of fever could easily have died of something else. Another writer urged citizens to look at other excesses of the season as the cause for any greater mortality, "...the quantity of melons, and other green trash of the same kind, that are at present devoured with so much keenness."(34)

Rush did not join in the optimistic chorus because there was no scientific basis for it. With too many patients dying, Rush knew better. Although at this point he didn't express any regret, seeing how the measures he had the college recommend only gave his fellow citizens false confidence that the epidemic could be controlled, must have added to his gloom. That night after he wrote the directions, his fears poured forth in a letter to his wife: "...the fever has assumed a most alarming appearance. It not only mocks in the most instances the power of medicine, but it has spread through several parts of the city remote from the spot where it originated.... Many people are flying from the city, and some by my advice." Advice which he had not mentioned in his public advisory.(35)

After the directions were published, Rush wrote to his wife that while he hoped the they would do good, "I fear no efforts will totally subdue the fever before the heavy rains or frost of October," as was the case in 1762. When three of his neighbors on Walnut Street between 3rd and 4th packed up to leave the city that week, all of whom relied on his advice, he did nothing to dissuade them. Indeed its likely he inspired the flight. On Monday morning he had a patient on Walnut Street between 2nd and 3rd. That was getting close. When Rush's sons said they were afraid that they would catch the infection from the clothes he wore while visiting patients, he agreed and sent them to Trenton to stay with an uncle.(36) Rush wrote in his notebook that there was "great mortality from want of caution among friends and nurses." He also observed that he "felt burning in stomach after entering into infected room."(37)

The disease was too powerful to be stopped by the college's directions. Rush summoned himself to a higher duty, to find a cure that would fundamentally alter the course of the epidemic. That seems so obvious an obligation from the perspective of the late twentieth century, but it wasn't then. Most doctors in the city were minimizing the threat and creating the expectation that traditional fever remedies could control what few cases of yellow fever there were. For example, Rush's old student William Currie described the disease in terms that allowed him to place it in Cullen's nosology. It was "the synochus of Dr. Cullen." Thus named, it took on the limitations that Cullen placed on that genera of disease. Currie thought it responded to the treatment Cullen recommended, with Currie's own touches which was quite in line with Cullen's teachings on how remedies must be fine tuned to meet local conditions.(38)

Most commentators suggest that Rush's sense of crisis prompted him to forsake what scientific standards he had and grasp at any straw, that he worked himself into such a frustrated state that when he finally found drugs that seemed to work, he proclaimed them as a sure cure without subjecting it to adequate tests. To explain why the man who in the first few weeks of the epidemic was its most scientific observer suddenly became a quack, critics at the time blamed ambition tinged with insanity. Historians agree and also finger his religious zealotry.(39)

No doctor in the 18th century had any use for the procedures now employed to prove the efficacy of drugs. There were simply not enough willing people. Medical science did not have enough prestige to engage in double blind tests. Eighteenth century doctors did understand that the return of health after the administration of medicine could be merely a coincidence. They knew that care must be taken to save patients from useless and harmful remedies. Not having the statistical apparatus to separate effective medicine from a placebo effect, they relied on their observational and analytical skills.

For example, in Europe especially it was acceptable to use the poor to observe the natural history of diseases, that is, what happens when illnesses are not treated. The poor also served to test medicines. Autopsies revealed not only the cause of death but the effect of medicines. Doctors tested medicines on themselves. Rush left a journal consisting solely of observations on his own health and the results of self-medication. Unfortunately his sons destroyed the journal.(40)

Not surprisingly for an era riding the crest of great advances in the chemical analysis of matter, great store was placed in the chemical analysis of medicines. One of Rush's major contributions to the field in the 1780s was his analysis of Dr. Hugh Martin's cancer powder. The secretive doctor from Pittsburgh intimated that it came from some newly discovered herb. Rush proved that it was none other than arsenic which for years had been recognized as effective against certain kinds of cancerous ulcers.(41)

The chemist's lab was recognized as a proving ground for medicine. Early in his career Rush had tested the effect of 67 herbs, acids, foods, and drinks on the earthworm, hoping that would point the way to finding a more effective medicine to treat intestinal worms in humans. The research was absurd on several levels, but Rush gleaned some insights into biochemical reactions which would influence him in his fight against yellow fever. He found that drugs like calomel, which he had used with success in treating intestinal worms, took many minutes to kill the earth worm in a dish. While other chemicals he knew to ineffective, killed the earthworm in a few minutes. He reasoned that many chemicals that acted quickly outside of the body were ineffective inside it because they underwent chemical changes. Calomel however "by escaping the digestive powers unchanged, [acted] in a concentrated state upon the worms."(42)

In explaining the staying power of pre-modern medicine (many of those medicines had been used for centuries,) historians point to their demonstrative affects on patients' system. The ability to induce sweating, vomiting, diarrhea, etc., made it seem that the doctor was accomplishing something. Since many diseases cured themselves, the doctor stood the chance of gaining credit for cures that we now know his medicines did little to effect.(43) While this certainly explains why medical practice maintained a level of satisfaction that enabled it to survive as a profession, it doesn't explain why the illusion persisted that there were knowable laws of physiology and pathology whose elucidation would allow the cure and control of disease. In the hands of serious practitioners like Rush, medicine was more than the management of side-effects in a timely enough way to entertain the patient into thinking that medicines were working.

In a lecture on medicines perhaps similar to what Rush may have heard, William Cullen explained how he administered tartar emetic, a potassium sulfide crystal residue of wine making, which was then a popular remedy for fevers. Cullen began giving small doses, and if that did not cause vomiting, he increased the dose, Not, he said, to bring on vomiting, but because the evident lack of effect on the intestines meant that the medicine was having an effect on the underlying nervous tension which Cullen thought the root cause of fever. If vomiting finally occurred after the larger doses, Cullen was undeterred in giving more explaining to his students that vomiting was obviously a manageable side effect whose occurrence shouldn't deter the continued application of tartar emetic.(44)

Then as now doctors had a lot of explaining to do: why a medicine that had no perceptible affect was indeed effective, and why a medicine that caused quick reaction was actually not doing anything to the point. Which is to say that after demonstrating some basic remedial benefit compared to no treatment at all, a remedy had to seem plausible in light of a rational system of pathology and physiology. That Rush was then in the midst of rethinking medical theories made this imperative a valuable check on his trials of various medicine. As we have observed, he was in no position to let theory dictate his remedies. Conversely he had done too much work on his theory, based on his observations of other diseases, to let one effective drug for yellow fever dictate a new theory. Rush was poised to be flexible and at the same time critical.

However, the acute social crisis of the epidemic limited his flexibility and tempered his self-criticism. He knew that in order to save lives he had to take shortcuts. But even that made him more modern. As Rush's assault on the earthworm indicates, the 18th century doted on throwing the encyclopedia at a problem. Eventually in the next 50 years medicines of all sorts would be tested against yellow fever.(45) Rush was forced to take measures to rapidly narrow the field.

Rush seemed to sense that there was little profit in retracing the paths that at that moment led him to a roadblock. So he lay aside his theory that fever was primarily a general condition caused by excessive action in the walls of the arteries. He turned instead to the lessons of morbid anatomy, and correctly decided that the disease was seated in the liver.(46) If Rush had opened the corpse of a dead fever victim himself and had given his own account of the diseased liver, his place in medical history might be quite different. Instead he recollected that Dr. Mtichell had done several autopsies back in the 1740s that showed the liver "either inflamed or obstructed, and the bile much vitiated in the gall-bladder or in the small bowels."(47)

Mitchell's treatment had been a vomit followed by bark, which was not working on Rush's patients. But since Mitchell's time mercurial medicines had gained a reputation for treating the liver.(48) From notes taken of Rush's lectures during the 1790-91 school year, his fascination with mercury is obvious. As a salve it was prized for the treatment of syphilis; as a pill, in the form of calomel, it was prized as a purge. Since it was notorious for its side effects, sore mouth, tooth loss, and decay of the jaw, Rush cautioned students to use it as a purge "under certain restrictions." When discussing a case of typhoid fever that had lasted twenty days, Rush wondered if mercury was not then in order, as a medicine of last resort. But that said, Rush went on to describe mercury's special qualities which made it seem a medicine deserving further research. Some doctors thought it also stimulated as it purged, and its good service in treating venereal disease showed that while it treated general symptoms, it also acted at the seat of morbid action.(49)

It might be argued that Rush's theoretical biases led him to embrace such a dangerous medicine. The fact remains that re-analysis of his predicament from the view point of morbid anatomy inspired him to try mercury. Rush's old student Wistar, with whom Rush was brainstorming and who never embraced Rush's medical system, was taken along by the same reasoning as Rush, and began prescribing mercury. They did however take different paths in their efforts to stop the diseased liver from secreting too much bile. Wistar rubbed mercury on the skin. Rush decided to use mercury internally in the form of calomel. Wistar used mild purges in his treatment and saw no need for calomel's stronger purging power.(50)

As much as Rush yearned for a simplification of medicine, he was not about to trust calomel alone. He decided to combine it with another purgative, the Mexican root jalapa. The combination was not unprecedented. Rush recalled an army surgeon, Dr. Thomas Young of Boston, who treated bilious fevers with a dose of 10 grains of calomel and 10 grains of jalap. Young gave the dose once or twice a day until it procured a large evacuation of the bowels. Rush had argued that the large doses were unsafe but Young's patients showed no marked ill affects. In fifteen years of practice Rush had never treated a condition that warranted such a dose. Yellow fever was that terrible.

Rush was struck with one phrase in Mitchell's monograph: "an ill-timed scrupulousness about the weakness of the body is of bad consequence in these urging circumstances." That advice prompted Rush to not only fly in the face of traditional practice which advised against depletion in a debilitating fever, but to invite violent exhibitions of vomiting and diarrhea. Mitchell argued that the yellow fever victim was in essence sweating poison internally. Rush aimed to expel the internal poison and stimulate the liver to stop secreting bile. He expected, as Mitchell had noticed, the crisis to resolve itself in a natural sweat.(51)

This was a complicated strategy. As he must have been aware, untrained practitioners were after the same sweat. They were trying to achieve it by the traditional direct method of putting patients in closed rooms, wrapping them with blankets and having them sip hot herbal teas.(52) So unorthodox was his medicine that Rush did not tell the first patients what they were getting, nor did he tell his apprentices what they were administering.(53)

With an increasing patient load and the panic around him, Rush knew he did not have the time to personally make a full experiment of the medicine. Evidently he concentrated on the case of Richard Stansbury, a Quaker teenager who had good nurses. Thus Rush did not have to be ever present. Reliable witnesses were there. Richard Spain, a block maker on 3rd Street had a case so malignant that a neighbor had angrily insisted that Rush instruct the family to prepare for rapid burial of the corpse. Rush had first seen him on Wednesday. That Friday Spain lay "without a pulse, and with a cold sweat on all his limbs." Rush had his apprentice Stall give medicine every six hours and closely attend the virtually abandoned man.

By Saturday morning the boy had 20 and the blockmaker 30 grains of calomel and jalap. Both were less delirious and had good pulses. Rush continued the dose through the day. By night Spain had a sweat, not the natural climax but still more a promise of recovery then a sign of impending death.(54)

Judging from the letter he wrote to Julia on Sunday morning, after three days of using mercury, Rush was once again energized. Like a good Christian, when he was feeling all-powerful, Rush preached humility. "O! the littleness of greatness! Thrones, titles, splendid and even commodious houses, wealth, friends - what are they all when viewed through the medium of a relentless and desolating fever? Help me, my dear Julia, by your prayers to `be always ready.' I have cut out much work for my divine master, to be performed in months or years to come, but if he means to have it completed by other hands, 'his will be done.'... If I survive the present dangers to which I am exposed, what offering of gratitude will ever equal the infinite weight of my obligations to my gracious deliverer? You must help me to be more humble, more patient, more devout, and more self-denied in everything."(55)

Go to Chapter 4

1. Rosenberg p 15.

2. Hawke p 335.

3. Neither the minutes nor few extent recollections of the college's meeting give much sense of the proceedings. My characterization of Rush's performance are drawn from his letters, accounts and notebooks under the assumption that what he wrote at the time reflected the arguments he used with his colleagues.

4. Butterfield pp 640-41.

5. Rush Notebook undated between Sept 8 and 25, 1793.

6. Rush 1793 pp 21ff.

7. Powell pp 30ff.

8. Defoe p 35.

9. Butterfield p 641.

10. Smith's notes.

11. Rush 1793 pp 21-23.

12. Powell p 57.

13. e.g. Currie 1792 pp 58-61.

14. Reps, pp 161ff.

15. e.g. Duffy (2) pp 53 & 156.

16. Currie 1792 pp 162-163.

17. Powell p 53.

18. Fed. Gaz., Sept. 3, 1793.

19. Carey pp 24ff; Powell p 59.

20. Some who still didn't think there was an epidemic objected, vide Fed. Gaz. Aug 28, 1793, and some thought quiet burials would only invite exaggeration which would hurt the city's reputation, vide B. Smith to D. Smith, Aug 27, 1793, Haverford.

21. Amer. Daily Adv. Aug. 29, 1793.

22. B. Smith to D. Smith, Sept. 2, 1793.

23. Pennsylvania Folklife, summer 1978, p 36.

24. Brown, Mervyn p 137.

25. Rush Notebook Aug. 31, 1793.

26. Fed. Gaz. Sept. 2, 1793; Grieve, p 624.

27. Powell p 23; Amer. Daily Adv. Aug. 29, 1793.

28. Rush Notebook Aug. 26, 1793.

29. Fed. Gaz. Aug. 31, 1793.

30. Clay. Gaz. Aug. 26, 1793.

31. Fed. Gaz. Aug. 28, 1793.

32. Ibid. Aug. 27, 1793.

33. S. H. Smith to his sister, Aug. 30, 1793, LC; Jefferson to Randolph, Ford VIII, pp 16-17.

34. Amer. Daily Adv. Aug. 31, 1793.

35. Butterfield p 640.

36. Butterfield p 642.

37. Rush Notebook Aug. 26, 27, 1793.

38. Currie 1793 pp 23-24.

39. esp King (1) pp 149-150; Powell p 127.

40. Corner p 5.

41. Rush 1815, vol. 1, pp 215ff.

42. Ibid. p 214.

43. Rosenberg p 19; Rothstein pp 27ff.

44. Thomson vol. 2 p 444.

45. LaRoche vol 2 pp 626-729.

46. Wistar to Rush, Nov. 1, 1793, Rush Papers, and Gen. Adv. Sept. 26?, 1793.

47. Butterfield p 648.

48. Wood, pp 358 & 889.

49. Smith's notes.

50. Wistar to Rush Nov. 1, 1793, Rush Papers; Gen. Adv. Sept. 26, 1793; Rush 1793 p 194 down plays the importance of his joint work with Wistar likely because of Wistar's slighting him in his Sept. 26 newspaper article.

51. Rush 1793 pp 197ff.

52. Phil. Gaz. "A Solemn Warning # ," Phil. Gaz. Oct. 1802.

53. Rush Notebook between dated sections 1799 and 1800.

54. Rush Notebook Aug. 31, 1793; Rush 1793 pp 201-2.

55. Butterfield p 647.