Destroying Angel: Benjamin Rush,

Yellow Fever and the Birth of Modern Medicine

by Bob Arnebeck

Chapter Sixteen

In previous epidemics the return to the city had in large measure in itself reassured people. Not this year. "In going back (although my family and immediate connections have all escaped,) I can hardly describe to you my sensations," Comptroller of the Treasury John Steele wrote. "It is literally going not to a house of mourning; but to a whole city in the state of the deepest sorrow and distress."(1) Joseph Scattergood and his mother returned to the city in a small sloop crowded with seventy other people. "Oh what a trying place Philadelphia has become to live in," she sighed.(2)

"The city wears to me a gloomy aspect," Mrs. Samuel Otis wrote to Abigail Adams. "and the mourners go about the street in great abundance. Those who have stayed through the sickness tell me they would never do it again."(3) Mrs. Adams was shocked to learn that four of the domestics who had served her died of the fever, as well as Joseph Anthony, the grocer who had been the chief supplier of the wants of the first family.(4) Despite the international crisis, in his State of the Union message, President Adams made the epidemics the first order of business, and called on Congress to consider regulations to help the states enforce their health laws.(5)

Religious leaders found a receptive audience. One tract blamed the "awful dispensation" on "pride, idleness, intemperance, profaneness, covetousness, injustice, sabbath-breaking, neglect of education, bad books and mockery."(6) The Society for the Suppression of Vice and Immorality petitioned the legislature once again for reforms, claiming "the Most High GOD has 'a controversy' with the inhabitants of our land and city."(7) Every pulpit and meeting house rang with such language.

But the city's leaders put no faith in prayers and legislating morals. Early in the epidemic, from their refuges in the country, civic leaders resolved to see that the devastation never occurred again. "Alas what will become of our city and our citizens?" the lawyer Jared Ingersoll wrote. "Is this to be an annual misfortune? Shall we next winter be busy devising ways and means to prevent a return of the calamity, or as heretofore forget. I am full of anxiety on this subject."(8)

A general meeting of citizens was held on November 23 to discuss what could be done.(9) Action was begun on three fronts: organization of a house by house inspection to purify, clean, or destroy suspected sources of infection; petitioning for a national quarantine of ships from the West Indies; and a new municipal water system.

Faith in science was paramount. In general terms it was a victory for Rush who had been preaching the need for comprehensive, rational reforms for years. But at the same time Rush's leadership was rejected. This year citizens acted before the doctors, in answer to the usual query from the governor, made their usual reports on the cause of the epidemic and suggested public health measures. It could be argued that by acting before the doctors' reported, the citizens showed their bias against what passed for science. But their actions really show their weariness with controversy and quest for the certainty they had hoped science would give them. By calling for action so quickly they also short circuited the usual political process of governor's address, followed by legislative committee action, and then amendments to the health laws brokered between urban and rural legislators.

The most impressive show of new resolve by the ad hoc citizens' committee was the campaign to clean houses. Admittedly this was upper class vigilantism, but it was scientifically informed. Even Samuel Mitchill, who believed he was hot on the trail of the specific gas which caused fever, and who was a Republican politician often the advocate for "the industrious poor," used the poor as scapegoats. After seeing his colleague Elihu Smith die, he raged in a letter to Noah Webster: "the inhabitants have really poisoned their city by the accumulation of excrement, putrid provisions and every unclean thing," plus their "gross animal diet" and intemperance. "If some of our citizens breathed air as pure and balmy as the breezes of Eden, they would engender this sickness by their way of life. They would breed it within them. To get the better of these visitations will therefore require more than municipal regulations. An alteration, and a considerable one too, of housekeeping and modes of life will be necessary."(10)

During the epidemic in Philadelphia civic leaders had not lost the opportunity to reform the poor. In the camps organized for refugees the watchword was discipline. Rules were posted and enforced by armed guards. There were schools, churches and doctors on the premises. Able bodied men were employed digging a canal. At one refuge people were housed in wooden buildings erected along a grid pattern of streets. The camp housed 2,000 people. The discipline there was especially lauded. Liquor was banned; people had to wash their "body clothes" and air out their bedding three times a week; food was withheld from those caught breaking those or other rules; repeat offenders were expelled; people in the camp had to get permission to leave; the whole place was surrounded by sentinels.(11)

After the epidemic the citizens' committee bullied political bodies into continuing the disciplining of the poor. The health committee initially looked askance at the idea of house by house inspections, but the citizens' committee raised a crew of 150 volunteer inspectors and gave the health committee no basis upon which to say no. The volunteers inspected "several hundred" houses by the end of February sending beds, bedding and clothes of people who had had the fever to the City Hospital to be "fumigated and purified" or destroyed.(12) They also kept an eye out for sources of putrefaction even among the well-to-do. For example the committee ordered out houses cleaned. Elizabeth Drinker was proud that the Drinker "necessary," cleaned for the first time in 44 years, was "so little disagreeable." She attributed that to the cold weather and the lime she put down it three times "when the fever raged."(13)

Rush did not react to this on-going campaign against the poor. He did not think the poor spread disease. Poor living conditions caused disease. Rush, however, was always inclined to support measures to reform his fellow men, and he let this mis-application of science pass without comment.

Privately at least, he did carp at the committee's other mis-application. It whipped up an irresistible demand for "pure water" and the City Council quickly authorized a committee to present a plan. The "watering committee" commissioned a report from Benjamin Latrobe, an engineer trained in England who after studying with England's foremost canal builder came to America in 1796. Latrobe worked quickly and proposed a plan to pump river and spring water to the city using steam engines. A sluice from the Schuylkill would bring water into the city which would be pumped into a center city basin and then distributed in wooden pipes along streets where each house could hook up to the system.(14)

Rush's reaction to Latrobe's plan was curious. Latrobe justified the scheme by using some of Rush's ideas to explain why a disease supposedly spread in the air could be checked by clean water. Philadelphia's well water, which very few Philadelphians actually drank, gave off a mephitic vapor adding to the epidemic constitution of the atmosphere.(15) In Rush's publications and those of the Academy, the use of streams of water to flush the streets and cool and refresh the air had long been advocated. In its most recent report to the governor, the Academy hailed water from the Schuylkill brought to the city to wash the streets as "a measure which we conceive promises to our citizens the most durable exemption from bilious fevers of all kinds, of domestic origin."(16)

Privately Rush separated himself from such enthusiasm. "The streams of water which are to be drawn through our city," he explained to Noah Webster, "will act but partially in preventing the return of our autumnal fevers. Southwark and the Northern Liberties will derive no benefit from them and they include nearly one half our inhabitants. No measures have been taken to prevent the accumulation of the filth in our docks which the streams of water will wash into them. We say in medicine that a knowledge of the cause and seat of a disease should precede the use of remedies for its cure. This rule has not been applied in the case of our annual calamity. Everything that is doing is empirical. It is palliative and partial, and may probably invite a return of the disease."(17)

His engineering solution was to remake the city with airy lots and deep sewers. Many others thought along the same lines. Jefferson and others thought a city with every other square vacant would invite enough circulation of air to make it healthy.(18) Secretary of State Pickering thought a new kind of wharf that maximized the cleansing potential of the tides could prevent the build up of dock side filth.(19) Samuel Mitchill decided calcerous stone rich in pestilence killing alkalis should be used to build docks, houses and streets. The government should require the new City of Washington to be built and paved with it. But none of these ideas sparked much interest.(20)

What probably soured Rush on Latrobe's plan was the excitement it generated. Many began to think the very survival of the city depended on it.(21) Rush thought it was just one of many needed reforms. However, hemmed in by his previous support for the general idea, he did not make his concerns public.

He needed to devote all his rhetorical skills to defeating quarantines which he considered the most pernicious aspect of the citizens' committee's plan. This year instead of being threatened by anonymous letters to modify his etiology to protect the city, as he was in 1793, Rush found himself writing anonymous newspaper paragraphs attacking this heterodox lay solution to a complex medical issue.

The committee's arguments melded politics with science into a common sense approach to the crisis. Quarantines need not continue forever, crippling the lucrative trade with the West Indies. Yellow fever had never appeared in the United States "but while war has raged" there. With peace the quarantines could end.(22)

There was too much at stake for doctors of both camps to accept such a naive moralistic view of the relationship between war and epidemics. Soon the great hope placed in science was thwarted by the continuing controversy over the fever's etiology. The day after the citizens' committee announced its program, "Impartial" posed a series of questions in Brown's Gazette: why did the fever only strike in July and August; why didn't Great Britain which had much more trade with the West Indies ever have an epidemic; why should the present war in the West Indies engender the disease when longer wars there hadn't; why did the fever end with frost which affected the air but not the supposed sources of contagion like bedding and clothing; where did inland cases of yellow fever come from; and why did New York, New London and Boston all agree that domestic filth generated the disease?(23)

When the medical societies did make their reports, the major bone of contention was whether the Deborah brought the fever to the city. The Academy of Medicine cited eight cases of the disease, some away from the waterfront, before the Deborah docked. The College of Physicians printed affidavits from the Deborah's crew about fellow crew members who had died of yellow fever in Haiti and on the voyage home. There were affidavits attesting that sick men from the Deborah were brought up to the city before the ship was quarantined and people who housed them got the fever. A group of boys who rowed out to the ship from Chester also took the fever, some dying. The college also noted that 26 other ships had come from sickly ports during June and July. Finally the disease differed from any that commonly appeared in the United States.

Within a month the Academy challenged every point. It matched the College's affidavits with their own proving that all the sick people on the Deborah went to the marine hospital away from the city where the fever spread. As for the boys in Chester, the man who was the college's source for the story double checked. Telling one of the survivors that "this affair was of too serious a nature to be trifled with," he found that none of the boys was ever on the Deborah. As for the disease not being like any other, the academy used morbid anatomy to prove Rush's unity of fevers. Over one hundred autopsies by members of the Academy showed that the organs affected by yellow fever were the same organs affected by the common bilious fever.(24)

In January Rush consulted with Physick on a patient who died of yellow fever who had said on his death bed that he "derived his sickness from smelling the foul air of his cellar." That inspired Rush, writing anonymously as "A Friend Of Philadelphia," to try again to convince his fellow citizens. He congratulated both the Academy and College for their reports. Both deserved the city's esteem. However, struck with several facts, he was forced to admit "that the yellow fever originated wholly from the foul air of ships and other sources of putrefaction among ourselves." The writer briefly listed the Academy's arguments and then moved on to discuss popular fears. Admitting that the fever arose from local causes would not ruin the city. London had thrived after the plague. The city should imitate New York where there was agreement on local causes and efforts to correct them.(25)

Rush did get support from New York. The call for a national quarantine was rejected there. The common council, bolstered by a report on the epidemic from a committee formed by the college of physicians, board of health, city corporation and chamber of commerce, claimed to have "unequivocal evidence" that putrid provisions made wet in an August 14 storm and flood, "did produce" the disease.(26) Rushites in New York simply ignored early evidence that the fever came from a West Indian ship.

The first victims, stricken at the end of July and early August, blamed the schooner Fox which arrived in late July from Jeremie, the same port the Deborah had come from. Doctors, however, did not take the accusation seriously. The area where the fever was centered, Coenties wharf, had been the site of a small epidemic in 1797. The health committee had pressed the common council to enforce a clean up there. That the fever returned to that very filthy spot seemed a proof of the local origin of the disease. Ships from the West Indies docked up and down the long waterfront, yet the fever returned to Coenties wharf. The fever did not spread until the water damage to the stores.(27)

An editorial, probably written by Webster, celebrated New York's lack of quarantines. By keeping ships loaded in the harbor Philadelphia only increased the likelihood of putrefaction on the ships which would make it unhealthy and dangerous to the community. New York's regulations were "more safe for the city, and less troublesome to the merchant; while we freely receive all fugitives from infected places, afford them all possible aid, and suffer no inconvenience from such acts of humanity."(28)

"A Philadelphian" wrote to Claypoole's Gazette on February 1 warning that if Pennsylvania made laws to combat "imaginary contagion" on ships, "New York will run away with our trade in the warm months." Instead Philadelphia should keep its streets, alleys and docks clean, make ships use ventilators and unload cargo below the city during warm months.

Yet after all of the arguments of the Rushites, with a minimum of debate and no partisan bickering, Congress passed a law requiring federal authorities to cooperate with state quarantines and authorizing the president to build quarantine stations away from ports, as well as warehouses where goods could be unloaded.(29) Rush's reaction to the federal law is not known.

The new quarantine law passed by the state legislature disheartened him. It increased the mandatory quarantine for ships from the tropics to 15 days. In addition numerous categories of goods had to be unloaded and purified at the Marine Hospital. Goods thought incapable of harboring contagion could then be loaded on lighters and brought up to the city.(30) Rush was amused to hear that in the Senate debate on the bill, one member insisted that "the yellow fever may be imported in a hogshead of sugar."(31)

Rush felt that he had completely failed. "The fever of 1798 has not produced a single convert to the true idea of its origins," he wrote to Noah Webster on February 20. "Our citizens admit that foul air gives activity to imported contagion, but they deny its origin from domestic putrefaction. The cooperation of the atmosphere in producing epidemics has been treated with ridicule. Currie is now the oracle of our city upon the subject of yellow fever."

Once again the old paranoia poured out in his private letters. He conjured that political opponents were about to deal with him as they would some seditious Jacobin or French incendiary: "The prejudices against the truth upon this subject are as strong as ever. Currie in a late publication has attempted to prove the assertion of the domestic origin of the yellow fever to be equal to treason, and has advised that the authors of it should 'No longer be tolerated.' Cobbett, after accusing our climate for two years for generating the yellow fever, now conforms so far to the current opinion of its foreign origin as to abuse me publicly for denying it. In short, some demon seems to have blinded our citizens as if to prepare the way for their future and greater suffering from that disease."(32) Nothing Currie and Cobbett wrote seemed to suggest that at all.

Actually Currie did not rise to the occasion and harness political support to increase acceptance of his theories. His model of contagion suggested a rapid spread of the fever. After the panic of the first week of August, the death toll seemed to stabilize if not drop. Surely something other than simple contagion was at work. In his account of the epidemic Currie could be particular associating the first victims with the Deborah, but in explaining why it spread, he too had to rely on the temperature and sources of putrefaction. Since he thought importation the crucial point, he did not detail variations in the environment during the epidemic.(33)

Rush did and in explaining the fever's spread almost hit on the right answer. "The weather was hot and dry in August and September," and "its influence upon the animal and vegetable life are worthy of notice.... moschetoes abounded, as usual in sickly seasons." Then he discussed the damage done by grasshoppers and how early the peaches ripened and added that "meteors were observed in several places."(34)

Rush failed to come up with a program of experiments that might eliminate possible causes, but so did Currie. So swept up were both sides with the rhetorical dimensions of the argument, that testing evidence seemed beside the point. In an address to the Academy of Medicine, Charles Caldwell, argued that the disease making processes of nature could not be replicated in the laboratory. Epidemics were coming with such regularity that simple observation seemed the all in all.(35)

With the rival scientific camps at loggerheads once again, the personal invective began. A scathing review of Currie's book ridiculed the author's science and prose.(36) Then "Principle" entertained the city with seven letters excoriating the doctor and his ideas, and hailing Rush as the paragon: "It is owing to his independent spirit, that the successful mode of treatment is so generally accepted; a treatment which you yourself made immense exertions to destroy, but which has finally triumphed over all opposition from the envious, and over popular clamor and party spirit."(37)

Controversy did not serve science well. The modern sensibility almost vanquished colonial gloom, but as much as it informed the citizen's efforts, science's inability to convince helped cause those efforts to falter. In petitioning the state legislature for financing, the committee was careful to separate itself from the increasingly unpopular scientific controversy. "Its cause appears to divide the opinion of physicians," explained the petitioners as they recalled the epidemic, "and its cure almost eludes the power of medicine - and of its nature we know little but bby its dreadful effects."(38)

With such lack of conviction, the reforms of 1798 soon unraveled. It became clear that the enthusiasm of the citizens of Philadelphia was largely built on the assumption that the whole state would help share the expense of purifying and making safe its major port. The state legislature refused to bankroll the water system. Citizens who "had persuaded themselves that the immediate introduction of a copious supply of pure water could alone save the city from the scourge of yellow fever," a member of the watering committee recalled, became "hostile" once it became apparent that the project had to be supported by subscriptions and taxes.(39) The lack of funds precluded any hope that water would be flowing before the next sickly season.

The state also refused to fund the debt of the health committee. Because of the extraordinary measures taken during the 1798 epidemic, spending $86,000 to relieve 11,353 needy people, the health committee was $49,000 in the red including $29,000 in unpaid bank loans. During the epidemic it had raised $38,000 in private donations and it hoped that, as in past years, the state legislature would come to the rescue. It didn't.(40)

And when the sickly season came, the upper and middle class volunteers were not there to inspect the houses of the poor. There was no one able to carry out the reforms. Yellow fever was that terrible. All who could fled.

With no new funding, chairing the health committee was not an attractive position. The shipper and political climber William Jones resigned. The man Governor Mifflin found to replace him was Edward Garrigues, the antithesis of Jones. The Quaker carpenter had never left the city during any epidemic, and, judging from his diary, he relished the Old Testament testing an epidemic afforded. The governor picked a man who could be guaranteed not to panic. The new powers of the committee would be unused, but its debt would not be increased.

While leaving the health office in late June Garrigues was seized with a severe pain in the chest. He made it home and the pain continued over night and into the next day. Finally he felt "the Everlasting Arm underneath" that consoles "far superior to the whole College of Physicians and anything the world can afford."(41) The man who two months before had been elevated to oversee the city's health as president of the newly reorganized, more powerful, health committee did not believe in medicine.

On June 18, there was "talk of a vessel below with sickness on board."(42) Then people along the waterfront began getting sick with bad fevers. Dr. Griffitts thought Penn Street should be evacuated and a vessel from Hamburgh "should have been burnt."(43) However, William Currie discovered that crew members of that ship got sick only after they arrived in port. A consensus grew among importationists that a vessel at the infected wharf, docked next to the Hamburgh ship, was the culprit. It was a prize brought in by the American Navy frigate Ganges on May 14, the day before quarantine regulations went into affect. It gave off a stench when it was cleaned on June 25. No men had been on board for weeks but their bedding had not been aired out. The prize had been in St. Domingue.(44)

The College of Physicians met and on July 1 notified the health committee that a malignant fever was in the city and that ships and people should be moved from the infected wharves and intercourse between the infected and healthy parts of the city should be cut off.(45) The health committee was not disposed to recognize that yellow fever was in the city. Garrigues wrote in his diary that all would be well "if we would center our minds on the Mountain of Rocks, as if ever we are saved it must be through his Divine Interposition."(46) Garrigues did not fear an epidemic, as "it may be a means of turning many to righteousness."(47)

He did investigate Griffitts's and Currie's claims, but he was not disposed to credit the projections of theorists. He decided there was "a lying spirit" afoot in the city.(48) The committee found two passengers from the prize who testified that there had been no sickness on the ship.(49)

On July 2, the committee replied to the college that it would not order an evacuation. To do so would incite terror which might dispose people to get the fever. An evacuation's affect on the health of the city was uncertain, but it would certainly "operate powerfully against the interest of citizens." In reply to a query from Baltimore health officials, the committee admitted that "several persons in one square of the city" had been sick, but they had had "no acquaintance or connexion with each other; each of whose indisposition can be attributed to distinct and different causes sufficient to have produced that effect; causes which would have operated similarly in every country and situation equally warm."(50) And then early July was exceptionally cool.(51)

Currie thought this was the cringing reaction of men more interested in commerce than the safety of the city. On the 11th he wrote a long letter to the committee warning that while there had only been 21 yellow fever cases and 11 deaths, in '93, '97 and '98 there had been an initial scare and then a lull in new cases. The fever had always returned later in the season causing many deaths. The pleasant weather at the moment would surely change. Like Noah Webster, Currie had also been reading about old epidemics, and cited the success authorities in Ferrera, Italy, had by removing people in any house where any one was sick to the countryside. That checked the epidemic's progress and soon other towns began imitating Ferrera.(52)

The health committee's rejection of the importationists energized Rush. He did not disagree with Currie and Griffitts that there was yellow fever in the city. He had been working with Physick at the city hospital where they had treated eight patients.(53) He had already sent his family out to his country house, with the promise that if the fever did become general, he would follow. As he put it in a July 18 letter, "the disease at present is stationary." He did not have any private patients with it and thought "there are not more than five cases of it now in the whole city. Still," he continued, "it may be epidemic. It began in the same creeping and fluctuating way in former years."

But while he agreed with Currie on the potential for an epidemic, he decided to take advantage of the health committee's public repudiation of the importationists. "The public mind" seemed ready "to receive truth" about the origin of the fever.(54)

Go to Chapter 17

1. Iredell p 538.

2. Scattergood to Scattergood Nov. 18, 1798, Haverford.

3. Otis to Adams Dec. 2, 1798, MHS.

4. Adams to J. Q. Adams, Nov. 13, 1798, MHS.

5. Richardson p 261.

6. Thaddeus Brown.

7. Phil. Gaz. Nov. 1798.

8. Ingersoll to Coxe Aug. 24, 1798, HSP.

9. Aurora Nov. 26, 1798.

10. Mitchill to Webster Sept. 17, 1798, Ford p 467.

11. Condie pp 85ff; on planned march of poor see Phil. Gaz. Nov. 5 & 8, 1798.

12. Phil. Gaz. Jan. 2, Mar. 6, 1799.

13. Drinker diary Feb. 5 & 6, Mar. 28, 1799.

14. Blake pp 25ff.

15. Latrobe p 111.

16. Academy 1798 p 11.

17. Rush to Webster, Feb. 20, 1799, NYPL.

18. Harrison to Jefferson, Carter p ; Rush 1815 vol. 4 p 135.

19. Arnebeck p 534.

20. Phil. Gaz. Nov. 13, 1798.

21. Cope pp 383-7.

22. Dec. 3, 1798, letter, Evans # ; or Comm. Adv. Jan. 22, 1799.

23. Phil. Gaz. Nov. 24, 1798.

24. Academy, 1799.

25. Rush 1815 vol. 4 p 55; Phil. Gaz. Feb. 6, 1798.

26. NY council minutes pp 494ff.

27. Hardie pp 25ff; Bayley (2) pp 91ff.

28. Comm. Adv.

29. Annals of Cong. p 2792.

30. Pa laws

31. Butterfield p 811.

32. Butterfield p 811.

33. Currie, 1799.

34. Rush 1815 vol. 4, p 45.

35. Caldwell, "Semi-Annual Oration," p 43.

36. Phi. Gaz. Feb. 23, 1799.

37. Ibid. Feb 25, 27 Mar. 18, 27, 1799.

38. Aurora Dec. , 1798.

39. Cope op. cit.

40. Amer. Daily Adv. Nov. 30, 1798.

41. Garrigues diary June 26 & 27, 1799.

42. Drinker diary June 18, 1799.

43. Ibid. June 30, 1799.

44. Currie 1800 pp 6, 11ff.

45. Phil. Gaz. July 15 & Aug. 23, 1799.

46. Garrigues diary June 28, 1799.

47. Ibid. June 29, 1799.

48. Ibid. July 3, 1799.

49. Rush July 1799 p 18.

50. Phil. Gaz. July 15, 1799, Aug. 23, 1799.

51. Rush 1815 vol. 4 p 40.

52. Currie 1800

53. Rush notebooks for July 1799.

54. Butterfield p 814.