Tuesday, February 2, 2021

Pernick's "Politics, Parties. and Pestilence" has Problems

They kept count during the epidemic. The Mayor's relief committee that sat daily at City Hall on Independence Square reported the number of patients sent to the Bush Hill fever hospital and the number of coffins provided for the dead. Toward the end of the epidemic, they sent a man to count the cases and deaths in every street and in every alley. Each religious denomination counted the number of burials. Newspapers still publishing reported a daily count of the dead.

Immediately, after the epidemic, Matthew Carey's instant history went through four editions with each succeeding edition listing the names of more dead. The Mayor's Committee accounted for the money it had expended and provided an inventory of all the beds, bedding, pills and potions that remained at Bush Hill. Dr. Deveze published accounts of cases at the hospital, patients kept anonymous. In his account, Benjamin Rush revealed the names of his patients both dead and living which lent some credibility to the outlandish claims of the number of people he saved.

Although congress was not in session during the epidemic, no city was more enmeshed in the political battles arising from the federal government's policies than Philadelphia which would be the nation's capital until December 1800. Yet in none of the contemporary accounts of the epidemic were any distinctions drawn between the two political parties, then known as Republicans and Federalists, or pro-French and pro-British, or Jeffersonians and Hamiltonians, or Democrats and Monocrats. It took a 20th century political scientist, Martin Pernick, to do that with a series of four tables in his William and Mary Quarterly article "Politics, Parties and Pestilence." 

They are:

Table I 1793 Party Affiliation of Physicians Who Expressed an Opinion of the Cause of Yellow Fever, Republican, Federalist, or Uncommitted;

Table II Opinions About the Cause of Yellow Fever Held by the Political Leadership of Philadelphia, Importationist, Domestic Origin or Unknown; 

Table III Opinions About the Cure of Yellow Fever Held by the Political Leaders of Philadelphia, Bark and Wine, Mercury and Bleeding, and Unknown

Table IV Personal Reactions of Philadelphia's Political Leadership: Stay, Flee or Unknown.

Pernick argues that in response to the epidemic "influences quite removed from medical science entered into the debate." Even though political parties were just forming as the comity in President's Washington's cabinet ended, neither side put politics aside just because people were dying.

Pernick briefly describes how Republican fortunes took a turn for the worse in the summer of 1793 when the extreme demands of the new French ambassador, wildly welcomed by Republicans in May, threatened American neutrality. The French Republic had just declared war on Britain and demanded American aid. Few Americans wanted war with Britain, yet. 

Then in August the influx of 2000 colonial French refugees from a slave rebellion and revolution in what would soon become Haiti offered more trouble for Republicans. "Unlike the earlier royalist refugees," Pernick writes, "the new arrivals included many white radicals and moderates...." They were natural allies of American radical Republicans.

In late August, the doctor sent by the governor to investigate the extent and source of the malignant fever in the city was also one of the leaders of the Democratic Society and organizer of a mass rally that greeted ambassador Genet back in May. After his investigation, on August 26, Dr. Hutchinson wrote to the governor: "It does not seem to be an imported disease; for I have learned of no foreigners or sailors that have hitherto been infected.... The general opinion both of the medical gentle|men, and of the inhabitants of Water-street is, that the contagion originated from some damaged coffee, or other putrified vegetable and animal matters;..." 

Hutchinson protected his French allies from any blame for bringing disease to the city. Another Republican doctor fed Hutchinson the theory that absolved the French. In a letter to Hutchinson sent August 24, Dr. Benjamin Rush suggested damaged coffee as the source of the disease. On August 19, he had been the first to identify the disease as yellow fever. Rush was a signer of the Declaration of Independence and, although not a street orator like Hutchinson, remained a publicist for republican causes.

By early September, Rush began administering and publicizing a "cure" for yellow fever which involved severe purging with an inorganic mercury compound called calomel (it taste like honey) and ever increasing amounts of blood letting. 

At about the same time, Secretary of the Treasury Hamilton, leader of the Federalists, got the fever and was cured by a boyhood friend. Hamilton publicly endorsed the remedies of Dr. Stevens which included Peruvian bark, wine and cold baths or at least frequently throwing cold water on the patient. Stevens then publicized his remedies.

Despite the rival cures, the fever spread and the members of the city council, save for the mayor, fled the city. Mayor Clarkson called a general meeting and a committee of more or less 18 active members took over the supervision of burial, running a fever hospital, providing relief to the poor and caring for orphans. The Committee met daily save for the two member running the Bush Hill hospital which was just outside the city limits. According to Pernick, although Mayor Clarkson was a leading Federalist, the majority of the members of the Committee were the city's leading Republicans.

If all that was true, Pernick's four tables carry some weight. As rapidly as the fever spread, there was a political division over the response to it.

There are problems with Pernick's thesis. When Hutchinson toured Water Street, the crowded low access road between the harbor and the plateau on which the city extended, there was no medical debate allowing him to weigh the evidence from both sides. Hutchinson recognized that he didn't have all the evidence. He also reported that there may have been cases in Kensington, just north of Philadelphia, before the fevers struck Water Street. If that was true,  rotting coffee may have not caused the outbreak in the city.

Pernick identifies Dr. William Currie and Dr. Isaac Cathrall as importationists.  In August 1793 neither Currie nor Cathrall were convinced that the fever was imported. They were not sure it was contagious and did not call it yellow fever, Cathrall excused his slow recognition of that to the fact that in early August when he found victims in houses and families only two people got the disease while other boarders and family members remained healthy.

Currie did epidemiological research that encompassed more cases, and he quizzed family members who didn't get sick and talked to the Catholic priest. He knew of two French sailors who got sick but was unable to talk to their French doctor so he had no evidence that they died of yellow fever. When he stopped writing his report on the September 3 and sent it to the printers. he declined to say if the fever was imported or like the jail fever was bred in crowded places.

He included a newspaper essay by a doctor who remained anonymous that blamed the filth of Water Street for transforming the summer flu that had swept through the city into a more dangerous fever. Thanks to " the situation of the houses on the west side, being half buried under ground, the number of sailor taverns and huxter's shops, which are receptacles of all kinds of filth, dirt and nastiness, and which from their situation are excluded from the benefit of free ventilation," there was less pure air on that street than in any other parts of the city.

There was no evidence on the scene to persuade Rush and Hutchinson that the disease was imported. However, Pernick loads other ammunition to zero in on the Republican doctors. In a  1789 publication and his medical school lectures, Rush promulgated the theory that all diseases had a local origin which effectively closed his mind to the evidence around him.

However, in his account of the epidemic, published in February 1794, Rush credits the French refugees for bringing influenza to the city: "During the latter part of July, and the beginning of this month, a number of the distressed inhabitants of St Domingo, who had escaped the desolation of fire and sword, arrived in the city. Soon after their arrival, the influenza made its appearance, and spread rapidly among our citizens." Rush was no stranger to the city's wharves. From 1782 to 1792 he served as "one of the Inspectors of Sickly Vessels for the Port of Philadelphia." (Corner, Autobiography of BR, page 216)

Rush also thought the fever was contagious. When he changed his mind, he revised his account taking out all references to contagion. Since any contagious disease can be imported into a city, Rush could not categorically believe that yellow fever could not be imported. It's also fair to note that the refugees began arriving in late July, not in August at the same time yellow fever cases began to be treated by doctors. They also arrived in other US ports, especially Baltimore and New Orleans and there were no reports of yellow fever there.

Pernick also mistakes the politics of the refugees. He cites Child's French Refugee Life in the United States, but Child actually says that while the refugees supported the Revolution, they bitterly opposed the Girondin party then controlling France. They  blamed that party for freeing the slaves and igniting the violence in Haiti. Genet, the Girondin's man in America who was the darling of the Democratic Society, distrusted the refugees

If Rush and Hutchinson had blamed the refugees, one could argue that the Republican doctors did so to help Genet marginalize them. Plus, since both Rush and Hutchinson were prominent in the Abolition Society, blaming them would punish the refugee slave owners who soon made it clear that they had no intention of freeing the 800 slaves they brought to Philadelphia, despite the laws of Pennsylvania. 

However, Pernick suggests that Jefferson dominated the doctors. They participated in "Jeffersonian councils." By August Jefferson saw that Genet was hurting the Republican cause, so the less said about the French the better. Did Rush and Hutchinson get the word?

Indeed, in 1793 Rush wrote in his commonplace book: "Mr. Jefferson's conversation on all subjects is instructing. He is wise without formality, and maintains a consequence without pomp or distance." (Corner, page 228) But during the conversation preceding that observation, Jefferson chatted about regional variations in spoken Italian and French.

During July and August, Jefferson slept in a house along the Schuylkill and commuted to his office and cabinet meetings in the city. He invited Rush out for dinner in early August and Hutchinson on August 30. It would helped Pernick's thesis if Rush had been invited after he saw cases of yellow fever, and Hutchinson came before he reported to the governor. 

Jefferson invited the doctors to his dinners because he liked to talk about science as a relief from politics. The doctors were fellow members of the American Philosophical Society. Jefferson also liked a diversity of scientific opinions. He  invited Dr. Benjamin Smith Barton to dinner on the 30th. Pernick identifies at Barton as the sole Republican doctor who thought the fever was imported. 

Jefferson did talk politics with Hutchinson and was relieved to learn that Hutchinson recognized the danger Genet presented to the party. He passed on Hutchinson's observations about the epidemic in a letter to James Madison. He dealt with political news in another paragraph.

Jefferson left the city without any more communication with the doctors there. He rued Hutchinson's death as also bad for the party but did not establish contact with Dr. James Mease who replaced Hutchinson as Port Physician. In an earlier letter to Madison about the epidemic he mocked Hamilton's claim that he had the disease. In his last letter, he reported that Hamilton "had truly the fever, and is on the recovery, & pronounced out of danger." He listed prominent men who had died, noted the inefficacy of all treatments and that he would be in Virginia as soon as possible.

Hamilton's September 11 letter, sent as he left the city, was soon in the newspapers. He didn't mention politics. He expressed alarm at both the deaths in the city and flight from it: "It is natural to be afflicted not only at the mortality which is said to obtain, but at the consequences of that undue panic which is fast depopulating the city, and suspending business both public and private." He hoped Stevens' cure would stem the crisis. He was persuaded that "where pursued, [it] reduces [the fever] to one of little more than ordinary hazard." 

At least one person took that as a political statement. Rush blamed political animosity for what he thought was a blatant attack on his remedies. Rush was expecting the College of Physicians to endorse his remedies. Suddenly, Hamilton's letter addressed to the College appeared. 

However, Hamilton did not refer to Rush's treatment. He wrote that Stevens' "mode of treating the disorder varies essentially from that which has been generally practised...."

Rush had announced the efficacy of calomel at a meeting of the College on September 3. Dr. Adam Kuhn published a description of his remedies which were essentially the Stevens' West Indian cure on September 7. He credited Stevens for advising him. However, Kuhn recognized the need to purge constipated patients but recommended cream of tartar or castor oil, not calomel. 

Rush had also conferred with Stevens to learn the finer points of timing cold baths. Then Stevens wrote a letter to the College which was printed in the General Advertiser which happened to be the radical Republican newspaper published by Benjamin Franklin's grandson. He described his cure meticulously. (An article timed to elucidate political divides during the Covid pandemic  summarized Stevens' three long paragraphs of remedies as "staying clean, hydrated, and inhaling herbs." The author forgot to mention the teaspoon full of Laudanum, an opiate, and "Flannel clothes wrung out of spirits or Wine impregnated with spices may be applied to the pit of the stomach and changed frequently.")

Stevens specifically criticized violent purges as going against medical theory which they did. Rush well understood that, and heard similar complaints from other doctors. 

How much Hamilton's endorsement added to the popularity of the West Indian remedy is hard to gauge but it certainly enraged Rush. Pernick admits that there really was no Republican cure and no Federalist cure, but he can't resist characterizing Rush's response to Hamilton's perceived attack as creating Republican dogma. Rush attempted to "rally the Republican leadership behind his 'egalitarian' medicine." Rush promoted the idea that with calomel pills and a lancet, anyone could treat disease.

However, Rush did not write to either Jefferson, Madison or local Republican leaders during the epidemic. As evidence for the attempt to "rally" the party, Pernick quotes a sentence from a letter Rush wrote to Elias Boudinot on October 3: "Colonel Hamilton's remedies are now as unpopular in our city as his funding system is in Virginia and North Caroline."

Rush was addicted to using analogies, still that was likely an accurate observation. But it didn't reflect a rallying of Republican leaders around Rush's cure. The two most active organizers of the Democratic Society, Hutchinson and lawyer Jonathan Sergeant stayed in the city. Before he died in early September, Hutchinson refused Rush's remedies. So did Sergeant when he died in early October.

Boudinot was a member of congress from New Jersey, and a stalwart non-partisan who idolized George Washington and supported his administration, which is to say he was decidedly not a Republican. He was Rush's wife's uncle. Like Rush, he was a devout alumni of the Presbyterian College of New Jersey (which became Princeton,) Religious scruples accounted for Rush's opposition to Hamilton's financial schemes and he likely knew that Boudinot shared them. 

Rush offered his quip about the competing cure at the end of a long letter cataloguing the suffering of the city, including the death of Rush's sister. Boudinot had written offering financial help to the city and Rush advised him to send money to the "Mayor or setting committee of the city."

Despite Pernick's tables tracing the political divide, Rush did not distinguish between the Federalists mayor and the committee with its Republican majority. Nobody else did either. As far as is known, there was never any differences between the mayor and committee. In one of its first acts, it turned its back on what Pernick suggests had become the Republican take on the epidemic. It resolved to build a hospital just for fever patients and also build a hospital for sick emigrants: "that as the increased trade and population subjects the citizens to constant danger from the numbers that are daily arriving from foreign parts, where infectious disorders are frequently prevalent; that this subject be laid before the citizens at their next meeting, in order that some steps may be taken to bring the subject before the Legislature, that the evils now experienced may be avoided in future, by suitable and comfortable provision for those who may suffer a similar affliction."

The French refugees were not singled out. A ship filled with Irish emigrants had just arrived.

The point Pernick made in Table 4 remains: at least some Federalist leaders fled and at least some Republican leaders stayed. But Republican doctors didn't advise that at the beginning of the epidemic. Both Hutchinson and Rush told people to flee. The Pennsylvania legislature convened in late August. The Federalist leader of the state senate, Samuel Powel III asked Rush whether senators should continue doing business. Rush advised flight.

Once he discovered the efficacy of calomel, Rush advised everyone that it was safe to stay. Once Stevens cured Hamilton, both of those gentlemen advised that flight was not necessary. At least, two Federalist leaders, Powel and Timothy Pickering stayed in the city so they could get  medical advice from Rush. (Pernick notes Pickering's defection but excuses it because he and Rush were friends.) Powel died and Pickering lost a son.

Republicans who stayed were not necessarily there because of any supposed imperatives of the Republican Party. When they organized the Democratic Society, Hutchinson and Sergeant made Charles Biddle its secretary, much to the embarrassment of Biddle who knew nothing about it and had many Federalist friends. Just before he died, Hutchinson warned Biddle to leave the city, said he must stay to do his duty as a doctor, and thought they would never see each other again. Sergeant had wealth and family, Biddle credited other doomed lawyers for staying in the city to collect fees for writing wills. He  explained Sargeant's staying in the city as arising from "motives of benevolence."

Pernick imposes politics on men who can best be described as acting in a non-partisan manner. Nothing precluded the Democratic Society of Philadelphia from organizing a relief effort. Indeed, another society whose members were shut out of political life did just that. The African Society offered their services under the auspices of the mayor to collect the dead, cart the sick to the hospital and follow Rush's directions for treating the sick.

Religion or one's moral compass has a good deal more to do with one's reaction to a deadly epidemic than politics. At least in 1793, when the sick and vulnerable were threatened with being abandoned, citizens didn't look forward to the November election. Not a few thought that they were in Biblical times and that they could not escape God's rod and they survived by His grace. However, Pernick examines the sermons thundered from pulpits after the epidemic and finds a political divide.

Religious leaders that Pernick identifies as Federalists not surprisingly harped on the infidelity of the French revolution as reason enough to God to visit pestilence on a country that harbored pro-French vipers. It was more difficult to find anyone blaming Britain for the visitation but Pernick did. He found a newspaper article that blamed the epidemic on building a new theatre, and "the actors and retainers of the stage, who actually arrived here at the time when the fever raged with the utmost violence," were English.

Pernick has to scramble to sort out such an attack as Republican. The best he can do is associate it with a Quaker petition to the State legislature demanding that theatrical entertainments be banned. At the beginning of the Revolution the city did that and theatres were banned until 1789. Without evidence, Pernick suggests that Republicans in the legislature were sympathetic because they were building alliances with Quakers. Actually, leaders of all religious denominations supported the Quaker petition. Theocracy was an ill fit with Republican rhetoric. The legislature seems to have killed the petition in committee, the time honored way of saving both parties from taking sides.

More to the point of his monograph, once the debate about closing the theatre filled the newspapers, the dispute over the cause of the epidemic took a back seat. Not that it began with any political overtones. The first to mount a well documented attack on Rush's position was Matthew Carey, a fellow Republican.  Doctors divided with Rush eventually leading a rump of followers out of the College of Physicians. The Republican governor, Thomas Mifflin, decided to address both possible causes: stiffen quarantines and keep the port cleaner. It didn't become a raging political issue.

Once again a letter Rush wrote provided fodder for Pernick to line up on the Republican side of the religious debate over causes: "And Benjamin Rush, the Enlightenment man of science, commented in retrospect, 'I agree with you in deriving our physical calamities from moral causes.... We ascribe all the attributes if the Diety to the name of General Washington. It is considered by our citizens as the bulwark of our nation. God would cease to be what He is, if he did not visit us for these things.'"

Washington-worship caused the epidemic!

To begin with, as well as being a "man of science," Rush was a Millenarian who believed that the Second Coming was coming soon and it behooved man to pursue Truth and practice Righteousness. In 1792, he attended a Jewish wedding and had a chat with Dr. Nassy, a French Jew. Nassy explained that circumcision limits venereal disease. Rush asked Nassy if the unsettled state of affairs in Europe suggested the imminent return of the Messiah. (Corner, page 223)

Pernick was wrong to suggest that Rush was writing retrospectively about the 1793 epidemic. He wrote the letter during the 1798 yellow fever epidemic. Pernick cuts out Rush's main point which was that party spirit on both sides is to blame for God's disfavor: "Antifederal infidelity and Federal hypocrisy, with all the vices that flow from both, pervade every part of the United States. A bitter and unchristian spirit has likewise divided our citizens. We have not, it is true, erected a guillotine in our country, but enjoy similar spectacles of cruelty in the destruction of public and private character in our newspapers. We have not instituted divine honors to certain virtues in imitation of the inhabitants of Paris, but we ascribe all the attributes of the Deity to the name of George Washington."

If Pernick read the next paragraph in Rush's, he would have found evidence of Rush himself modifying the supposed dogmatic republican strictures of 1793: "Our fever increases. It is much more malignant than in 1793 and 1797, and requires in many instances a different treatment from the fever of those years. In many cases it will bear but small bleedings, and in some none at all. Those cases which bear plentiful bleeding generally end favorably." Rush also noted that he had slept "two miles from the city" and then went to visit patients in the city and worked at the fever hospital which was on the outskirts of the city. He also implied that there was no rancor that Pernick ascribed to partisan politics during the 1798 epidemic. He wrote in a P.S. "No part of this letter must be made public. Persecution at present sleeps against me."

During a smaller yellow fever in epidemic in 1797, the editor of Porcupine's Gazette began unmercifully attacking Rush for replicating the French Revolution with his bloody remedies. William Cobbett, an Englishman, was arguably the best newspaper writer in the city and had a wide following. Others, including Dr. Currie, attacked Rush leading to duels and lawsuits. It didn't completely divide Republicans and Federalists. Rush's old friend President John Adams appointed him to a government sinecure, treasurer of the Mint.

Still, one could give Pernick's thesis a better run through the 1797 epidemic then it had during the 1793 epidemic. Then in 1798, when party animosity reached its peak in Philadelphia, yellow fever demolished Pernick's thesis.

The city had a health committee chaired by a Republican. On September 1, it instructed everyone to leave the city. Cobbett decreed that bickering about the cause of the epidemic could wait until it was over. He left the city. Two partisan editors stayed, tried to raise the political stakes, and both died of the fever. The radical Republican Bache ignored Rush's cure and took cold baths in vain.

There was a possible political divide over providing for the poor in the city who had no place to go. One camp was private, the other public. When the city reopened, leaders of both political parties endorsed inspections of suspect houses and all outhouses, where, come to think of it, "Politics, Parties and Pestilence" belongs.

Exploring the uses of political rhetoric is something political scientists do but taking discourse out of context to create a dynamic that didn't exist does not help us understand the 1793 epidemic. Forget Pernick. In their 925 page history The Age of Federalism: The Early American Republic, 1788 - 1800, Stanley Elkins and Eric McKitrick, state the obvious in the paragraph they devote to the epidemic: "The epidemic of yellow fever in Philadelphia which took some four thousand lives during the months of September and October had as one of its effects that of bringing politics to a temporary standstill...." Their point is that Philadelphia newspaper who were then the fount of most political news were otherwise occupied or ceased publication.



Saturday, January 30, 2021

Battle of the Cures: Kuhn, Rush and Stevens

Doctors responded to the yellow fever crisis by having directions for the treatment of the fever printed in the newspapers. Dr. Adam Kuhn, the "A.K." of the first letter, was one of the city's most prominent practitioners and also taught at the medical school. Dr. Edward Stevens was new to the city, but gained immediate prominence because Alexander Hamilton credited him for curing his fever. Dr. Benjamin Rush's letter was also printed as a handbill. Kuhn was out of the city when his letter was printed, and Stevens about to leave the city. Since historians so often accuse Rush of suiting his therapy to his medical theories, I have highlighted the portions of Kuhn's and Stevens' letters which pertain to medical theory. Rush at this time consciously avoided mention of medical theory.

"PUTRID FEVER

EXTRACT OF A LETTER

Philadelphia Sept. 7, 1793

I received your letter to day and shall with pleasure give you every information in my power respecting the malignant fever, which proves so fatal among us. As I consider debility and putrification the alarming circumstances to be attended to, and to be abbreviated from the earliest commencement of the disease, my method treatment is instituted accordingly and has generally been successful. I do not administer any emetic, neither do I give a laxative unless indicated by the costiveness, when I recommend cream. of tartar or castor oil, but prefer a clyster of either. In case of nausea I order a few bowls of camomile tea to be taken; if the nausea continues, it is to be relieved with the continuous saline draught in a state of effervesence, elixir of vitriol, and, if necessary, laudanum. The sickness of the stomach may also be alleviated by applying mint, cloves, or any other spice with wine or spirits to the pit of the stomach. The stomach being composed, 20 drops of elixir of vitriol are to be taken every 2 hours in a cup full of strong cold camomile tea, and if bark can be obtained, two drachms of the best pale bark in substance are to be taken given 2 hours, alternately with the elixir of vitriol. When an ounce of bark has been administered in this manner, the dose is to be diminished to one drachm every two hours, as the continuance of large doses might disorder the stomach or bowels. Should the bark prove purgative it will be necessary to give 10 or 15 drops of laudanum after every stool. But if the bark cannot be retained on the stomach, 20 drops of elixir of vitriol are to be taken every hour, and recourse must be had to bark clysters.

Two ounces of bark are to be put into three half pints of boiling water and be boiled down to a pint; the decoction to be strained and to 4 ounces of the decoction we add from two to four drachms of finely powdered bark and fifty drops of laudanum. This mixture is to be injected every 4 hours or oftener if the symptoms are violent. One or two glasses of Madeira wine may be added to each injection where the debility is great. Wine is to be given from the beginning; at first weaker wines, such as claret and Rhenish; it these cannot be had, Lisbon or Madeira diluted with rich lemonade. The quantity is to be determined by the effects it produces and by the state of debility which prevails, guarding against its occasioning or encreasing the heat, restlessness or delirium. I prefer pale bark from a conviction that most of the red bark offered for sale is adulterated. But I place the greatest dependence for the cure to the disease, on throwing cool water twice a day over the naked body. The patient is to be placed in a large empty tub, and two buckets full of water, of the temperature 75 or 80 degrees Fahrenheit's thermometer, according to the state of the atmosphere, are to be thrown on him.

He is then to be wiped dry and put to bed, it is commonly followed by an easy perspiration & is always attended with great refreshment to the patient. The remedy however must be applied from the earliest attacks of the disease and continued regularly through the whole course of it. Of regimen it is needless to say much to you: ripe fruits, sago with wine, and rich wine-whey are the most proper. A spacious chamber with a free circulation of air and repeatedly changing the bed and body linen are highly necessary. If the bark clysters should bring on costiveness the laudanum may occasionally be omitted; if this is not attended with the desired consequences, we have recourse to a common injection. Sprinkling the chamber with vinegar, washing the face, neck, hands and feet with it and then wiping them dry, will have their use. The fumes of vinegar and of nitre will contribute much to sweeten the air of the chamber.

I am, & c,

A. K.

N.B. The practice of applying the cold bath to fevers is not new. In a malignant fever which prevailed in Breslau in Silesia and proved extremely fatal, yielding to none of the usual remedies, DR. DE HAEHN a physician of the place had recourse to this remedy and found it effectual. It also had been used with advantage in England with putrid fevers. In many of the West India islands it is generally employed in their malignant fevers. DR. STEVENS, a gentleman of high character in this profession who is now in this city, assures me that in the island of St. Croix where he practiced medicine many years, it has been found more effectual than any method heretofor practiced.

I am moreover indebted to Dr Stevens for the following observations: that laxatives are never employed but when the clysters are not attended with the desired effect of moving the bowels; that in violent attacks of the disease bark clysters are repeated every two hours, and the water is applied to the body every 6 or 8 hours and even more frequently; that when there is disposition to diarrhea the elixir of vitriol has a tendency to increase it, as is therefore laid aside and that the disease which he has seen in this country is of the same nature with the malignant fever of the West Indies.

 

Sir,

If you are of the opinion, that the enclosed statement can have the least tendency to ally the apprehensions of the citizens, I beg you to make any use of it you may think proper.

I am with respect,

Your most humble servant,

A. KUHN

Sept 13, 1793

Matthew Clarkson, Esq. Mayor of the city of Philadelphia

From the 23d, of August, the day on which I saw the first patient with yellow fever, to the 3d day of September, when I was myself confined with a remittent fever, I visited sixty persons, ill of various complaints. The greater part, were indisposed with the remittent and intermittent fever, which always prevail among us, at this season of the year, which all yielded readily to our usual mode of treating those diseases, except in one gentleman, who had been many years an invalid-Seven only of this number had the yellow fever; three of them were patients of other gentlemen of the faculty. Of these seven, I was called to four, in the early stages of the disease. Three of them are now well; the other was in the fourth day of the disease, when I became unwell myself. He had then, no unfavourable symptoms; but died on the 8th day, from the time he was seized.

 


 

DR RUSH'S DIRECTIONS

For Curing and Preventing the

Yellow Fever

As soon as you are affected (whether by night or day) with a pain in the head or back, sickness at stomach, chills or fever--more especially if those symptoms be accompanied by a redness or faint yellowness of the eyes, and dull or shooting pains about the region of the liver, take one of the powders* in a little sugar and water, every six hours, until they produce four or five large evacuations of the bowels--drink plentifully gruel, or barley water, or chicken water-or any other mild drink that is agreeable, assist the operation of the physic. It will be proper to lie in bed while the medicine is operating, by which means a plentiful sweat will more easily be brought on. After the bowels are thoroughly cleaned, if the pulse be full of tense, 8 or 10 ounces of blood should be taken form the arm, and more, if the tension or fulness of the pulse should continue. Balm tea, toast and water, lemonade, tamarind water, weak camomile tea, or barley water, should be drank during this state of the disorder--and the bowel should be kept continually open, either by another powder, or by small doses of cream of tartar, or cooling salts, or by common opening clyster; but if the pulse should become weak and low after the bowels are cleaned, infusions of camomile and snakeroot in water or in substance, may be administered in the intermission of the fever. Blisters may likewise be applied to the sides, neck, or head in this state of the disorder, and the lower limbs may be wrapped up in flannels wetted in hoe vinegar or water. The food shall consist of gruel, sago, panada, tapioca, tea, coffee, weak chocolate, wine whey, chicken broth, and the white meats, according to the weak or active state of the system. The fruits of the season may be eaten with advantage at all times.

Fresh air should be admitted into the room in all cases and cool air when the pulse is full and tense.--The floor should be sprinkled now and then with vinegar-and the discharges from the body removed as speedily as possible. The best preventatives of the disorder are a temperate diet, consisting chiefly of vegetables, great moderation in the exercises of the body and mind, warm cloathing cleanliness, and a gently open state of the bowels.

B. R.

Sept. 10 1793.

* Each powder consisting of ten grains of Calomel, and fifteen grains of Jalap, for an adult.

 

 


FOR THE GENERAL ADVERTISER

FROM DR. E. STEVENS

TO

DR. JOHN REDMAN

Sir,

IN compliance with the request of the learned body over whom you preside, I now cheerfully transmit them a few brief and detached observations on the nature and treatment of the present and fatal disorder which prevails in the city. Their humane activity to ascertain the real character of the complaint and to establish some fixed and steady mode of cure for it are fresh proofs of their benevolence and clearly evinces that disinterested liberality for which they so eminently distinguished. I only regret that their application to me, has approached so near the moment of my departure that I have not sufficient leisure to elucidate the subject so amply and satisfactorily as the importance it deserves. Imperfect however as the enclosed sketch may be, I can with truth assure them that it is dictated soley by a philanthropic demise of desire of checking the ravages of the disease and of restoring tranquility to the dejected minds of the public.

This disorder arises from contagion. Its approaches are slow and insidious at the commencement. It is ushered in with a slight degree of languor and lassitude, loss of appetite, restlessness and disturbed dreams, depression of spirits and a want of inclination to perform the ordinary occupations of life. The patient does not consider himself sufficiently sick to complain or call in the assistance of a Physician. His feelings are rather unpleasant than alarming. This train of symptoms continue for 2 or 3 days and if not removed by timely aid is succeeded by a sharp pain in the head, anxiety and suppression about the Praecordia, a febrile surge pulse, great prostration of strength and a variety of morbid Phaenomena which are too well known to the faculty to need description. In the first stage of the disorder a little attention and well directed efforts of a skillful practitioner may generally prove successful in the mitigating the violence of future symptoms and preventing with much danger or long confinement. At the first appearance of languor, lassitude, &c. especially if the patient has been near the source of contagion, he should carefully avoid fatigue of the body and application of the mind. Everything can tend to debilitate should be carefully guarded against. He should remain at perfect rest. His diet should be fuller and more cordial than usual, and a few extraordinary glasses of Madeira may be allowed. He should take the cold bath every morning, and if his sleep is disturbed, a gentle opiate combined with a few grains of volatile salts and some grateful Aromatic may be administered at night. A few doses of good genuine bark may be taken in powder during the day and if the stomach should become afflicted with Nausea, a strong decoction of the same may be substituted. Great care should be taken to keep the mind of the patient calm and serene--neither to terrify it with needless apprehension, nor alarm it by the melancholy relation of the spreading mortality that surrounds him. It is at this stage of the complaint that the Physician may lay the foundation of future success. But unfortunately, it is the period of the disease which is commonly too much neglected by the patient. Gentleman of the faculty are rarely called in until the symptoms are more alarming and dangerous. But it is a matter of material consequence to the patient to know that by a little bit of attention at the commencement, and by carefully watching the approaches of the disease even though it should by contracted, it may be rendered mild and may terminate favourably . Its also of equal consequence for practitioners to attend to these particulars in laying down the prophylaxes to their patients.

When the disorder has gained ground and becomes violent and when the danger is imminent the most unremitted exertions should be made by the Physicians to mitigate the symptoms. The Nausea and vomiting may be relieved by an infusion of camomile flowers given frequently until the stomach is sufficiently emptied of all crude matter. Small doses of a cordial mixture composed of the oil of peppermint and compound spirits of lavender may then be taken until the sickness abates. If notwithstanding the instability of the stomach should continue, recourse must instantly had to the cold water bath which must be used every two hours or oftener if the urgency of the symptoms should require it. After each immersion, a glass of old Madeira or a little Brandy burnt with cinnamon may be administered. Flannel clothes wrung out of spirits or Wine impregnated with spices may be applied to the pit of the stomach and changed frequently.

An injection containing an ounce of powdered bark mixed with this sago to which a tea spoon full of Laudanum has been added should be administered. These injections may be continued every two hours omitting the laudanum after the first. As soon as the stomach can bear the medicine and nourishment in small doses; as much Madeira wine may be given as the patient can bear without affecting his head or heating him too much. All emetics and violent cathartics should be avoided. If the bowels should not be sufficiently open a laxative of clyster may be necessary of a few grains of powdered rhubarb added to each dose of bark until the desired effect is produced. If diarrhea should prevail it must be checked by a starch injection blended with laudanum, by the tincture of E. Kino yaponica or a decoction carcarilla. All drastic cathartics did injury when the disease is in its advanced stage. If stupor, coma, or delirium should come on a large blister be applied between the shoulders and small one to the thighs, stimulant cataplasms should also be applied to the feet; when haemorahagies appear the elixir of vitriol may be administered in conjunction with the bark. But great care should be taken to prevent it from affecting the bowels. If the pulse should be sunk, the prostrations of strength great and the subsultus teninium take place small doses of the liquor mineralis haffinanni of vitriolic aether diluted with water may be given. Musk and camphor in this stage of the disease have likewise proved effectual; upon the whole, sir, I may sum up this hasty outline by inculcting the use of the tonic plan in its fullest extent and by warning against the ill consequences of debilitating applications or profuse evacuations in every period of the disease; the cold water bath, bark and wine, a spacious and well ventilated room, frequent change of bed and body linens and attention to rest and quiet if properly persevered in will, in most cases prove successful and strip this formidable disease of its malignity, its terror and its danger.

The descriptions I have given of the disorder & the utility of the plan of cure I have laid down are confirmed by experience and coincides with our reason and the soundest theory; the cause producing the effect is strong debilitating power; the symptoms occasioned by its application indicate extreme debility in the animal functions and great derangement of the nervous system; ought not therefore the remedies adapted to the complaint, to be cordial stimulating and tonic? Should not violent evacuations which evidently weaken and relax be avoided? These are hints which it would be presumptuous to extend or dwell upon; Their superior judgement will I am convinced supply every deficiency and enable them to pursue that plan which is best adapted to public utility and the effectual removal of the present dreadful malady. If the few observations I have suggested be serviceable to the inhabitants of this city my intention will be fully answered and my feelings completely grateful.

I have the honor to be, Sir,

Your most obedient servant,

Edward Stevens

 

Wednesday, January 13, 2021

No, Rush did not trudge, and other liberties Powell took with facts in Bring Out Your Dead

In his 1949 history of the 1793 epidemic, Bring Out Your Dead, J. H. Powell begins his narrative on page 8 with a description of Dr. Benjamin Rush on his way to see a patient on August 19: "Rush turned down Walnut Street, passed Judge Peters' fine place on the corner, and began to purposefully stride toward the river."

In an autobiographical essay written in 1800, Rush answered a question often put to him. How did he find the time to accomplish all he had done? He listed six reasons and number five was: "By visiting my patients in a carriage, I lost but little time out of doors. I was carried to them with more quickness, and was less liable to interruptions and delays in the streets when I visited them on foot." (page 91, Corner, Autobiography of Benjamin Rush)

There is no evidence that because of the increase in his business in August 1793, he decided to walk instead. Indeed, Dr. Charles Caldwell, in his autobiography written in 18--, recalled Rush's sarcastic jokes in his medical school lecture after the epidemic. Rush had shocked his colleagues by urging them to give patients doses of ten grains of calomel and ten grains of jalap. The former was an mercury compound and the latter a root from Mexico both evacuated the body "up and down." His students, Caldwell especially, favored what was called "ten and ten." Caldwell found it effective when he treated patients with it during the epidemic. So, Rush sassed his colleagues to an appreciative audience. Caldwell remembered:

"Dr. K[uh] n ," said [Rush], "called it a murderous dose! Dr. H[od]ge called it a dose for a horse! And Dr. B[ar]t[o]n called it a devil of a dose! - Dr. Hutchinson]." he continued , “who is nearly as large as Goliath of Gath, and quite ├ís vauntful and malignant, even threatened to give me a flogging. Dr. H. flog me! -Why, gentlemen, if a horse kicks me, I will not kick him back again. But here is my man Ben " ( his coachman ) “whose trade is to beat beasts. He is willing to meet Dr. H. in my place, and play brute with him as soon as he pleases. I have that to do which belongs to a man." (page 184)

Powell has Rush "stride" on page 8, then he "trudged" on page 9, and finally "plodded" at the bottom of page 10. All the while, Ben stayed home with the horse and carriage. Of course, Powell used a well established literary technique as a convenient way to begin to describe the city. But Powell is not trying to see the epidemic through Rush's eyes. Quite the opposite, beginning on page one, Powell uses information in Rush's account of the epidemic, without attribution, and tweaks that information to make a point Powell wants to make which is often the opposite of the point Rush was trying to make.

Rush begins his account by describing the weather and diseases observed during from December 1792 to September 1793:

The weather for the first two or three weeks in August was temperate, and pleasant. The colera morbus, and remitting fevers were now common. The latter were attended with some inflammatory action in the pulse, and a determination to the breast. Several dysenteries appeared at this time, both in the city and in its neighbourhood. During the latter part of July, and the beginning of this month, a number of the distressed inhabitants of St Domingo, who had escaped the desolation of fire and sword, arrived in the city. Soon after their arrival, the influenza made its appearance, and spread rapidly among our citizens. The scarlatina still kept up a feeble existence among children. The above diseases were universal, but they were not attended with much mortality. They prevailed in different parts of the city, and each seemed to appear occasionally to be the ruling epidemic. The weather continued to be warm and dry. There was a heavy rain on the 25th of the month, which was remembered by the citizens of Philadelphia as the last that fell, for many weeks afterwards.

Rush was following a time-honored way to describe an epidemic. Hippocrates himself advised it. Rush included tables compiled by the clockmaker David Rittenhouse of the months from January to November 1793 giving the daily temperature in the morning and afternoon, wind direction and whether it was fair, cloudy or rained.

Powell's introduction used information Rush provided but not for future scientific reference. Powell shaped it to foreshadowed catastrophe. For example:: " Sweltering and dusty in the August heat, Philadelphians endured the summer ills and waited for the fall." Rush had written: "The weather for the first two or three weeks in August was temperate, and pleasant."

Powell and Rush also differ on what May was like. Rush remembered that "There were several warm days in May, but the city was in general healthy." Powell writes that May "was uncommonly wet. Day after day, a dismal driving rain, cold and relentless, poured from the northeast." The weather tables show otherwise. Only on two days was it raining all day,  May 3 and May 26. On the former day it was 60F and 63F at 7 and 2, and 61F and 66F on the latter. It rained in the morning or afternoon on several other days. All in all, a rather normal May.

Powell rarely cites sources, and he may have had several for his description of the drought. But one observation clearly came from Rush's account:

There was something in the heat and drought of the summer months, which was uncommon, in their influence upon the human body. Labourers every where gave out (to use the country phrase) in harvest, and frequently too when the mercury in Fahrenheit's thermometer was under 84°. It was ascribed by the country people to the calmness of the weather, which left the sweat produced by heat and labour, to dry slowly upon the body. The crops of grain and grass were impaired by the drought. The summer fruits were as plentiful as usual, particularly the melons, which were of an excellent quality.

Powell adjusted that curious observation into another dire foreboding: "In the great heat farmers dropped in the fields, because, the country folk said, there was no wind and the sweat dried slowly on their bodies."

Farmers recruited laborers from cities and villages to help in the harvest. The farmers didn't faint in the fields. Powell doesn't note the relatively cool temperature and never mentions the melons.

After noting the fainting farmers, Powell continues: "country folk could tell the auguries of other signs - large numbers of wild pigeons had always meant unhealthy air, and never had the city markets scene so many wild pigeons as were sold in the stalls in 1793. Strange diseases were attacking animals, diseases like the 'yellow water' afflicting horses in New Jersey and cows in Virginia."

Powell collected those auguries from Rush. On page 180 of his account, the doctor wrote: "The wild pidgeons were common during the winter of 1793 in many parts of Pennsylvania. But they have occasionally appeared in great stocks in our state in former winters, without having been the harbingers of a sickly autumn."

While Powell collected suspected harbingers for atmospherics, Rush had to take them seriously as indications of the “state of the air” which doctor since Hippocrates had blamed for diseases. Rush wrote on page 153:

...such was the state of the air in the summer of 1793, that it predisposed other animals to diseases, besides the human species. In some parts of New Jersey, a disorder prevailed with great mortality among the horses, and in Virginia among the cows, during the last autumn. The urine in both was yellow.—Large abscesses appeared in different parts of the body in the latter animals, which when opened, discharged a yellow serous fluid. From the colour of these discharges, and of the urine, the disease got the name of the yellow water.

His point was that the "state of the air" shared by horses and men might have fostered both yellow fever and yellow water. Rush suggest the same state inspired an unusual number of “moshettos.” Powell mixes mosquitoes and yellow water into his cauldron of auguries like one of the witches in MacBeth.

Powell had other accounts to glean for auguries. The Lutheran minister Henry Helmuth wrote several pages on occurrences that fated the city to have a deadly epidemic. Powell quoted only Helmuth's suggestion that “a merry sinful summer" preceded the epidemic.

For some strange reason, Powell associated the merriment of the summer with the influx of refugees from what would become the black Republic of Haiti. He had previously noted that the refugees were “guant, hungry, sickly.”

Philadelphia was a new and fresh experience for the refugees; so were they for Philadelphia. Their insouciance, their cleverness in occupations, their street games and songs, their ready adjustment, their avid participation in the cock fighting, rope dancing, gambling, taverns, theatres, and alehouses of Philadelphia contributed to give the city, in spite of the heat and drought, what the Reverend J. Henry C. Helmuth termed "a merry sinful summer."

Scholars now estimate that upwards of 2000 white refugees came with 800 slaves mostly servants. In no shape or form did Helmuth suggest that the refugees in particular had anything to do with the "sinful summer." He wrote in A Short Account of the Yellow Fever in Philadelphia for the Reflecting Christian:

Philadelphia far exceeded most of the cities of North-America, in luxury and dissipation among all classes of people. It was Philadelphia, that did not rest, until the performing of theatrical exhibitions was authorised by law. It was Philadelphia that refined so much on this species of vanity, as to erect: one of the largest houses upon the continent for theatrical exhibitions and engaged actors at a prodigious expence ; as if one house, that existed before were not sufficient to ruin our young people,too much neglected already. It was Philadelphia that imported from luxurious Europe, the number of 70 or 80 actors and retainers to the stage, who actually arrived here exactly at the time, when the fever raged with the utmost violence. It was Philadelphia, that contained those parents who had given willingly 300 dollars to obtain a perpetual right of free access with wife and children to the plays, in order to obliterate in their hearts all taste for what is serious and useful, I will not say godly and heavenly....
It was Philadelphia, that during the whole of last summer was so eager to fee the rope-dancing and other mews exhibited in the city, that one hardly knew how to pass along, for the immense number of people, who were either going to these diversions or returning therefrom. Many a one carried thither, that money which he wanted exceedingly for the support of his family. Most of them distracted their hearts, there in such a manner, that on the following Sunday they either did not go to church at all, or else could have no benefit from the explanation of the word of God, every part of their minds being so filled with those follies, that it was impossible, that any thing serious could find room therein. After such a merry, sinful summer, by the just judgment of God, a most mournful autumn followed, which commenced when the much esteemed and celebrated Circus was hardly closed.
Powell not only neglects those signs that the godly could easily interpret as boding ill for the city, he ignores the campaign to ban theatrical entertainment that was mounted immediately after the epidemic.

Powell uses Helmuth's account in his description of visits to the sick at the peak of epidemic. Like Rush, Helmuth also trudged:

Through the awful loneliness of the night, the Reverend J. Henry C. Helmuth trudged 'with a trembling heart' going from one victim to another, raising a fearful din in the city as he raised a door knocker, radiating a saintly calm as he entered a sickroom, facilitating many a passage into eternity. Down streets empty as a wasted desert... hear no sound but the doleful creaking of the dead cart as it went on its ceaseless rounds.

To begin with, in his account, Helmuth uses the phrase "with a trembling heart" not to describe himself but a man fleeing Water Sreet, where the fever first struck the city in August: "he would go with a trembling heart and hasten away." Helmuth doesn't mention a "door knocker," or "desert" but does mention the dead cart: "the constant going backward and forward of the dead-cart, especially its doleful noise in the night time...."

To be sure, despite a "trudge" here and there, Powell sweeps us along with his narrative, but especially in the 18th century religious writers were practiced at stopping the narrative with images to make the reader reflect. "The constant going backward and forward of the dead-cart" does that, while "ceaseless rounds" doesn't.

Helmuth only uses the word "eternity" three time and not in the context of his "facilitating many a passage into eternity." Powell uses that cliches phrase to dodge describing what pastoral care Helmuth did give.

In Bring Out Your Dead, a phrase which Helmuth nor anyone else reported ever hearing in Philadelphia, Powell hails the ad hoc civic response but devotes only a few pages to what for many was an intense religious experience. Powell graduated from Swarthmore College, a premiere Quaker liberal arts college that has a manuscript collection of letters from Quakers who suffered through the epidemic. Despite that, Powell ignores the Quaker response to epidemic, not even mentioning their Yearly Meeting held in Philadelphia in September. He shows scant interest in the response of other denominations. The Lutherans get more space because Helmuth's account provided grist for Powell's secular mill.

That ignoring religion likely pleases modern readers doesn't make Bring Out Your Dead good history. Merely quoting first hand accounts doesn't make good history either, which brings us back to Rush striding, trudging and plodding on August 19. He was going to consult with Drs. Hodge and Foulke about one of their patients. Between the time Rush's walk changed from a stride to a plod, Powell has him thinking about his recent cases, which, Powell writes, Rush had found to be “puzzling medical problems.”

Since people in the 18th century had no concept of viruses and did not know that mosquitoes spread yellow fever, it is easy for a 20th century historian to describe them as puzzled. We are almost certain that they had no cure or preventative for the disease. There is still no cure and a vaccine is the only preventative. From that almost sure ground, we can belittle anyone who confronted the epidemic, but even if Rush was putting on a brave front to hide his nagging doubts, a historian should at least show us that brave front.

In his account, Rush didn't allude to being puzzled. He wrote: “None of the cases which I have mentioned, excited the least apprehension of the existence of a yellow fever in our city; for I had frequently seen sporadic cases in which the common bilious fever of Philadelphia, had put on symptoms of great ma|lignity, and terminated fatally in a few days, and now and then with a yellow colour on the skin, before, or immediately after death.

Beginning in the mid-20th century, infectious diseases were exceptional. In the 18th century they ruled.

Only Rush left an account of his consultation with Hodge and Foulke. He wrote:

On the 19th of [August] I was requested to visit the wife of Mr Peter Le Maigre, in Water-street, between Arch and Race-streets, in consul|tation with Dr Foulke and Dr Hodge. I found her in the last stage of a highly bilious fever. She vomited constantly, and complained of great heat and burning in her stomach. The most powerful cordials, and tonics were prescribed, but to no purpose. She died on the evening of the next day.

Upon coming out of Mrs Le Maigre's room, I remarked to Dr Foulke and Dr Hodge, that I had seen an unusual number of bilious fevers, accompanied with symptoms of uncommon malignity, and that I suspected all was not right in our city.

Dr Hodge immediately replied, that a fever of a most malignant kind had carried off four or five persons within sight of Mr Le Maigre's door, and that one of them had died in twelve hours af|ter the attack of the disorder. This information satisfied me that my apprehensions were well found|ed. The origin of this fever was discovered to me at the same time, from the account which Dr Foulke gave me of a quantity of damaged coffee which had been thrown upon Mr Ball's wharf, and in the adjoining dock, on the 24th of July, nearly in a line with Mr Le Maigre's house, and which had putrefied there to the great annoyance of the whole neighbourhood....

Upon my leaving Mrs Le Maigre's, I expressed my distress at what I had discovered, to several of my fellow citizens. The report of a malignant and contagious fever being in town, spread in every direction....

Powell recounts the conversation as Rush described it, and then throws a lightning bolt: "The news brought Rush up short, and he seized upon it avidly. All his patients... had been in this neighborhood. infections could obviously be traced to the noxious effluvia of the rotting coffee." Several sentences on, Powell sums up: "There in Cathy LeMaigre 's parlor, he had his revelation. He did not hesitate to pronounce the disease the bilious remitting yellow fever." Powell then has Rush go to tell Mayor Clarkson and Governor Mifflin. (With such dire news to spread, this would have been a good time for Ben and his carriage to appear.)

According to Rush, he had more thinking to do:

After this consultation I was soon able to trace all the cases of fever which I have mentioned to this source. Dr Hodge lived a few doors above Mr Le Maigre's, where his child had been exposed to the exhalation from the coffee for several days. Mrs Bradford had spent an afternoon in a house directly opposite to the wharf and dock on which the putrid coffee had emitted its noxious effluvia, a few days before her sickness, and had been much incommoded by it. Her sister Mrs Leaming had visited her during her illness, and probably caught the fever from her, for she perfectly recollected perceiving a peculiar smell unlike to any thing she had been accustomed to in a sick room, as soon as she entered the chamber where her sister lay. Young Mr M'Nair and Mrs Palmer's two sons had spent whole days in a compting house, near where the coffee was exposed, and each of them had complained of having been made sick by its offensive smell, and Mr Aston had frequently been in Water-street near the source of the exhalation.

This discovery of the malignity—extent—and origin of a fever which I knew to be highly contagious, as well as mortal, gave me great pain. I did not hesitate to name it, the Bilious remitting Yellow Fever. I had once seen it epidemic in Philadelphia, in the year 1762....

Rush left us four sources of information on the epidemic: his account published in February 1794, his letters to the newspaper, his brief clinical notes, and his letters to his wife. She and some of their children were spending the summer at her brother's place in Princeton, New Jersey, the family's usual summer retreat. Rush wrote to her on August 21with an addendum in the morning of the 22d. He did not sound like the man Powell described on August 19:

To prevent your being deceived by reports respecting the sickliness of our city, I sit down at a late hour, and much fatigued, to inform you that a malignant fever has broken out in Water Street, between Arch and Race Streets, which has already carried off twelve persons within the space which has been mentioned. It is supposed to have been produced by some damaged coffee which had putrefied on one of the wharves near the middle of the above district. The disease is violent and of short duration. In one case it killed in twelve hours, and in no case has it lasted more than four days. Among its victims is Mrs. LeMaigre. I have attended three of the persons who have died with it, and seven or eight who have survived or who are I hope recovering from it.

As yet it has not spread through any parts of the city which are beyond the reach of the putrid exhalation which first produced it. If it should, I shall give you notice, that you may remain where you are till you receive further advice and information from me. The influenza continues to spread, and with more violent symptoms than when it made its first appearance. I did more business in 1780 than I do at present, but with much less anxiety, for few of the diseases of that year were attended with any danger, whereas now most of the cases I attend are acute and alarming, and require an uncommon degree of vigilance and attention He added a P.S.: “John [their son] should come home as soon as his vacation expires.”

He does not use the words “yellow fever.” He recalls 1780, not 1762. Rush wrote a short account of the 1780 epidemic. That August there were several days when the temperature was about 90F. Laborers died in the heat. Then it turned cold on the 19th and a fever swept the city that was commonly called “the break-bone fever.” Dengue fever which is spread by the same mosquito that carries yellow fever is still commonly called break-bone fever. Fortunately, few died of the fever.

 
Back to 1793: It is not certain when Rush did his epidemiological research that tied his recent cases of malignant fever to the rotting coffee, but the letter suggests that he did not do it not while with his colleagues on the 19th. The letter also suggest that he was not trying to prove how the disease had spread but to show that those who got it had been exposed to the smell. He first was pleased with that limit on the disease. Only in retrospect, did that initial research prove how insidiously the disease spread. There is no mention of seeing the mayor or governor. 

A revelation is the sudden realization of what should have already been apparent. It can be at once gratifying and embarrassing. Judging from what he wrote on the 21st, Rush did not have a revelation. The fevers he treated at the beginning of August were not puzzling, but the LeMaigre consultation gave him a clearer understanding of what was going on and good reason to advise people to stay away from that block of Water Street. But in his mind at the time, it wasn't even an augury of a city wide epidemic. He was waiting for more information including how several patients would respond to treatments he recommended. Confirmation that there was a dangerous epidemic came so quickly, within 5 days, that Rush was certainly justified in highlighting his assessment of the situation on the 19th in his account of the epidemic. 

But a historian has to account for his equivocal letter to his wife. Powell doesn't do that. He also doesn't simply congratulate Rush for having the “revelation.” He takes what only can be described as a sentimental digression.  

Powell keeps harping on the presence of the refugees from St. Dominque. He is certain they brought the disease to the city, and, like most modern commentators, scoffs at the anyone blaming rotting coffee. He turns the clock back two weeks and describes what were the first two documented cases on Water Street. Philip Syng Physick made notes of the autopsy of the first victim, an Englishman, who died the day the doctor came. He feared that he might have been poisoned. Isaac Cathrall made notes of the symptoms an Irish woman, who roomed one door down from the Englishman, suffered over four days before she died. On August 5th, while Cathrall was treating his patient, Rush visited the dying child of Dr. Hodge who lived across the street. Powell writes: “If only Rush had stumbled into Cathrall back on August when he went up Water Street to see Dr. Hodge's child!” 

Powell suggests that class differences kept Rush from hobnobbing with refugees, French sailors, poor folk on Water Street, and the doctors like Cathrall who treated them. He gives Rush a character of which his contemporaries were completely unaware. Powell did not report on what Rush did on August 22. He sat at the head table for the dinner celebrating raising the roof on the new African Church. On the way, he had fresh melons sent to the prisoners in the jail nearby who were watching the work on the church all to remind them that God cared for them too. Rush prided himself for helping the dispossessed.  

Powell also assumes that Rush was loath to associate with young doctors. That is more nonsense. Both Cathrall and Physick had recently earned their M. D.s at Edinburgh just as Rush had. Such shared experiences always create a bond. He mentions both in his account of the epidemic using information from autopsies they performed on fever victims.  

Cathrall wrote a monograph on yellow fever in October 1794 in which he pinpoints French sailors, not refugees, as the source of disease. He also explains why the first cases of the epidemic were misinterpreted: “During the first two weeks of it's appearance in this city, it was almost entirely confined to that part of Water-street where it commenced; and the inhabitants of that neighbourhood were seized in succession. For the first ten days there were seldom two attacked with the disease in the same house, which induced some to think that it was not contagious;...” Neither the Irish woman's husband nor their two daughters got sick.  

In August, Cathrall shared his observations with an older doctor. Powell makes Dr. William Currie a bit of a hero because he became one of Rush's most persistent critics. Currie wrote a monograph about the deaths on Water Street and had it at the printers on September 3. While he didn't treat a patient there he talked with Cathrall and put his case notes in his monograph, He talked with Physick and summarized his autopsy report. He talked to the Catholic priest who attended some of the dying. He talked to the daughters of the owners of the boarding house. Their parents were the next to die there. He could not find the French physician who treated one of the sailors who died. At that early date, he stubbornly resisted having a revelation: “That the disease made its first appearance in the house already mentioned, is clearly established; but whether it was imported and introduced there by the Irish family, or by the French lads, or was generated there, I have not been able to collect a sufficiency of evidence to determine.” 

Evidently, none of the West Indian refugees in Philadelphia showed symptoms of yellow fever, none died of it. As the epidemic wore on, they demoralized others by walking the streets with impunity. Previous exposure to the disease had given them immunity. Blaming them for the epidemic, as Powell insists doctors should have, would have created a useless, if not dangerous, horror. With their superior knowledge, historians should be careful what they wish. Rush's theory blaming the rotting coffee is a more accurate assessment than Powell's. 

The problem then and now are the mosquitoes. One species, the Aedes aegypti, which has never been identified as endemic to Philadelphia, spreads the disease. It has a short range and breeds in relatively clean water. So both sides of the argument were partially right. Those mosquitoes were probably imported in the casks of fresh water always found on sailing ships. Enough of the those moquitoes sucked the blood of passengers, probably sick sailors and not refugees who were immune by prior exposure, and then within a radius of 500 feet began infecting people on shore. In the first two weeks they went as far as the smell from that coffee. Especially after the heavy rain on August 25, they found places to breed throughout the city. Many contemporaries intuitively understood that. The doctors, Rush included, can be faulted for debating the issue, but even they waited until after the epidemic. 

The newspaper editor Matthew Carey came out with the first instant history is early November. While composing it, he asked Rush what evidence he had that the fever had been generated in the city. Rush promised to get the evidence to him. Mercifully, the likes of Powell were not on the scene. The 800 people of color, truly of all shades, who had just landed, would have taken the brunt of the city's anger. The reaction to the epidemic would have been another racist stain on American history. 

That rain on the 25th was widely misinterpreted at the time. Powell has doctors “trudging through the fury of the northeast storm,” while almost everybody else packed up, closed their houses and “a huge throng...streamed out to the country.” If he had only read the letters left by Quakers still to be found in the Swarthmore and Haverford College libraries!  

The Quaker merchant Benjamin Smith on Front Street, just up from Water Street, was recovering from the influenza. All that remained of it was a troublesome cough. His wife Debby seemed to be coming down with the same bug. At least he was well prepared to be her physician. He would see that she soaked her feet in hot water, sipped chamomile tea until it brought on a sweat, drank plenty of "gruel water" and kept her body "open" with purging salts. Then that evening, Debby's fever became worse and she complained of "a violent pain in the head." Smith sent for Debbie's mother, Margaret Morris, who gave her Peruvian bark which seemed to lessen her attack and by morning she seemed out of danger. Margaret also opined that the rain would rid the city of sickness. They didn't pack up and leave the city.