In the summer of 1793 and a ghastly epidemic of Yellow fever gripped the largest city of America and the nation’s capital. Estimations of the number of deaths in 1793 by yellow fever was four to five thousand roughly a tenth of the capital’s fifty thousand residents. Much of the federal government was forced to flee the city to escape the fever.
On August 19, 1793, Philadelphia recorded its first fatality of Yellow Fever, Peter Aston. What many residents believed it was simply a common autumnal illness, Benjamin Rush, quickly identified as Yellow Fever. Universal Terror spread throughout Philadelphia and many fled the city. Those who stayed home, sought refuge indoors. Congress was adjourned and moved to the then remote village of Germantown. Streets became empty as business halted. Nurses could not be had at any price, and a general sense of chaos pervaded the city.
Yellow fever is an acute, infectious, hemorrhagic viral disease transmitted by the bite of a mosquito but this was understood until 1881. In 1793, Yellow Fever was a well-known illness that affected sailors who travelled to the Caribbean and Africa characterized by disquieting color changes including yellow eyes and skin, purple blotches under the skin from internal bleeding and hemorrhages, and black stools and vomit, all of which were accompanied by a high fever. In 1793, people of the French Caribbean colony of Saint Domingue (now Haiti) were fleeing a revolution from France and thousands of infected individuals landed at the Philadelphia docks. This combined with the dry, hot summer and low water tables of 1793 created the perfect breeding grounds for mosquitoes and the spread of Yellow Fever.
Interestingly, children often suffered from a milder case of Yellow Fever while adults severely suffered. The number of orphans increased as parents became casualties to the fever. Like the current Coronavirus pandemic, the spread of Yellow Fever to Philadelphia resulted in panic as the number of infections increased exponentially. The number of deaths changed from “ten victims a day in August to one hundred a day in October” and people were “in health one day were buried the next.” The city was almost completely unprepared for such a catastrophe. “No hospitals or hospital stores were in readiness to alleviate the sufferings of the poor.” Hope became dismal and the atmosphere of Philadelphia was “deserted and desolate.”
Fear was everywhere and many resorted to prayer and appealed to the divine. Dr. Rush believed, however, that Yellow Fever was caused by unsanitary conditions, especially those of the docks, sewage system, and rotting vegetables. He concluded that the illness was not transmitted from human to human but by “putrid exhalations” in the atmosphere. He also recognized that weather played a part in the epidemic and that the infection did not spread from human to human contact. Though many people of the time wanted to point blame at the newly arrived Saint Domingue revolution refugees, Rush was adamant to not point the blame to outsiders but instead accuse the sanitary conditions of the city and implore residents to clean up the city so as to not “entrail the disease upon future generations.” He believed the epidemic could be prevented by cleaning the docks, pumping out the bilge water of ship (water that collects and stagnates in the bilge of a ship), cleaning sewers more often, washing the streets in warm weather, removing filth from home better, and eating less meat in the summer.
Unfortunately, Dr. Rush also believed in the medical orthodoxy of the time, a balance of humors. He thought that blood leeching and purging would restore his patients to health. In some cases, he would remove a very high proportion of blood from the body. He often gave calomel, a mercury compound, as a method to purge the bowels. We don’t know if this increased the mortality of the disease, authorities of the time insist it saved lives, but logic would say it did.
Unlike our current pandemic, mosquitoes spread Yellow Fever by biting uninfected individuals after biting infected ones. Frosts in mid to late October which froze over the stagnant pools of water where mosquitoes breed greatly decreased the incidence of Yellow Fever infections. By November, the horrific epidemic was over, and residents finally returned to their homes and lives. Those who stayed such as Dr. Rush or Absalom Jones to fight the Yellow Fever were glorified heroes. The Yellow Fever epidemic of 1793 forever changed Philadelphia. Though the initial impact was gloom and dread, great adaptations were made by the people of Philadelphia. Hospitals, isolation hospitals, and orphanages were built. Political leaders learned the importance of nursing care from the epidemics and attempted to provide it more carefully. Aggressive attempts were made to improve the city’s sanitary conditions. Laws came into existence for homeowners to hold responsibility for cleaning up their property
If there is a lesson to be applied to our current situation from the Yellow Fever Epidemic of 1793, its that panic cost lives. Cooler heads and a focus on the cause and control of the epidemic are what we need. Its too late to PREVENT the current disaster but it is a good time to control its progression, through THOUGHTFUL measures to limit spread. Above all else, we need to focus on how to improve our medical, economic, and political systems so that future outbreaks do not cause chaos.