Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Thirteen

From the modern perspective, by the end of the 1797 epidemic, the absurdity of Rush's quest to revolutionize medicine had been thoroughly exposed. Bleeding had failed in a celebrated case. Other prominent doctors blamed it for Dr. Way's death. Public opinion against it was organized by Cobbett, the most effective propagandist then working in the new nation.(1) Rush responded with vindictiveness and a lawsuit evidently designed to stop public inquiry into a public danger. Rush made clear his wish to retire from practice at least in Philadelphia. Yet, Rush's revolution continued.

What ever his personal failings and flailing, Rush's science remained the best defense against an increasingly sickly environment. Given that threat, his critics were simply not credible. Dr. Currie offered the same therapy as Rush, but with an old theory not as empowering as Rush's incisive simplifications. To contemporaries Cobbett's intent was not to open inquiry into medical practices but to close one avenue of research. Writing in the late 19th century the political historian Henry Adams set the modern tone for framing the event: "if ever medical practice deserved to be libeled," surely it was bleeding.(2) As we shall see the suit became a way for Rush's contemporaries to use the legal system to protect scientific research from uninformed prejudice. (Thanks to delaying tactics by Cobbett's lawyers, the case was not heard until December 1799.)(3)

Dazzled by the paragons buoyed into our remembrance by all the political froth of the period, we are prone to forget how demoralizing the political arena became to contemporaries less concerned about the rhetorical expressions of freedom than merely surviving. One of the bright young men of the era caught the mood. Let "the love of science, & passion for its application to rural & civil purposes,... displace & succeed that ardor for party contention & debate which now continually poisons our national tranquility."(4) For Elihu Smith and a growing number of American intellectuals, Rush, the political pamphleteer of '76 turned medical researcher, personified the process.

The prospect of Rush's coming to New York which Dr. Rodgers revealed to his colleagues, inspired in some of them visions of the doctor making a triumphal entry along with many of his Philadelphia students. It would mark "an era in the medical history of the United States," Elihu Smith thought, and explained to Rush that his work had awakened "a spirit of research & observation, of discussion & industry, far beyond every thing before known in the United States & which promises to conduct us rapidly to the goal of truth, & summit of medical improvement."(5)

Admittedly Rush remained a symbol of another sort to the older generation. Judging from the cranky regard President John Adams had for his old friend, it is evident that the luster of the old political Rush added no shine to the new scientific Rush. In November President Adams appointed Rush treasurer of the Mint, a sinecure that Rush eagerly accepted because the economic depression had lessened his fees.(6) At the same time Adams had to be coaxed and cajoled by his cabinet to even enter Philadelphia and open the next session of Congress. He was never more sure that infection lurked everywhere. When told that Rush thought it was safe, Adams recalled how his old friend used to connive to get Philadelphia made the federal capital and doubted that he would ever say anything to hurt the city.(7)

Meanwhile Alexander Hamilton, a trustee of Columbia college, engineered a postponement of any decision on Rush's appointment to the medical school there. Rush reacted promptly by withdrawing his name. He explained to Dr. Rodgers that he thought in New York he could "live in peace with everybody," since most there understood the domestic origin of the yellow fever, which Rush thought was "the principal source of hostility," to him. Rush was not unhappy with the turn of events. It was "peculiarly gratifying," that his old political enemy Hamilton had blocked his appointment.(8)

As much as he believed partisan politics influenced his critics, he resisted the temptation offered by his critics to make bleeding, purging and local origin the Republican medicine. Not that he was becoming circumspect. He was eager to fight for his principles and practices. But he waged war at the medical school.

Judging from the notes of one student, he gave his lectures with gusto: "In an inflammatory disease, provided the pulse continued to call for the lancet, I would go on bleeding till I got nothing but pure water out of his veins. You have no alternative gentlemen. Your patient will die without it and you should at least give him a chance." As the ancient Roman Celsus said "a doubtful remedy is better than none." He didn't ignore his critics. Noting that other doctors ridiculed him for bleeding patients "till they were as pale as Jersey veal," he welcomed the insult, promising to "bleed my patient till they do become pale." "I would sooner die with my lancet in my hand," he rallied, and promised that with early treatment with mercury and bleeding, "I doubt not but it will be so rare for a man to die of a fever, as it is now to die of a toothache."(9)

It would seem that with the fever gone, so, once again, were Rush's doubts. But his published account of the epidemic reveals new, and, even in the light of modern medicine, significant thinking about yellow fever. The pro-bleeding bravado of his lectures was missing in his essay. He seemed to be trying to appeal to doctors like John Warren in Boston, who had raved about mercury in fighting the 1796 epidemic there, but were cool to bleeding.(10)

"Considering the great prejudices against blood-letting, I have wished to combat this fever with mercury alone," Rush confessed, "But... I have been afraid to trust to it without the assistance of the lancet. The character of the fever, moreover, like that which the poet has ascribed to Achilles, is of 'so swift, irritable, inexorable, and cruel' a nature, that it would be unsafe to rely exclusively upon a medicine which is not only of less efficacy than bleeding, but often slow and uncertain in its operation, more especially upon the throat and mouth."(11)

Rush at last recognized the bad side effects of mercury. He also noted that initiating bleeding after the first day of a fever was dangerous, and could lead to death. He attributed that to the peculiar violence of the fever which "when left to itself for two or three days, fills and suffocates the viscera with such an immense mass of blood, as to leave a quantity in the vessels so small, as to barely keep up the actions of life."(12) He recognized what in the late 20th century is deemed one of the key symptoms of yellow fever, dangerously low blood pressure. Several other doctors had opined that bleeding was fatal in yellow fever. Rush was the first to try to explain why.

The glory of Rush, to contemporaries, was that he tried to explain why. He deserves credit for not being so doctrinaire, so self righteous, as historians peg him. He made these observations while his work was under public attack, when falsification would have been easy. Recognizing that scientific achievement, perhaps we can forgive him his characteristic inspirational bombast that he included in his account. He sounded the heroic refrain, listing five doctors who bled over 100 ounces from patients. The old equation held, "the quantity of blood drawn in this fever was always proportioned to its violence," and few diseases were more violent.(13) As in other years he blamed his opponents for defeating his efforts: "...from the fears and prejudices that were excited against bleeding and mercury by means of the newspapers, the success of those remedies was much less than in the years 1793 and 1794."(14) He claimed that doctors who bled lost one in ten, those who didn't lost many more.(15)

In conclusion Rush listed 13 "signs of moderate danger," and 25 "signs of great danger" in yellow fever patients. But the dogmatic assurances of his earlier works that the fever could be controlled was absent. He concluded by observing that he had seen some with unfavorable symptoms live, and some with favorable symptoms die. "The words of Morellus, therefore, which he has applied to the plague, are equally true when applied to yellow fever. 'In the plague, our senses deceive us. Reason deceives us. The aphorisms of Hippocrates deceive us.'" The lesson was to never give up, "to dispute every inch of ground with death."(16)

Progress in the use of bleeding in other conditions also encouraged him to believe that despite some equivocal results during the epidemic, his fundamental ideas were sound. He found evidence that bleeding could prevent the formation of kidney stones, prevent miscarriages, and cure many of the ills of old age.(17) Rush could also cite the advances of others. In the Medical Repository, the new medical journal, Elihu Smith reported on his successful use of mercury, especially mercurial frictions, to cure mania. Edward Miller, a co-founder of the magazine, described cases showing that calomel was good for children and abstinence made mercury's work easier.(18)

Finally away from the emotions of the epidemic and the controversy over his bleeding and his character, it became apparent to many that Rush's therapies seemed to have passed the test the epidemic gave them. The city was not devastated. Estimates of the death toll varied from 1000 to 1100 dead, mostly in the poorer suburbs.(19) There seemed ample evidence that the major cause of mortality was not Rush's remedies but delays in seeking medical aid. Dr. Michael Leib, one of the five visiting physicians, explained to the health committee that he wasn't called to some victims until the 7th day of their fever, so "this awful malady is nurtured and transmitted from one to another; for when a patient is little less than a living cadaver, we must cease to be surprised at the continuance of the disorder under so impure an atmosphere."(20)

Admittedly, by modern standards, the uncritical enthusiasm Rush and his allies had for any apparent gains made over clinical symptoms was less than scientific. The creation of a scientific standard, especially in the provincial American setting, was a daunting task. The overly optimistic projection of the possible fruits of scientific research was a necessary first step. The public at large seemed to understand as they remained at once incredulous and tolerant, doubting Rush's claims and trusting his practices.

The Drinker family religiously read Cobbett. When they returned to the city in late October 1797, Henry Drinker's kidney condition flared up. He still summoned Rush, who recommended his losing 6 to 8 ounces of blood and taking "juniper berry tea sweetened with honey." The Drinkers sent for the bleeder.(21) Elizabeth Drinker, an inveterate reader of medical works including Rush's, never expressed any sympathy for his theories, but moderate bleeding didn't clash with her own ideas. To the patient the ultimate point of Rush's new ideas was the relieving cut in the arm which had been a dominant therapy for centuries. But Elizabeth Drinker still used Kuhn as her personal physician.(22)

The greater frustration, especially with the epidemic over, was not a cure but prevention. While medical students were thrilled with Rush's defense of bleeding, what society looked to science for was an explanation of yellow fever's cause and spread. That was an issue that Rush seemed to have lost his way on. Unlike in 1793, he did not gain credit for first identifying the epidemic. Currie had and that seemed a credit to his science. As the epidemic wound down in October he did not lose that advantage.

In a series of letters he argued that it was impossible for a contagious fever to arise from vegetable putrefaction. He thought the yellow fever "propagated by contagion," from infected people or clothing "conveyed a short distance from its source, through the medium of the air, and received into a sound body by the lungs, stomach, and perhaps the pores of the skin." Currie reviewed epidemics in the United States from 1699 to 1795 and traced all to imported contagion. He noted that during the present season the streets and wharves "were remarkably clean" and the atmosphere "frequently refreshed with heavy rains." He ridiculed Rush's rotting coffee theory or blaming rotten vegetables in the hold of one ship for starting the 1797 epidemic. The city might as well be deserted "so long as a vegetable is suffered to rot in our streets, or a vessel with bilge water is permitted to enter our ports." To prove importation, he quoted several British doctors, including Colin Chisholm's recent book which traced epidemic yellow fever in 1793 from Boullam, an island off West Africa, coming by ship to Grenada in the West Indies and from there to Philadelphia.(23)

As he had done in 1793 Governor Mifflin asked the College of Physicians and Benjamin Rush what caused the epidemic and what could be done to prevent a recurrence. Currie dominated the proceedings of the College. In combating Currie's opinions during the epidemic, Rush had relied on a cadre of ex-students and other young doctors primarily attracted to him by his therapies. They had helped amass evidence in support of his theories and fought for them in the press. To recognize their efforts and to add prestige to his answer to the governor, Rush formed a group of thirteen physicians into the Academy of Medicine of Philadelphia.(24)

This was in no way an impartial investigating committee. They all supported Rush. In reply to the governor the Academy even deduced the local origin of the fever from the efficacy of Rush's remedies. Through the use of depleting remedies, yellow fevers were often changed into more manageable remittents. Therefore the yellow fever was the common bilious fever made worse by local conditions.

Of course the primary argument against importation was that cases of yellow fever occurred before the arrival of allegedly offensive ships. All those cases importationists did tie to the docks were caused by ships from Europe, not the West Indies, with rotting vegetable matter and putrefying coffee on board. Thus instead of longer quarantines, during the summer months ships with cargo liable to putrefaction should be required to unload away from the city, and all ships should be required to have ventilators.

Of course the Academy's emphasis was on local filth. In effect it wanted the urban environment under the complete control of physicians. It told the governor that the "streets, gutters, cellars, gardens, yards, stores, vaults, ponds, &c" should be freed of all matter liable to putrefy in the heat of the summer months. A committee of physicians should inspect such areas. Until water could be brought from the Schuylkill to wash the streets, water from the pumps must be used. In conclusion the Academy pointed to the example of the Hollanders whose habits of "extraordinary cleanliness" had been imposed by the need to rid their cities of pestilential fevers.(25)

In its answer to the governor, the College of Physicians blamed the Arethusa for starting the epidemic that spread from Penn Street into Southwark, and the ship Hind that came to the city directly from Port au Prince for infecting Kensington. The College called for stricter enforcement of quarantines, including mandatory quarantine during the summer months for all ships from the Mediterranean, West Indies, South America and Africa. Yet the College did not neglect recommending cleaning the city and bringing in fresh water to flush the streets.(26)

Then began the war of affidavits. The Academy produced sworn testimony to show that the last yellow fever case aboard the Arethusa occurred over 40 days before the ship reached Philadelphia. The College replied in kind. The Academy tried to impress on the community that this was no frivolous disputation. In a public letter to the governor it warned that to blame the Arethusa and Hind was "replete with danger to the lives of our fellow citizens and to the prosperity of our city."(27) Learning from the their allies in New York, Rushites realized that describing yellow fever as local, controllable condition rather than a importable, highly contagious disease was more useful economically to the city.

The governor saw a happy congruence in the reports of the two medical societies. The reforms proposed by those who believed the disease imported and those who believed it of local origin were "perfectly consistent with each other," and "most efficacious when employed together." He recommended that measures be taken to both strengthen quarantines and clean the city.(28)

In turn the legislature enacted laws requiring mandatory quarantines for vessels from southern ports, with violators getting up to a year in prison.(29) Verbatim records of the legislature's debates were not taken. But obviously legislators genuinely feared imported contagion. And so did their constituents, even the merchants. That quarantines were easy to impose, made all feel safer. Keeping the city clean was more problematical, as it entailed telling citizens, not foreign sailors, what to do.

The political solution was not to tell citizens to clean like the Dutch, but to hitch the city's future to a public works project that promised health. Well before the onslaught of epidemics, city leaders had discussed the improvements necessary to ensure the growth of the city. Benjamin Franklin thought enough of the need for a municipal water system that he wrote a codicil to his will shifting money he had left for making the Schuylkill River navigable to piping pure water into the city from Wissahickon Creek.

Since 1793 frequent mention had been made of the benefits to be derived from flushing the streets with water during the sickly season. In its 1797-98 session the legislature recommended that "pure water" be brought into the city. However, since the legislature, and the city government, did not combine the "pure water" proposal with any comprehensive plans to enforce cleanliness in the meantime, it is likely the real impetus for the interest in the project was to breath life in to the bankrupt Delaware-Schuylkill Canal Company.(30)

The relatively low death toll among the city's elite made it easy for the public to dismiss the alarms of the doctors of both camps. There was no public pressure on the legislature to take any draconian steps to save the city from another epidemic. One Quaker diarist thought that if everyone had only listened to the "voice within," they would have stayed and all survived.(31) A socialite returned and soon became skeptical of the so-called epidemic since no one she knew or knew of died.(32) Blaming the victims was also popular. The store keeper Joseph Anthony thought the only danger was "in the wretched and filthy dens at the lower part of town, among the intemperate and abandoned class."(33)

Significant as Rush's efforts to take a comprehensive view of the implications of the epidemics were, he made little impression on the public at large. Even well-informed citizens looked askance at the doctors, principally because their rivalry made their opinions suspect. After recovering from the loss of his wife in the epidemic, Rev. Nicholas Collin proposed the formation of "a society for investigating the causes of the late mortality in Philadelphia." He wanted people not involved in the doctors' disputes or official political response to the epidemics to collect and evaluate the evidence. He argued that physicians embroiled in controversy could not be trusted to present all the facts. There were newspaper notices summoning Collin's society to meet, but it's not known how active it became.(34) Evidently as affecting as the epidemic had been to Collin personally, it did not move many of his fellow citizens to short circuit the doctors' controversy with independent action. That would have to wait until the next epidemic.

The city's reaction to the epidemic from Collin's doubts to the legislatures equivocations left Rush frustrated. In April he sent Noah Webster the Academy of Medicine's proof of the local origin of the late epidemic. "It cannot be refuted, but will not produce in our city such an effect as to clear a single gutter of its filth," Rush fumed and warned, "I fear nothing but another visitation by the yellow fever will cure us of our infidelity upon this interesting subject."(35)

Since both sides of the etiological argument were partly right, it might be wished that Rush had shown more open mindedness in considering the evidence amassed by Currie. That he didn't see the need to defuse controversy and foster open inquiry like Collin's can be blamed on his stubborn regard for his theories like the doctrine of the unity of fevers. In a medical treatise on bilious fevers published in early 1798, Currie challenged Rush on that very issue. He reminded him that in his history of the 1780 bilious fever epidemic, he said bilious fevers were never contagious. Currie agreed with that and argued that because yellow fever was contagious it had to be a distinct fever.

Currie also quoted an attack on Rush published in Ireland that ridiculed the idea that putrefying vegetable matter could cause malignant fever. Indeed if Rush was right, Currie argued the market people would get it every summer. Yellow fever had to have come to the city by contagion: "If we go down to the meadows and marshes on the flats of the Delaware and the Schuylkill, and look for it among the diseases, which exhalations engender, it is not there. Imagination, and her whimsical daughter, Theory, have created something in those places, which they have called its likeness; but the Sallow Imp of the marshes, is the offspring of different parents, and differs essentially in its character from the jaundice-eyed fiend, which extends its destructive sway by contagion."(36)

Unfortunately just as he got to the crux of the matter, Currie was as prone as Rush and his followers to turn up the rhetoric, and to use it against an easy target. In reply to Currie's October letters on the epidemic's cause, Noah Webster in New York had written a series of 25 letters published in his Commercial Advertiser. He sought to destroy the idea of specific contagion by arguing that the "epidemic constitution of the atmosphere" associated with various gross terrestrial and celestial phenomena might determine when diseases sparked by vegetable putrefaction would spread and become epidemic.(37) In his book, Currie used Webster's expansive use of the epidemic constitution, which now included volcanoes, earthquakes and comets as causes of epidemics, to impugn Rush's more discreet recourse to it.

Currie ridiculed the very practice of theory making. To believe Rush and Webster required "that credulity which never reflects; and to ascribe the difference in the effects of the same cause, to a revolution in the atmosphere, is a doctrine too unphilosophical and visionary to be embraced by any but visionary people; especially, as no experiments have been made to prove that any such revolution in the atmosphere has taken place."(38)

This indeed is a telling point. In retrospect we might wish that Rushites had been less avid in collecting evidence and had tried to create contagion in a laboratory. But the evidence seemed so obvious. Webster pointed out that New York had been exempt from epidemic fevers for the last two years because of efforts to clean-up sinks of putrefaction.(39)

In the Medical Repository Elihu Smith showed how the 480 BC plague in Athens was probably yellow fever and of local origin.(40) He also attacked the British doctor Chisholm whose book tracing the so-called Boullam fever from Africa to Grenada was often quoted by those believing in importation. Smith told a compelling story of how Chisholm conspired with slave holding planters to tar the attempt to grow cotton with free labor on an African island by blaming the deadly contagious fever on that.(41)

The Medical Repository, true to its charter, began to amass reports on local fevers that invariably supported Rush. The local doctor proved the Newburyport fever of 1796 was not imported.(42) A report from the Baltimore health committee at first glance seemed against the Rushite position since it was published to counteract the "exaggeration, slander and falsehood" spread by one of Rush's former apprentices. But it also showed how the exigencies of combating the spread of the epidemic forced the committee to forget about importation and try to promote cleanliness.(43)

Valentine Seaman analyzed New York's minor epidemics in 1796 and 1797 complete with maps showing the residence of each fever victim. With his maps Seaman showed the proximity of deaths to sinks of filth and garbage. Indeed the people themselves in East George Street approximated a mass of putrefaction. One cellar "contained fourteen persons, men, women., and children, black and white, all huddled together...." Yet Seaman's epidemiological approach did lead him to the wharves and the fact that first cases came from or had close contact with incoming ships. He concluded that in many cases unhealthy conditions on ships did provide "an enlivening spark from abroad" which set off the epidemics. The lesson Seaman drew was that in Philadelphia where the fiction of importation was insisted upon to flatter the city another devastating epidemic occurred. In New York, where doctors taught citizens the necessity of cleanliness, sparks from abroad were not allowed to start a conflagration, a repetition of the deadly epidemic of 1795 was avoided.(44)

And, of course, Currie and the importationists had no experimental evidence. They tried to trace cases and root arguments in data, but offered no proof. Currie rewrote his history of the early days of the 1793 epidemic, showing how it spread from sailors.(45) The obvious rejoinder was: Rush was the first to recognize the epidemic. Weren't his observations at the time more valid than self-serving remembrances four years later?

Even after espousing his theories, Rush remained a close observer of all phenomena surrounding the epidemics. He was not like Webster looking for far away earthquakes. He began his account of the 1797 epidemic by describing the epidemic constitution of the atmosphere in his usual particular way, quoting meteorological observations, noting an epidemic among cats and that "moschetoes were more numerous during the prevalence of the fever than in 1793," as well as "an unusual number of ants and cock-roaches."(46) The disease attacked "more persons three days before and three days after the full and change of the moon, and of more deaths occurring at those periods than any other time."(47) He included his own long list of "vegetable and animal matters" which "in a state of putrefaction" were capable of producing "bilious, remitting and malignant fevers." He went well beyond the general "marsh exhalations" listing cabbages, potatoes, peppers, Indian meal, onions, mint, anise seed, cotton, hemp, flax straw, coffee, etc.(48)

He also included a short essay entitled "An Account of Sporadic Cases of Bilious Yellow Fever in Philadelphia in the Years 1795 and 1796," which was little more than a synopsis of the diseases and weather during those years. "This detail of facts," Rush explained, "apparently uninteresting to the reader in our present state of knowledge of epidemics, may possibly lead to principles at a future day."(49)

Currie's attacks on Rush's theory-making are appealing to modern ears, but to many contemporaries, especially young doctors, they seemed to close avenues of investigation, and destroy reasons for hope. Rush encouraged Webster's foray into medical theory. He noted that Sydenham had believed the same idea and called the exhalations from the earth "a mineral vapor."(50) In his essay on the '97 epidemic Rush mentioned Webster's discoveries and hoped that "men of genius and observation may perhaps discover hereafter a connection between certain phenomena in the heavens of another kind, and a morbid constitution of the atmosphere." He then quoted at length from an article about a halo around the sun.(51) "Go on - go on with your inquiries," Rush wrote to Webster, "Cause physicians to blush, and instruct mankind to throw off their allegiance to them. Posterity will do you justice. The man who produces truth upon the origin of pestilential fevers, and persuades the world to conform to it, will deserve more of the human race than all the heroes, or statesmen that ever lived."

To be more respectful of Currie's arguments or even to accept importation would not have required Rush to repudiate his unitary theory. He had argued that contagiousness varied with the intensity of a fever. It was just that the import of Currie's arguments left him and many younger doctors cold. A Frenchman who had first settled in Connecticut came to Philadelphia to practice. His inspiration was not Currie and quarantines, but Rush and the future of medicine.

Dr. Felix Pascalis-Ouviere contributed a memoir of the '97 epidemic in which he lauded Rush for never ceasing "to warn his fellow citizens" about local sources of miasmata. He welcomed Rush's "enlightened judgment, that... from sudden changes and the extremes of the climate, and from the grossness and indigestive quality of their aliments,... that infectious miasmata could aggravate the bilious remittent, and convert it into a malignant and contagious fever." Currie was not mentioned in the book. Rush was hailed for his contributions "to the discovery of truth, and the improvement of medical practice."(52)

It was not theory per se that deluded Rush and others, but the convergence of so many symptomatically similar fevers at that time, and with, one might add, similar etiologies. To imply that but for trade with the West Indies, North America would be the land of health as advertised in the promotional literature, became out of fashion. Currie failed because he did not have a new theory for new problems. He sought to recapture the certainties of the 18th century medical world. Yellow fever did not cooperate.

Go to Chapter 14

1. Butterfield p 1213.

2. H. Adams, p 82.

3. Phil. Gaz. Dec. 19, 1798; Butterfield p 1210.

4. Cronin p 299.

5. Cronin p 387.

6. Rush would later blame Cobbett's and Fenno's attacks exclusively for ruining his practice, but from letters at the time it is clear he was suffering, like so many who provided services, from lack of payment due to the economic crisis. See Butterfield pp 796-7 & 975.

7. Adams to Pickering Oct. 14, 1797, MHS; Adams to Wolcott Oct. 12, 1797, CHS.

8. Butterfield pp 794-5. It bears noting that Hamilton thought the epidemic of 1795 was of local origin, see Syrett, Sept. 20, 1795.

9. Rush lecture 1798 pp 10,11, 16, 68, 69, 159, LC.

10. Phil. Gaz. Dec. 29, 1796 & MR # 1 p 136.

11. Rush 1815 vol. 4 p 25.

12. Ibid. p 20.

13. Ibid. p 22.

14. Ibid. p 31.

15. Ibid. p 31.

16. Ibid. pp 32-35.

17. Rush Lecture 1798, op. cit.

18. MR vol. 2, # 1, pp 58, 181.

19. Rush 1815 vol. 4, p 18.

20. Leib to Health Committee Sept. 25, 1797, Girard Papers.

21. Drinker Diary Nov. 14, 1797.

22. Ibid.

23. Gaz. of U. S. Oct. 5, 7 & 12, 1797.

24. Butterfield p 797.

25. Academy 1798 pp 1-13.

26. Ibid. pp 14-18.

27. Ibid. pp 23-49.

28. Phil. Gaz. Dec. 9, 1797.

29. Phil. Gaz. Feb. 15, 1798.

30. Blake pp 10ff.

31. Scattergood diary pp 84-7.

32. Bordley to Daurigard & De la Roche, both Nov. 29, 1797, HSP.

33. Anthony to , Oct. 1797, HSP.

34. Phil. Gaz. Dec. 29, 1797.

35. Ford p 461.

36. Currie 1798 pp 24, 37, 43, 191-206, 227.

37. Spector pp 61ff, 73.

38. Currie 1798 p 227.

39. Spector p 101.

40. MR vol. 1 #1 p 3.

41. MR vol. 1 #4 pp 478ff.

42. MR vol. 1 #4.

43. MR vol 1 #3 p 395.

44. MR vol 1 #3 pp 315ff.

45. Currie 1798 p 212.

46. Rush 1815 vol 4 p 8.

47. Ibid p 17.

48. Rush 1798 p 100.

49. Rush 1815 vol 3 p 241.

50. Ford p 459.

51. Rush 1798 p 9.

52. Pascal pp 15, 16, 51.