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Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Seven

"Narratives of escape from great dangers of shipwreck, war, captivity, and famine," Rush wrote in his account of the epidemic, "have always formed an interesting part of the history of the body and mind of man. But there are deliverances from equal dangers which have hitherto passed unnoticed; I mean from pestilential fevers."(1) His characterization of his plight is at once perceptive and a seeming admission of his failure. His well publicized perfection of his remedies and optimism about controlling the epidemic could not stem his own fears as the epidemic reaped a greater and greater toll in his own household. But he was not admitting failure. In the usual escape narrative, all credit goes to God. Even in the darkest days of the epidemic, Rush proved the redemptive power of science.

Stall got the fever on the 18th; another apprentice, Fisher, got it on the 20th. Two weeks before when Coxe and Fisher were sick, all in Rush's household considered their indispositions a joke, but this time the two young men did not respond to treatment. Plus everyone else in the house seemed to be slowly succumbing. Coxe and Rush's sister, who despite his entreaties that she leave had stayed to help him, also complained of feeling unwell. For a few days, only the black servant Marcus could help Rush mix his medicines, then he also got sick. Other blacks like Richard Allen also succumbed. Rush treated Allen and insisted blacks, if they got the fever, would get it lightly.(2)

Rush himself could barely climb stairs, and had "a slow fever, attended with irregular chills and a troublesome cough." On the 20th he still visited 25 patients, prescribed for 25 who came to his door and sent 38 to other doctors. Then on the 21st, he was too weak to go out. Ulcers developed in his throat along with "cough with copious expectoration." He blamed the ulcers on the disease, not calomel, which he still prescribed in his back parlor "for crowds of sick people." He found it more comfortable to sit cross legged like "the Arabians."(3) Soon, too weak to even sit Arabian fashion on the floor, he lay on his couch dispensing advice and hope. In the evening he worked on his notes of the epidemic, careful to transcribe and amplify on them in a legible hand so that if he did die his great work would not be lost.(4)

It must not have been easy work. The reality of yellow fever challenged his sovereign medicines. He learned of eight deaths in families he knew. Stall confessed that despite his grave illness he feared taking Rush's medicine more, and had lied when he told his master that he had taken his medicine. Clearly the time was at hand for Rush to rethink his therapy. However, he didn't and his reasons are plausible.

The rest of the city, well over half the population had stayed, experienced the same sense of weariness and hopelessness. The common reaction was to lash out at scapegoats. Many began blaming the poor and African Americans for spreading the contagion. "It is well ascertained," a letter from the city that appeared in a New York paper explained, "that the disorder rages most violently and destructively in confined places and narrow alleys,... in poor dirty houses, and amongst the intemperate, imprudent people, and sad havoc made among sailors, woman of bad character, and those who frequent such places. Water Street, Pewter-Plater, Coombes, Mead, and other Alleys..., are most infected."(5)

Not surprisingly since poor people did not have the resources to better cope with the disease, they did seem obvious sources of contagion. As Rev. Helmuth noted, they "did not take the slightest precaution to cleanse the stuffy air - windows and doors closed; no fumigation; no sprinkling of vinegar."(6) The deaths of Mayor's Committee members were blamed on their visits to the poor.(7) The Committee took pains to prove the poor at fault. It hired a man to conduct a block by block census. On Market Street he counted 163 houses shut, 112 open, 807 people had fled, 849 had stayed. Only 39 people had died. Then he went into the alleys off the street where the poor crowded. In Letitia Court with 14 houses, only 3 were shut; of 88 who remained in them, 18 had died. He found that mortality in some alleys off Front Street was as high as 31%.(8)

During the epidemic the attacks on African Americans were not public, perhaps because they served as nurses and undertakers for the elite and did burial services, under the auspices of the mayor.(9) But in private letters the prejudice against them is evident. John Welsh avoided blacks on the streets reasoning that since they nursed the sick they must carry the disease.(10)

Rush did not succumb to such reasoning. It was morally repugnant to him, but he found a scientific basis for his opinion. Unlike at the beginning of the epidemic Rush no longer tracked cases. He no longer believed a pattern of infection could be discerned. He sensed contagion everywhere. "Every room in our house is infected, and my body full of it," he wrote to his wife. His "breath and perspiration" smelled of it. His eyes were tinged with yellow. He no longer anointed himself with vinegar. However he still watched his diet, living on milk and vegetables. He had apple pie and milk for supper every night, and blamed people taking the disease on their eating a "French salad," or "six spoonfuls of broth," or "six mouthfuls of meat."(11)

By resigning his city to a state of universal contagion Rush avoided the pitfalls of finding blame. He correctly assessed the increasing power of the epidemic, and made public health simply personal health. In a public letter he advised that since one could no longer avoid contagion, people should stay in the city because they "cannot avoid carrying the infection with them" into the country. "They had better remain near to medical aid and avoid exciting the infection into action, which is now in their bodies, by a strict attention to former directions," i.e. avoid fatigue, eat lightly and use vinegar.(12)

To his horror, Rush suffered through an experimental test of his theory. He cut himself while leaving his carriage. He dressed the wound and then was mortified to see that the dressing had fallen off and that it had been off while he had been in sick rooms. Contagion had to have entered his body through the wound. However in a few days he began to heal normally. He deemed it proof that his vegetable and milk diet, and his avoidance of fatigue, were indeed the best preventatives.(13)

Yet, as much as he marshaled his science, he couldn't quiet his sense of impending death. He slept fitfully as Stall lay dying, fearing that noise in the room above was "occasioned by the securing of Stall in his coffin." His ears had deceived him. Stall had not died yet. The noise must have been the nurses restraining the patient or cleaning an explosion of vomit or blood. Then he dreamed that he had the yellow fever, covered with the red bumps "which are the immediate fore runners of death."(14)

Stall's death a few days later exposed the hollowness of his advice to remain near medical aid. To his wife he lamented the "want of bleeders as well as doctors." With apothecary shops closing, many "were unable to procure the mercurial purges when they are prescribed as soon as is necessary," it meant that "the help of man is now at an end." He hoped "the hour is not distant when God will make bare his arm for our deliverance."(15)

It bears noting how easily, how gloriously he could have chosen this moment to relinquish his scientific gains and, in effect, give up. Critics who damn Rush for letting religion get in the way of science need to explain why he did not preach on God's role in the epidemic. He believed the epidemic heaven sent. The newspapers revealed a split in the religious community. There were objections to churches remaining open.(16) Others argued that increasing righteousness was the only redeeming feature of the epidemic. For example, Rev. Helmuth gloried in the experience of coming together in God's house at such an affecting time. "My God! what hours were these! What comfort pervaded our otherwise distressed congregation!")(17) The Society of Friends held their yearly meeting in the city as scheduled. To change the time or place of the meeting was a haughty attempt to escape "the rod" of God, from which, of course, they believed there was no escape.(18)

Here indeed was an opportunity for a millennialist physician with a supposed weakness for metaphysics. Yet Rush refrained from publicly discussing the meaning of the epidemic in religious terms. He devoted himself to his medical practice and what observations his physical limitations allowed him.

Not that he earns much credit from historians for that. They fault him for developing the dogmas of his new therapeutics when he was surrounded by the sea of death attesting to their ineffectiveness. They point to how grotesque his scrambling for excuses became as enough of his patients died to belie any claims that he could cure 99 out of 100. The death of another apprentice, John Alston, resulted, Rush said, because "he refused to be bled for nearly a whole day because I was unable to visit him, and life and death often turn upon the application of a remedy at an hour or a moment in this ferocious disease."(19) Then Coxe reported another excuse for the failure of Rush's therapy. He learned that Alston died after puking and that was caused by an ignorant black nurse giving him a pint of cold water after he had taken a dose of medicine, instead of giving him tepid chicken water before the dose.(20)

His friend Samuel Powel got the fever as he was commuting from Chester, his wife's refuge in lieu of Mount Vernon, to his townhouse on South Third Street. The richest man in Philadelphia found a bed in a small, bare farm house he owned just across the Schuylkill River, and sent a messenger to Rush who sent back a prescription. Powel hired a young doctor in the neighborhood to attend him and follow Rush's orders. Rush had the momentary satisfaction of a note from Powel reporting, "I certainly don't feel worse for the operation. The discharge from my bowels are exactly as you described them."(21)

Early in the morning a few days later, Rush was woken by Dr. Griffitts and taken to Powel who was in a desperate situation, suffering from "langour, delirium, and hiccoughing." Rush failed to revive him and left Griffitts, Powel's nephew, to lessen the agony of death. As a rule, to keep up his courage and maintain his effectiveness for helping the living, Rush avoided the dying. That Powel, who was seemingly well attended during his illness, should be near death after using his remedies, did not give Rush pause. He blamed "the neglect of a 4th bleeding by the young doctor who attended him." History would blame the preceding three bleedings for cheating Powel of any chance for survival.(22)

What Rush did for his ill sister, he never described. But he seemed to glory in what he did for everyone but her. He decided the weakness which had kept him at home so many days were providential. "Hundreds more, especially of the poor, have been relieved by my advice at home whom I could not have visited and who would otherwise probably have died."(23) "In short," he boasted to his wife, "to tell you of all the people who have been bled and purged out of the grave in our city would require a book as large as the Philadelphia directory."(24)

It was a curious claim to make while his sister was dying upstairs. But he had an excuse for the failure of his treatment. She was a bad patient, and waited three days before taking calomel and being bled. This "infatuation" people had that they were not in danger was one of the fever's "most characteristic symptoms." But not the worst symptom. Her struggle reminded him that the disease "is indeed a most formidable one in all its forms. No wonder it requires medicines that possess the strength of Hercules to subdue it."(25)

The more Rush learned about lapses in treatment, the more convinced he became that those lapses, not the treatment, caused death. Rush made that point with a vehemence that shocked some patients. For two days Rush bled and dosed Ebenezer Hazard. On the third day he again prescribed bleeding. Hazard felt his own pulse and objected. Rush warned that "this opinion [is] one of the most dangerous symptoms of the case; the disorder was extremely insidious; the case extremely critical; not a moment to be lost; send for the bleeder directly. In the mean time, take this pill; and, if that does not operate in one hour, take this. You must be glystered today; but, if your are not bled today, I shall not be surprised to hear that you are dead tomorrow."

Hazard couldn't understand this new approach to disease. He called in Dr. Hodge, who offered to consult with Rush, as they had often done before. Rush refused, and, in a letter to his wife fumed, "this man has seen a great deal of the disorder, but he is no more wiser for it than the black nurses who attend the sick." To us, Rush also seems out of line, but primarily because experience has proved that his medicines were ineffective. His sense of alarm remains a hallmark of modern medicine.

Of course, Hazard did think he proved Rush wrong. He took the bark and wine Hodge prescribed. As he recovered Hazard recoiled at the newspaper ads for "Dr. Rush's Mercurial Sweating Purge," which reminded him of ads for a "mountebank." Recalling the doctor in the novel Gil Blas, Hazard dismissed Rush as "a perfect Sangrado, [who] would order blood enough to be drawn to fill Mambrino's helmet, with as little ceremony as a mosquito would fill himself upon your leg." But Rush was unfazed by Hazard's recovery. He told his wife that purging and bleeding "laid the foundation" of Hazard's cure.(26)

For a brief moment it appeared that Rush's remedies would be proven wrong by the growing reputation of the Bush Hill hospital. On Saturday the 28th the patient count at Bush Hill reached 106.(27) On October 1, 48 new patients were admitted. Rumors of cures increased the flow of patients. Dr. William Annan, who worked for the Mayor's Committee examining people who wanted to go the hospital, found that "no sooner was a person afflicted with a head ache or oppression about the praecordia [chest] then he became anxious to be removed to Bush Hill."(28)

And if the blistering there seemed too harsh a remedy, French remedies got another boost when a Dr. Roberts, interrupted a trip from the Philippines to France to help in Philadelphia.(29) The merchant Miers Fisher, who was one of his first patients, found his methods "easy and simple, differing exceedingly from Dr. Rush's practice." "He reprobates the mercurial purges and violent bleeding," and used "barley water, tamarinds, and a gentle purge compound of manna, tamarinds and four other ingredients." With all patients, Fisher said, he had "met with uncommon success."(30)

Then French methods seemed to falter. The Mayor's Committee was chagrined to note that, even with patients eager to come, and improvements at the hospital to reduce overcrowding, many died within three days of admission. The mortality rate was still about 50%.(31)

An Irish clerk of a French merchant house who came to Philadelphia in late September lived with Stephen Girard. He joined Girard's clerks in walks through the empty streets of the city to play with the creole girls from St. Domingue. The night before he got the fever a sweet seventeen year old let him play pirate with her. Nothing Girard and Deveze could do from baths to herbs could save the boy.(32)

Most threatening to Rush was a thoughtful letter to the newspaper sent by his old collaborator Wistar discussing his own case. Wistar reported that calomel and jalap relieved him temporarily. But he was not sure if mercurials or milder saline cathartics were better. That said, he endorsed cold air as the best remedy. Having the window open had revived him far more than any medicine. Wistar also acknowledged Kuhn for stopping his diarrhea with laudanum, and prescribing a "tincture amara" which, after sipping for every two hours for 24 hours, allowed Wistar to "eat rice and chocolate without suffering."

Rush wrote a short letter for publication chiding Wistar. If he had taken calomel as Rush had prescribed it, he would have recovered quickly and been back at work, "uniting at the same time, his testimony, with that of thousands of his fellow citizens, in favor of that excellent remedy."(33) Rush thought Wistar "certainly calculated to injure" him "and to create doubts as to the efficacy of the new remedies." There were enemies every where. One patient, Van Berckel the Dutch ambassador, first took advice from Kuhn and suffered five days thinking he had a common fever. Rush lectured him: "Hundreds have been sacrificed by this mistake. We have but one, we cannot have but one fever in town."(34) Worse still the ambassador bumped into Alexander Hamilton on the road, and was told, that if he got the fever, to get directions on Stevens's methods from Oliver Wolcott. The story gnawed on Rush and he fancied a political conspiracy against his remedies arising from his support for Jefferson.(35)

Rush feared a"dull and wicked confederacy," which would drive him from the city. Seeing no scientific basis for the attacks Rush blamed personal and political vendettas. "Never did I before witness such a mass of ignorance and wickedness as our profession has exhibited in the course of the present calamity," he wrote to his wife. "I almost wish to renounce the name of physician. Even the nod of Dr. Kuhn in his lurking hole at Bethlehem commands more respect and credit from my brethren than nearly 1,000 persons in different parts of the city who ascribe their lives to the new remedies.... The principal mortality of the disease now is from the doctors."(36)

Compounding those frustrations was his personal isolation. After reading Wistar's letter, Rush threw down the paper, and quoted Shakespeare's "This was the most unkindly cut of all...." Wistar was his Brutus. There was no one there to reassure him. Coxe had gone home sick. His sister was ill. His mother went to bed early, so he had "to pass three or four gloomy hours in the back parlor by myself.... In vain did I strive to forget my melancholy situation," he wrote in his account of the epidemic, "by answering letters and by putting up medicines. My faithful black man crept to my door, and at my request sat down by the fire, but he added, by his silence and dullness, to the gloom, which suddenly overpowered every faculty of my mind."(37)

Historians, who have scant respect for Rush's medical ideas anyway, grasp on to such emotional excess to push Rush beyond the pale of science. Powell faults him for over reacting to his colleagues' "rejection of his revelation."(38) King scorns the paranoia and the fanaticism worthy of a religious bigot.(39)

Admittedly, Wistar's thoughts on remedies seem sensible from this distance, but he had spent the past weeks in the countryside convalescing. Kuhn and Stevens had offered their remedies after observing a few cases and then they left the city. Two other doctors wrote long essays on the disease, impugning Rush's analysis. However, neither one had seen a case of yellow fever.(40)

What fueled Rush's anger pertains to the essence of modern medical research. Wistar and others, by shirking duty, by their lack of engagement, forfeited a right to impugn the work of one who was there. Someone who had not seen the diseases in weeks was not qualified to comment on it. If Rush was blinded by anything, it was not religious zeal or medical theories. He was blinded by experience. After reading the 121st Psalm, he wrote to his wife: "The exercise of my body and mind in the duties of my profession adds daily to the vigor and activity of both. Never was the healing art so truly delightful to me! and never had I more reason to be thankful than I now have for the honor God has done me in giving me health enough to renew my intercourse with my patients."(41)

Faith in Rush's methods remained unshaken. There's no evidence that Wistar's thoughts impressed many contemporaries. Wistar's aunt came down with the disease, and promptly sent for a doctor who used Rush's methods.(42) John Connelly was one of the Committee members charged with searching out the sick poor and sending them to the hospital. Connelly, who as an Irish Catholic probably didn't harbor any anti-French sentiments, had been an early admirer of Rush's, and, he remained so. He tried to keep victims out of the hospital by distributing Rush's pills. He found that if the poisonous bile was in the body for over 10 or 12 hours, "patients rarely recovered." Those who refused calomel, saying they had the common fall fever, usually died.(43)

In early October Timothy Pickering wrote to a friend that he had "such confidence in the safety of Dr. Rush's practice that my fear of the disease is greatly abated." He and his family were careful to follow Rush's strictures, but a maid and his six year old son Edward got the fever. The maid recovered while groaning "loudly" about the purging and puking. After getting the same medicine, his son didn't recover, and "... he refused to take anything and in answer to his mother's importuning said his throat was stopped." Rush allowed enemas which after four tries caused "several small evacuations." Then the boy puked dark matter. Before he had only puked while being bled. Pickering thought the "critical moment" had arrived and begged Rush to hasten his visit. Rush came but could not save the boy. Pickering did not blame Rush. Purging had saved his maid, and it appeared his son's obstinacy led to his death.(44)

Margaret Morris treated several of her servants and grandchildren "as Dr. Rush directs," with some experimental variations of her own. She had a maid who was vomiting blood lick salt and alum and then quenched the resulting thirst with elixir of vitriol, vinegar and water. Rush told Morris that the spontaneous bleeding cured the maid. Then Benjamin Smith reported that his three servants were ill. With medicines in hand Margaret went to Front Street and purged everyone. The servant with the most obstinate fever was bled to the point where he was "low indeed" and "cold at the extremities" through the night, but the crisis passed and he survived.

Then the two Smith children felt ill. Only their daughter didn't improve. Smith blamed her for not taking a "sufficient quantity" of medicine. On October 5 Benjamin's father sent down a bundle of dried herbs that he thought might be useful, including "tanzy, wormwood of two sorts, one Italian, cardes, balm, isip, pennyroyal." He recommended chewing the wormwood to prevent infection and told of a Frenchman who cured a servant with "cardes benedictus or the blessed thistle." It had been hailed in 1578 as a cure for the plague. There's no evidence that Benjamin Smith used the herbs. He respected his mother-in-law's respect for Rush's methods. Unfortunately bleeding was unable to save Smith when he got the fever.(45)

In 1797 epidemic the Swedish Lutheran minister Nicholas Collin lost his wife to yellow fever. That inspired him to organize a laymen's inquiry into the causes and treatments of the disease. In 1802 he wrote that in 1793 there was marked success in the practice of some women who wrapped people in blankets and sweated the fever out while they administered herbal teas. If so, it did not impress the medical faculty of Philadelphia.(46)

Calomel purges and bleeding increasingly became the remedies used by most American physicians in the city. Dr. Hodge thought the disease had changed its character no less than four times, and so he adjusted his remedies. He began to appreciate the relief purging and bleeding afforded the patient. At the end of October Ebenezer Hazard wrote a paragraph on treating the fever for a New England newspaper. He most likely consulted with Hodge before writing it, and far from ridiculing Rush, Hazard wrote, "it seems now to be agreed that bleeding and purging, according to the state of the pulse, are necessary in the beginning; and bark, wine, and nourishing food, as soon as the disorder is checked."(47) Even William Currie began to use calomel and bleed.(48) Rush's decisive modern approach began to win the day, and contemporaries understood the implications. As was customary then, newspapers throughout the nation reprinted what appeared in the pages of the newspapers in the nation's capital. All of the important letters that Rush wrote to the Philadelphia press appeared in papers from Boston to Charleston. The hope they expressed stood in stark contrast to the almost Medieval fear that gripped the rest of the nation as it placed Philadelphia under a tight land and sea quarantine, replete with militia guarding the roads and threats to "smoke" refugees from Philadelphia in order to disinfect them.(49)

Secretary of War Knox found that the alarm of the people "really inexpressible." He had to wait out a 14 day quarantine which would allow him through New York.(50) That city had a specially appointed health committee to investigate all reports of sickness. All refugees from Philadelphia were taken to tents in an island in the harbor. A night patrol was formed to prevent secret landings. All people seeking passage by boat into the city had to get the health committee's permission which they were chary of giving.(51) James Graham, a Philadelphia doctor then in New York, fumed in a letter home, that New Yorkers wouldn't mind placing guards "round Philadelphia armed with rifle guns and shooting down like black birds every affrighted citizen who would attempt to leave it." (Graham got back to Philadelphia, worked at Bush Hill, then privately until the fever killed him October.)(52)

Rush did not ridicule sensible precautions taken by people outside the city. He told his wife that she should "converse with nobody now who comes from Philadelphia. Everything is infected in our city."(53) But he did not publicize those thoughts, and remained the beacon of rationality in the sea of fear.

In the first week of October, as the daily death toll climbed to over a hundred, Rush wrote to a New York doctor answering his queries about the epidemic. He was ready to give some of the theory behind his remedies. Purges created "an artificial weak part, which, by inviting a determination of the fluids to the bowels, prevents those effusions in the brain, stomach, bowels, liver, and lungs which bring on death." "The pulse, the appearance of the blood, the spontaneous hemorrhages, and the weather" all indicated the need for bleeding. As the season advanced more and more blood had to be taken, up to 80 ounces, 5 pounds, "and in most cases with the happiest effects."

He ridiculed other remedies. Laudanum was poison in this fever. Bark, wine and cold baths were useless. He did encourage "cool air and cool drinks," and blisters were of some use for local pains if put on after sufficient purging. Only in the case of persistent vomiting, not relieved by bleeding, did he suggest a gentle remedy; "a tablespoon of sweet milk given every half hour, or... weak camomile tea."

He repeated his assertion that he cured 99 out of 100, but qualified the claim. That success came before his "late indisposition," after which some died "from the want of well-timed bleeding and purging." Recovery often depended on the application of remedies at a "certain hour." He blamed nurses, the lack of bleeders, and the increased "concentration of the contagion in every part of the city," for decreasing the success of his remedies. With proper care, however, the fever was "as much under the power of medicine as the measles or influenza."

In the last part of the letter he ridiculed the opponents of his methods. In using wine, bark and laudanum, "they might as well throw water and oil at the same time upon fire in order to extinguish it." They called the disorder the jail fever, then the common remittent. By insisting otherwise he may "terrify" his patients, "but I save them by their fears, for I excite in them at once a speedy application for help and a faithful obedience to all my prescriptions."(54)

Contemporaries found his continued belief in rational means to conquer the increasingly ferocious killer inspiring. A student of Rush's in New York, Elihu Smith, made it a point to talk with friends who had made it out of Philadelphia. A young doctor Smith had known in medical school, Samuel Conover, described his own cure early in the epidemic with wine and opium, and told Smith that Rush had not been as successful "as Rush himself supposes." Smith passed that on to a Hartford doctor without endorsing it, "I trust more to Rush than to Conover..., he will come forth as gold from a furnace."(55)

Rush's sister died at 3 p.m. on Tuesday, October 1. Within a half hour Rush left the house to visit patients. He did not have time to see her buried. His black servants saw to it. "According as a sense of duty, or as grief has predominated in my mind," Rush wrote a few months later, "I have approved, and disapproved, of this act ever since." At last a death affected, deeply affected him. In his account of the epidemic Rush wrote "From this time I declined in health and strength. All motion became painful to me. My appetite began to fail. My night sweats continued. My short and imperfect sleep was disturbed by distressing or frightful dreams. The scenes of them were derived altogether from sick rooms and grave-yards. I concealed my sorrows as much as possible from my patients; but when alone, the retrospect of what was past, and the prospect of what was before me, the termination of which was invisible, often filled my soul with the most poignant anguish. I wept frequently when retired from the public eye...."(56)

Such was his devotion to duty that he cheated himself of the release of mourning. But if he was indeed breaking down, he concealed it well. Rush completed the week with eclat. On Wednesday he reported that he could walk up stairs without resting and without aid of the banister. On Thursday the 3rd he "paid between 40 and 50 visits." That evening he still had strength enough to finish the long letter to the New York doctor explaining the triumph of his remedies.(57)

Go to Chapter 8

1. Rush 1793 p 339.

2. Butterfield pp 674 & 684.

3. Butterfield p 675; Rush Notebook Sept. 21, 1793.

4. Butterfield p 683.

5. NY Diary Oct. 5, 1793.

6. Tappert pp 169-70.

7. Powell p 187.

8. Minutes p 43.

9. Allen p 4.

10. Welsh papers Sept. 27, 1793, HSP.

11. Butterfield pp 666, 670, 681; Rush Notebook undated.

12. Ibid. pp 227-8.

13. Rush 1793 PP 354-5.

14. Rush Notebook Sept. 21, 1793.

15. Butterfield pp 676, 679, 690.

16. Gen. Adv. Sept 23, 1793.

17. Helmuth, pp 42, 44, 45.

18. Yearly Meeting Epistle 1793, Swarthmore; for personal expression of this attitude see Morris to daughter Aug. 31, 1793, Haverford.

19. Butterfield p 679.

20. Butterfield p 684.

21. Powel to Rush, undated, Rush Papers, vol. 36.

22. Rush Notebook Sept. 25, 1793; Butterfield p 686.

23. Butterfield p 685.

24. Butterfield p 689.

25. Butterfield p 686.

26. MHS Colls., 5th series, III (1877) pp 334-6; Butterfield pp 701. 702, 706.

27. Minutes p 40.

28. Annan to Rush, undated, Rush Papers.

29. Fed. Gaz. Oct. 5, 1793.

30. Welsh papers Oct. 15, 1793, HSP.

31. Minutes p 66.

32. Diary of Peter Sequin.

33. Gen. Adv. Sept. 26, 1793. Fed. Gaz. Sept. 28, 1793.

34. Butterfield p 683.

35. Butterfield p 701; Michael Pernick, in a 1971 article, suggested that the medical disputes that raged in Philadelphia during the epidemic were caused by political differences. Hamilton, the Federalist leader, endorsed the cure of Dr. Stevens in opposition to Rush's cure. Republicans rallied behind Rush. So that just as there was a contrasting Federalist and Republican views of politics, so there was a Federalist and a Republican cure. This is a happy analysis of the problem since it at least assures us that those dying, to the extent they were conscious at all, had a sense of having had doctors treat them as well as possible as far as political scruples allowed. Of course, Pernick's analysis is nonsensical. This epidemic allows of no happy analysis, no slant on things that distances the plight of people then from us simply because they were so quaint as to suborn medicine to partisan politics. Even in that highly politicized era, such thoughts in the darkest days of the epidemic were strange. The editor Benjamin Franklin Bache who was notorious for tarring every issue with the muck of politics had just closed his newspaper and left the city later explaining that printing the disputes of the physicians was "very injurious," and no one had any taste for politics. See Pernick and Gen. Adv. Nov. 23, 1793.

36. Butterfield P 701.

37. Rush 1793 p 349.

38. Powell p 200.

39. King (1) pp 147-150.

40. Fed. Gaz. Sept. 24, 1793.

41. Butterfield p 687.

42. C. Haines to cousin, Sept. 23 & 29, 1793, Wyck Papers, APS.

43. Connelly to Rush, Rush Papers.

44. Pickering to Clark, Oct. 1, 1793, MHS; Pickering to Rush, undated and Oct. 4 & 8, 1793, Rush Papers.

45. Morris to sister, Oct. 13, 1793; Morris to son, Oct. 15, 1793; B. Smith to D. Smith, Oct. 4,5,7 & 9, 1793; & D. Smith to B. Smith, Oct. 5, 1793, Haverford.

46. "Proposal" Phil. Gaz. Dec. 29, 1797; "A Solemn Warning # ," Phil. Gaz. Nov. 1802.

47. MHS Coll. III (1877) p 335.

48. Currie 1794 pp 40-2.

49. Carey pp 34-55.

50. Knox to Washington, Sept. 18 & 24, 1793, LC.

51. NY Minutes, NYHS; Powell pp 223-4.

52. Graham to Wolcott, Sept. 14. 1793, CHS, & ad in Fed. Gaz. Sept. 26, 1793, & obit. in Ibid. Oct. 23, 1793.

53. Butterfield p 665.

54. Butterfield pp 694-699.

55. Smith to Cogswell Oct. 12, 1793, Yale.

56. Butterfield p 690; Rush 1793 pp 349-50.

57. Butterfield pp 693, 701.