by Jim Murphy
Benjamin Rush received hundreds of frantic notes begging his help, such as this one written by Revolutionary War hero Thaddeus Kosciusko during the 1797 yellow fever epidemic. (THE HOUGHTON LIBRARY/HARVARD UNIVERSITY)
Another doctor might have thrown up his hands in bewilderment and admitted defeat. Not Benjamin Rush. He believed firmly that every illness had a cure and that all he had to do to discover it was to work harder. He spent every minute he could rummaging through his library, searching for some bit of information that might show him the light. It was while poring over his old medical books that he came upon John Mitchell’s letter about the yellow fever plagues that had occurred in Virginia some fifty years before.
One of Mitchell’s observations leaped off the page for Rush. Mitchell asserted that as soon as the stomach and intestines filled with blood, they had to be emptied at all costs. Otherwise, the blood would turn putrid and stop the body from its normal process of healing.
Mitchell also advised physicians to put aside any “ill-timed scrupulousness about the weakness of the body” and purge the patient ruthlessly. Instead of merely helping nature to heal the body, Mitchell was telling doctors to command and direct it along the proper course.
Rush then decided to try the strongest purge he knew of, known as the “Ten-and-Ten.” Last used during the Revolutionary War, this recipe called for the patient to swallow ten grains (not quite one-third of an ounce) of calomel (mercury) and ten grains of jalap (the poisonous root of a Mexican plant related to the morning glory that was dried and powdered before ingesting). Both were highly toxic, and the body would work hard to expel them. Rush would, in effect, poison a patient in order to produce extreme vomiting and diarrhea.
His first use of this treatment seemed to work, even though he had to force the concoction down his patient’s throat. He then decided to speed up the process by increasing the dosage to ten and fifteen and administering it three times in a single day, until it resulted in five large evacuations.
Rush next began experimenting with the amount of blood he would remove from the body in an effort to reduce inflammation. He, like most doctors then, believed that the human body held approximately twenty-five pounds of blood. Since the body actually holds less than half of this amount, most people who were bled so drastically passed out at some point in the procedure. For Rush, and for other doctors as well, this was simply a sign that the treatment was indeed working.
Few doctors kept accurate records on recovery rates during the yellow fever plague. But since Rush saw improvement in those he treated, he sensed that his cure was working, and working well. On September 3 he claimed that eight out of twelve patients had gotten better with just one treatment. The next day saw nine out of ten over the fever. By September 5 he was able to write Julia that “I now save 29 out of 30 of all to whom I am called on the first day [of their illness].”
Many doctors disputed Rush’s cure rate and felt his “Ten-and-Fifteen” purge and copious bleedings dangerous. Dr. Adam Kuhn called the mercury and jalap drink “a murderous dose” and said so in the newspapers. Dr. Jean Devèze, a recent French arrival, condemned Rush with a passion: “He, I say, is a scourge more fatal to the human kind than the plague itself would be.”
Other doctors agreed with Kuhn and Devèze and put forward their own treatments, though no one claimed to have found an absolute cure, as Rush did. Almost every one of them called for much milder methods than Rush’s. Dr. William Currie completely rejected Rush’s bloodletting and the use of mercury, saying such methods “cannot fail of being certain death.” Instead, he suggested modest purging, that patients be gently induced to sweat, that their hands and feet be bathed in vinegar and water, and that they get as much cool, fresh air as possible.
Rush took any challenge, whether from a disease or from a colleague, as a personal attack to be confronted and conquered. When his ideas were questioned, he sensed a malicious conspiracy and counterattacked: “Besides combatting with the yellow fever, I have been obliged to contend with the prejudices, fears and falsehoods of several of my brethren, all of which retard the progress of truth and daily cost our city many lives.”
Those he challenged fired back with equal ferocity. Ebenezer Hazard refused Rush’s treatment as extreme, saying, “He . . . would order blood enough . . . drawn to fill [a] helmet, with as little ceremony as a mosquito would fill himself upon your leg.”
This wasn’t a behind-closed-doors disagreement, either. It was carried on in the city’s newspapers, so that all citizens knew of the dispute. Some even joined in with their own opinions. From his upstate New York retreat where he and his wife were recuperating, Secretary of the Treasury Alexander Hamilton wrote to praise the cure used by his doctor, who had openly rejected Rush’s cure. The secretary of war, Henry Knox, also followed the public feuding, and wrote: “The different opinions of the treatment excite great inquietude—But Rush bears down all before him.”
Then Rush fell ill, and everyone waited to see what would happen.
To his credit, Rush did not hesitate to use his own cure. He turned himself over to two of his young assistants, who bled him and administered the purge. It would be months before Rush truly regained his strength, but within five days he was back on his feet and valiantly seeing patients in his home. On September 19 he hired a horse-drawn carriage and began visiting patients again.
His fever lingered on, his cough worsened, and climbing stairs was difficult, but in Rush’s mind his treatment had produced yet another cure. “Thus you see,” he wrote to Julia, “that I have proved upon my own body that the yellow fever when treated in the new way, is no more than a common cold.”
People now flocked to his home for the cure. One hundred fifty a day sought him out; his five assistants each saw thirty patients a day. They bled so many and so aggressively that they ran out of vessels to hold the blood. In the end they were forced to perform this procedure out-of-doors, bleeding patients directly onto the paving stones of the road.
Neither Rush nor his assistants could handle the press of sick people demanding his cure. Rush then showed members of the Free African Society how to drain blood from a patient and they marched out to perform over 800 bleedings. Even Rush’s eleven-year-old servant boy, Peter, was trained to open a vein and sent out to see the sick.
Barbers often substituted for doctors prior to the nineteenth century. This lithograph depicts an unhappy patient having blood drawn by a local barber while a curious bystander peers over his shoulder. (THE COLLEGE OF PHYSICIANS OF PHILADELPHIA)
In reality, Rush’s cure probably did more harm than good. Yet he never lost faith in it, never doubted it. Not even when three of his assistants and his beloved sister, Rebecca, died did he doubt. Why should he? Every day he received letters thanking him for his cure; every day hundreds of desperate people lined up outside his door or sent him frantic notes asking for his help.
While a handful of his colleagues embraced his cure, most of Philadelphia’s doctors condemned his methods and dubbed Rush the “Prince of Bleeders.” Yet they may have judged him too harshly. Medicine was in a curious state of transition at the end of the eighteenth century—groping toward more scientific and precise explanations of diseases, while still clinging to beliefs hundreds and even thousands of years old that were rooted in mythology and folk tales. Rush’s treatment was based on accepted (if extreme) medical principles of the time and tested under the pressure of a raging plague. Maybe even more important, it gave the average citizen—trapped in Philadelphia and at the mercy of the mysterious killer—cause for hope. Dr. Benjamin Rush was, after all, living proof that the disease could be beaten.
Rush became a hero, and his fame soon spread beyond Philadelphia. Circuit Judge William Bradford, after hearing a number of stories about Rush’s bravery and cures, wrote, “He is become the darling of the common people & his humane fortitude & exertions will render him deservedly dear.”
So formidable was his reputation that Benjamin Rush could stride
into a sickroom and calmly tell a suffering individual: “You have nothing but the yellow fever.”
From The Federal Gazette, October 9, 1793. (THE LIBRARY COMPANY OF PHILADELPHIA)
CHAPTER SEVEN
“By Twelve Only”
Ye unfeeling savages! Ye monsters in the shape of men! Remember that your judge will probably, one day, say to you, “I was a stranger and ye took me not in, depart from me ye workers of iniquity.”
—“A.B.” IN THE FEDERAL GAZETTE, OCTOBER 1793
Saturday, September 14. As Mayor Clarkson approached city hall that morning, he carried with him the full weight of his city’s almost complete collapse. He knew, for instance, that the courts had all but ceased to operate, committees were not meeting, the work of the Guardians had come to a stop, and Bush Hill was in turmoil despite the heartfelt efforts of the black volunteers there.
One after another, the city’s newspapers had suspended operations, until only Andrew Brown’s Federal Gazette and Philadelphia Daily Advertiser was being published daily; the National Gazette, under the editorial direction of Philip Freneau, appeared from time to time. Taverns were closing for lack of customers, and the street markets remained deserted. Doctors were openly disputing every aspect of the fever, and the College of Physicians, which had promised to meet every Monday, had given up. Even the blacks of the Free African Society—the only ones actually doing anything in an organized, citywide way—were coming down with the disease.
That is why the mayor and a small group of citizens had taken the drastic and illegal step of calling for the formation of a special committee to run Philadelphia. Clarkson and his committee had, in effect, seized control of the government. If he needed proof that this was a necessary action, it greeted him that morning at the steps of city hall. There Clarkson had to push his way through a crowd of vendors selling coffins and patent medicine cures.
Aside from the mayor, the committee was made up of twenty-six individuals, though illness and death soon reduced their numbers. In the end, the business of running all of Philadelphia was, as Clarkson would write, “principally conducted by twelve only.”
One of the first decisions made by the committee was to borrow $1,500 for the purchase of medicine, coffins, and a variety of other necessary items, as well as to pay for doctors, nurses, and gravediggers. All told, the committee would spend $37,647.19 to combat the sickness that infested their city. This is a great deal of money even today, but in 1793 it was a fortune. What is more, the members of the committee could be held personally responsible for all of this money because they had no legal authority to borrow or spend it.
The magnitude of this responsibility and the courage of the committee members become clear when we learn that the majority of them were not wealthy. They were, as the mayor himself put it, “mostly taken from the middle walks of life.” One of them was an umbrella maker; another built cabinets; another, chairs. Two carpenters volunteered, as did a teacher, a mechanic, a coach builder, and a playing-card maker. If they were compelled to repay even a portion of the debt, it would ruin most of them financially. Yet they overcame their fears and took on the responsibility in order to save their stricken city and its people.
As president of the committee, Clarkson presided over its daily meeting and helped organize its operation. Specific assignments were then handed out to members. Henry Deforest took on the formidable task of providing food for the city; Samuel Benge took charge of carrying the sick to Bush Hill and seeing that the dead were properly buried.
Once the committee began to act, it was everywhere. The members went street by street to catalogue the number of houses boarded up, infected, and open. The homes of dead fever victims were cleaned to remove the “seeds of its infection.” Because relatives were sometimes impossible to locate, the committee began to administer the estates of the deceased who had no legal heirs or executors available. After the potter’s field and Bush Hill cemeteries were full, they took over the public square nearest Bush Hill and began burying paupers there.
Out of a committee of supremely enterprising and resourceful members, one managed to outshine the rest in the range of activities he assumed. His name was Israel Israel, a reserved, forty-seven-year-old tavern keeper and merchant. When the first orphans were found huddled near a blacksmith’s forge, Israel and two others were given the task of finding shelter, care, and support for them. A house was rented, a matron hired, and provisions carted to the door of this new city institution. As more and more children turned up, the Orphan Committee’s burden increased in scope until it was caring for 192 children.
But Israel’s work did not end with helping Philadelphia’s orphans. When complaints came in about the foul smells wafting from the potter’s field—smells that many feared were spreading the disease—Israel went with James Sharswood to personally inspect burial procedures. It was Israel who was asked to arrange for the harvesting of grain at Bush Hill; and it was Israel again who headed the Committee of Distribution, the group responsible for warehousing and handing out food, firewood, and clothes to the city’s growing number of needy families.
Israel’s patience, strength, and ingenuity were tested every day of the plague. It was Israel who went to the almshouse to persuade that institution to open its doors to additional paupers, Israel who met with the angry owner of Bush Hill the minute he returned to town to work out fair compensation. He had been called on to help, and he helped in every way possible.
Israel Israel was a wealthy man who dedicated much of his spare time to helping less fortunate Philadelphians. (THE ABBY ALDRICH ROCKEFELLER FOLK ART MUSEUM, COLONIAL WILLIAMSBURG FOUNDATION, WILLIAMSBURG, VA.)
Soon after being established, the original committee divided itself up into a variety of subcommittees. Each subcommittee handled a specific duty, such as obtaining five hundred cords of wood before winter set in, cleaning the streets, or distributing cash to those in need.
By far the most desperate situation was at Bush Hill. Medical student Charles Caldwell helped out for a few days and then left. The four doctors appointed to attend the patients rarely showed up. Two of them made a number of visits but spent more time performing autopsies on dead bodies than ministering to the sick. When the Guardians ceased performing their duties, it meant there was no one to supervise the place at all.
The black nurses did their best to care for, comfort, and clean up the sick and dying, but their task was overwhelming. In September the average number of deaths per day began to rise at an alarming rate, and relatives and neighbors hurried anyone they suspected of having yellow fever off to Bush Hill. “Poor people,” Mathew Carey noted, “[were] forced . . . to that hospital, though labouring under only common colds and common fall fevers.”
Over one hundred people now jammed the mansion, and the dead lay unburied. As a member of the mayor’s committee, Mathew Carey had a special understanding of conditions at Bush Hill. “The sick, the dying, and the dead were indiscriminately mingled together,” he recalled. “The ordure and other evacuations of the sick, were allowed to remain in the most offensive state imaginable. . . . It was, in fact, a great human slaughter-house.”
The committee sent a delegation to the house, and a list of needed items was drawn up and ordered. A carpenter was found to build beds; a horse, cart, and attendants were hired to bring in the sick and carry out the dead. And then two committee members, Peter Helm, a barrel maker, and Stephen Girard, a wealthy merchant, did an amazing thing: They volunteered to personally manage Bush Hill.
We don’t know much about Peter Helm. He was skilled enough at his woodworking that the ever-demanding President Washington employed him several times to make objects for his household. He was also a devout member of the Moravian congregation, a Christian denomination that accepted the Bible as the sole source of faith and practice. When Helm read Psalm 9:18, “For the needy shall not always be forgotten; the expectation of the poor shall not perish for ever,” he knew his duty was to serve them. When he read a little la
ter, in Psalm 23:4, “Yea, though I walk through the valley of the shadow of death, I will fear no evil,” he knew he would be safe.
Helm was a humble man who brought to Bush Hill three enduring qualities—an established work ethic, an endless supply of kindness, and an indomitable spiritual courage.
Much more is known about the forty-three-year-old Stephen Girard. He was French-born, blind in one eye, and he detested inefficiency and failure. As one of Philadelphia’s wealthiest citizens, he could have fled the city, as others from his economic class had done. But he didn’t. He had business to attend to, and besides, he did not believe the illness ravaging his city was a contagious plague. He held to this opinion even though he contracted a mild case of yellow fever during the last week of August, the sort of near miss that frightened many other citizens into either hiding indoors or fleeing to the countryside.
Girard brought along a calm personality, a steely determination, and an unerring sense of organization.
And so Peter Helm and Stephen Girard marched off to Bush Hill in mid-September. Noting his assignment in his private papers, Girard added, “I shall accordingly be very busy for a few days.” In fact, Helm and Girard would faithfully attend to what came to be known as the pest house for sixty straight days.
The first thing they did at Bush Hill was to divide the chores. Helm dealt with what went on outside the building, while Girard directed what happened within.
Helm established a simple system for receiving new patients and having the dead carted away for burial. He set up an area where coffins could be made, provided decent housing for the nurses and other staff members, had the barn converted so those recovering from their illness could be kept apart from the newly ill, and found storage for supplies. He even had the pumps repaired so that fresh water could be provided to patients for the first time.