Yellow Fever in New York City, 1791-1799

By Bob Arnebeck

a paper presented at the 26th Conference on New York State History, June 9-11, 2005, Syracuse, NY

My primary motive in writing this paper is to alert historians to the contemporary descriptions of the urban environment that arose from efforts to discover the causes of the epidemics. My paper tries to place these works in some context. Since they are not readily available, I have placed excerpts from four of them on line. Click the author to go to the link: Richard Bayley, Valentine Seaman, Elihu Smith, and A.B. Other information about these epidemics can be found on my My yellow fever web page.

The yellow fever epidemics that struck port cities between Norfolk, Virginia, and Newburyport, Massachusetts, in the 1790s are generally glossed over by historians as aberrations, as indeed they were.(1) Yellow fever is not a disease of temperate latitudes, but that was scant solace to those terrorized by the epidemics, and this now obscure tropical disease became a major medical topic of the day. In the preface to his 1855, 767 page book on yellow fever, Rene Laroche opined that in past sixty years as much was written about yellow fever as any other medical topic,(2) most of it proven wrong by modern medicine. However, in New York City especially, self-appointed researchers as well as sanctioned committees, scoured parts of the city block by block searching for the causes of the epidemics. To be sure 18th century etiology of diseases can seem bizarre to us today. Benjamin Rush, for example, published a list of over a dozen vegetables said to cause fevers when they rotted.(3) However, by taking their suggested causes seriously, we can learn how people in the 1790s related to their environment because they saw many infectious diseases, especially seasonal fevers, as a consequence of an imbalance between people, their community and nature. By trying to see a fever epidemic through their eyes, the seemingly simple "walking city" of the late 18th century is thrown into relief, from the quays to the bedrooms. However, causes could also be far reaching. In 1799 Noah Webster, then a newspaper publisher in New York City, wrote a two volume work to prove that the recent epidemics were caused in part by a volcanic eruption of Sicily's Mt. Etna in 1789.(4)

What we know today about yellow fever, a virus spread from person to person by the urban-dwelling Aedes aegyti mosquito, was not known in the 1790s. That can make sifting through the rationalizations of the 1790s akin to decoding a farce. But if we assume a position of superior knowledge, let us humble ourselves by recalling that those who battled yellow fever in the 1790s had one up on modern commentators. At a 1986 conference on the treatment of yellow fever, not one of the doctors attending had ever seen a case.(5) From the descriptions of the course of the disease in the 1790s, we know that the it often began with a sharp headache and a rapid decline to prostration, with, for some, the skin turning yellow, and, for about ten percent of the victims, death, always, it was often said, accompanied by black vomit.(6) There could be many particular agonies. On September 8, 1795, a delirious William Dewitt, a baker on Whitehall Street across from the Battery, was brought to Bellevue, which was organized by New York City as the hospital for fever victims, and nothing the doctor did could help. Early the next morning nurses found Dewitt had escaped and lay naked inside a nearby summer house. He was dying yet that afternoon had the strength to chase other patients with a club. It took three men to subdue him and push him into a little room where he died two hours later. One of the first patients brought to Bellevue, a doctor wrote in his diary, was "in a shocking condition - 10th day of the disease - vomiting blood by the mouthfuls." He died in two hours.(7) The classic picture of an epidemic, a line of prostrate bodies, a handful of harried health care workers, the periodic removal of the dead, doesn't suit yellow fever. This was a shocking disease that could make victims monsters. No symptom seemed subtle. Vomiting blood out of the mouth was the half of it. Blood could also come out of any orifice, ears, nose, uterus, pores. Hiccuping could be incessant, demonic. Needless to say treatment was problematical. In late September 1795, Elihu Hubbard Smith joined another doctor in trying to cure the apothecary Nathan Webb with bleeding and purges. Their patient suffered one of the worst side effects of venesection in yellow fever. "We were near an hour employed in attempting to stop a bleeding which took place from a vein which had been opened before," Smith wrote in his diary. "The blood was entirely destroyed in its texture; the man stupidly insane; the house deserted; a negro nurse only remaining; except a drunken relation of the landlord, who with oaths & imprecations, refused to allow our moving the sick man, from an apartment five feet wide by twelve long, into an unoccupied, airy room. We did it however - & exerted every thing in our power to restore sensibility & hope to a man, thus forlorn, & without relation or friend near him, to yield any assistance." Webb died the next day.(8)

A graduate of Yale College, and already a noted poet, Smith turned his back on literature to devote his life to medicine and try to discover the cause of the recent epidemic. "I went on to Bunker's-Hill, this morning," he wrote in his diary on October 20, 1795, "that I might survey the town, in all its parts, advantageously, and at my leisure...."(9) Smith did not climb Bunker's Hill without preconceptions. He had just read Benjamin Rush's memoir of the 1793 epidemic in Philadelphia. This was the first work published on yellow fever by an American, even though the country had a long history with the disease. Philadelphia and New York City had yellow fever epidemics in 1699 and 1702 respectively,(10) and the disease appeared again in the 1730s and 40s,(11) but after a yellow fever epidemic in Philadelphia in 1762 killed "several hundred" people, these cities and neighboring ports avoided the scourge.(12) Indeed a conviction took hold that epidemic fevers were diseases of the past in the urban centers of the progressive new nation.(13) That infatuation informed New York City's reaction to an epidemic in 1791 which killed some 100 people around Peck Slip, and which would be largely unknown to history save that a young doctor wrote his dissertation about it in 1792.(14) He described the epidemic disease as typhus, until Philadelphia was struck by yellow fever in 1793 and he realized that it had been yellow fever.(15) The 1791 epidemic was not publically mentioned until it ended. During the fall of 1791 New York newspapers reported on epidemics in Lincolnshire, England, and Constantinople, but not on their own sickness.(16) This was typical of the time. In hometown newspapers, to avoid quarantines and protect a city's reputation, so important as cities competed for business, the first word about a deadly epidemic was often the all clear.

During Philadelphia's 1793 epidemic, which killed upwards of 5,000 in the city of 50,000, the number of deaths made obfuscation impossible though not a few insisted until mid-September that the city was only experiencing a bad flu epidemic.(17) That reaction was in part to defeat the efforts of other cities, especially New York, to completely quarantine Philadelphia. In New York there were citizen patrols in every ward pledged to ferret out any refugees from Philadelphia so that the contagion of yellow fever would not be introduced. The governor's Health Committee organizing the effort thought in retrospect that such vigilance likely saved the city from tragedy.(18) The Philadelphia epidemic inspired debates that would rage in medical circles for another one hundred years: was yellow fever contagious, and was the fever imported from the West Indies or did it arise from mephitic matter in the city?(19) Benjamin Rush and others blamed a load of rotting coffee dumped on the Arch Street wharf for sparking the Philadelphia epidemic.(20) The answers to these questions were fraught with political overtones. In Philadelphia commercial interests objected to Rush's theory and insisted that yellow fever was contagious and imported from the West Indies.(21) As they learned more about the disease, doctors realized that yellow fever was less contagious through person to person contact than they originally thought, and thus dependent for its spread only on local environmental conditions.(22) There soon developed a politically acceptable middle view in this debate: the disease was not contagious and thus quarantines of infected cities were not warranted, and the disease was generated by local conditions that could be isolated and ameliorated, and thus infected cities need not be evacuated. Business could go on as usual, despite a deadly epidemic. New York City would champion this view, but only when it was itself infected. In 1794 a merchant died of yellow fever in New York, but he had just come to the city from New Haven, where there were reports of an epidemic. New York City quarantined ships and people from that neighboring port. Seventy eventually died in the New Haven epidemic(23) and 200 to 300 died in a yellow fever epidemic in Baltimore.(24)

In late July 1795 New York's port physician, Dr. Malachi Treat, got a fever immediately after inspecting the Zephyr, a ship from the West Indies that had three crew members sick with fevers. The ship's boy died the day Treat boarded the vessel, and Treat died a few days later.(25) The Health Committee was prepared, opening a fever hospital in a house called Bellevue about a mile up the East River that they had purchased in the spring. But the committee denied that there was a yellow fever epidemic. During the whole of August it encouraged a vigilant lookout for infected ships and cleaning the "streets, yards, cellars and markets" near the East River. Yet it insisted that these were wise precautions for any hot season.(26) On August 15 it reported that only 14 had died from fever the week before "in this large and populous city." In the next three days, seven more died. The committee issued its usual upbeat assessment, what apprehensions there were in the city arose from "the peculiar sensibility of the public mind, arising from the late suffering of Philadelphia, New Haven and Baltimore."(27)

Doctors cooperated with the committee. On August 15, they met, and reported to the newspapers "that no CONTAGIOUS fever, in any particular different from what this city has been accustomed to, for some years past at this season, exists at present."(28) Soon after the meeting Dr. Valentine Seaman went into the infected area of the city, and reported to the health committee that he had found "the cause of the present complaint,... a fruitful matrix generating the seeds" of the fever. The city corporation had built up Water Street in that area with landfill without requiring lot holders along the street to fill their yards to a level with the street. "Hence, the refuse water and offal substances from the families occupying these places are left to stagnate and putrefy." Seaman thought if the problem was "not properly cared for," more would die in the vicinity.(29) Members of the Health Committee investigated and ordered ditches filled and rotting cotton and coffee removed from one store. When the committee learned that 11 people had died of the fever on the 25th, it ordered more stores cleaned. In its report on August 28, the committee noted those clean-ups and re-iterated that "the disorder which exists principally, if not altogether, along a part of the Eastern shore of this city, is a local malady."(30)

On the 31st Pennsylvania Governor Mifflin ordered a quarantine for ships from New York. His action was applauded in Philadelphia. New Yorkers were dumfounded. A merchant with a store in the infected area reported that "business continues there as lively as ever: men, women, and children continually walking the streets, under no apprehension of danger."(31) One newspaper wit wrote to "A Friend in Philadelphia" that "We are all popping off here like rotten sheep. Two hundred carcasses have been burned at the Battery - 500 hanged for fear of catching yellow fever, and about 35 or 40 guillotined - all the windows in town are broken by the firing of cannon.... Pray send us about 100,000 dollars to stop the contagion, and it may compensate us in some measure for an attempt to make our vessels ride 40 days quarantine in European ports."(32)

New York's governor John Jay sent Mifflin letters from the Health Committee, medical society and common council to assure him that the city had never been healthier at that time of year. The medical society reported that the fever had never been contagious, and with cloudy, cooler weather, was fast disappearing.(33) The health committee began publishing the number of fever deaths each day, and tried to explain them away, noting that "a large proportion of the deaths hitherto reported have fallen among emigrants lately from Europe, strangers, and other transient persons."(34)

Then in mid-September the situation changed. However, the city's panic was reported in Philadelphia newspapers, not in New York. "My God! what a change.... The fever is spreading fast," exclaimed a letter dated the September 17. "Forty three persons have died with it in 3 days; agreeably to the report of the committee, and how many more God only knows. My family are gone to Long Island. I shall remain till a stop is put to business."(35) In his diary Elihu Smith noted the alarm:"Wherever you go, the Fever is the invariable & unceasing topic of conversation.... People collect in groups to talk it over, & to frighten each other into fever, or flight." Smith thought the number of people who had fled the city "cannot be less than 12 or 15,000."(36) New York editors did their best to remain upbeat. Rain, winds and cooler temperature on the 21st prompted the hope that "the city will be clear of sickness in a few days.... Broad street, Broad way, all the north of the city, and many other parts, are as healthy as usual." A doctor wrote that he had scientific proof that the epidemic would soon end. The thermometer dropped to freezing on September 21. But the health committee recorded 32, 31, and 29 deaths on the 25th, 26th and 27th.(37) The deaths continued into October. Several prominent men got the fever, but they survived.(38) The Health Committee reiterated that mostly emigrants and poor living in the low lands along the East River died. It broke down the 380 deaths it recorded in September by profession, "only 5 or 6 [were] well known and established merchants," and the committee was careful to note that the one preacher who died did not belong to a respectable denomination. (He was a Methodist.) Yet, not until October 22 could the committee announce the end of the epidemic,(39) and on November 4 the committee published a long letter congratulating itself for "undeviating veracity" which subdued the terror despite "falsehoods [that] have been propagated from the basest, meanest, and most despicable motives." The official count of fever deaths was 730, only 150 were "citizens," and "nearly one half the city has either wholly escaped, or experienced only here and there a scattered case."(40) (read the report)

Within a year, three physicians and a layman critical of their essays, published their opinions on the origins of the epidemic. Prior to the germ theory of modern medicine, most diseases were assigned four classes of causes: remote, proximate, predisposing and exciting. Remote causes were often environmental but a previous illness could be a remote cause.(41) Proximate did not refer to the neighborhood but the body. For example, Rush thought "the state of the blood vessels" was the proximate cause of fever.(42) Predisposing causes included the weather, but also race, nationality, diet and morals. Exciting causes, of course, were not bacteria or viruses, but often quite innocent mistakes, like indulging in a bite of beef when a deadly epidemic was in the air.(43) However, the remote cause of all summer and autumnal fevers was generally thought to be the heat of the season acting on poorly drained areas, be they marshes or urban puddles.(44)

In New York all three doctors focused their attention on the low ground along the East river, especially the "new made-ground" claimed from the river by Dutch methods to allow for the expansion of the port and commercial facilities. Dr. Richard Bayley estimated its extent to be about 50 acres from Whitehall to Catharine-street, "on average, four hundred feet in breadth." Bayley described the line of the streets parallel to the river and the slope of the streets running into river, finding a continuum of poorly drained land from which the fever could be generated and spread throughout the district.(45) Dr. Valentine Seaman pinpointed where the fever began and described, though unfortunately never made, a colorful map of how the fever radiated through the district so "that the low ground in the southeast of the city as above mentioned, would appear as the grand center of the calamity, diffusing its effects, like diverging rays, to the adjacent parts; aiding by its most powerful influence, different secondary centers, already smoking hot, to flame out its pestiferous operations."(46) Dr. Elihu Smith called less attention to the direction of the streets, then to how they bounded a sunken area. "Thus you will perceive," he wrote, "that the part of the city where the fever was most active, for the longest period, forms, as it were, a basin, having its side, nearest the water, a little inclined." Within this basin, there were several smaller cavities that, he wrote, seemed "contrived, by art, for the dwelling place of fever." He christened one cavity the "court-yard of the palace of death."(47)

As long as humans have been tormented by mosquito borne diseases, they have recognized that low, wet ground could be unhealthy, without, until the mid-19th century, suggesting that the mosquitoes had anything to do with it. Ironically, the doctors mentioned mosquitoes as being numerous and tormenting especially in the fever district.(48) However, describing a low wet area was not giving a cause sufficient in itself, after all just north of this area was an extensive swampy district.(49) In the urban context a few feet could make all the difference because of what could collect in small spaces. Describing Water Street from Peck-slip to New-slip, Bayley noted that in many places there was a ridge just two feet high behind houses making the "an accumulation of filth... almost a necessary consequence. Water will frequently become stagnant, and this containing animal and vegetable matters, exposed to the hot sun, must prove a fruitful source of noxious vapours. Under these circumstances, it is natural to expect that those who are exposed to the influence of such foul air, should feel its effects..."(50)

Seaman thought the lower end of Dover Street was the source of the fever and did not stint in trying to pinpoint the exact spots: "several store-houses and granaries, built partly over water with piles, without having space under them filled up." Partitions under the stores prevented "the free circulation of the tide from washing away any thing from under them," causing "the fermentation of the putrefactive materials" including "the showers of grain that frequently would pour down through holes that the rats sometimes would gnaw in the floor." There was proof enough in the mere association of these conditions. "Hence there can be no wonder," Seaman concluded, "that the seeds of this disease should ripen in such a hot bed of putrefaction, aided by the effluvia emitted from the great flats of mud in the several surrounding impaired docks, left bare during the recess of every tide. It is remarked that several persons employed in a large grain store house, thus situated over such a source of noxious miasmata, were among the first victims of the disease."(51)

Smith called attention to temporary impediments to drainage. "In all the streets where buildings were going forward, the workmen were allowed to restrain the course of the water, in the gutters, by forming little dams, for their convenience in making their mortar." Of course, building was occurring throughout the city, but Smith was able to even turn that fact into an argument for how the environment confined the epidemic. On Broadway, "one of the streets the best calculated of any in the city for free ventilation," where workers were building the new Tontine Tavern, "the stench was exceedingly offensive, and.... allowed to remain for near two months; though it was almost under the windows of the principal magistrate of the city. If this were true of the widest, and one of the best aired and cleanest streets, of New-York, what think you was the state of those narrow, crooked, flat, unpaved, muddy alleys, mentioned above?"(52)

Smith's impolitic aside suggests that these doctors were not influenced by the political imperative so apparent during the epidemic that this be considered an affliction confined to the east side of the city. The doctors' inclination not to thoroughly investigate why people outside deadly zone they described got the fever arose from the standard approach to epidemiology then. Seaman simply insisted, without pinpointing the areas, that places outside the zone where there were several cases, also had offensive puddles of filth, and where there was no evident filth, the person infected must have come too close to filthy area.(53) Bayley and Smith fell back on a tradition as old as medicine itself. When the spread of disease could not be strictly explained by person to person contact or nearby putrefaction, it was assumed that the "constitution of the air" in and surrounding the area of the epidemic could induce illness in anyone who excited his or her weakened body through over exertion or over indulgence.(54) Using his cavity metaphor, Smith described the diseased air as slowly overflowing the sunken district and suggested it may have overspread the city if all had not been purified by the frosts of October.(55) All of the doctors pointed out that the east side of the city did not receive the refreshing winds that the higher areas of the city experienced, and they noted that the layout of the quays on the east side caused eddies of putrefying material when the tide went out.(56) These investigations were so empowering that, guided by Smith, newspaper publisher Noah Webster solicited reports on diseases and environmental conditions elsewhere in the country.(57) Smith's essay was printed in a compilation of essays edited by Webster which included reports on the epidemic in New Haven and another of a bilious fever in Sheffield, Massachusetts.(58) In 1797 Smith and his colleagues began publishing the Medical Repository, a quarterly scientific magazine dedicated primarily to elucidating the environmental causes of fever in the United States.

Of course, these doctors recognized that the environment could not explain everything. Like the Health Committee they noted that the epidemic was largely confined to the city's recent emigrants. Smith speculated that the poor Irish especially "coming from a cooler country, in crowded vessels" were most predisposed to catch the fever, especially since they had to change "a vegetable, for an animal diet... and the little they have bad, and badly cooked; hard laborers and hard drinkers, fall the first and most numerous victims to disease." But even here, the environment was a powerful factor in shaping the epidemic, since the emigrants lived "in narrow and nasty streets, on the border of our worst slips and docks; in cellars; or half-underground rooms." And Smith saw this combination of powerful predisposing and remote causes as changing the very nature of the disease, making it worse since "these circumstances of themselves are enow to convert what would otherwise be only a simple remittent, to what is now denominated a malignant fever."(59) Led by Benjamin Rush, it was then the fashion to dismiss the idea that specific diseases had particular causes. Instead, a fever could evolve in one person through several states with yellow fever and plague being the most malignant, a cut above typhus and then the common intermittents or malaria.(60)

These essays, Smith's especially, seem not unlike those written a hundred years later, when social workers and muckraking journalists left their campuses and mid-town offices and descended on the city's slums. However, in actuality, Smith lived right on the outskirts of the area he so maligned, in an equally poor part of town.(61) New York City in the 1790s was very much a walking city. This idea was suggested by Sam Bass Warner in 1967 to describe cities in that day when everything one needed was within a radius of a mile. While recognizing differences in class, race, and nationality, Warner suggested the smaller compass of the city allowed for more amiable relations between disparate groups. This idea has been challenged by other scholars who have shown class antagonisms created zones where certain groups were not welcomed and did not go.(62) The yellow fever epidemic of 1795 certainly drew a line across the city which many people would not cross at least in the summer and early fall.

However, Smith's, Seaman's and Bayley's views of the epidemic were soon challenged, and in a way that helped make the city seem somewhat whole again. In the early summer of 1796 a series of seven long letters on the 1795 epidemic, signed by "A.B", were published in the New York Gazette and reprinted in the Philadelphia Gazette. Drs. Bayley, Seaman and Smith took great pains to prove that yellow fever was not brought by ships from the West Indies.(63) A.B. made the case that it was, by being even more particular than the three doctors in describing conditions along the waterfront. When the doctors catalogued the nuisances in the dozen or so affected streets, they described "dirty wooden houses" surrounded by sinks of miasma. To make his case, A.B. described a block of Water Street as having "eighty-five dwelling-houses, mostly on the north side: of those eighty-five, twenty-eight were taverns and boarding houses." A. B. did not gloss over the filth in the streets and in yards, nor the overcrowding, but instead of like Seaman describing vignettes of putrefaction, A.B. gave evidence of a close connection between the first people to get the fever and the vessels with sickened crews from the West Indies: "I was informed by a near neighbor of a woman who died of this fever, August 3, in a house nearly the opposite the foot of Dover-street, whose situation was high, open, and dry, that it was judged she caught the fever, from infection in some goods she had purchased from the sailors belonging to one of those vessels, or from their cloathing, while in her shop." There were high, airy rooms in the low part of the city where native New Yorkers died whose connection with the disease was not through filth but through contagion. However, after establishing that ships brought the "seeds" of the fever, A. B. showed street by street, how unclean and crowded conditions, allowed the fever to spread. Yet when he reached a street that had been kept clean by the efforts of the residents, he too relied on the old saw, bad air, to explain why people there got sick and died.(64) (He too mentioned mosquitoes but didn't blame them for the spreading the disease.(65))

A.B.'s more particular account of the epidemic's spread did not convince the proponents of local origin. A conclusion of their analyses was that yellow fever had been and would continue to be generated in the city whenever environmental conditions deteriorated in the late summer. So in 1796 when there were cases reported near Whitehall, a higher part of the water front, to the west of the low district, often exposed to the west winds, both Bayley and Seaman studied the disease and found evidence to support their arguments that yellow fever was, as Bayley put it, "that murderer of our own creating."(66) Indeed, Bayley boasted of virtually predicting an epidemic near Whitehall, when, in April, he observed the type of fill used for some new-made ground to extend a large dock further out into the river. In July the fever first attacked sailors on a Danish ship that had just docked, and Bayley showed that the sailors sickened after they disembarked. Neighbors complained of the stench coming from the dock fill, in which there were said to be three dead horses.(67) By order of the Common Council "a new surface of wholesome earth" was placed on the dock. Thanks to that, a series of days with strong winds and a thunderstorm with much lightning, Bayley thought the area was purified and the epidemic was nipped in the bud.(68) Seaman also studied that outbreak and also another small flare up in the summer of 1797 in George Street. In his report this time he did more than talk about a map of the epidemic. He made two maps of affected areas each covering four blocks along the waterfront. He marked the house where people died of the fever, naming the victims and where they lived. He could trace every case, but one, to putrefying animal and vegetable matter in streets or yards. That one exceptional case he could only characterize as "a mystery."(69) He opined that the disease did not spread through out the low areas of the city because good policing kept the areas much cleaner.(70) Seaman also examined ships with sickness on board and concluded it was "probable" that "an enlivening spark from abroad" started the epidemics.(71) The fact that one of his maps vividly showed how closely fever victims were clustered around where ships were docked,

perhaps prompted him to modify his former stance that incoming ships had nothing to do with the epidemic.

It is not uninteresting to step back and contrast the alarms about epidemic disease which are so prevalent today, despite modern methods of detection and vaccination, with the confidence of the mid-1790s when doctors thought deadly epidemics could be controlled simply by manipulating the environment and regulating people's behavior. Although it did not have the acres of new-made ground that New York City had, that could be blamed for engendering fevers, Philadelphia did have alleys in most city squares, many crowded with poor people in small houses, which, while they didn't divide the city neatly into healthy and sickly zones as in New York, did give doctors and city officials confidence that quick action in infected squares could prevent another epidemic like the one in 1793. In 1794, 95, and 96, Benjamin Rush cited sporadic cases of yellow fever in the city as proof of its domestic origin and urged isolating and cleaning infected areas.(72) When yellow fever struck again in 1797, the Philadelphia Board of Health and the governor announced an energetic plan of action, including roping off and evacuating infected neighborhoods and putting yellow flags on the doors of infected houses. Unlike in New York, the geography of the relatively flat city laid out on a grid did not make it easy to recognize infected area, so the city authorities would mark them. The governor ordered "camps," 20 to 30 tents set up in a common between Broad Street and the Schuylkill, well away from infected areas, to accommodate those healthy people who were evacuated. The sick were taken to a fever hospital outside the city. Twenty-four health wardens picked by the Board of Health enforced regulations and sent people to the tents and the fever hospital.(73) The general public reaction to news of a epidemic was flight. The generally accepted count was that by the end of August, 35,000 people had left the city.(74) Meanwhile, in the city the effort to treat the epidemic as an environmental phenomena that could be isolated failed. Many doctors attacked the Board of Health for precipitate action in removing patients. Unknown parties began removing the yellow flags the board placed on infected houses and tore down the barricades the board placed around infected areas.(75) The view that yellow fever was a local disease got a boost when deaths began to concentrate in Southwark and Kensington, poor areas just outside of the city, and Rush could argue that cases in the city proper "were easily traced to the above sources."(76)

The mistaken environmental view of disease, that prompted doctors and many city officials to divide cities into districts disposed to support epidemics and those that could be kept entirely exempt from them, did not serve the public well in 1798, especially in New York City. The first public reports of the return of yellow fever were in Philadelphia in late July. Although disagreeing as always on how the fever was introduced into the city, doctors all agreed that the infected area on Water Street between Walnut and Spruce should be evacuated and the city be kept scrupulously clean. The Board of Health followed the recommendations. The area evacuated was small enough, so the consternation of the year before was avoided.(77)

Then someone died on Walnut Street beyond 3rd Street, and trust in scientific control of the epidemic ended. "The fever spreads like wildfire," a resident wrote on the 8th. "It is now at the corner of 4th and Walnut Street - and the corner of 3rd and Walnut so that we cant go out of doors without danger. It is appearing in every quarter of the city."(78) Rush thought the fever spread more in one week than in three weeks in '93 and '97. There had been evacuations of affected cities during all the epidemics, to date, but for the first time, on September 1, the Philadelphia Board of Health urged residents to leave the city. Both the government and private charities organized housing for the poor in tent and wooden cabins outside the city.(79)

In New York the first victims lived near Coenties wharf. Residents blamed sick sailors on a ship just in from Haiti for spreading diseases. Doctors pointed out that ships from the West Indies docked all along the waterfront, and that Coenties wharf had a small outbreak of sickness the year before, and recommendations that the area be cleaned up were not followed.(80) Then after torrential rains on August 14 reports came in of rotting meat in cellars in Pearl Street. The Health Committee ordered the meat removed from the city.(81) On August 28 the Health Committee reported that the sickness near the wharf had ended but "unhappily" had popped up in other areas, "principally in unventilated situations."(82) The committee did not even think of recommending evacuation of the city, nor did it provide tents for people who wanted to leave the infected area. A writer privy to the thinking of the Health Committee wrote a long report for the newspapers in which he cited clusters of local cases and causes for each: new made ground, crowded buildings, offensive sewers, and/or swampy lots.(83) While thousands evacuated the city, the official view of the epidemic remained that it was local, and the letters of those who stayed in the city reflected this. 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,(84) or staying between Trinity Church and the upper part of the Battery, one could feel safe.(85) But the relentless progress of the epidemic undermined efforts to minimize its impact. When the epidemics ended with the coming of frost in late October, the official death toll in Philadelphia was 3,645(86) and in New York City 2,086.(87) There were also yellow fever epidemics in Boston, New London, Chester and Wilmington. In one private letter, based on the assumption that official tallies of the dead missed many victims, an estimate of the toll for the whole eastern seaboard was 10,000.(88)

These epidemics quite overwhelmed scientific commentators. Not a few died of the fever, including Elihu Hubbard Smith, a few days after he wrote to Benjamin Rush that since "the complaint is in great measure local, and the inhabitants of the pestilential district having mostly fled, the extension of the sickness is not greatly to be apprehended."(89) Instant histories of the epidemics in Philadelphia and New York were written by journalists;(90) a doctor's memoir of the Philadelphia epidemic was in large part a compilation of newspaper reports with few medical conclusions drawn from them.(91) There was an evident loss of confidence in the ability to pinpoint the source of disease in the urban environment. A grieving medical colleague of Smith's expanded the indictment of the poor from not just their living conditions but to their whole way of life. "If some of our citizens breathed air as pure and balmy as the breezes of Eden," Samuel Latham Mitchill wrote to Noah Webster, "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."(92) In his search for causes, Webster struck out in the other direction. Not the individual poor, but the entire world was diseased because of a change in the atmosphere arising from recent volcanic eruptions and earthquakes. This pattern was evident in history and if history was any guide, this epidemic constitution of earth's atmosphere could continue for many years.(93)

Those in charge of public policy could not engage in airy speculation, and both Philadelphia and New York continued to police areas of perceived contagion. Since Philadelphia was so flat, with generally gentle slopes to low lying areas on the river, basing policing on the terrain gave way to house by house inspections by volunteers in all wards of the city.(94) A committee with the three commissioners of health, three members of the medical society, three members of the chamber of commerce and four aldermen investigated the causes of the New York epidemic and recommended reforms. It maintained the stance taken in 1795. The sources producing the fever were "filthy sunken yards, where the offals of the house and wash of the kitchen be until the earth absorbs or the sun exhales them - lengthy sewers without floors, and of little descent - foul slips exposed to the sun great part of the tides - decaying docks out of repair - vacant water lots - ground under stores and houses built on piles or timber, and running bare part of the time - these are generally receptacles of every description of impurity and carrion."(95) What was notable as the committee amplified on these causes was that they were not described as only pertaining the 50 some acres of low ground so minutely examined after the 1795 epidemic.(96) The torrential rains on August 14 that flooded cellars rotted meat in more than just the cellars of Pearl Street. The problem had been city wide and not recognized at the time. This meant city had to police not just low areas and the houses and stores there, but cellars anywhere in the city.(97) The reforms recommended were draconian including the banning meat packing south of Corlaer's hook and not even oysters should be brought into the city between May and October.(98) The major recommendation, a system to supply "fresh water" to the city, was aimed to purify the whole city, not just what were once thought to be the usual haunts of the fever.(99) The committee recognized that one implication of the belief that the epidemic was local and able to be confined led to preventable loss of life. In preparation for future epidemics, it recommended that tents should be provided for people in infected areas who had no place else to flee.(100) During the 1798 epidemic the city set up soup kitchens in the infected areas encouraging people to stay.(101) The death toll finally was high enough, the list of victims varied enough, that New York officials realized that even with ventilated rooms, clean gutters and soup kitchens, which according to the medical science of the day should have obviated the remote and predisposing causes of the fever, an epidemic could still spread and the business of the city had to be put on hold and people moved to safety.

The reaction to the epidemic of 1798 could have been a prologue to a major change in the American way of life. The zeal for inspecting houses and the wide spread displeasure with the manner in which certain people lived were quite bipartisan. The Republican newspaper in Philadelphia, the Aurora, was one of the leaders of the movement to inspect houses.(102) Samuel Latham Mitchill who inveighed at the poor in New York was a prominent Jeffersonian politician.(103) However, while the threat of epidemics continued to terrify New York and Philadelphia, prompting widespread evacuations of the former in 1799 and 1802, the number of deaths never climbed above 500 in those years. Health authorities were pro-active. In New York, sick sailors discovered on a ship returning from Havana on June 22, 1799, were immediately taken to the Marine Hospital for quarantine on Staten Island, and the ship thoroughly cleaned with vinegar and all interior walls whitewashed.(104) Early in the epidemic the Health Committee had to battle the widespread rumor that it "smuggled" 15 to 20 fever victims out to the hospital every day "that they may die snugly." It reported that it treated 71 at that hospital and only 14 died.(105) Then in early September there was alarm at the number of vagrants roaming the streets at a time when "so many of our citizens have left our homes."(106) As usual the number of deaths increased in mid-September, sometimes as much as 12 a day. Newspapers not only reported the daily toll in New York, but Philadelphia as well. The New York Commercial Advertiser provided a rundown of the "State of Health in the United States," reporting that "New York, (in the city and suburbs) sickly, but recovering," while New Jersey was "remarkably healthy." Reports were terse, for example, "Virginia has no prevailing epidemic at present, though many die at Petersburgh of common disorder."(107) Such reports captured a national mood that historians have quite neglected. In one of his diplomatic dispatches the British ambassador to the United States, writing from Greenwich, Connecticut, in October 1799, reported that there were fewer deaths in New York which "some people ascribe... to the more general emigration of the inhabitants...," but he worried about reports that even in the countryside, "attendants of the sick are said to have been infected by the disease." "So that," he concluded, "there appears to be no perfect security in any quarter."(108)

The "local malady" of New York so confined in 1791 that it was virtually unknown even in the city, so assuredly an environmental nuisance in 1795, had spread its terror throughout the whole country irrespective of what appeared to be environmental factors. During the 1798 epidemic in Philadelphia, two young socialites moved into a house in the suburbs to escape the scourge and then to the shock of the nation both were found dead, evidently of the fever. A friend of the young ladies, a senator from South Carolina, asked Benjamin Rush how that could have happened, wondering if the soil around the seemingly safe house had too much moisture for the ladies' delicate system to bear.(109)

The best modern explanation for the waning of the epidemics is that exposure to the yellow fever virus gives lifetime immunity. As with many viruses, many infected by yellow fever do not exhibit any untoward symptoms. The pool of immune people grew. Some medical commentators recognized this immunity, while others, like Benjamin Rush, claimed to have seen multiple infections.(110) As the almost annual epidemics became smaller, medical investigators in Philadelphia tried to zero in on causes. They published lists during the 1802 epidemic with the name, residence, and circumstances of each known victim, for example: "Richard Essick's boy, in Southwark or Moyamensing, used to carry victuals to his Father, who worked at Brown's bake-house, died on July 12."(111) But this closer focus did not unlock the keys to epidemics' cause, and rather than look harder for environmental factors some like Edward Miller, an editor of the Medical Repository and once dedicated to ferreting out environmental causes of disease, simply blamed the latitude. He capitalized this passage in his Report on Yellow Fever, "WE LIVE IN THE LATITUDE OF PESTILENCE, AND OUR CLIMATE NOW PERHAPS IS ONLY BEGINNING TO DISPLAY ITS TENDENCY TO PRODUCE THIS TERRIBLE SCOURGE." Furthermore, "impurities" on the ground that had been deemed temporary and removable were now seen by Miller as "moulded" by time and poor policing. They had "been long accumulating," and temporary clean-ups were no assurance of safety.(112)

1. The 1793 epidemic in Philadelphia rated one paragraph in Stanley's and Elkins's, 754 page, The Age of Federalism: The Early American Republic, 1788-1800; see page 365

2. LaRoche, Rene. Yellow Fever, considered in its historical, pathological, etiological, and therapeutic relations, Philadelphia, 1855, p. v.

3. Rush, Benjamin, An Account of the Bilious Remitting and Intermitting Fever as it appear in Philadelphia in 1794, Philadelphia, 1796.pp. 100-101.

4. His book was: History of Epidemic and Pestilential Diseases; his assertion about Mt. Etna is in the Commercial Advertiser (New York), 23 Mar.1799

5. Monath, T. P. "Yellow Fever: A Medically Neglected Disease," in Review of Infectious Diseases, 1987, 9 (1) p. 165.

6. For the most detailed contemporary account of symptoms see Benjamin Rush, An Account of the Bilious Remitting Fever as it appeared in Philadelphia in 1793, Philadelphia 1794. (It is essential for a correct understanding of Rush's work during the epidemic to read an early edition of his work. The version reprinted by the Arno Press in 1972 was edited by Rush to conform to his post-1798 conviction that yellow fever is not contagious.)

7. Alexander Anderson diary, New-York Historical Society.

8. Cronin, James E. The Diary of Elihu Hubbard Smith, 1973, p. 69.

9. Ibid., p 75.

10. Duffy, John. Epidemics in Colonial America, Baton Rouge, 1971. p. 142, 145

11. Ibid., p. 149-59

12. Redman, John. An Account of the Yellow Fever as it Prevailed in Philadelphia in the Autumn of 1762, Philadelphia,1865; Laroque discusses the lack of precise numbers of dead, p. 62.

13. Currie, William, An Historical Account of the Climate and Diseases of the United States of America, Philadelphia, 1792, p 42,

14. Addoms, Jonas Smith, Inaugural Dissertation on the Malignant Fever which prevailed in New York in the months of August, September and October 1791, New York, 1792.

15. Rush, An Account of the Yellow Fever, 1794, pp. 85-6.

16. Dunlop's (Philadelphia) 7 Oct.1791; New York Daily Advertiser, 19 Oct. 1791; New York Journal, 15 Oct. 1791

17. Federal Gazette (Philadelphia), 30 September 1793.

18. Minutes of the Common Council of the City of New York, 1784-1831, NY 1917, II p 203; Powell, J. H., Bring Out Your Dead: the Great Plague of Yellow Fever in Philadelphia in 1793, New York, 1949, pp. 223-4: Heaton, Claude Edwin, "Yellow Fever in New York," Bulletin of the Medical Library Association, 1946, April: 34 ( 2), p 68

19. Coleman, William, Yellow Fever in the North: The Methods of Early Epidemiology, Madison, 1987, p 12-13.

20. Rush, Benjamin, Medical Inquiries and Observations, vol. 3, Arno Press, 1972, vol. 3, p. 43; or An Account of the Bilious Remitting Fever as it Appeared in Philadelphia in 1793, Philadelphia, 1794, p. 12.

21. Butterfield, L. H., Letters of Benjamin Rush, vol. 2, Princeton, 1951, p. 729-30 n.1.; Anon. to Rush Nov. 23, 1793, Rush Papers, Historical Society of Pennsylvania; Matthew McConnell to Rush Oct. 26 & 29, 1793 Rush papers, HSP.

22. At first Rush thought the fever was contagious, then changed his mind, and carefully revised all his writings on the fever eliminating any suggestion that it was contagious.

23. Hoadley, Frederick H.., "A Review of the History of the Epidemic of Yellow Fever in New Haven, Connecticut, in the year 1794," New Haven Colonial Historical Society Publication, vol. 6. 1900, pp. 223-262.

24. Baltimore Daily Intelligencer, 2 Oct. 1794. Thomas Drysdale letters on the Baltimore epidemic were published posthumously in 1804 in Coxe's Medical Museum

25. Davis, M.L., A brief account of the epidemical fever, New York, 1796 p. 14;

26. Philadelphia Gazette, 12 aug 1795 (This Philadelphia newspaper provides the best running record of the epidemic because it reprinted everything about the fever reported in the New York City newspapers, plus letters from people in New York that often weren't published in New York papers.)

27. Phila Gazette 27 aug 1795; Davis, p. 23

28. Davis, p 21

29. Seaman, Valentine, An Account of the Epidemic Yellow Fever, New York, 1796, pp. 32-34.

30. Davis, p 23

31. Phila Gazette 5 Sept 1795

32. Weekly Museum, NYC, Sept. 5, 1795

33. Phila Gazette 24 Sept 1795

34. Davis, p.

35. Phila. Gazette, 18 Sept 1795

36. Cronin, p. 60.

37. Phila Gazette, 7 October 1795, letter of Dr. William Smith

38. Ibid. 4 and 9 October 1795

39. Phila Gazette 24 October 1795.

40. Phila Gazette, 5 November 1795

41. Rush, Med Inq & Obs, 1815 vol. 2, p. 49. Rush lists rheumatism and gout as remote cause of pulmonary consumption.

42. Rush, Benjamin, "An Inquiry of the Proximate Cause of Fevers," in Medical Inquires and Observations, vol. 4. Philadelphia 1796 p. 121.

43. Rush, Med Inq Obs 1815 vol 3 p 49

44. Cullen, William, First Lines in the Practice of Physic, pp 70-1.

45. Bayley, Richard, An Account of the Epidemic Fever which prevailed in the City of New York, 1796, p. 61

46. Seaman, Valentine, An Account of the Epidemic Yellow Fever, New York, 1796, p 5.

47. Webster A Collection of Papers on the Subject of Bilious Fever, Prevalent in the United States for a Few Years Past. 1796. P 70

48. On mosquitoes Bayley p ; Seaman p. 3 : Smith p 76 .

49. Smith, p 69.

50. Bayley, p 63.

51. Seaman p. 35

52. Smith, p. 73

53. Seaman p 5

54. Bayley, p63.

55. Smith, p. 111

56. On quays see Smith p 72; Seaman 35

57. Webster's circular is dated 31 Oct. 1795, and was in the 3 Nov 1795 Phila. Gazette.

58. Webster A Collection of Papers on the Subject of Bilious Fever, Prevalent in the United States for a Few Years Past. 1796.

59. Cronin, p 57; Smith 80ff

60. Rush, Medical inquiries and observations : containing an account of the bilious remitting and intermitting yellow fever, as it appeared in Philadelphia in the year 1794. Together with an inquiry into the proximate cause of fever ; and a defence of blood-letting as a remedy for certain diseases. Philadelphia, 1796, p..

61. Cronin p 12

62. Betsy Blackmar, "Re-Walking the Walking City: Housing and Property Relations in New York City, 1780-1840," Radical History Review, 21 (1979), 131-151

63. AB # 1 is in 1 July 1796 Phila Gazette, #2 in 2 July 1796; on ships not bringing fever see Bayley p 7ff; Seaman p 22; Smith p 95ff

64. A.B. 14 July 1796 Phila Gazette

65. Ibid.

66. Bayley, Letters from the Health Office, 1799.

67. Ibid.

68. Ibid

69. Seaman, Valentine, "An Inquiry into the cause of the pestilence of the yellow fever in New-York", Medical Repository, vol. 1, p. 325

70. Ibid. p 319

71. Ibid, p 328

72. Rush 1794 p 73. Rush's campaign against the domestic sources of yellow fever was complicated by his insistence that he could cure the disease when summoned to a patient in time. Thus the few deaths, which led most to assume there was no epidemic, emboldened Rush's belief in the efficacy of his treatment.

73. Aurora 22 & 24 Aug. 1797, Phil. Gaz. 26 Aug. 1797; Folwell, Richard, Short History of the yellow fever epidemic, that broke out in the City of Philadelphia, in July 1797, Philadelphia, 1799. p 17.

74. John Dawson to James Madison, Sept. 7, 1797, Rutland, Robert Allen, Papers of James Madison, 1977.

75. Folwell pp 14-17; Rush Notebook Aug. 26, 1797, HSP; Phil. Gaz. 28 Aug. 28 1797; Porcupine's Gazette (Philadelphia) 25 Aug.1797.

76. Rush vol IV, 1815, p 4

77. Condie pp 47-8; Currie, William, Memoirs of the yellow fever, which prevailed in Philadelphia, and other parts of the United States of America, in the summer and autumn of the present year, Philadelphia, 1798 p. 10

78. Margaret Morris to sister Aug. 8, 1798, Haverford College Library..

79. Condie, Thomas, History of the Pestilence, commonly called yellow fever, which almost desolated Philadelphia in the months of August, September & October, 1798, 1799. pp. 85ff; Currie, pp. 63ff

80. Bayley, Richard, Letters from the Health Office, New York, 1798, p.75

81. ibid. p 77

82. Ibid p 80.

83. Phila Gazette, 4 Sept. 1798

84. Miller to Eliot, Oct. 3, 1798, Massachusetts Historical Society

85. Troop to Livingstone Sept. 20, 1798, Haverford College Library, Manuscript collection.

86. Hardie, p 108.

87. Burrows, Edwin G. and Wallace, Mike, Gotham: a history of New York City to 1898, pp. 356-359.

88. Horatio Gates to William Fenwick, 5 Nov. 1798, Gates Papers, Microfilm edition, UMI, Ann Arbor,

89. Smith to Rush, 13 Sept. 1798, Rush Papers, HSP

90. Condie, Thomas, History of the pestilence, commonly called yellow fever, which almost desolated Philadelphia, in the months of August, September & October, 1798. Philadelphia, 1799;

91. Currie, William, Memoirs of the yellow fever, which prevailed in Philadelphia, and other parts of the United States of America, in the summer and autumn of the present year, Philadelphia, 1798

92. Mitchill to Webster, 17 Sept. 1798, in Ford, E. Notes on the Life of Noah Webster, 1912, p. 467.

93. Webster, Noah. History of Epidemic and Pestilential Diseases

94. Aurora (Philadelphia) 11 Jan 1799

95. Common Council Minutes, p. 501

96. Ibid. p. 494

97. Bayley, Letters, p. 95

98. Ibid. pp.503-504.

99. Ibid. p. 507.

100. Ibid. p. 507.

101. Hardie, p. 57; Burrows, Edwin G. and Wallace, Mike, Gotham: a history of New York City to 1898, pp. 356-359

102. Aurora 3 March 1799

103. Hall, Courtney Robert, A Scientist in the Early Republic: Samuel Latham Mitchill, New York, 1967.

104. Phila. Gazette, 21 August 1799

105. Ibid. 3 Sept 1799

106. Ibid. 5 Sept 1799

107. NY Comm. Adv 7 October 1799

108. Liston, Robert to Grenville, 7 Oct. 1799, Foreign Office Correspondence, Vol. 42 (F.O. 5/25) Library of Congress, Manuscript Division.

109. Pierce Butler to Benjamin Rush, 14 October 1798. Rush Papers, Historical Society of Pennsylvania. (I have not found Rush's reply but I assume he agreed with Butler who was a close student of his friend Rush's ideas.)

110. Seaman recognized immunity, see p. 319 ; Rush did not, see Med. Inq. And Obs. 1815, vol. 4, p 17. He believed that all fevers were one, exhibiting increasing malignancy dependent on severity of causes.

111. American Daily Advertiser, 30 Sept. 1802

112. Miller, Edward, The Medical Works of Edward Miller, New York 1814, p. 129