An American Plague

by Jim Murphy

  The idea that illness was caused by microscopic organisms, such as bacteria and viruses, was not known at the time. Instead, doctors based their medical thinking on the 2,500-year-old Greek humoral theory. This concept stated that good health resulted when body fluids, called humors, were in balance. The humors were phlegm, choler, bile, and blood.

  Disease arose from an imbalance of these humors—too much of one, not enough of another. Any number of things could cause this condition, such as poor diet, excess drinking, poison, or a dog bite, to name just a few. Even bad news could unsettle the humors and cause illness. So it made sense to Rush, Hodge, and Foulke that the putrid-smelling air could upset people enough to cause an outbreak of violent, fatal fevers.

  Rush, however, sensed something else. The symptoms he was seeing reminded him of a sickness that had swept through Philadelphia back in 1762, when he was sixteen years old and studying under Dr. Redman. Rush was never shy with his opinions, and standing there in the LeMaigres’ parlor, he boldly announced that the disease they now confronted was the dreaded yellow fever.

  Putting the name yellow fever to the illness was not to be done lightly. Yellow fever was one of the most vicious diseases in the world and could create panic anywhere. It appeared suddenly, savaged its victims’ bodies, and—because there was absolutely no cure—killed at an alarming pace. While mortality rates for yellow fever varied widely, it was not unusual for it to kill 50 percent of those who contracted it. What is more, the stench of a yellow fever victim’s bodily evacuations and breath, the odor from their soiled clothes and bed linens, and even the air that escaped from their sickroom was believed by many to spread the disease with lightning speed.

  Rush had, in short, announced that Philadelphia was in the grip of a deadly, unstoppable plague.

  Hodge and Foulke thought they and their colleagues needed to see and discuss many more fever cases before putting a name to the disease, especially such a terrifying name. A mistake would disrupt the workings of the city for no reason. Rush understood this well, but he did not waver from his diagnosis. Once his mind was made up, he rarely changed it.

  After Rush left the LeMaigres’ home, he made it a point to tell his friends about the reappearance of yellow fever, and he advised them all to leave the city. He visited the mayor of Philadelphia, Matthew Clarkson, and the governor of Pennsylvania, Thomas Mifflin, to inform them as well. Next he went about town to confer with other doctors.

  On Monday, August 19, and for several days after this, the fever was still pretty much confined to the Water Street area near Ball’s Wharf. Only a handful of doctors had encountered it firsthand. Therefore, most of the city’s eighty physicians did not believe that the illness described by Rush was indeed yellow fever. They felt that the disorder must be one of the other common fevers that often struck during warm weather. Among the possibilities mentioned were jail fever, camp fever, eruptive military fever, and autumnal fever. Any one of these could cause violent physical suffering and death.

  Rush was annoyed that his diagnosis and warnings were being “treated with ridicule or contempt,” but he shrugged off these doctors as ignorant. They would come around to his view in time, he knew. He only hoped it wouldn’t be too late.

  Meanwhile, the deaths kept coming at an alarming rate. Catherine LeMaigre died on Tuesday, despite the efforts of her three highly skilled physicians. On Wednesday twelve more died; thirteen died on Thursday.

  Others besides the doctors were beginning to notice the illness. The Reverend J. Henry C. Helmuth found himself visiting more and more of his congregation with fevers of a “most dangerous complexion.” He stopped by the home of a man that Monday and made sure he was well taken care of and comfortable. “Nevertheless to my very great surprise, he was a corpse on the 20th,” Helmuth reported bluntly.

  “’Tis a sickly time now in Philada,” another citizen, Elizabeth Drinker, wrote, “and there has been an unusual number of funerals lately here.” A few days later she would add, “’Tis really an alarming and serious time.”

  “The fever has assumed a most alarming appearance,” Rush wrote to his wife, Julia, who was summering in Princeton with their youngest children. “It not only mocks in most instances the power of medicine, but it has spread thro’ several parts of the city remote from the spot where it originated.”

  Not just the fever spread; word of it spread as well. That Thursday, Mayor Clarkson placed a notice in the newspapers saying there was “great reason to apprehend that a dangerous infectious disorder” was loose in the city. He ordered laborers hired by the city, called scavengers, to clean the streets of decaying garbage and dead animals, since their vile smell might well be causing the disease.

  Governor Mifflin was equally upset. The state legislature was scheduled to assemble on Tuesday, August 27, and he was to deliver a formal speech on the condition of Pennsylvania. Should the meeting be canceled, he wondered, if the fever really was so dangerous? And should he and his family leave the city? He then asked that the health officer of the port and the port physician investigate the disorder and issue a report.

  Both the mayor and the governor wanted to confront and contain the disease as quickly as possible. They also wanted to keep the citizens of Philadelphia calm by showing that they were taking firm steps to deal with the problem. But it was already too late.

  Thursday’s newspapers had been read by thousands of individuals. These people spoke with neighbors and friends and business associates about the “dangerous, infectious disorder.” This group then spread the alarming news even further. The city’s taverns buzzed with talk of the strange, killing fever, as did the street markets and shops.

  Rain fell on Saturday, but it didn’t stop the death carts from rumbling through the streets carrying seventeen more people to their graves. “They are a Dieing on our right hand & on our left,” wrote twenty-one-year-old Isaac Heston to his brother, “we have it oposit us, in fact, all around us. Great are the number . . . Calld to the grave.”

  John Hills’s 1796 map of Philadelphia shows how densely settled the streets and alleys near the Delaware River had become. (THE LIBRARY COMPANY OF PHILADELPHIA)

  Fear, it seemed, was spreading even faster than the disease.

  On Sunday, August 25, a savage storm hit the city, bringing winds and torrents of rain. Water cascaded off roofs, splashed loudly onto the sidewalks, and ran in burbling rivers through the streets. The howling wind and pounding rain made a frightful noise, and yet through it all a single, chilling sound could still be heard—the awful tolling of the church bells.

  From The Federal Gazette, August 30, 1793. (THE LIBRARY COMPANY OF PHILADELPHIA)

  CHAPTER THREE

  Church Bells Tolling

  From house to house the dread contagion flew,

  And on its way a num’rous train hath slew!

  —SAMUEL STEARNS, 1793

  Sunday, August 25. The spread of the disease and of fear among the citizens had one immediate consequence: people began leaving the city. Clothes were packed in haste, windows slammed and shuttered, doors locked tight. Sometimes servants were ordered to stay behind to guard the house against thieves; sometimes everyone living under a roof fled. Printer and publisher Mathew Carey watched sadly as “almost every hour in the day, carts, waggons, coaches, and chairs, were to be seen transporting families & furniture to the country in every direction.”

  Hundreds exited Philadelphia on that rainswept Sunday. More left in the days to follow, as Dr. Rush’s advice to “Fly from it!” was repeated over and over again. Shop owners, carpenters, councilmen, and printers. Lawyers, ministers, nurses, and bankers. People of every rank and station wanted to escape the spreading pestilence and breathe the fresh, healthy air of the countryside. Twenty-three watchmen were supposed to patrol the city’s streets every night, but their numbers had dwindled to a mere handful by the end of the week.

  Elizabeth Drinker, as she appeared in a silhouette portrait. (THE HISTORICAL SOCIETY OF PENNSYLVANIA)<
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  Suddenly, the fever seemed to be everywhere. Elizabeth Drinker felt surrounded by disease when she made this diary entry for Wednesday, August 28: “There is a man next door but one to us, who Dr. Kuhn says will quickly die of this terrible disorder. Caty Prusia, over against us is very ill, and a man at ye Shoemakers next door to Neighr Wain’s; some sick in our Alley.”

  Mayor Clarkson’s order to clean the streets was being carried out, but not very rapidly. Like others around them, many scavengers abandoned their brooms and shovels and ran from the city.

  People whispered rumors of more and more deaths. They saw friends and relatives sicken. They heard the church bells tolling, tolling, tolling—and they ran. Drinker’s diary entry for August 28 concludes: “Isaac Wharton and family are moved out of Town, P. Hartshorne’s family, and Neighr Wain’s also out; the inhabitants are leaving the City in great numbers.”

  Judge William Lewis saw house after house in his neighborhood abandoned, saw the streets empty, saw the hearses constantly passing his home, and fled. He then wrote a letter to his good friend Dr. Rush, in which he confessed, “I never left Phila. With so much pleasure as yesterday nor never found Such Pleasure in the Country as I do today.” Historians now estimate that as many as 20,000 people abandoned the city during the fever.

  This meant that thousands were left behind. Most of these stayed because they were poor and had no place to go. They did not own country homes or have relatives or friends outside the city who would be willing to put them up until the fever ended. A few—a very few—chose to stay because they felt a sense of duty to their city and its trapped inhabitants.

  One of those who stayed, and would stay throughout the fever, was Matthew Clarkson. He had grown up in a prominent New York family, contributed large sums of money to the Revolutionary cause, helped found the Bank of Pennsylvania, and gone on to amass a fortune as a trustee of the Mutual Company, selling insurance to Philadelphia’s citizens. He entered politics as an alderman in 1790, and then because of his record of achievement and an amiable personality, the rest of the aldermen chose him to be mayor in 1792.

  Clarkson stayed despite many good reasons to flee. He was sixty years old, with a wife and nine children to look after. In addition, his title of mayor was largely an honorary one. At the time, the mayor of Philadelphia had no real power. All authority to pass laws and raise money was held by a variety of committees made up of members of the town council. Even in an emergency the council was supposed to appoint a committee to determine a course of action.

  Add to these one more compelling reason for Clarkson to abandon his post: yellow fever had already seized his wife and killed his youngest son, Gerard.

  Mayor Clarkson could have cited his powerlessness, could have pleaded concern for his family, and fled the danger, as many other aldermen were doing. Yet he understood that as mayor he was the symbolic head of the town. If he scampered off like the rest, it would be like a father abandoning his family. He chose to stay and act, even though he knew it would mean breaking the law.

  This 1939 painting of Matthew Clarkson was based on a nineteenth-century one and minimizes his most noticeable physical feature. Clarkson suffered from strabismus, a muscle condition that caused his two dark eyes to always peer in different directions. (THE NATIONAL GRANGE MUTUAL INSURANCE COMPANY/THE GREEN TREE COLLECTION)

  One of the first things he did was to ask the country’s most prestigious medical society, the College of Physicians, to assemble on that rainy Sunday, August 25. The College was dedicated to improving the science of medicine, and its member physicians were among the best educated and most experienced doctors in the United States. A few had even been around in 1762, when the last yellow fever epidemic had struck. If any medical group was qualified to provide guidance concerning yellow fever, it was the College of Physicians.

  What took place that day did not bode well for Clarkson or for Philadelphia. Of the twenty-six physicians who made up the College, only sixteen appeared. Some of those absent had good excuses, such as having to attend to an increasing number of patients ill with the fever. But many physicians had simply chosen not to show up or had already moved to the countryside.

  What is more, their meeting produced very little that would calm their fellow citizens. There was a terrible fever running through the city, the learned doctors all readily agreed. But after comparing descriptions of the symptoms, they began to disagree on the nature and cause of the illness as well as what to do about it.

  Essentially, the doctors formed two camps. One, headed by Benjamin Rush, believed they were facing yellow fever and that it had a local cause—the stagnant, foul-smelling air that had infested Philadelphia all summer. Some factors affecting the quality of the air, such as the hot, humid, oppressive summer weather, were out of their control. But other things could be done to purify it, such as getting rid of the bad coffee and cleaning up streets and alleyways.

  Opposing Dr. Rush was Dr. William Currie. Currie was not as well known as Rush in Philadelphia, but he was the only member of the College who had actually done research on yellow fever—enough to have written two books about the disease. And he wasn’t afraid to disagree with his more famous colleague.

  Currie agreed that there was a terrible fever infecting the city, but he simply did not think it was yellow fever. In addition, he felt strongly that whatever fever they might be facing had been imported from another area—probably from the West Indies by the recently arrived Santo Domingans—and that it was spread by close contact with an infected person. Currie admitted that the illness was “strengthened by a particular construction of the atmosphere,” but he insisted that the best way to deal with it was by quarantining the sick.

  Most of the doctors at that first meeting felt they did not know enough about the illness to give it a specific name. While they did not immediately side with Currie, their cautious approach miffed Rush, who felt they should have deferred to his medical opinion. He had, after all, actually dealt with yellow fever firsthand, while Currie had merely studied the disease. Still, Sunday’s discussion and disagreements were “a free communication of sentiment,” as Dr. Samuel Griffitts remembered. During the weeks to follow, the divide between members of the College would grow wider and the arguments more heated and personal.

  The doctors met again on Monday, though this time only eleven of them were in attendance. At this meeting they issued a list of measures for citizens to follow; the list was sent to Mayor Clarkson, who sent it on to Governor Mifflin and the newspapers. Many of the recommendations were intelligent and reasonable: Clean up the streets, set up a hospital for fever victims, avoid fatigue, limit the intake of beer and wine, put patients in airy rooms, and remove fouled clothes and bed linens frequently. Other suggestions offered a false sense of security: The doctors recommended that strong-smelling substances, such as vinegar, be sprinkled on handkerchiefs and held to the nose to ward off the fever, and that gunpowder be burned to purify the air.

  One suggestion alarmed many citizens: Stay away from anyone with the fever. Heightening the panic was what the list did not offer: A cure for the disease.

  When the list was published on Tuesday, the blazing sun had reappeared, and fetid, warm air once again choked the city. And people were still pulling out of Philadelphia in droves. Even those who were initially hesitant about leaving read the list and joined the exodus.

  Philadelphia that day was a completely changed place from the week before. Few people walked on the streets who were not fleeing. Those who felt they had to go out to check on an aged parent, or to buy medicine or food, did so wearing vinegar-soaked clothing and clutching bags of camphor—a bitter-smelling substance we now use in insect repellent—to their noses. Mathew Carey went around town noting carefully what was happening and would later turn these observations into a written history of the epidemic. “The smoke of tobacco,” he pointed out, “being regarded as a preventative, many persons, even women and small boys, had segars almost constantly in the
ir mouths. Others placing full confidence in garlic, chewed it almost the whole day; some kept it in their pockets and shoes.”

  Everyone walked in the middle of the street so they wouldn’t get too close to infected homes. People stayed clear of funerals, doctors, and ministers. “Acquaintances and friends avoided each other in the streets,” Carey observed, “and only signified their regard by a cold nod.”

  Stores and workshops began to close. Every school in town suddenly shut its doors, either because the teachers demanded it or because no students showed up for classes. Fires were lit on street corners to dry up the unhealthy, humid air and to drive away the bad smells; the sound of gunfire erupted day and night as frightened citizens attempted to cleanse the air with gunpowder smoke. “The streets,” Carey reported, “wore the appearance of gloom and melancholy.”

  Four men in a tavern extol the fine quality of Isaac Jones’s tobacco in this early watercolor advertisement. (THE LIBRARY COMPANY OF PHILADELPHIA)

  There were, of course, a few hardy individuals out and about. A contributor to Dunlap’s American Daily Advertiser who went by the initials “A. B.” could be seen poking around rainwater barrels in his neighborhood. “Whoever will take the trouble to examine [them],” he noted, “will find millions of the mosquitoes fishing about the water with great agility, in a state not quite prepared to emerge and fly off.” “A. B.” then advised readers that a gill (about four ounces) of common oil poured into the water would kill off these troublesome creatures within twenty-four hours.