Destroying Angel: Benjamin Rush,
Yellow Fever and the Birth of Modern Medicine
by Bob Arnebeck
It might be objected that Rush's floundering for even more depleting remedies only flattered his sense of making progress in elucidating the laws of medicine because by the law of averages some of his patients had to survive and thus add another anecdote to his statistically incompetent defense of his antidotes. Surely this was the time for him to recognize the impotence of his therapeutics even as he strained to affect the suffering patient as much as the disease itself did. Here dogma, it would seem, defeated any honest evaluation of patients and the success of his practice.
In the 1830s when the assault on purging and bleeding in fevers began among America's academically trained physicians, a most telling point in the eyes of 20th century historians was made by Jacob Bigelow of Massachusetts in an address "on self-limiting diseases." He argued that in many diseases nothing the physician did could affect the outcome and that the affects observed after purging and bleeding were merely changes in the symptoms of the disease not any result of therapy.(1) If physicians had recognized that during the epidemic of 1798, a generation or two might have been saved from mercury and the lancet.
But physicians, even Rush, did have a sense of diseases that cured themselves. In his account of the 1798 epidemic Rush contrasted his successful depleting regimen with the mild salts and warm baths used by some French physicians. His remedies worked; theirs "succeeded only in such cases as would probably have cured themselves."(2) Rush had no basis to turn his back on the advances he had made in the fight against yellow fever. To begin with, equivocal results in fighting deadly epidemics were to be expected. Sydenham taught that no two epidemics are the same and that remedies successful during one might fail in the next. That said, other physicians continued to be impressed with the effectiveness of Rush's depleting therapy. Finally the aftermath of the deadly epidemic was not the time for doctors to suggest that they were worse than the disease. The nation needed a dose of hope. To suggest that it might be wise to let nature take its course would have seemed, given the fear at the time, tantamount to giving the nation a death sentence.
No better symbol of the terror of the epidemic was the Philadelphia health committee's inability to replicate the cool confidence of 1793. Throughout August it had only recommended the evacuation of a few squares south of Walnut Street. But on September 1 it called for the general evacuation of the city. It pleaded for the wealthy citizens to raise money to support encampments for the poor on the west bank of the Schuylkill. Public resources were inadequate. "We call your attention to the actual and undisguised state of our city. Consider the mortality and rapid increase of the sick at so early a period. View the list of your physicians, and mark how few are at their posts; and we believe you will think, with us, that the preservation of health is only to be attained by flight.... (T)he lives of hundreds, perhaps of thousands, may be preserved, by the adoption of these or similar measures."(3)
At the same time reports came in of fever spreading in Boston,(4) New London,(5) Portsmouth,(6) New York, Chester,(7) and Wilmington.(8) These alarms were not rumors. Unlike in 1794, no one wished yellow fever on any city to prove a theory or revenge a quarantine. In New York the rumors tended to make the situation seem better than it really was. The epidemic was repeatedly "confined" and then a few days later appeared in a new neighborhood.(9)
New Yorkers clung to every healthy block as evidence that it did not have as bad an epidemic as its rival port. By avoiding docks and wharves,(10) or staying between Trinity Church and the upper part of the Battery one could feel safe.(11) Through out September the health committee dealt with local nuisances like sewers and bad smells emanating from cellars. But the death toll inexorably rose.(12)
The sine qua non of terror was quickly achieved. In a letter written September 17 Charles Brockton Brown who had just seen two friends, one of them Elihu Smith, die of the fever tried to describe how bad it was in New York, how much worse than Philadelphia. A greater proportion of the population died and "the victims to this disease have been in innumerable cases selected from the highest and most respectable class of inhabitants."(13)
Philadelphia however was worse off. The newspapers that spread the stories of the city's crisis were decimated by the epidemic. Fifty-one men in the printing trade got the fever. The two leaders of the partisan press died; Bache of the Aurora on September 11, and John Fenno, Sr., of the Gazette of the United States on the 16th. Fenno's wife died on the 6th. No one made any issue of the medical treatment Bache and Fenno received. Republican though he was, Bache did not take Rush's cure. A French doctor gave him baths and gentle medicines. Perhaps taking a lesson from that, when Bache's assistant William Duane got the fever he took 212 grains of mercury and though his "gums [were] inflamed, teeth loose and [his] face swelled," he survived to marry Bache's widow and carry on the Republican traditions of the Aurora.(14) The most affecting token of Philadelphia's despair was the death of Mayor Hillary Baker, who had stayed to relieve the distress of those who remained in the city.(15)
There was no escaping this fever. Even a rich family like the Drinkers could only find cramped quarters in Germantown. Beyond a thin partition, a Frenchman vomited through the night.(16) Country air did not prove a universal tonic. The most puzzling death near Philadelphia was that of two prominent young socialites, Lucy Breck and Eliza Wescott. They both died in the Breck summer house north of the city. They had been outside the city for many days and had no intercourse with anyone from the city.
Senator Pierce Butler became obsessed with their deaths. On October 14 he wrote to Rush asking "What gave to these young women the fever?" Butler hazarded an answer. The soil around the house was "cold clay, some of it low and moist." That alone may have felled the delicate women. "May there not have been some miasmatic exhalations engendering intermittents; and which from the relaxed state of those ladies frame, for such they assuredly were, from some predisposing cause in the surrounding atmosphere may have given to a common intermittent the type of the epidemic." If that were the case, one had to do more than just flee the city to escape the fever. Rush's answer to Butler's letter has not been found.(17)
Demoralization was general. In a September 20 letter to his brother, William Russell, a Boston merchant, contemplated "the dreadful calamity with which this country is now visited in each of the commercial cities to a degree beyond all former precedents. Distressing and alarming as it has been upon former occasions it is far more so upon this and the direful consequences have attained an excess which has spread alarm through the whole continent."(18)
Alice Cogswell who was recovering from a cancer operation in Princeton might have been expected to ignore the epidemics in light of her own troubles. But the epidemic served as a metaphor for her own insecurity: "What sad havoc does this pestilential fever make with the inhabitants of this world, wives torn from their husbands, husbands torn from their wives, and in some instances whole families swept to eternity without one relict left to mourn their loss. It is enough to make ones heart weep drops of blood, or rather streams, my soul turns with horror from this scene of wretchedness and misery to the world beyond the grave where there is no more sorrow or grief. It is the god of heaven that thus desolates the world and he has just reason for it...."(19)
Dr. Alexander Anderson volunteered to be the physician at Bellevue Hospital during the epidemic. When he arrived there were 20 patients, four of whom died on his first day. When a colleague, Dr. Chickering, took the fever, he was amused and joked that when he recovered he would "practice without fear." Then Dr. Chickering died and Anderson's brother was sick.
Faced with his own brother in a dangerous condition, Anderson lost his confidence in Rush's remedies. He conferred with Dr. Bayley about a better way to treat patients, but the older doctor seemed "at a loss." As his brother got worse, his father became ill. His brother died on the 8th. As his father got sicker, Anderson sought out Dr. Dingley for consultation. Anderson had bled him twice, and was disappointed when Dingley only prescribed "innocent things." (Dingley died a few days later.) Anderson saw to it that his father got calomel. On the 10th his father was so ill that Anderson had to resign from Bellevue to spend all his time with him and when able "practic'd among the neighbors many of whom are taken ill."
His father died on September 12. Then his wife died within the week. His mother died on the morning of the 21st, "delirious all night and suffer(ing) much pain." Anderson served patients until the epidemic ended, then took a sea voyage, returned and devoted the remaining years of his long life to wood engraving. He wrote in his memoirs fifty years later, "the succession of calamities" he experienced in 1798 "seemed rather too severe."(20)
In this sea of despair, life lines came from two principal sources. Religious conviction saved many, but medical science seemed more to the point. One bled the extra pint, took the extra dose of calomel, craved salivation, and in desperation experimented. One has to be careful when invidiously comparing the solace provided by religion to the heroism of medical science. However in the epidemic of 1798 there is an objective measure provided by the experience of the city's Quakers.
Since 1793 many of them had played a dangerous game, and the religious society as a whole concluded that epidemics were best met by simply going about one's business with circumspection and trusting in God's protection. The Quakers convened their Yearly Meeting in the midst of the epidemic in 1793, in 1797 and again in 1798. There were protests. The wife of one delegate ridiculed the decision to meet as an attempt to make Philadelphia the new Jerusalem.(21) An anonymous handbill was circulated in the city: "REFLECT BEFORE IT IS TOO LATE.... WHY DO YOU PREFER FAMINE, SICKNESS AND DEATH TO HEALTH AND PLENTY? It is not too late to remove BEFORE IT IS TOO LATE."(22) But the majority of the sect's leadership felt that by postponing or relocating they second guessed God. Indeed by petitioning from the site of the epidemic they increased their moral authority.
Warner Mifflin, a representative of a Delaware meeting, covered a petition for the emancipation of the slaves with a letter to President Adams noting, "the awful judgments (as I believe of an offended God,) now displayed conspicuously over this city thru the grievous mortality suffered on its inhabitants.... I say awful for so it has felt to me a little like taking my life in my hand to come hither singly to endeavor in my small measure to promote the cause of righteousness in the earth."(23)
Not a few Quakers stayed in the city to be tested by God. After she recovered from the fever Jane Snowden wrote to the Quaker spiritual leader Rebecca Jones with a full sense of her own spiritual growth. She explained that at the beginning of the epidemic she had wanted to flee, but couldn't. She compared it to being in prison. She was "bound in a place of deep suffering." She assured Jones that the freedom of her friends outside the city gave her strength. She was not at all critical. But her survival was empowering and she was ready to testify: "If the people should refuse his repeated visitations and continue to rebel against the holy one of Israel who could marvel if another vial of the Lord's indignation should be poured forth on the inhabitants of this land."(24)
Joseph Scattergood and his mother Sarah felt no bitterness when they saw most of their friends leave, but they "could not find strength to leave" themselves. Joseph appreciated the testing. "Altho' death is daily set before mine eyes," he rhymed in his journal, "Yet sinful thoughts now frequently arise." Only Joseph's fourteen year old sister Mary, characterized by a visiting English Quaker as "volatile but improving," wanted to leave. All three of them got the fever, Mary died. Joseph recovered first and prided himself on walking to meeting when, "There was not a person to be seen in the street and as I passed along my own footsteps sounded solemnly in my ears." When his mother recovered, the testing was over. They left the city to join friends in Burlington where "the Gospel trumpet was sounded."(25)
The growing death toll of members soon forced the society to rethink its position. The harmony so prized at Quaker meetings could not be achieved. After going through business for several hours, it was decided to adjourn until December 10.(26) Over the next month, "many" who attended the meeting got the fever. The last of eight "valients" to die of it was Warner Mifflin. The Quakers did not hide their sacrifices. On October 3 the Philadelphia Gazette printed the names of the 111 Friends buried in the Quaker burying ground in July, August and September. When they met in December the Quakers decided to henceforth hold their annual meeting in the spring.(27)
In retrospect it was a pathetic confrontation. Immediately after Walter Reed proved the agency of the aedes aegypti mosquito in spreading yellow fever, the habits of the insect were intensely observed and tested. It showed a predilection for black and blue cloth, just the colors worn by Quakers in the 1790s.(28)
But while science had the last laugh on the sect, its stand in the 1790s formed a principal challenge to medicine. In writing about their ordeal Joseph never mentioned a doctor; Sarah mentioned that there was a doctor, but not his name. While noting the services of the nurses and the visits of Quaker ministers, no one who wrote about their suffering mentioned what medicine they may have taken.
One frequent visitor to the Scattergoods was Edward Garrigues, a Quaker carpenter and president of the committee appointed by the health committee to visit the poor. He kept a diary and it's clear that he had lost all confidence in medicine. In '93 he had taken Rush's cure.(29) In August 1798, Garrigues's wife got sick but recovered by the next day. Garrigues wrote that he was sure she didn't have the fever because "none really affected therewith recover." In staying and helping the poor, Garrigues hoped to reduce their suffering and achieve for himself a "sweet solacing peace," so that "the Master's presence was eminently manifested to the humbling of many minds." There was no compulsion, as there was among Committee members and ministers in '93, to distribute calomel to the sick. Garrigues celebrated, not cures, but that "we of this city are in nearly equal jeopardy with the Israelites of old."(30) Like the Scattergoods, he never mentioned a doctor.
One was in their midst. The heroism of Rush in 1793 was replicated by a Quaker doctor in 1798. Like Garrigues and Scattergood, Samuel Griffitts left a diary. In it the success of science clearly manifests itself as much as the mercy of the Lord. What encouraged Griffitts was the success of Rush's remedies. He marveled at how sure a guide the pulse was in managing the bleeding of patients. He became convinced of the efficacy of salivation and thought mercury the key weapon against the scourge.(31)
Others did also. In mid-September a week old report from two Boston doctors, John Warren and Isaac Rand, was printed in the Philadelphia Gazette. They credited Rush's remedies for subduing the epidemic there. Bleeding followed by purging with calomel, and the use of mercury to induce salivation had cured 49 out of 50 patients. There was no timidity in the use of calomel. One patient got 230 grains over three days. The bulk of the doctors' communication described autopsies of victims who came to them too late to get calomel. Excessive amounts of blood and bile throughout the cadavers supported the need for venesection and purging. The doctors graciously credited "the learned Dr. Rush of Philadelphia" for emphasizing the importance of salivation.(32)
At first New York doctors exuded confidence. Dr. David Hosack showed that "lime-water mixed with an equal quantity of new milk" had cured three cases in which black vomiting had begun.(33) Several articles appeared in New York papers attesting to the virtues of alkaline medicines and lime as a disinfectant. "LIME has subdued the poisonous vapor issuing from the sewer of Burling-slip...," boasted a September 7 article. "LIME WATER, soda and pearl ash are capable of restraining the black vomit."(34)
Of course these remedies did not fit readily into Rush's depleting system, but Elihu Smith managed to do it. He shared with Rush his excitement over alkalies which invariably relieved victims of "all commotions of the alimentary canal." But his confidence in Rush's depleting remedies in combination with alkalies had not diminished. He thought that the alkalies aided the cure by "partially decomposing the calomel and thus diminishing the tendency of this latter medicine to irritate the stomach."(35)
By end of the second week of September, Smith himself had the fever. In his case the new alkaline treatment did not work. Nothing could "compose his stomach." Most of the time he was in a stupor, but when revived he could answer questions rationally. Smith pressed upon his colleagues, Mitchill and Miller, the importance of inducing salivation. Heroic measures failed Smith. Because of his vomiting, calomel would not stay in his system. Mercury rubs failed to bring the hoped for soreness and saliva. He revived enough mid-day on the 19th to see that his vomit was black, "pronounced the word 'decomposition' and died."(36)
The letters of one family reveal the inclination to go to extremes. William Robinson got the fever and was treated by Hosack's method, a purge followed by sweating. The treatment left Robinson with "a lax and uneasiness in the bowels." Robinson's family then called in a doctor who got the bile out of his system with constant "gentle" purges. Robinson's wife was sure "that nothing will give effectual relief in that disorder but a continued discharge of bile." Robinson himself thought that Hosack had him on the road to recovery. Over a month after his illness he confessed to being weak. "...my stomach, bowels and head are not yet right." The family's position is understandable. With so many dying, how could they stint on medicine.(37)
The extreme level of medication, especially self medication, became evident to William Currie who worked at a hospital set up at one of the camps where 2,000 poor people sought refuge from the epidemic. In private practice Currie had success with bleeding and salivation in August. With patients in the camp he learned the limits of mercury. "The incautious and too copious employment of mercury," he wrote on October 22, "has in several instances been followed by the most deplorable effects. In some cases it has occasioned not only the loss of teeth, but of part of the jaw bone. In some, a rigid contraction of the lower jaw - a gangrene of, and consequent loss of part of one of the cheeks -the tonsils and palate - loss of speech, &c."(38) In his writing on the epidemic he would become, briefly at least, an advocate of Hosack's approach, before returning once again to bleeding and purging.(39)
The therapy achieved new heights of popularity just at the moment Rush began discovering its limitations, and when the rising death tolls - 3500 and 1500 in Philadelphia and New York respectively,(40) might have suggested that it was useless. We can explain why it thrived without insulting the modern understanding of its limitations and danger. As important as how a therapy saved lives was how it controlled the patients. Failure of therapy, which was common at the time in virtually all dangerous diseases, did not necessarily negate the benefits of medicine.
Yellow fever was simply not a disease to be borne successfully by religiously or philosophically inspired resignation to fate. There is a major genre of literature, now largely forgotten, on Christian dying. Using true life examples the books tried to show how one was to properly prepare oneself through devotional literature and Biblically inspired testimony.(41) In not a few cases of yellow fever the patient could not sit still, could not keep clothes on, could not behave with any decorum. Religion did not subdue the patient. Bleeding and purging did.
Given the severity of the epidemics, even if there had been no Rush, bleeding and purging would have flourished. Doctors are always scapegoats, and it is easy to find contemporary quotes making the connection between bad medicine, bad doctors and their bad theories. But that misses the point. In the late 18th century bad diseases made desperate patients take drastic remedies. There was nothing new in that. What was new was the attempt of doctors to better inform the process in an organized, publicized effort to control the disease. It is easy to ridicule the succession of claims: shake the gall bladder, LIME WATER, salivation.... But each claim was a result of research, i.e. observation informed by theory, given in what was really a new language of scientific progress. Morbid anatomy inspired Rush's new approach; modern chemical discoveries inspired the promoter of lime water, Samuel Mitchill; salivation was more mysterious, hence its appropriation in Philadelphia by a quack, but doctors like Elihu Smith were busy working on a theory by beginning to investigate other chemicals that induced salivation.(42)
Every epidemic inspired more doctors to search for cures. The death of his good friend Rep. Jonathan Coit prompted Elisha Perkins to put aside his electric points, so well geared to mine the lode of patients with chronic complaints, and work on fevers. Perkins' defection from electricity is significant. He gave up the charming mysterious toy of the Enlightenment savant to join colleagues across the nation in dealing with an increasingly deadly reality of American life. He gave up being America's only electric points man to join one of the first crusades of modern medical science.(43)
Even as dispirited as he was at the end of the epidemic, Rush continued his crusade. In his medical lectures immediately following the epidemic, his old confidence returned. Not that he concealed challenges to his ideas. He admitted that in some case bark and laudanum were successful. But "after the 20th of September, copious bleeding, in many instances, supplied the place of emetics, and produced, when properly used, a safe and easy termination of the disease."(44)
He argued that most died from want of physicians, not because of them. An opinion had become current and popular, he explained, that the disease was aggravated by harsh remedies, and that it was to be cured by the operation of nature, aided by the most simple medicines. "To the influence of this opinion must be ascribed, in part, its greater mortality than in former years." The efforts of doctors were not judged fairly. The deaths of untreated patients or those given "lenient medicine" were not blamed on physicians.(45) Rush insisted that if patients got the right remedy at the right time, and were not hounded by people casting doubts on its effectiveness, more people would have lived. Many died "who had fever lightly and could have been cured."
"Medicine is a more certain and perfect science than is commonly supposed," he concluded, and bucked himself and his students up with prophecy. "The seed of improvement and certainty in medicine, which are now sown, and seem to perish, shall revive at a future day, and appear in a large increase, in the health, and lives of our fellow creatures."(46)
Rush felt that his principles and practices survived the epidemic. He did have sense enough to mute the bravado of the revolutionary. Perhaps because, as he spoke in early December, the frustrations of his fellow citizens boiled over.
Go to Chapter 16
1. Rothstein p 178
2. Rush 1815 vol. 4 p 50.
3. Phil. Gaz. Sept. 1, 1798, also Currie 1799 and Condie.
4. Phil. Gaz. Aug. 31, 1798.
5. Phil. Gaz. Sept. 15, 1798.
6. Phil. Gaz. Sept. 24, 1798.
7. Currie 1799 p 86.
8. Phil. Gaz. Oct. 12, 1798.
9. C.B. Brown to brother Aug. 25, 1798, Dunlap. Rodgers to Morse Aug. 25, 1798, NYPL.
10. Miller to Eliot, Oct. 3, 1798, MHS.
11. Troop to Livingstone Sept. 20, 1798, Haverford.
12. Bayley (2) pp 80ff.
13. Dunlap p .
14. Tagg p 396; Duane to Coxe Sept. 28, 1798, HSP.
15. Phil. Gaz. Sept. 26, 1798.
16. Drinker diary Sept. 4, 1798.
17. Butler to Rush Oct. 14, 1798, Rush Papers.
18. Wm. Russell to brother Sept. 20, 1798, HSP.
19. Cogswell to Mason Cogswell Sept. 8, 1798, CHS.
20. Anderson Diary Sept.-Dec. 1798, NYHS; Burr p .
21. Mary Morton to Thomas Robinson Sept. 22, 1798, Haverford,
22. Currie 1799 p 87.
23. Mifflin to Adams Sept. 24, 1798, MHS, actually it was not sent until 1801, see Churchmen to Adams Jan. 17, 1801.
24. Snowden to Jones Sept. 28, 1798, Haverford.
25. Scattergood diary Aug. 18 & Sept. 23, 1798, Sarah Scattergood to Thomas Scattergood Sept. 27, 1798, & Smith to T. Scattergood Sept. 30, 1798, Haverford.
26. Minutes of Yearly Meeting, Swarthmore.
27. Snowden to Jones, op. cit.; Epistles of Yearly Meeting Dec. 15, 1798, Swarthmore; Sarah to Thomas Scattergood Nov. 6, 1798, Haverford.
28. Theobald, vol. 3 p 142.
29. Rush Accounts 1793.
30. Garrigues diary Aug. 18, 21, Sept. 9. 1798.
31. Griffitt's diary Sept. 6, 17, 18, 19, & 22, 1798.
32. Phil. Gaz. Sept. 14, 1798.
33. Currie 1800 p 109.
34. Comm. Adv. Sept. 7, 1798.
35. Smith to Rush Sept. 10, 1798, Rush Papers.
36. Dunlap Diary pp 335-45 & Mitchill to Webster Sept. 17, 1798 in Stokes.
37. A. Robinson to M. Morton Oct. 17, 1798, & Wm. Robinson to M. M. Oct. 1798, Robinson Papers.
38. Currie 1799.
39. Currie 1800 p 79 & Currie 1811 pp 75-6, 84.
40. Condie p 108; Hardie p 14.
41. Arnebeck (2) pp 65-78.
42. Cronin p 380.
43. Miller pp 41-57.
44. Rush 1977 p 67.
45. Ibid. pp 68 & 69.
46. Ibid. p 85.