Friday, November 27, 2020

The Covid-19 pandemic and Yellow Fever in the 1790s

"...alarm through the whole continent"


Portrait In Memoriam of Eliza Wescott
Eliza Wescott and Lucy Breck fled from Philadelphia to escape its yellow fever epidemic. With only one maid to serve them, they secreted themselves in Lucy's family's summer home north of the city. The two young women with rich fathers made clear to their many admirers that they wanted to be alone. Within two weeks both were dead.

Other than proving the power of epidemic disease, do their deaths tell us anything about the year old Covid-19 pandemic? During the current pandemic, Philadelphia's 1793 yellow fever epidemic has been remembered. Almost 5000 people, 10%  of the city's population, died in what was then the country's commercial center and nation's capital. 

However, Eliza and Lucy didn't die during that epidemic. They carried their fears of yellow fever to a rustic retreat five years later during Philadelphia's third yellow fever epidemic. So, as we face a second year of Covid-19 and talk of a new normal, we are not necessarily in a place where the nation has never been before.

This stone covers the remains of Elizabeth Wescott and Lucy Breck, Two dear friends who died on the same day, September 10, 1798

In 1794, there were epidemics in Baltimore and New Haven, 1795 in New York City, 1797 in Philadelphia, and then came the demoralizing epidemics of 1798. Death and panic spread in port cities from Wilmington, Delaware, to Newburyport, Massachusetts, with upwards of 10,000 dead, roughly 5%  of the urban population of the then largely rural country of 5 million people.

It can fairly be said that the nation went through a reign of terror. In a September 20, 1798, letter to his brother, William Russell, a Boston merchant, contemplated "the dreadful calamity with which this country is now visited in each of the commercial cities to a degree beyond all former precedents. Distressing and alarming as it has been upon former occasions, it is far more so upon this and the direful consequences have attained an excess which has spread alarm through the whole continent." 

Alice Cogswell, in Princeton, wrote to her son who was a doctor in Hartford, Connecticut: "What sad havoc does this pestilential fever make with the inhabitants of this world, wives torn from their husbands, husbands torn from their wives, and in some instances whole families swept to eternity without one relict left to mourn their loss. It is enough to make ones heart weep drops of blood, or rather streams, my soul turns with horror from this scene of wretchedness and misery to the world beyond the grave where there is no more sorrow or grief...."

The yellow fever and Covid-19 are both viruses but otherwise rather different. The former attacks the liver, the latter can destroy the lungs. If it is going to kill you, yellow fever will do it a week. Black vomit is the sure sign of death. Covid can keep you hooked up to a ventilator for a couple weeks before you die. Yellow fever killed many people in their prime of life, especially males from 14 to 40 years old. Covid mainly kills the aged. Yellow fever is spread by certain species of mosquito. Covid spreads from person to person. In Philadelphia, frost killed the mosquitoes. (In August 1793, on only three days was the temperature at 3pm under 80F. There was not a night below freezing until October 29.) Covid has no known seasonal limit.

The range of any yellow fever epidemic is also limited. We now know that an Aedes aegypti mosquito carrying the virus never flies very far. Then and now, the disease primarily impacts cities. Knowing what we know now, it easy to picture the mosquitoes carrying the yellow fever virus, which was then endemic in the West Indies, hitching a ride on the fresh water casks carried by sailing ships and then finding a place to breed in the fresh water cisterns behind many stores and homes in Philadelphia. People noticed that there were more mosquitoes than usual, but most people assumed people on ships brought any new disease and quarantine was the best way to fight it.

Then, people who had no contact with the waterfront began dying. With each succeeding epidemic more people became convinced that local conditions, not ships from the West Indies, caused the fevers. Senator Pierce Butler became obsessed with Eliza's and Lucy's deaths. (Philadelphia was the nation's capital until 1800.) On October 14, 1798, he wrote to Dr. Benjamin Rush asking "What gave to these young women the fever?" Butler hazarded an answer. The soil around the house was "cold clay, some of it low and moist." That alone may have felled the delicate women. "May there not have been some miasmatic exhalations engendering intermittents [malarial fevers]; and which from the relaxed state of those ladies frame, for such they assuredly were, from some predisposing cause in the surrounding atmosphere may have given to a common intermittent the type of the epidemic." 

Rush's answer to Butler's letter has not been found. However, there is no mystery about what Rush thought. He blamed the 1793 epidemic on the smell from coffee beans left to rot during an August heat wave on Philadelphia's Arch Street wharf. 

Arch Street Wharf

Contagion from that combined with the heat and stench throughout the city made the air deadly. At first, he thought the fever was also passed from person to person, but he soon changed his view. The fever spread because people breathed the same air. Other doctors doubted the seriousness of the fever. But the rising death toll convinced many that they faced a deadly contagious fever that was beyond control. 

Since the most popular instant history of the epidemic was written by a man who fled, historians ever after have given the impression that everyone who counted left the city. However, thanks to the stubbornness of the large and literate Quaker community in the city, we have several first hand accounts from people who stayed. 

Quakers at the time deemed it a sin to neglect duties in order to escape a scourge that was so obviously a judgment of God against a sinful city that didn't ban theaters and a sinful nation that didn't abolish slavery. Their Yearly Meeting, which required the attendance of leading Quakers throughout the neighboring countryside, convened as scheduled in late September, despite the rising death toll.

In early September, doctors blamed an uptick in deaths on the lines of volunteers fighting a fire, but social distancing was not enforced afterwards. There was no lockdown: market days on Saturday and Wednesday continued, church services continued, banks stayed open, and the Federal Treasury clerks stayed in their desks nearby. The post office remained open but there was no delivery of mail. In those days, there were no public schools. One report alluded to many teenage apprentices enjoying themselves in the woods surrounding the city. Newspapers published advice on treatment and the reports of an ad hoc committee supervised by the mayor that organized the city's response to the epidemic.


Those reports gave the names of people admitted to the hospital and when they were discharged or when they died. The one hospital in the city did not accept patients with a potentially contagious disease. At that time, victims of epidemics were never treated where there were other patients. The committee commandeered an estate outside the city and turned it into a fever hospital. 

It accepted all classes, so the Haines family, who were prominent Quakers, did not send their ill 64 year old mother to it. Only an African American nurse, presumed to be immune to the disease, sat and slept beside her. Benjamin Rush inspired three leaders of the black community to provide nurses and a crew to collect to dead.

A doctor made daily visits to Margaret Haines. No one masked their face. It was not something in the air, but the air itself that was thought to be contagious. When he visited a patient, Rush first had windows opened and bed covering removed. He rinsed his mouth with vinegar, stopped his nose with a cloth soaked in vinegar, avoided deep breathing, did not swallow, dipped his finger in camphorated vinegar before taking a pulse or touching the patient and when he left the room, he again rinsed his mouth with vinegar.

Margaret Haines' doctor prescribed blisters and bleeding. A spiritual advisor made longer visits and took no precautions, which eased her dying and his death soon after. During her illness, her son who came from outside the city only saw her through a window. Letters he wrote to his wife in the country were smoked before being sent.

Doctors and laymen shared their remedies in the newspapers. Dr. Rush first urged a sweet tasting mercury compound called calomel to purge the body and then advised also taking out a pound of blood and then another pound when needed. No doctor in the 18th century ascribed to the adage that while medicine is good for bacterial infections, it is powerless against viruses. (I was reminded of that during a check up in May 2020.)  

Doctors then didn't know about bacteria and viruses and no ailment was exempted from their remedies. Other doctors advised taking a bitter quinine bark in wine as well as having buckets of cold water pour over your body. A good measure of how much panic yellow fever cause is that with each succeeding epidemic most doctors began to purge and bleed. There was and is no cure and Rush's treatment had the virtue of sedating a patient in a disease notorious for causing unbecoming delirium.

By the second week in September, anyone leaving the city was suspected of carrying the contagion. Local governments kept refugees away or put them through quarantine. Secretary of War Knox was stopped by several militias as he tried to get from Philadelphia to his farm in Connecticut. One New Jersey city allowed him to quarantine there for 14 days so that he could travel through New York City where patrols were vigilant, and, at night, sometimes violent.

People in the city also warded off others, even relatives. An uncle refused to take in the children of a nephew who died and a niece who remained sick. Another Quaker family took them. After the ad hoc committee asked for help, a rich philanthropist arranged to take care of orphans.

Working outside the city, government leaders kept tabs on the situation. President Washington had planned to be away from the city for much of the fall. He prolonged his stay at Mount Vernon, cooled all talk of moving the federal government elsewhere, and visited the city before the all clear. Congress had adjourned in March and convened as scheduled in early December.

Governor Mifflin asked doctors what should be done. The College of Physicians noted that yellow fever had rarely threatened the city, was obviously imported and better enforcement of quarantines would prevent its return. Rush blamed unhealthy conditions in the city and urged a general clean up. The Quakers and other religious leaders soon grabbed more attention by urging a return to the moral fervor exhibited during the Revolution. Once again, theatrical entertainments must be banned.

The state legislature allowed theaters to remain open. A grand jury investigated current conditions in the city and found there was "no cause for uneasiness or complaint." To prevent another epidemic, it suggested cleaning the streets with water and planting trees. After that bow to Rush, it satisfied the College of Physician by suggesting that the city build a marine hospital south of the city to hold people in quarantine as well as a nearby "pest house" for victims of any future epidemic.

The legislature also established a five man Board of Health, which soon led the city in an act of revenge. When yellow fever struck Baltimore, Philadelphia told stage companies not to bring any passengers from that city. Yellow fever in other cities kept fear of another epidemic alive in Philadelphia. Before slapping a quarantine on Baltimore and then, in 1795, on New York City. Philadelphia had to certify its own health.

Covid has been tracked all around the world, first by the number of deaths and hospitalizations and then by the number of positive tests. In the 1790s, only reported deaths measured the virulence of an epidemic. Officials in both Baltimore and New York City downplayed the number of deaths. The New York City health committee published names of just over 700 victims to prove that they were mostly newcomers or of no account. Thanks to a street by street, alley by alley census taken at the end of the epidemic, Philadelphia would have data to prove that the principal victims of the epidemic were poor, but too many prominent families were grieving for authorities to harp on that.

The different reactions of each city had nothing to do with politics. Simply put, Philadelphia was the largest city in the country and its many deaths were hard to hide. Both Baltimore and New York City also had docks set well off from the rest of the city. In Philadelphia, Society Hill was rather close to the docks.

While quarantines showed that a port was serious about keeping diseases at bay, during July and August the heat alone seemed enough to make an uncomfortably large number of people sick. So, to prove that a city was serious about keeping a few illnesses from becoming an epidemic, Rush's strictures about cleaning up docks and streets gained credence.

These preparations were overwhelmed by the next epidemic. In July 1797, those doctors arguing that yellow fever was invariably imported thought they had a smoking a gun. Sickness on board a ship spread to shore. Seeing his theory of local origin challenged, Rush insisted that no one in the city had yellow fever. All that played out in the newspapers.

The city quickly worked itself into a panic. Although only 10 or 12 had died and not many more were sick, people sensed impending danger, even Quakers. Margaret Morris lost half her family in '93, and was desperate not to lose more. A cousin searched all the villages near the city but "every place" was full. She finally took her extended family to Burlington, New Jersey, the city she had left 20 years before.

The Health Committee and governor announced a plan of action that  included roping off and evacuating infected neighborhoods and putting yellow flags on the doors of infected houses. The governor ordered "camps" of 20 to 30 tents set up in a common between Broad Street and the Schuylkill, well away from infected areas, to accommodate those healthy people who were evacuated. Twenty-four health wardens picked by the Health Committee enforced regulations and sent people to the tents and the fever hospital. The city had lost its lease on the fever hospital used in 1793. Calls for a state built fever hospital had gone unheeded. A quarantine hospital built on an island below the city was too small, so the Health Committee prepared the old Wigwam tavern on the east bank of the Schuylkill for fever victims.

The Treasury department, which had suffered deaths in '93, moved out to the banks of the Schuylkill. The state legislature met on August 29. It passed an emergency appropriation of $10,000 to finance health measures and relief, and then adjourned. Meanwhile, the official death toll and number of hospital admissions, reported daily in the press, were low. At the end of August there were only 20 patients in the hospital, 5 convalescent and 15 sick. Yet by the end of August 35,000 people had left the city. Meanwhile, unknown parties began removing the yellow flags the committee placed on infected houses and tore down the barricades the committee placed around infected areas. The Quakers once again had their Yearly Meeting but only 72 of 136 delegates showed up, only 10 of 25 Philadelphia delegates.

The panic distressed the Secretary of the Treasury. He wrote to President Adams, who was back home in Massachusetts, that "The general interest of the country requires that as little public notice be taken of this sickness, especially as some of the physicians have erroneously attributed to it a domestic origin. The loss of capital and credit which Philadelphia must suffer cannot be easily calculated. The sufferings of the poor can be hardly considered as yet commenced." He blamed bleeding for assuring the deaths of many of the intemperate poor.

Soon, the epidemic took the lives of 1100 people, but deaths were confined to certain areas of the city. That made it easier for Philadelphia to join Baltimore and New York City in blaming the poor. Most of the $10,000 from the legislature was distributed to the poor. Two hundred people lived in the Health Committee's camp. It gave a dollar a week to heads of family, 855 people mostly women. It hired 639 men to drain wet areas for 75 cents a day. By 1797, there was a general recognition that all African Americans were not immune, only those born in Africa. One merchant recruited a crew of 20 to 30 black men to clean his own and other stores.

Although there was a better coordinated civic reaction to the epidemic, in most respects the 1797 epidemic was more demoralizing. The failure of preventative measures was widely blamed on the remedies doctors offered. There was no real political divide in the city over what had to be done, but William Cobbett, aka Peter Porcupine, a British journalist who published a lively newspaper called Porcupine's Gazette, couldn't resist accusing Benjamin Rush of using French methods to kill patients. He accused Rush of being in the cabal of radical republicans eager for France to defeat Britain in their on and off wars. Meanwhile, the Federalist and pro-British President, John Adams, appointed Rush to a federal sinecure at the mint and the British ambassador remained his warm friend. French doctors in the city roundly criticized Rush's remedies. 

In the 20th century, a political scientist wrote a paper crediting political allegiance for determining what remedy a sick person took in 1793, but there is scant evidence for that. Benjamin Franklin Bache, editor of a partisan republican newspaper, wrote at the end of the 1793 epidemic that no one had any taste for politics. (He also died of yellow in 1798 after taking remedies Rush abhorred, wine and cold baths.) So far, during the Covid pandemic only politicians have been accused a killing patients, not doctors. In the 1790s, the dispute over treatments was only political in Cobbett's eyes. Philip Freneau, a leading republican editor backed the royalist Cobbett. The dispute became personal spawning duels and libel suits. A $5,000 in Rush's favor forced Cobbett to return to Britain.editor Bache died of the fever after taking treatments that Rush abhorred.

The disputes between doctors and attacks on Rush dashed any hope, often expressed by Rush, that medicine could control the epidemics. Vaccination was not yet in civilization's arsenal. Both Philadelphia and New York City trusted in a new water system that would pipe water to and throughout the city. Such improvements were inevitable as the cities grew. Before he died in 1790, Benjamin Franklin had speculated on what needed to be done. He thought the should pipe in water for Wissahickon Creek but it used water from the Schuylkill River instead.

In the meantime, when there were no fevers in the city, it was widely thought that there was a sure remedy at hand. Like the face mask today, back then many thought cleaning would save the day. In a letter in a New York newspaper, Rush advised: "Keep your streets, wharves, docks yards and cellars CLEAN, and you will have NO YELLOW FEVER." At the beginning of the summer of 1798, many thought Philadelphia had never been cleaner. Due to a crisis with France, which would lead to the so-called Quasi-war, congress stayed in session well into July. Authorities forced quarantines well south of the city on all ships coming to Philadelphia from the West Indies. Those who could afford it arranged for summer housing in the countryside. Even Rush bought a place just north of the city and, as always, sent his wife and children farther away.

Then in July, people began dying. In early August, the Health Committee ordered the evacuation of a few blocks near the river. A general flight from the city began. On September 1, the Health Committee advised everyone to leave the city: "We call your attention to the actual and undisguised state of our city. Consider the mortality and rapid increase of the sick at so early a period. View the list of your physicians, and mark how few are at their posts; and we believe you will think, with us, that the preservation of health is only to be attained by flight."

At the same time, news came of epidemic fevers in Boston, New London, New York, Wilmington and smaller ports. Those who fled to the country like Eliza Wescott and Lucy Breck went with a sense of resignation if not dread. Some who stayed resigned to the point of debauchery. Since he no longer had the energy to visit patients, Rush served as physician at the fever hospital. He found that some women patients remained uncovered while attended. He found them "exceedingly" prone to lust. In his memoir of the epidemic, he quoted Boccaccio on the plague: "It suspended all modesty so that young women of great rank and beauty submitted to be attended, dressed and even cleansed by male nurses."

During the three epidemics, 1793, 1797, and 1798, different doctors using different remedies ran the hospitals. The death rate in the hospital was the same for each epidemic. People lost faith in physicians. African American nurses were in great demand.

The health establishment lost faith in people. Rush duly noted that all the lascivious women in the hospital died. Meanwhile, the Health Committee set up a tent camp outside the city. A private group set up a camp called "Master's Place" and set out to reform the poor.

In the camps, the watchword was discipline. Rules were posted and enforced by armed guards. There were schools, churches and doctors on the premises. Able bodied men were employed digging a canal. At Master's Place, people were housed in wooden buildings erected along a grid pattern of streets. It could house up to 2,000 people, twice as many as were accommodated at the Tents. The discipline at Master's Place was especially lauded. Spirituous liquors were banned; people had to wash their "body clothes" and air out their bedding three times a week; food was withheld from those caught breaking those or other rules; repeated offenders were expelled; people in the camp had to get permission to leave; the whole place was surrounded by sentinels. 

Philadelphia did get one break. The frosts came early that fall. But the end of the epidemic brought little joy. Not as many died as in '93 but the accumulation of death was telling. The Quakers did meet again but adjourned so that their next Yearly Meeting would be in April.

To ward off the next epidemic, work began on the Water Works, and newspapers supporting both political parties called for volunteers. Not only did the city have to be clean, but every house, too. Soon upwards of 140 citizens inspected "several hundred" houses by the end of February sending beds, bedding and clothes of people who had had the fever to the City Hospital to be "fumigated and purified" or destroyed. They also kept an eye out for sources of putrefaction. The Health Committee ordered out houses cleaned. (Elizabeth Drinker, a rich Quaker, was proud that the five men who cleaned the Drinker's "necessary" for the first time in 44 years found it "so little disagreeable.")

In the preface of his novel about the 1793 epidemic that he wrote in New York City in 1798 after nursing two friends who died of yellow fever, Charles Brocken Brown predicted the beginning of a new era in politics, economics and morals. He never made explicit predictions but what he seemed to be driving at was that the epidemics would end political bickering and statesmen would be guided by science; that the gap between rich and poor would be addressed (he bristled at claims that only the poor died); and that no one sick or in need would be abandoned.

It did not turn out that way. In his annual message in 1798, President John Adams ignored pleas from Quakers that ending wars and slavery would end epidemics. Instead, he asked congress to think about more extensive quarantines.

Timothy Pickering, John Adams' secretary of state, who lost a son to yellow fever in 1793, sketched out a plan for wharves that while hard to implement in Philadelphia could save the new city of Washington from fevers generated at docks. The nation's capital-to-be was expected to become a major port city, . The basic idea was to have wharves out in the deep part of a river with bridges giving access. No filth could accumulate.

Our most scientific president, Thomas Jefferson, sketched out a generic plan for new cities in the west that he thought would keep them healthy. In 1802, William Henry Harrison, then governor of the Indiana Territory, wrote to Jefferson that he would use the "plan for a Town which you supposed would exempt its inhabitants in a great degree from those dreadful pestilences which have become so common in the large cities of the United States." The basic idea of the plan was a checkerboard of squares with every other square left in its natural state. (Today Jeffersonville, Indiana, is a suburb  of Louisville, Kentucky, with a checkered history, if Wikipedia is to be believed, of gambling and Klan activity.)

Jefferson drew a personal lesson from the epidemics that did little to shape a response benefiting the general public. He resolved to never spend the months of July, August and September along tidewater. He kept to that resolution even when a British warship captured American sailors just off Norfolk in June 1807. Most thought it would lead to war. But Jefferson did not want to return to Washington, which has tides, and call congress into session. The crisis passed.

In the wake of the epidemics, there was no consensus that people could prevent them by working together. Those who could simply fled. Just as seems to be the case with the Covid pandemic, flight from the city sparked interest in rural retreats. However, having a country seat or at least land had been an ideal of the better sort in cities long before the epidemic. 

Of course, Philadelphia, New York, Boston and Baltimore continued to grow. What passed for medical science in that day lent a hand. Cities were not stigmatized as being uniquely unhealthy because the countryside was not such a healthy place as settlement expanded. Doctors seemed to delight in turning epidemics confined to one area into pandemics spreading across the continent.

Rush and his disciples continued to preach that unhealthy conditions could be found anywhere. In 1797, America's first science magazine, the Medical Repository, began collecting accounts of diseases throughout the country. Those reports made epidemics among far off Indian tribes or in army forts along the frontier seem as important as epidemics in Philadelphia and New York. 

In 1799, after researching epidemics in Biblical, Greek and Roman history, Noah Webster found that "all great plagues of the earth have been attended with eruptions of volcanoes." Mount Etna in Sicily had erupted in 1789. He proved to his own satisfaction that the whole country was blanketed by a dangerous atmosphere and that deadly states of the atmosphere occur twice a century and last "ten, eleven, or twelve years."

The one thing the epidemics definitely changed was American medicine. Historians characterize the medical practices of the early 19th century as both heroic with harsh medicines and sectarian. Some accuse Rush's purging and bleeding of killing more people than the epidemic, but he started a movement. A writer in the Medical Repository boasted "under the desolating influence of this distemper, the Americans grew vigilant, and suffered none of its accompaniments to escape their notice. They beheld its rise, progress and decline, year after year, under circumstances most favorable to its investigation. Their feelings, their hopes, their interests, all prompted them to be correct in their observations, clear in their narratives and fair in their reasonings."

In 1813, Dr. John Warren of Boston lauded mercurial purges. He credited the yellow fever epidemics for bringing them into vogue for fighting any fever. He used mercury to treat everything from measles to rheumatism. He used it as a prophylactic taking taking a grain of calomel a day to keep his gums constantly sore. European visitors often remarked on the number of Americans without teeth. In that day before Mountain Dew, calomel did the trick. The fashion for strong purges slowly ended as malaria retreated from New England and then, by 1830, from the Middle Atlantic states.

The work of African American nurses during the epidemic is relatively well documented. (At that time, much of what African Americans did and suffered in the North was completely ignored.) So modern scholars have examined what role the epidemics played in shaping American racism. Rush and others hailed what the nurses did, but they didn't win universal praise and gratitude. Most were not trained in what passed for nursing in that day. Margaret Haines found hers "little used to good nursing" but "very attentive" and she "pleased" the patient. However, since they tended the sick, many thought they were contagious and should be avoided. When a patient died, nurses in general and black nurses especially were blamed.

Scholars highlight private remarks stigmatizing blacks that were written, even by Quakers, in private letters during the most distressing weeks of the epidemic. But in that era, acceptance of African Americans as equals was unlikely. In the years before the epidemic, many Quaker abolitionist advocated sending them back to Africa. 

Their service during the epidemics, stepping in when no one else would, probably gave African Americans a sense of their importance to American society that endured longer than slurs made by whites. When analyzing racial attitudes in the past, the endurance shown by blacks is more important than the lapses of whites who, for a few months, saw their shining city on a hill devastated by yellow fever.

Bob Arnebeck

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