Water Street served the wharves and warehouses built out over the Delaware River. Across the street only 30 feet wide were boarding houses and taverns built into a slope that led up to the plain where most in the city of 50,000 lived. Fortunes were made on Water Street, which didn't prevent it from being a congeries for the penniless. It was the first landfall for most emigrants and not much account was taken of those who died before they moved beyond it. Europeans who came to America suffered what was called a "seasoning," which not infrequently led to death from disease within a year. Some were felled by pneumonia inflamed by the intense cold and changeable winter weather of America. But more succumbed to the summer and autumn fevers that plagued, but did not as often kill, natives as well. Indeed that period from the dog days of August to the first frost, when diseases caused by proliferating bacteria and parasites predominated, was called the sickly season.
So when an Englishman who had just arrived and an Irish woman who had landed in June both died at Dennie's North Water Street boarding house on August 4 and 6 respectively, no one thought much of it, which is not to say they were neglected. The tax supported Overseers of the Poor and the privately supported Medical Dispensary provided free medical aid to the poor and assigned two young physicians to treat the unfortunate emigrants.
Although both had recently returned from Edinburgh, then the world's leading medical school, Philip Syng Physick and Isaac Cathrall, were perplexed. Physick thought the Englishman, a Mr. Moore, died so quickly that he might have been poisoned. After studying at Edinburgh, Physick studied with Dr. John Hunter then the leading medical researcher in London noted for his zealous curiosity. Physick felt compelled to perform an autopsy, but found nothing suspicious. Cathrall marveled at the long morbid dance the fever put the Irish woman, Mrs. Parkinson, through: severe head and back pains, great thirst, offensive stools, much vomiting, delirium, red spots on face and breast, blindness, sore throat, hiccuping and death. She had languished a room away from the Englishman whose symptoms, coma and death in 24 hours, were completely different. Her family remained healthy. Malignant as the fever was, it evidently was not contagious.
Dr. Hugh Hodge felt more desperate about his fever patient. His two year old daughter was suffering through her third summer. The common killer of young children in the hot months was the bloody flux, dysentery. She did not have that, so Hodge prayed that her fever would resolve itself, as it often did in children, as the agony accompanying teething. After a week she did not get better. On August 5 Hodge sent for Dr. Benjamin Rush. As the two emigrants were dying a half block away, Rush looked at the little girl.
Rush knew the fright given parents when any child under 3 years old was sick. The youngest of Rush's seven children were 9 months and 2 year old. It was an axiom that half the children born would not reach the age of three. Rush and his wife Julia had lost four children in infancy. He saw in an instant that he could do nothing for the Hodge child, and suggested some palliative that his colleague might not have tried himself. The child was in God's hands.
Rush's Account page 8
The day after Rush saw Hodge's child, his old friend Thomas Bradford sent word that his wife Polly was very sick. Most populous city in the nation it might be, Philadelphia could seem a very small town. Almost 30 years ago she had been Rush's first love, the girl he had left behind when he went off to complete his medical studies at Edinburgh. There the company of Jane, daughter of the Earl of Leven, a 16 year old who was beautiful, lively, and rich, made it easy to forget Polly, the hatter's daughter. Which is not suggest that in August 1793 poor Polly was about to be overwhelmed with her old beau's erudition.
Rush never hid his learning, but he was a practitioner of the old school, quick with a Bible quote and possessed of the common touch. His father, a gunsmith, died when Benjamin was five and to support the family his mother sold groceries and liquor under the sign of the Blazing Star on Second Street across from the market sheds on High Street (popularly called Market Street.) Rush never forgot his roots. And many, especially female patients, were attracted to him by his physical presence. He looked too much like a saint to be feared as a pedagogue. He did not wear flesh well. And to someone in pain his wiry asceticism, broad head and piercing blue eyes gave the impression of pure energy consecrated to relieving distress.
At first Polly's "bilious remittent fever" did not seem out of the ordinary. As always in August the mild intermittent fevers, that could afford a victim two good days of work for every one day of chills and sweats, were giving way to the more debilitating remittents. Most intermittents were the mildest strain of malaria, while the remittents were caused by more deadly malaria parasites, spoiled food or bad water. In the remittents, a fever might go off for a few hours only to return with equal force. The intermittents generally responded to Peruvian bark, the fever specific the Inca Indians had made from the chinchona tree. But the bark had a propensity to upset the stomach, and was of little help in a remittent with bilious symptoms, that is to say, stomach distress. The difficulty was that depleting a weak body was dangerous. The art was to cleanse the stomach and bowels without prostrating the patient and then restore the body's strength.
Rush gave Polly a mild purge, probably cream of tartar, a residue in the wine making process (potassium bitartrate in modern terminology,) but there was no relaxation of her stomach distress. Rush noticed that she had uncharacteristic inflammatory symptoms. Her face was flushed, not sallow, and her pulse rapid. So he had her bled, sending for a professional adept at the sometimes tricky business of finding a good vein, usually on the arm, pricking it with a lancet, keeping up a good flow of about 10 ounces and stopping the wound so that it would not reopen.
Bleeding is the most notorious of the discarded medical procedures. Many medical histories dismiss it as a naive, primitive attempt to eliminate poisons from the blood. In the 18th century doctors generally bled at any sign of inflammation, i.e. redness of the skin accompanying wounds, swellings, sprains or broken bones, or discomforts accompanied by congestion caused by an excess of fluids be it from colds, serious bronchial infections, hemorrhoids or the multitude of conditions that produce pus and bleeding, all accompanied by a rapid pulse. Bleeding was also acceptable without inflammatory symptoms. Doctors and patients learned to appreciate how it first relaxed and then invigorated. For many it was a ritual that accommodated the body to seasonal changes every spring and fall.
This is not to say that Rush prescribed the widely accepted procedure by rote. In the preface to the second volume of his Medical Inquiries and Observations published in July 1793, he had written that it was "impossible for a physician to prescribe, without a theory of some kind." As an apprentice he had copied down the published aphorisms of the great Dutch exponent of the theory of humors Hermann Boerhaave (1668-1738,) who blamed fever on changes in the blood brought on by "morbific matter" restricting its flow. Bleeding thinned the blood thus easing the inflammation caused by the obstruction.
William Cullen (1710-1790), Rush's teacher at Edinburgh, exploded those theories. Fever was in essence a nervous disorder. Rush adored Cullen, and returned to Philadelphia convinced that fever arose from nervous "spasms upon the extremities of the capillary vessels." However, Rush found that in practice Cullen's theory "did not accord with many of the phenomena of fever." The violence of the fevers he had to treat forced Rush to again see fever as more a matter of blood than nerves. However, he did not go back to the outdated theory of infected or obstructed humors. A disciple of Cullen's in Edinburgh, John Brown (1735-1788,) an eccentric genius whose drunkenness Rush did not admire, dazzled the medical world with brilliant lectures simplifying life, disease and death. The essence of all was "excitability." So in his lectures at the University of Pennsylvania medical college, Rush modeled his approach to medicine on Cullen's, tantalized his students with Brown's simplifications, and then offered his own refinements. He theorized that in fevers there was a dangerous excitability in the arteries. Thus Rush bled to relieve arterial spasms.
Bleeding didn't seem to help Polly either. Rush was not one to let nature take its course. He thought a doctor had to use his art to counteract nature, or, as critics then and now put it: kill or cure. So he prescribed a stronger purge, 6 grains of calomel, mercurous chloride in modern terms. Mercurial medicines were principally prized as the cure for syphilis. Cullen held that repeated doses helped the body expel syphilitic poison. It was also the purge of choice to help assure that a patient inoculated with small pox would have a mild case of the disease. Even at the low dose Rush gave Polly, calomel could cause a violent reaction as it worked either "upward or downward," as it was euphemistically expressed at the time. The dose worked to Rush's satisfaction. That accomplished, he restored her system with tonics and a strict diet.
The Hodge child in death and Polly in recovery shared one unsettling symptom. The child's corpse was yellow. Rush told Hodge that that was not uncommon in a fever with "symptoms of great malignity." Rush would soon note a yellowish tinge to Polly's skin. But beyond noting it, he thought little of it and saw no reason to think that she had anything more than the usual bilious fever. What began keeping him and his assistants busy was an outbreak of influenza that Rush blamed on the influx of creole and French refugees from the slave rebellion (revolution, it succeeded) in St. Domingo, today's Haiti. Most Philadelphians tried home remedies to get through their misery, but Rush had more patients than he could handle. Fortunately John Redman Coxe, one of Rush's student apprentices (who was the grandson of the doctor, John Redman, with whom Rush apprenticed,) took care of most of the extra business the outbreak brought Rush's way. Rush did not apologize for using Coxe since it saved a patient the bother of sending for a bleeder. The young man was eager to perfect the art of cutting a vein. Not that Rush was bored by the disease. He had just published an essay on the influenza epidemic of 1789 in the second volumes of his Medical Inquiries and Observations.
In the second week of August he continued to have a few cases of malignant fever, that is to say any fever in which death seemed a too possible prognosis. The most distressing was that of the only son of the widow McNair. Before he died blood gushed out of his nose. Rush blamed the violence of the disease on the "debility and fear" of the 19 year old. In the following week Rush had more cases of influenza, scarlatina and dysentery, and thankfully no fevers as alarming as McNair's.
Then fever cases began to cluster.
On August 18, Dr. Benjamin Say called Rush to consult on the case of a Water Street merchant. He found Peter Aston "sitting upon the side of his bed, perfectly sensible, but without pulse, with cold clammy hands, and his face of a yellowish color." He died a few hours later. Say was dumfounded because Aston had been strong enough to shave himself that morning. On Monday the 19th Hodge and Dr. John Foulke called Rush to Peter LeMaigre's house on Water Street where Mrs. LeMaigre was "in the last stage of a highly bilious fever. She vomited constantly, and complained of a great heat and burning in her stomach." She was one of the beloved characters on the waterfront, her husband was a leader in providing charity for the French refugees.
As the three doctors left her room, Rush counted the "unusual number of bilious fevers" that had threatened, if not claimed, the lives of patients. Five of his had been seriously ill and McNair had died. Rush worried that "all was not right in our city." Hodge knew of four or five who had died "within sight of Mr. LeMaigre's door." One victim died 12 hours after getting sick. Dr. Foulke, who lived a few hundred feet away on Front Street, called attention to a possible cause for the cluster of deaths. In late July water soaked coffee had been taken out of a ship and left to rot on a wharf. The stench had appalled the neighborhood.
Eighteenth century doctors were familiar with the contagious spread of diseases like influenza and smallpox. They knew that other diseases did not behave in the same way. Bilious remittents were seldom contagious like smallpox, yet under certain conditions there could be an epidemic of bilious remittent fevers as deadly as smallpox. That month there were published reports of 500 dying near Georgetown, Maryland, of flux, i.e. violent diarrhea, which visited every part of the country every summer without such mortality. Not suspecting a capricious insect vector spreading malarial fevers, typhus, and plague, or water-borne bacteria causing dysentery and typhoid, doctors theorized that deleterious air caused the diseases in people made susceptible by debility, and that when enough people became sick, the air could become so deleterious that few people could avoid getting sick. Or put simply, a sick environment made people sick.
Cullen repeatedly impressed upon his students that it was without doubt that fevers were caused by the miasmatic air from marshes acted upon by heat. The emphasis was necessary to liberate the mind from the thralldom of the previous century which assumed that disease was caused and spread by invisible atoms floating in the air or in clothing. Such reasoning, Cullen thought, bordered on the occult and closed the mind to the environment and diet which even Hippocrates had argued was the basis of all disease.
Rush had applied Cullen's lessons in his study of Philadelphia's break-bone [dengue] fever epidemic of 1780, published in the first volume of his Medical Inquiries. Rush blamed the miasmata arising from the marshes south of the city. During its occupation of the city, the British army cut down all the trees that had purified the winds blowing up from the marshes. The effluvia arising from rotting vegetable matter like coffee beans was the same as that arising from a heated marsh save that it was more concentrated and more noxious.
Cullen's First Lines of the Practice of Physic
Rush had no trouble connecting all of his recent fever patients to the rotten coffee. Rush customarily quizzed his patients on where they had been as well as what they had been doing, eating, drinking or who they had seen. Polly Bradford had spent the afternoon with an acquaintance who lived near the rotting coffee. So outside Mrs. LeMaigre's room, Rush told his colleagues that the city faced an epidemic of the "highly contagious, as well as mortal... bilious remitting yellow fever."
Rush was not unfamiliar with the disease. In 1762 while a 16 year old apprentice to Dr. Redman, he had seen yellow fever "spread like a plague, carrying off daily for some time, upwards of twenty persons." Rush had not seen a case of yellow fever in years. In his medical school lectures his basic argument was that fevers were becoming a thing of the past. As civilization advanced, diseases of the nervous system caused by luxury would predominate. He imparted a modicum of knowledge about yellow fever since a few of his students might see service in the West Indies as ship's doctors. All authorities agreed that while the disease was not contagious in the islands themselves, outside the islands, as was the case in Philadelphia in 1762, yellow fever was highly contagious. In addition he noted that according to Dr. John Lining, who had practiced during Charleston's yellow fever epidemics in the 1740s, blacks were immune.
Of course, he spared his colleagues the lecture. However, just because three doctors agreed on the presence of a contagious fever, it did not necessarily follow that they would sound an alarm. Hodge and Foulke looked to Rush for guidance on that matter too. Rush was a constant complainer on the need for keeping the city cleaner. His most memorable campaign was his effort in the early 1780s to get Dock Creek covered. That creek, which emptied into the Delaware just south of Walnut Street, had turned into an open sewer. It was covered in 1786, quickly contributing to the health of the city. Worried that he had cried wolf too often, Rush suggested that Foulke write to the mayor urging that the offensive coffee be cleaned up, and the rest of the waterfront as well. Rush began advising those families who used his services regularly of the danger and frankly warned them that the best preventative was to "fly from it."
Back in his own house on Walnut Street between 3rd and 4th Streets the contagion seemed far enough away, i.e. six blocks. He did not send any members of his family out of town, which would have been easy enough. That summer, as usual, his wife Julia, three daughters and 7 year old James went to Princeton, New Jersey, to rusticate with her family. She was the daughter of the late Richard Stockton, the pride of Princeton who had signed the Declaration of Independence along with Rush. Staying with Benjamin were 16 year old John, 13 year old Richard and 2 year old Ben, as well as his invalid mother, sister (a refugee from an unhappy marriage,) his man servant Marcus, a servant boy and a maid for baby Ben.
Rush's home was his office. Paying patients were always accorded the courtesy of a personal visit from the doctor. Poor patients could visit Rush through a gate on the street, going around the back, where his cow kept the grass trim, and into his back room shop where his five apprentices prepared medicines. Despite the yellow fever alarm on Water Street, most calls continued to be for influenza, but Rush was fearful. As he explained in an August 21 letter to his wife, "most of the cases I attend are acute and alarming, and require an uncommon degree of vigilance and attention."
But there was no general panic. On Thursday the 22nd Rush joined a hundred white men who met that hot day "under the shade of several large trees" a mile south of the city of Philadelphia. The white men sat down at makeshift tables and one hundred black men and women served them a "plentiful" dinner, liquors of fine quality and melons for dessert. For the African Americans it was a gesture of gratitude, not servility. The whites had helped finance and build the first African Church in the New World, an Episcopal Church on 5th below Walnut Street, where Rev. Absalom Jones (a store clerk who bought his own freedom) would preach.
Rush sat at the head table. He had not hammered a nail, his monetary contribution was nominal, but when Jones and Billy Gray, his partner in this historic endeavor, had been discouraged, they had come to Rush. The last road block had been the French refugees who came to the city that summer retelling horrors of blacks killing whites on the island of St. Domingo. Already plagued with a housing shortage and high rents, Philadelphia had 2,000 more people to accommodate, and most of them, even the cream of the wealthy planter society with their slaves in tow, were now destitute. Merchants who promised to give to the African Church gave to French relief instead.
Jones and Gray went to Rush and the doctor wrote to John Nicholson, state comptroller, land speculator and patron of industry and invention, one of America's first entrepreneurs. He loaned $1,000 that paid the carpenters and got the roof up on the two story brick church. Rush had a genius for knowing the pressure points in his community. In a week the state legislature would convene and consider the impeachment of Comptroller Nicholson. Rush knew that Nicholson's defense against the scorn of men was good works, though of course he denied the charge that he fixed a state bond issue for the benefit of himself and his friends.
Not that Rush mistook what the gathering of blacks and whites celebrated. They were there to celebrate the rise of the oppressed not the charity of the elite. He offered a toast: "May African churches everywhere soon succeed African bondage." And sometime during the celebration, on impulse, he spread the spirit of redemption. He sent a cart load of melons to the prison near the church,
with a note reminding the inmates to enjoy the fruit for "the Being who created it still cares for them, and that by this and other acts of kindness conveyed to them by his creatures, he means to lead them to repentance and happiness."
Not a few of the young men who signed the Declaration of Independence saw that act as the prologue to a lifelong commitment toward bettering the condition of the human race. Most of the signers were lawyers, and pursued further reforms in the political arena. In 1776 Rush was a 30 year old physician and only served a half year in Congress. His only other stint in electoral politics was in 1787 as a member of the Pennsylvania convention ratifying the Constitution. In debate he raised some eyebrows when he proclaimed that the same God who had parted the Red Sea had guided the hands that wrote that document.
Rush was a very religious man who thought that the Millennium was at hand, and good works prepared the way for Christ's reign. A fluid writer Rush wrote a steady stream of pamphlets urging abolition, penal reform, limits on capital punishment, keeping the Sabbath, education for girls, a national university, a Secretary of Peace, no liquor for those under the age of 35 save for medicinal purposes, and no smoking. Few were the occasions in life when one of his pamphlets was not apropos. For example, as the sun set on the celebration for the African church, the author of "A Moral and Physical Thermometer," which equated degrees of alcohol consumption with moral and physical degradation, was pleased to note that, despite the presence of liquor, no one was drunk.
Perhaps it was a degree of guilt over leaving his post for two hours, that prompted him to describe the fever that day as "stationary." He would more than atone for his brief desertion which proved to be his only hours of enjoyment for the next three months. And perhaps he was already thinking ahead. Twelve days after celebrating the church, Rush would remind the Africans of their supposed immunity to the fever and call on them to serve God by helping to save the city.
Go to Chapter Two
