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The Yellow Fever Epidemic in Philadelphia

I've spent half a century (yikes) writing for radio and print—mostly print. I hope to be still tapping the keys as I take my last breath.

Lunch at Charlie Brubacker's followed by dinner at Maisie Smith's. That's how an epidemic travels.

Lunch at Charlie Brubacker's followed by dinner at Maisie Smith's. That's how an epidemic travels.

The summer of 1793 had been unusually hot in Philadelphia and the city was surrounded by marshes; this environment provided perfect breeding conditions for the mosquitoes that carried the yellow fever virus. The result was a devastating death toll.

Philadelphia in 1793

The city of about 50,000 was the capital of the United States, waiting for the completion of the building of Washington, 140 miles to the south.

Philadelphia was the largest city in the country at the time and its residents suffered through a horribly hot and humid summer. Open sewers and muddy swamps captured rainfall and created a lovely habitat for the Aedes aegypti mosquitoes that fed voraciously on the people.

Meanwhile, a slave revolt was underway on the Caribbean island of Hispaniola in what was to become Haiti. French colonists escaped the violence and arrived at the docks of Philadelphia; some of them carried the yellow fever virus in their blood.

Philadelphia Docks; gateway for an epidemic.

Philadelphia Docks; gateway for an epidemic.

Effects of Yellow Fever

Once a mosquito takes blood meals from a human it goes off to digest the banquet and, when it gets hungry, it comes back for more, very likely from a different donor. If the annoying critter picks up a virus from the first bite, it will still be there when it finds a second victim. To get its meal, the skitter first injects a blood thinner and along with that comes the virus.

Between three to six days after being infected, the sufferer will feel no symptoms, then a fever develops and the acute phase kicks in. This brings headaches, muscle pain, vomiting, dizziness, and loss of appetite. For some of the people infected that’s as far as it goes.

Yellow fever victim in Argentina in 1871.

Yellow fever victim in Argentina in 1871.

However, other patients move into the toxic phase and, as the name implies, it’s not good. The Mayo Clinic lists the symptoms:

  • Yellowing of your skin and the whites of your eyes (jaundice);
  • Abdominal pain and vomiting, sometimes of blood;
  • Decreased urination;
  • Bleeding from your nose, mouth, and eyes;
  • Slow heart rate (bradycardia);
  • Liver and kidney failure; and,
  • Brain dysfunction, including delirium, seizures, and coma.

Not surprisingly, given that list of horrors, as much as half the patients who reach the toxic level die. There is no cure, but there is now a vaccine.

From healthy to critically ill.

From healthy to critically ill.

The Philadelphia Outbreak

A man called Peter Aston has the dubious distinction of being the first yellow fever fatality in Philadelphia. That was on August 19, 1793.

At first, as yellow fever was not endemic to the region, Aston’s death was put down to an ordinary fever. However, as more victims fell ill, Dr. Benjamin Rush, a man who had signed the Declaration of Independence, noticed an “unusual number of bilious fevers, accompanied with symptoms of uncommon malignity. All was not right in our city.”

He identified the cause as yellow fever.

Dr. Benjamin Rush.

Dr. Benjamin Rush.

Publisher Mathew Cary watched the epidemic spread and wrote that by August 25, “universal terror” had gripped the city. Over the next few weeks, 20,000 people fled.

In echoes of what is happening today, people locked themselves in their homes to avoid the contagion. Businesses closed and the streets were deserted.

Lillian Rhoades wrote about the epidemic in her 1900 book The Story of Philadelphia. She described how “the hearse and the doctor’s [carriage] were the sole vehicles on the street. The hospitals were in a horrible condition; nurses could not be had at any price: to go into a house in which nearly every bed contained a dead body, and the floors reeked with filth, was courting death in its most dreadful form.”

In August, the death toll was 10 people a day; by October, it was 100 people a day.

Epidemic Brings Out the Best and Worst

A tidal rivulet called Dock Creek was filled with garbage and rotting dead animals around which buzzed clouds of flies. There was decaying food, overflowing toilets, a general high degree of filth, and a horrible stench.

Dr. Benjamin Rush blamed the disease on these unsanitary conditions. He was right that the foul environment caused disease, just not yellow fever.

However, he stoically stayed at his post doing what he could. While others were running as far away as they could he said, “I have resolved to stick to my principles, my practice, and my patients to the last extremity.”

Rush tried blood letting and purging the bowels, among the few treatment weapons physicians had in their arsenals at the time. These therapies did save a lot people but drew the ire of journalist William Cobbett. The writer was a rascal untroubled by the need for accuracy in his reporting who called Dr. Rush “mentally unstable,” and “a quack.” A lawsuit forced Cobbett to leave America with shame and humiliation in his wake.

It was also erroneously believed that African-Americans were immune to the disease. Many black women volunteered to care for the sick and paid for their kindness with their lives.

Richard Allen was a religious leader in the black community. Sadly he reported that “Many of the white people, who ought to be patterns for us to follow after, have acted in a manner that would make humanity shudder.”

But, some white people could not set aside long-held prejudices. Mathew Carey, published a venomous pamphlet in which he wrote “The great demand for nurses … was eagerly seized by some of the vilest of the blacks. They extorted two, three, four, and even five dollars a night for such attendance, as would have been well paid by a single dollar. Some of them were even detected in plundering the houses of the sick.”

In response to Carey’s racist tirade, Richard Allen and Absalom Jones (pictured) published a rebuttal setting the record straight.

In response to Carey’s racist tirade, Richard Allen and Absalom Jones (pictured) published a rebuttal setting the record straight.

After The Yellow Fever Epidemic

In October 1793, the first frosts of autumn arrived. The cold weather killed off the mosquitoes that carried the disease, but by then at least 5,000 people had died.

Dr. Benjamin Rush emerged as the hero of the disaster. He came down with yellow fever but his assistants saved him by applying his treatment regimen. Judge William Bradford said of the doctor that “he is become the darling of the common people and his humane fortitude and exertions will render him deservedly dear.”

The city fathers recognized the need to clean up the rubbish and fetid swill. They also built hospitals with isolation wards, and embarked on a program of improving nursing care. There was also a major improvement to the water system, so that residents no longer had to choke down “evil-smelling and evil-tasting water.”

However, yellow fever outbreaks of lesser intensity returned to Philadelphia in 1794, 1797 and 1798.

Bonus Factoids

  • It wasn’t until 1881 that mosquitoes were identified as the carriers of yellow fever, and it wasn’t until 1937 that an effective vaccine against the disease was developed.
  • Groping in the dark for relief, the list of useless therapies was massive: gargling with vinegar or salt water, smoking tobacco, sipping water in the belief that whatever was causing the illness would be washed into the stomach and destroyed by acid, carrying a rope covered in tar, and avoiding “unnecessary intercourse.”
  • In Panama and some other Spanish-speaking countries, yellow fever is graphically called vómito negro, meaning “black vomit.”
  • According to the World Health Organization, about 30,000 people die from yellow fever every year and 90 percent of those fatalities are in Africa.

Sources

  • “Philadelphia Under Siege: The Yellow Fever of 1793.” Samuel A. Gum, Pennsylvania Center for the Book, Summer 2010.
  • “Yellow Fever.” Mayo Clinic, undated.
  • “The Rise of Gospel Blues: The Music of Thomas Andrew Dorsey in the Urban Church.” Michael W. Harris, Oxford University Press, 1994.
  • “11 Things You Might Not Know About Philly’s 1793 Yellow Fever Epidemic.” Sandy Hingston, Philadelphia, February 5, 2016.
  • “Yellow Fever Epidemic of 1793: ‘All Was not Right in Our City.’ ” Maiken Scott, WHYY, October 25, 2019.
  • “When the Solution to an Outbreak Was Right in Front of Us.” Natalie Wexler, The Atlantic, April 1, 2020.
  • “Black Nurses and the 1793 Philadelphia Yellow Fever Epidemic.” Elizabeth Hanink, Working Nurse, undated.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2020 Rupert Taylor

Comments

Miebakagh Fiberesima from Port Harcourt, Rivers State, NIGERIA. on April 20, 2020:

Rupert, thanks for sharing. You remind me of my basic biology lesson. Though they is vaccine now, the disease still rages in most countries of the world. Thanks.

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