On August 22, three days after Rush's alarm, Philadelphia's mayor, Matthew Clarkson,
informed the two city street commissioners of the presence of "a dangerous, infectious disorder,"and prodded them to have the city's 40 scavengers clean Water Street and its gutters and then clean the rest of the city. He also asked the city's College of Physicians to meet and suggest what should be done. At the same time Governor Thomas Mifflin, who worked at the State House in the same complex of buildings on the square that housed City Hall, ordered the port health officer, Nathaniel Falconer, to investigate, and he in turn asked the port physician James Hutchinson to tour North Water Street between Arch and Race Streets and assess the danger. All those measures were reported in the Philadelphia newspapers the following week.
It's tempting to attribute Philadelphia's openness to factors like its moral character and sense of high purpose. The city was founded as a "Holy Experiment" by Quakers who professed a passion for honesty. Quakers no longer dominated the city but many members of the elite had Quaker roots. Rush's grandfather was a Quaker. While only a minority of zealous Quakers still cherished the city as the New Jerusalem, many of its citizens thought the cradle and capital of the American republic was in a league of its own. Perhaps by not reacting to the epidemic like a provincial port jealous of rivals, Philadelphia sought to live up to its pretensions as the nation's Metropolis, leader in politics, commerce, science and medicine.
However, during the ensuing weeks of terror and the decade of epidemics to follow, Philadelphia's establishment showed a keen desire to limit the damage to the city's reputation, and was not beyond dissimulation. Probably Philadelphia had no choice but to be open about the epidemic because of geography. Peck Slip, the center of the 1791 New York epidemic, was several blocks away from Wall Street and on the other side of town in relation to Broadway. Water Street was just down a slope from the banks, counting houses,meeting houses and churches of Philadelphia.
William Penn planned the city so it would be difficult to conceal unsavory occurrences. Penn knew the London that suffered the Great Plague in 1665 and the Great Fire in 1666. Winding streets and cul de sacs, traps for breeding fires, fevers, and felons, that cities like Boston and New York were perpetuating in the New World, were to be outlawed in Philadelphia. His city, a rectangle one mile wide on the plain that stretched two miles from the Delaware to the Schuylkill Rivers, would have a grid pattern of streets conducive to health, safety and commerce. Of course the plan was soon modified as the tentacles of self-interest overlaid the grid, but the net result was to make Philadelphia still very much a place where everyone knew everyone else's business.
The focus of the fever, Water Street, had not been on Penn's original plan. The first Quaker settlers had lived in caves dug into the cliffs above the Delaware. By decree Penn forbade the building of warehouses below those cliffs so that the crowded unhealthy harbors of England would not be replicated. Within forty years the decree was overturned by merchants who wanted the customary conveniences accorded commerce. Penn wanted commercial development along the shores of both rivers, another measure to reduce unhealthy dockside crowding. But settlers in the vast continent had a tendency to huddle together. In 1793 there was scarcely another building between 6th Street and the Schuylkill River a mile and a half away.
Landlords and speculators took advantage of the crowding. Rents in the city were notoriously high. The poor, who could not afford to rent small rooms in tenements along Water Street and in the small alleys that sliced into every city square, were forced to live in the suburbs built on undesirable tracts next to the unhealthy marshes north and south of the city, far from Water Street where many of them had to earn their daily bread.
On Thursday and Friday Dr. James Hutchinson had a short walk to Water Street to determine if there was indeed a malignant fever threatening the city. Weighing over 300pounds, Hutchinson was a hard man to miss. And he had attributes beyond bulk which attracted attention. He was a leader of the pro-French party then coalescing around Thomas Jefferson, forming what would be called the Republican Party (which would grow into today's Democratic Party.) Like much of the world then, there were sharp political divisions along Water Street. Most merchants supported Alexander Hamilton's pro-British Federalist Party and were quick to blame a French privateer for the fever. Hutchinson was pleased when he found enough reputable Republican or French merchants to attest that French sailors did not bring the disease, and certainly not the privateer Sans Culotte that had brought in the British merchant ship Flora as a prize of the war then raging between Britain and France.
And, for that matter, Hutchinson didn't find an alarming number of fever cases. He determined that in a block where a goodly portion of the 248 ships then along the waterfront were moored and that teemed with upwards of 400 residents, only 67were sick, not really many during the "sickly season." Most had influenza or "common remittents." There were only 12 cases of"malignant fever," including Peter LeMaigre who was so sick that he had not been told of his wife's death. Hutchinson even demonstrated how safe the block was. He found an old woman alone in a small, stinking, enclosed room. He threw open the window and sat with her. When contagion might be in the air, doctor's usually kept their visits very brief.
To complete his investigation Hutchinson wrote to all his fellow physicians who might have cases along the waterfront,asking them for "facts... relative to the existence of the disorder." Rush was no stranger to the deteriorating conditions on Water Street. He was treating Peter LeMaigre, and Thomas Miller, another young merchant, and his baby son. Rush also had several patients on other streets: John Chaloner, an auctioneer on 3rd Street who recently visited LeMaigre; Frederick Starman, a merchant on 2nd Street, who had gotten a whiff of the wind blown putrefaction from the wharves; and a Danish sea captain in Kensington, whose ship had just left the Arch Street wharf.
Only Rush's short and alarming reply to Hutchinson's note remains: "A malignant fever has lately appeared in our city, originating I believe from some damaged coffee, which putrefied on a wharf near Arch-street. The fever was contained for a while to Water Street, between Race and Arch Streets, but I have lately met with it in Second Street, and in Kensington; but whether propagated by contagion, or by the original exhalation, I cannot tell.... I have not seen a fever of so much malignity, so general, since the year 1762."
While gratified that Rush did not blame French sailors,Hutchinson must have gotten a sinking feeling when he got that note. He knew how exhausting an opponent Rush could be. Indeed on Saturday afternoon, an American Daily Advertiser correspondent who called himself "Philanthropas" wrote that "a mortal disease has begun to rage in this city. It is probably infectious, and it is to be feared that it may become epidemic unless measures are seasonably taken to prevent its progress." Someone was trying to stampede the city into action even before Hutchinson presented his evidence to the governor, and Hutchinson had to suspect that Rush was behind it.
Hutchinson began his medical studies as an apprentice to an apothecary, then studied with Rush at the University of Pennsylvania. The support of a wealthy Quaker enable him to go to Europe to study. He returned somewhat too ambitious for his old teacher. Hutchinson wrote a medical monograph, shared it with Rush, who then did all he could to keep it out of print. Hutchinson never forgave him. (Rush, however, threw no other roadblocks in his old student's way. By 1789 he was a member of the University of Pennsylvania medical school faculty, and further burnishing his scientific credentials, he was the secretary of the American Philosophical Society, the foremost scientific body in the nation to which Rush also belonged.) Despite Rush's alarms, Hutchinson would not be panicked and he assured all who asked, that the danger was very limited.
Unfortunately the disease would not wait until Hutchinson marshaled his data to prove that all was well. It began raining Saturday night just as the last of the sweepings from Saturday's market were being heaped together outside the three block long market buildings in the middle of Market Street (a block south of infected Arch Street.) The fourth block of the market, the temporary stands of the vegetable and fruit sellers, was still humming with last minute haggling until rain cleared the street. It was not a night for hanging around under the "triple row" of street lamps, "blazing crescents," as one poet put it, "fed by naptha and asphaltos," rehashing the day's bargains, and debating whether, if pestilence was in the city, there would be a market Wednesday and Saturday as usual.
The Quaker merchant Benjamin Smith did not take the short walk from his South Front Street store and house to the market. He had been looking forward to doing just that. Influenza had kept him inside for the past week, and all that remained of it was a troublesome cough. But prudence overruled his inclination to get his life back to normal. And 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 salts. Then that evening, Debby's fever became worse and she complained of "a violent pain in the head."
As Rush walked along the rainy waterfront Sunday morning, he saw no diminution of the terror. "I witnessed a scene...," he wrote to his wife after visiting the Miller family, "which reminded me of the histories I had read of the plague. In one house I lost two patients last night.... His wife is frantic with grief." Thomas Miller had bled profusely from the mouth before dying.
At the meeting of the College of Physicians in the afternoon, Rush was not so melodramatic, but he made sure that the facts were properly marshaled before his colleagues. In response to Hutchinson's claim that there were only 12 cases of malignant fever, he added his own cases with those of Foulke and Hodge, and showed that 12 people had died of malignant fevers in the last 12 hours. Rush suspected that the fever was contagious. That it had spread along Water Street was not conclusive since everyone in the area had been exposed to the putrefying coffee.
Perhaps even more alarming, relatives of the McNair boy, the Stephens family on 2nd and Chestnut, had the fever and while they had seen McNair before he died, they had not visited Water Street nor smelled the coffee. Sixteen days had passed between Mr. Stephen's last visit to McNair and his taking the fever, a sobering fact. No one could be sure they were free of possible contagion until 16 days after their last contact with it. The fever had already spread beyond the limits of Hutchinson's inspection. Indeed Rush was treating three seamen in Kensington. Dr. Say had 40 cases there, and knew of 20 deaths.
The Philadelphia College of Physicians, founded in 1787, had 26 members who were the cream of the profession. Upwards of 200 people in Philadelphia, including Hannah Toy, listed themselves as physicians. (There was no system to license physicians as there is today.) Further diluting the power of the college was the disinclination of many to rely on any physician even when threatened by a deadly fever. For example when his wife seemed to have the fever, Benjamin Smith sent for her mother Margaret Morris, not her brother Dr. John Morris, who was a member of the college. Like many women then, Margaret was the medical adviser for an extended family and decided when home remedies would do and when a physician's advice was needed, and which physician would best serve. (And her ministrations of bark seemed to cure her daughter.)
Finally the college had done nothing in the realm of public health save, at Rush's prodding, recommending that the legislature raise duties on imported liquor. Yet the college had no doubt about its duty in the face of a deadly contagious disease. Its model, the College of Physicians of London, had been founded in the reign of King Henry VIII, and during the Great Plague of 1665, its essential service was to lessen fear by publishing simple directions to guide people in treating the disease, preserving their health and preventing the spread of the contagion, which didn't prevent 40,000 people from dying.
At that moment Rush and his colleagues were at a loss to suggest a remedy. Those who had cases could only report on what had not worked. For Rush the gentle purges that worked in 1762, did not work in 1793. His patients thought bark offensive, even when mixed with wine. When given through the anus in a glyster, bark had no affect. Ipecac, a vomit often used to relieve bilious fevers, was problematical because in many patients the pressing need was to stop vomiting. Polly Bradford, and others he had cured earlier in the month, had not endured such agony. He used cataplasms and poultices on the chest, neck or extremities and vinegar baths as a last resort to revive comatose patients.
The perplexed college asked its president, 80 year old John Redman,who did not attend the meeting, to report on his experiences in the epidemic of 1762. The assembled physicians did think they could suggest preventatives and measures to limit the contagion. They appointed a committee of four, Rush, Say, Hutchinson and Caspar Wistar, a former student of Rush's, to advise citizens and city officials on how to combat the epidemic
The question of how to prevent yellow fever would divide the medical community until Walter Reed's experiments in 1901 proved that the Aedes aegypti mosquito spread the disease. Rush and several of his colleagues in the college would soon become bitter enemies as they advanced their mistaken theories. Rush already sensed Hutchinson's anger at having his report upstaged at the meeting. Yet the committee came to early agreement on what must be done and trusted Rush to do the bulk of the writing.
By evening he combined strictures gleaned from literature about the plagues of Europe with modern medical appreciation of environmental and personal cleanliness. As a rule in America, where malaria was endemic, fever victims were not avoided. But this malignant fever was more than a mere "intermittent." Rush advised "that unnecessary intercourse with the sick should be avoided," and "places should be marked where the fever is known to exist." Pains had to be taken to prevent the contagion from concentrating which would increase its virulence. The sick should be in large airy rooms and waste immediately removed. The sick poor who lived in close unhealthy quarters should be taken to a special hospital. (The Pennsylvania Hospital did not treat infectious disorders.)
Supposing that one could carry the infection without showing symptoms of the disease, Rush warned citizens to avoid fatigue, the hot sun, night air, too much liquor, and anything else that might lower their resistance. He endorsed two age old preventatives, vinegar and camphor. They should be infused in all infected room and kept on handkerchiefs and in smelling bottles. He also outlined measures for city officials. Stopping the tolling of church bells and making burials private saved all from deeper gloom. Cleaning streets and wharves gave confidence to the healthy as it diminished the contagion which could arise from filth any where. Fires in the street, often mentioned in plague literature, had been proven by modern chemistry to vitiate the life giving properties of air. Exploding gunpowder, however, did increase the amount of oxygen.
That done, Rush wrote to his wife. The emotion lacking in his strictures poured fourth: "...the fever has assumed a most alarming appearance. It not only mocks in the most instances the power of medicine, but it has spread through several parts of the city remote from the spot where it originated.... Many people are flying from the city, and some by my advice." That advice was not mentioned in his public advisory. Of course those he had advised to flee were his well-to-do friends who had comfortable retreats in the country. They could move without the commotion and distress which Rush thought brought on the fever, or as he put it, were its exciting cause.
Rush didn't even think of fleeing. In his lectures he told his students that he prayed that the doctors of Philadelphia would not disgrace themselves by fleeing a plague as many London doctors had done during the Great Plague. That was no reason for his sons, sister and mother to stay with him, yet he did not send them away. He only confined the boys to the house and obliged them "to use precautions against the disorder." And Rush assured his wife that he was using "every precaution that experience has discovered to prevent taking the infection." He had a patient's bedding removed before a visit to allow noxious air to dissipate, rinsed his mouth out with vinegar before and after seeing the patient and, while at the bed side, stopped his nose up with a cloth soaked in vinegar, avoided breathing, did not swallow his spittle, and dipped fingers in camphorated vinegar before taking a pulse or otherwise touching the patient.
Yet, Rush was quick to add that his real trust was in God. He had his very being "in a more especial manner in God alone." When he went to bed Sunday night, he sought consolation in religion, and urged his wife to pray for his protection, adding "I hope I shall do well, I endeavor to have no will of my own." That gave him strength to "subdue" his sympathy for patients, "otherwise I should sink under the accumulated loads of misery I am obliged to contemplate." He read the Bible that night, the 45th chapter of Jeremiah, his favorite prophet: "The Lord saith thus; Behold, that which I have built will I break down...." One passage so struck him that he quoted part of it to his wife: "seekest thou great things? Seek them not, for behold I bring evil on all flesh." Rush added "what powerful antidotes are war and pestilence to pride, vanity,and ambition!" Perhaps he was applying the scripture lesson to his fellow citizens still unaware of the terrors in store, or to himself, a way to still his ambition and pride as he anticipated the coming crusade that he must have felt ordained to lead. Yet then as now, rivalries in science are intense. How uncomfortable the fleshy Hutchinson must have looked at the meeting as the pestilence proved so mortal, so contagious.
Go to Chapter Three
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