Given the place and time, Philadelphia, five years after the ratification of the Constitution, it is not surprising that efforts were made to put the best face on the situation. Hutchinson's death did not stop the drumbeat of published optimism. Mayor Clarkson announced that only 140 people had died in the city, of all causes, since August 1, not a high number at all for the sickly season. "The disorder must soon be checked," a New York newspaper quoted "a Philadelphia physician" as writing, "such are the precautions used by all who are here; and I assure you the number of sick is comparatively small, the population of our city considered."
Judging from the letters of the young merchant's clerk John Welsh, who stayed at his post on South Front Street shipping gin and cheese, optimism thrived on Kuhn's theory that while many were sick, very few had yellow fever. "Every street in the city has a share of it...," Welsh wrote. "Every house in Pear Street [where his clerk Josey Gill lived] but Mrs. Gill's and one other, contains sick persons, but the doctors call the most of their complaints the remitting and intermiting fevers. The generality of the people believe it to be a species of the contagion less dangerous."
Rush thought such ideas nonsense. In a postscript to one of the letters he wrote to his wife that weekend he noted that "the yellow fever has chased it and nearly all other diseases from our city." At the onset of any discomfort one had to take his medicines. Not that Welsh felt no alarm. His daily letters throbbed with desperate reflections on the fever: "The almost certain estrangement of relations and friends, when their services are most wanted, is truly shocking;" "people shun each other as if death was the invariable follower of a touch, or as if they perceived a baneful fume breathed from the others nostrils." Welsh felt weak, but attributed it "to inhaling so much camphor and debilitating scents," and the 89 degree heat.
Thomas Jefferson came to town that Saturday still taking the epidemic lightly. When he heard why his rival Hamilton would miss the cabinet meeting on Saturday, he joked in a letter to James Madison about Hamilton's inveterate timidity, adding that "his friends, who have not seen him, suspect it is only an autumnal fever he has." Then after the Saturday cabinet meeting, Jefferson scouted opinions and found reason for concern beyond the death of his friend Hutchinson which he owned was a blow to the Republican cause. "The yellow fever increases," he reported to Madison. "The week before last about 3 a day died. This last week about 11 a day have died; consequently, from known data about 33 a day are taken, and there are about 330 patients. They are much scattered through the town, and it is the opinion of the physicians that there is no possibility of stopping it." Jefferson concluded from the safety of his rural retreat, "I would really go away, because I think there is rational danger."
Evidently he had not talked to his friend Rush, perhaps upon the doctor's advice. Rush was sure he carried contagion that might overwhelm someone just in from the countryside like Jefferson. He had dedicated himself to healing the sick. He saw Margaret Morris and dozens like her that weekend, not Jefferson.
On Friday evening a servant informed Morris that her son Dr. John Morris was sick. The relationship between them was strained. Like Ephraim in the Bible, he had "joined himself to Idols," i.e. he was a drunkard. She forgot his transgressions and rushed to his Pear Street house. She found two doctors there, Thomas Parke and Samuel Powel Griffitts, both Quakers like Morris. They had prescribed a blister and Rush's calomel and jalap. They thought he had favorable symptoms and would recover. Margaret thought her son "struck with death."
All the doctors' prescriptions worked exactly as they should. Still on Saturday morning "his skin was as yellow as gold." He had convulsions and was delirious. The family maid had left two days before to attend her sick mother, leaving only a 10 year old indentured servant girl to help John's wife Abby care for four children including a baby. Margaret took charge of the situation, sending the two older children to their grandfather Benedict Dorsey, a respected Quaker grocer who lived four blocks away. Heeding Rush's initial alarms, he refused to take them in, afraid they were carrying the disease. The children's mother, Abby, went to change his mind. While she was gone, her husband had one of his strongest fits. Margaret could not call on the frightened children for help. When Abby returned she provided no relief. She never told her mother-in-law what her father said to her. She simply "went upstairs, undrest and went to bed, saying she had got the disorder and she'd die." She lay in the room next to her husband.
Margaret sent the baby to a wet nurse, the toddler to her house, and again sent two children to their grandfather. When they didn't return, she felt more encouraged as she faced the difficult task before her. As she scouted the Morris house, in which she had been a stranger since her estrangement from her son, she found the Morris boy cowering in the cellar. His grandfather had only taken his sister. Margaret sent him to Benjamin Smith with a message that she needed help.
The mayor's letter relaying the offer of the Free African Society to provide nurses, appeared in all the newspapers at the end of the week. As the letter instructed, Smith applied to Absalom Jones and William Gray who both lived near Pear Street, and by the evening a man and woman came to help Margaret Morris. As was the case in most of the letters describing their help, the nurses remained nameless.
Soon after the nurses arrived Rush came to see his colleague. Dr. Griffitts had the fever and asked Rush to attend his patients. Rush was gratified to see the black nurses. The Free African Society had provided nurses for most of his patients. He gave Dr. Morris more calomel and jalap, and while not much encouraged, judging from the patient's pulse rate, he told Margaret that his fever was lower. He did not see Abby in the next room. Evidently Margaret viewed her as afraid, not sick with the fever. Still she had to be attended during the night. Margaret wanted to stay with her son and decided that she would feel more comfortable with the woman nurse. The male nurse sat by Abby. Shortly after one o'clock Margaret gained the first sleep she had had in two days.
Around 3 a.m. the cry of fire rang out. A soap house on 2nd Street between Market and Chestnut Streets was ablaze. One man roused by the alarm recalled the gloom that spread over him. He wondered what was to become of his city, then he bathed his temples and forehead with "proper vinegar," took some into his mouth "and went forward." When he reached the fire only one line of buckets had been formed. He followed cries to form a second and found himself next to a lad cursing enthusiastically as he passed the buckets. "I said audibly," the man recalled, "that this was a serious time, and intimated the impropriety of such language." The lad fell silent. Sailors from French ships moored nearby brought up pumps and put out the fire. Two people died in the blaze, and most of the copies of Currie's pamphlet were burned in a nearby printing shop.
Pear Street was oblivious to that drama. Margaret Morris woke at about 5 a.m.. felt her son's pulse, and "thought the fever gone off." She tried to give him medicine but he could not take it. She feared the worse, sent the male nurse to get Benjamin Smith and had the woman stay with Abby. Three weeks later she recalled her son's last moments. He was sensible for the first time in three days and mother and son were able to reconcile: "he spoke to me in a manner that poured balm into my wounded heart, lamenting errors of his past life and had hopes of mercy. This was all I had presumed to ask for, and my chastened spirit said 'thy will be done.' A convulsion fit followed, and after that a sweet composure took possession of his features and he departed without sigh, groan or struggle." She knew that her son had to be buried within hours to save all from the smell of his corpse. That the morning was cloudy and cooler was a blessing, but she decided not to wait for family to help her prepare the body for the grave.
Rush began his morning rounds by visiting the Morris house, arriving soon after the doctor died. "His excellent mother rushed from his bed into my arms," Rush wrote to his wife that night, "fell upon my neck, and in this position gave vent to the most pathetic and eloquent exclamations of grief that I have ever heard. I was dumb and finding myself sinking into sympathy, tore myself from her arms and ran to other scenes of distress."
Margaret managed to prepare her son for the grave and even see him buried promptly, with the help of the Free African Society that organized a group of black men to handle infected corpses. But Benjamin Smith saw that she was "scarcely any longer herself." She collapsed in complete prostration. Benjamin had her carried back to her own house and sent for Rush. Smith also arranged to move Abby Morris. When her father refused to take her in, the business-like Smith didn't recriminate against the most un-Quakerly act and solicited the help of the relative who had the most commodious house, Richard Wells, cashier of the Bank of North America. Wells polled each member of his household on North Third Street and they all agreed to take Abby in.
Rush was unable to see Margaret until the morning. He found her resting comfortably and determined that she was only exhausted. The death of John Morris did not weaken Rush's belief in his cure. Morris, after all, was a drunkard, and that weakened his resistance to any disease.
Sunday sermons had set off lamentations that flattered Rush's belief that his mission was a holy one. There was a growing conviction among preachers that the epidemic was heaven sent. One exhortation appeared in a daily newspaper on Saturday. An anonymous writer asked "whether he that rides the whirl-winds" was not "humbling a proud and idolatrous generation." He cited "the prodigality of this place,... our playhouses, circuses, palaces, carriages and costly edifices.... Our souls are delighted with the perishing things of this world." Citizens should not flee but "humble themselves under JEHOVAH'S awful rod...." Quakers recalled a visiting Quaker from England who had predicted "that he who sitteth on the pale horse whose name is death would be sent through the streets of Philadelphia."
Rush girded himself with religious metaphors. "Hereafter my name should be Shadrach, Meshach, or Abednego," he wrote to his wife Tuesday evening, "for I am sure the preservation of those men from death by fire was not a greater miracle than my preservation from the infection of the prevailing disorder." Rush saw himself as marshaling the forces of good, and so did others. Richard Wells stopped him on the street on Sunday and told him "Doctor, you have been highly favored in your discovery and success. Be humble and thankful." In reply Rush quoted the Bible, "who am I and who am I from, that I should have been so highly favored."
As he crossed Arch and Third Streets in his carriage, people stopped him, and he was dragged "to six different and new applications." Dr. John Penington ran across Third Street to tell him that the disease yielded to strong purges "in every case." He visited and prescribed for upwards of 100 people a day. John Connelly, a prominent auctioneer, took him by the hand and "with a faltering voice and his eyes overflowing with tears told me that he carried me on his heart to the footstool of his Maker." Rush seemed almost joyous at times. He bumped into an African American woman he knew, and cried "Hah! Mama, we black folks have come into demand at last." She squeezed his hand. Of course he constantly reminded himself of the misery, pledged not to forget the poor, and prayed for cleansing heavy rains or frost. But this was his moment. He felt that God was steadying him. He had health and "uncommon tranquility of mind." He did not have to hide the truth from patients. He simply told them "you have nothing but a yellow fever, and mercury and jalap are as certain a cure for it as bark is for an intermittent."
Rush had one rival for popular esteem. "Doctor Nassy, a frenchman, has almost made a monopoly of praise," John Welsh wrote. "It is said he has lost but one patient." As for Rush, "there has been great talk of his sovereign medicines, calomel & jalap, but it seems now to die away." David Nassy, a French Jew who had wide experience in the West Indies, had been in the city for several years and was a member of the American Philosophical Society. He responded to the epidemic by opening an office, and while he used remedies not much different than what Kuhn, Currie and Stevens offered, he added bleeding to his arsenal. When a patient sent for him, Nassy sent a bleeder ahead to take 6 or 8 ounces of blood out of the patient's vein. A friend who had taken refuge along the Schuylkill wrote to Rush about another French doctor, who had just arrived from St. Domingo, who "lets blood plentifully."
Rush bled two patients on Sunday, but, as he told his wife "not until they had been thoroughly purged." He justified bleeding by noting that with cooler weather, "the disease has put on in some cases inflammatory symptoms." Many doctors then viewed an epidemic disease as a protean entity literally saturating the air and, through that medium, the body. Just as a body exhibited changes with the changing seasons, so did a reigning epidemic. Rush had identified his enemy and to his own satisfaction determined that calomel and jalap could cure it, but a drop in temperature of ten degrees could radically alter the situation, giving the epidemic new life and requiring new remedies.
For the moment, in most cases, all that was needed was mercury and jalap. That's what he and his apprentices gave to the 120 patients a day who came to his house. Two more of his apprentices, John Coxe and Edward Fisher, moved in with him. Rush almost considered them his equals. His wife Julia worried that the disease might come to Princeton. He respected her fear, even their sons might be carrying the disorder. Since the fever could spread across a street, "and perhaps much further," if it did come to Princeton, she must "keep out of the way of it." He would send out his apprentice John Coxe to treat people, as he was "master of the symptoms of the disorder as well as of the remedy, and has cured several persons whom I have never seen." The sudden indisposition of Coxe and Fisher did not daunt him nor them. "They have seen so much of the efficacy of mercury in the disorder that they treat their complaint with as much indifference as a common cold."
That weekend he learned that another one of his five apprentices, Warner Washington, had the fever. His situation put Rush into a dilemma. Washington, a 21 year old nephew of George Washington, did not send for Rush out of shame. He had been strickened at his mistress's house outside the city. Rush sent Stall out to treat him, but expected the worse. "From the violence of the symptoms and the progress of the disease," Rush explained to Julia, he feared Washington would not recover. He cautioned her that 99 out of 100 who took his medicine "on the first day recover, and all would recover probably, had I time to attend closely to them after the expulsion or extinction of the poison by the mercury." He couldn't explain to her that Washington's immorality placed him in grave danger. The constitution of the patient and all that affected that constitution, food, drink, air, fear, anger, etc., bore heavily on the outcome. Often the disease itself was only secondary, only that which debilitated the body so that it could not survive a glass of cold water or a remembered sin. Yet by the next day Stall seemed to have Washington on the road to recovery.
As the new week began the case that terrorized the city and stirred Rush's ambition was Alexander Hamilton's. "The condition of this town is, in my opinion, truly alarming," wrote a Treasury clerk reflecting on the news that his boss was near death. The fever proved "fatal in almost every instance." He knew of five deaths, three near the office on Chestnut Street between Second and Third Streets. The disease was so contagious it was impossible to say, how slight a communication with infected persons, or their attendants may convey it." When the chief auditor left for a scheduled vacation, his 20 clerks fled. (Yet the Treasury stayed open. Joseph Nourse, the register, refused to give any of his 39 clerks leave. Interest payments were due on government bonds October 1. Nourse reasoned that if he let one clerk go, they all would flee. The customs house also stayed open. Otherwise the port would have to close. The clerks there went to the office, but kept the doors locked, only collecting documents through a narrow slit in a window.)
Hamilton's illness put Rush in a quandary. He was the professed enemy of the Treasury secretary's policies, and no friend of the man personally. Hamilton put himself in the care of Dr. Stevens, a boyhood friend from St. Croix where both were born (likely by the same father). But Rush put saving the city above politics and professional scruples. He called on Stevens in hopes that his methods if not his hands could cure his political enemy. Stevens, however, was well satisfied with his gentle remedies, bark, wine, small doses of "oil of peppermint and compound spirits of lavender," and "infusing" chamomile flowers into the secretary's body. When the secretary's condition worsened Stevens's had him held up in a tub every two hours as cold water was splashed over his naked body. After that he sipped a little brandy burnt with cinnamon, and, while he lay in bed, flannel cloths soaked in "wine impregnated with spices" were applied "to the pit of the stomach and changed frequently."
Rush had more success trying to save other symbols of the city's stability. Thomas Willing, president of the Bank of the United States, sent a note to Rush on Monday: "the weak state of my stomach and heavy sweats in the night require some immediate check." Rush was soon at his side with purging medicines. Then a drama played out in the parlors of two of the city's most famous families that showed how Rush anchored the courage of one city leader.
George Washington had an abiding affection for Philadelphia because some of his best friends lived in the city. By and large most had already fled the epidemic. The Powels, perhaps his and Martha's closest friends, had not. As a leader in the Pennsylvania legislature, Samuel Powel had to stay through Friday, but now was free to leave. His wife Elizabeth called on the president Monday, and he invited her and her husband to accompany the presidential party to Mount Vernon. The Powels had visited in 1787 and Elizabeth, with whom Washington had such a special chemistry that biographers would accuse them of having an affair, liked the idea. Samuel Powel did not. His reason for staying was in essence his confidence in his doctor, Rush. As Elizabeth explained in a letter to the Washingtons, Samuel argued that it was foolish to leave "the only spot where physicians [were] conversant with the disorder." Powel did not forbid his wife such a pleasant escape. She decided to stay, and follow "duty" over "inclination." If her husband got sick, not being at his side would be "a lasting source of affliction."
Washington had never used Rush's professional services. During the war the doctor had written a letter to Patrick Henry suggesting that Washington was not the man to continue to command the army. Henry had shared the letter with his fellow Virginian. When Washington made William Shippen, Jr., Rush's victorious rival for control of the Army Medical Corps during the war, his private physician in Philadelphia, Rush took the slight personally. Actually Shippen had married into the Lee family, a sterling qualification in the eyes of Virginians. Washington also respected Rush's courage. He decided leaving on Tuesday as scheduled would be a blow to the city's morale. Then his wife insisted that she would stay too. Rather than hazard her life, he left.
Powel was one of the few public official who stayed in the city. Save for the night watchmen, city services ended. Of the 20 overseers of the poor, only 3 remained to oversee poor relief in the city and operations at Bush Hill, the fever hospital. A correspondent in a newspaper complained that people "refuse to suffer their friends to be carried thither, because it is at present conducted mysteriously." Actually it was conducted scandalously. The two young physicians in charge, Physick and Cathrall, did not reside there. They visited patients once a day at 11 a.m., leaving nurses in charge the rest of the time. Later the nurses were accused of having "rioted on the provisions and comforts prepared for the sick." On Monday afternoon, the three remaining overseers went to the mayor and told him they needed help. In Tuesday's newspaper Mayor Clarkson summoned citizens to a Thursday meeting at the State House to discuss the crisis.
Rush's reaction was instantaneous. He wrote a broadside to answer the crisis. He realized that the hospital offered no hope, and that all who needed him could not see him or even one of the several other doctors who were using his methods. His solution was to recommend self-medication. "Dr. Rush's Directions for Curing and Treating the Yellow Fever," was printed and distributed to newspapers and apothecary shops.
"As soon as you are afflicted (whether by night or day)," it began, "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 in 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 from the bowels..."
The powders were his mixture of calomel and jalap which his apprentices and areas druggists made up whenever they had a moment free from seeing patients. Then he recommended taking 8 to 10 ounces of blood from the arm if, after purging, the pulse was full or tense. To bolster the body after all those depleting remedies, he was prolix in his descriptions of various weak drinks and gruels that could be taken along with fruit in season, nor did he neglect blisters and blankets soaked in hot vinegar wrapped around the lower limbs. Vinegar should also be sprinkled around the floor.
Rush cut a remarkable figure. "The pleasure of the Lord continues to prosper in my hands," he began his Wednesday letter to his wife. But yellow fever was as remarkable. Sixteen hours later, Rush wrote in his notebook, "an awful day."
Go to Chapter Six
Thursday, March 29, 2012
Wednesday, March 28, 2012
4. Purge
Before dawn on Saturday, market day, farmers' carts heavy with produce rolled into the city, except for ripe peaches. Joseph Cooper, who owned an orchard on the outskirts of town, made the market girls carry his peaches, ripened to perfection, on their heads - a precaution to prevent bruising. No characterization of how the market went that day has been found. What happened there was so essential to the life of the city and economy of the hinterland that it is unlikely there was much diminution of business.
If the talk of the market mirrored the concerns expressed in the newspapers then there was worry about the need to make sure the corpses of fever victims were buried properly, to fill holes in Water Street with quicklime, to shut the tanneries, and don't forget "the Asiatic remedy of myrrh and black peppers." But the lead paragraph in the Federal Gazette that evening was reassuring. The editor was "happy" to pass on "the assurances of several respectable physicians, that the progress of the infectious fever... is considerably abated." Benjamin Smith quoted and endorsed the Gazette's opinion in a letter to his father. He was busy with a ship from Liverpool - the first cargo of the new goods from Britain that flooded the market every fall. Only one person he knew was sick, Richard Stansbury, the lad Rush was treating.
Then something happened on South 2nd Street dashing hopes that all was well. Dr. Hutchinson awoke with a sharp pain in his head. The night before he had dined with Secretary of State Jefferson at an estate along the Schuylkill. Famous as the former ambassador to France's wine cellar was, Hutchinson knew he did not have a hangover. Hours before he had described the fever's symptoms to Jefferson. It "begins with a pain in the head," and could end in death "from the 2nd to the 8th day."
When Rush heard the news he commented knowingly that by going out to see Jefferson and returning in the cool night air, Hutchinson had excited the infectious matter which was in his system. Rush congratulated himself for at least persuading Wistar not to accept Jefferson's invitation. Rush had dined there two weeks earlier and at least three of the secretary of state's guests suffered as the "cool air awakened the contagion influenza."
Hutchinson summoned Dr. Kuhn, considered by many the city's best practitioner, and envied by Rush because Kuhn was rich. Wealth did not preclude his being close to Hutchinson, the city's leading pro-French radical Republican. Kuhn's son-in-law was Benjamin Bache, Benjamin Franklin's grandson and the editor of the city's radical Republican newspaper, the General Advertiser. Within a few weeks Kuhn would jot down the gist of his examination of Hutchinson:
"he had gone to bed about 11 o'clock perfectly well and he indeed never felt better or in higher spirits." A few hours later, at three, he woke "with a most violent headache attended with fever." A few days before, Kuhn had told Margaret Morris that only 9 people had died of yellow fever in the city. So he quizzed Hutchinson sharply, asking several times if he had a chill, a pain in the back or uneasiness in the stomach. "He declared that he had no chill, sickness, or pain any where but in his head, which he described as excruciating." Kuhn noted that his skin was dry, his pulse "not much more frequent and not fuller than in health."
Kuhn suggested that Hutchinson take a lenient purge. The two doctors decided that cream of tartar would be best. Hutchinson's wife, who was in her ninth month of pregnancy, was an uneasy bystander during this consultation. "With great anxiety," Kuhn recalled, she asked him if her husband had yellow fever. Hutchinson saw Kuhn's embarrassment and "immediately answered there was no doubt of it. A week ago he had examined the houses along Water Street." Kuhn did not disagree.
That evening Kuhn returned to his patient. He had had one bowel movement "of a putrid nature." Once the stomach and bowels were evacuated, Kuhn treated putrid fever by using remedies that would "produce a fermentation in the stomach and correct putrefaction." He suggested wine whey and water, or lemonade, and ripe fruit. Once putrefaction was checked, he would "restore tone to the system." Hutchinson indicated he wanted a tonic and chose elixir of vitriol, sulfuric acid in wine which thanks to the zing it imparted to the mouth had been a popular tonic at least since 75 B.C. Kuhn also suggested a cold bath of which doctors with experience in the West Indies spoke so highly. When Kuhn left, Hutchinson had himself splashed with cold water and found it refreshing. He also decided he didn't feel adequately purged. He took more cream of tartar and passed a restless Saturday night.
Neither doctor thought of calomel, the mercury compound Rush was using. In his lectures at the medical school Kuhn cautioned against mercury. It would bring on incessant salivation, with hawking and spitting, "a very disagreeable companion."
That weekend Rush set out to see if calomel could save the city. On Sunday morning he reported to his wife that, "thirty-eight persons have died in eleven families in nine days in Water Street, and many more in different parts of the city." Of his patients, Richard Stansbury probably would not survive the day. Rush thought spots that appeared on his thigh - definitely not mosquito bites, were a mortal sign. He gave the lad 40 drops of laudanum, opium dissolved in wine, to make death easy. Stansbury was "a sweet youth," a little older than Rush's son Richard (a future Secretary of State.) Many of the dead had been boys between the ages of 16 and 19, so he was thankful that his sons had left the city. Richard Spain survived. Stall reported that the blockmaker would get his 8th dose of calomel. He had not yet been purged. His sweats were not natural. At least it was evident that large doses of calomel were not as poisonous as so commonly feared.
The patient Rush devoted most attention to Sunday morning was the wife of Captain Bethel, a ship's chandler on North Front Street. She was Rush's mother's step-daughter from her last marriage. Rush decided to use the new remedies on her and invited Dr. Wistar to observe the power of calomel. She was experiencing the restlessness characteristic of the early stages of the fever. Rush told her to "drink copiously of chicken water," i.e. a very weak broth, and lie in her bed. Still searching for quicker action Rush made pills different from those Stall had been giving Spain, mixing 10 grains of calomel with 15 grains of rhubarb. She took the first dose, and the two doctors did not have long to wait for a reaction. She vomited "a large quantity of bile."
More comfortable with books than with body fluids, Wistar was taken aback by the violence of the reaction, and asked, "whether it gave relief as an emetic or cathartic?" That is, was it intended to induce vomiting or purge the intestines and bowels. Rush answered that while the target was only the stomach, not the seat of putrefaction below, the puking was a good sign showing that the medicine provided "more speedy service." Wistar argued that if relief came from vomiting, a medicine with less bothersome side effects could have been used. Rush ended the discussion by giving Mrs. Bethel another dose. Wistar left and, two months later when this treatment became an issue in a controversy with Rush, Wistar recollected that he thought Mrs. Bethel looked "very unwell."
Rush later told Wistar that he waited until the pill brought on a copious purge followed by a sweat. Then he thought she was "much relieved." That same day, Sunday, Stall's patient had "two copious, foetid stools. His pulse rose immediately afterwards, and a universal moisture on his skin succeeded the cold sweat on his limbs." Rush was still cautious about the cure. That evening he received a note from Samuel Powel, the speaker of the state senate. If Rush could not allay the senators' fears, "it will be impracticable to keep the members in town." Rush scrawled on the back of Powel's note, "I know of but one certain preventative of the disorder, & that is to keep at a distance from infected
persons and places."
Meanwhile Dr. Hutchinson had not been inactive. The cream of tartar inspired three bowel movements that Sunday and the 300 pound man had gone down two flights of stairs and his back steps so that he could do it in the out house. Kuhn thought Hutchinson was too weak for such exertion, and expressed "extreme regret." During the night Hutchinson could not stop his bowels, and had eight more movements. Kuhn thought that very dangerous in a putrid fever and set out to stop it at any costs. He prescribed laudanum. To check possible over sedation from that opiate, Kuhn also prescribed one ounce of bark as a tonic.
Hutchinson passed 10 stools on Monday and had bleeding hemorrhoids. Kuhn was not sanguine, as he explained to Samuel Coates, president of the Pennsylvania Hospital, whom he met in the streets. "What would you think of him venturing down three pairs of stairs, after such a severe illness," Kuhn xplained. He would have whipped one of his own patients for such an act of impudence. Kuhn said he had had great hopes of recovery, but no more, "Hutchinson must submit to his fate." Coates told his friend Rush the news, which seemed to highlight the success of his mercurial purges.
In the letter he wrote to his wife on Tuesday, Rush reported that on Monday he was called to 12 patients, and "eight are out of danger, from the powerful operation of the medicine I mentioned in my letter of yesterday." (That letter is missing.) Rush was ready to announce a cure for yellow fever.
Not that Spain had recovered. Rush later wrote that it was "a few days" before Spain was "out of danger." At least one of the twelve to whom he gave mercury, Stansbury, had died. While prostrated by the medicine, Mrs. Bethel had never exhibited the worse symptoms of the disease. Judging by how soon they were up and about, two other survivors of the trials also had the fever lightly. Neither Dr. William McIlvaine nor the lawyer William Lewis could have had mercury before Sunday, yet by Tuesday McIlvaine credited Rush with saving his life, and Lewis was well enough to leave the city on Thursday, join his family in the country and write a witty letter to Rush.
He had saved one person that all who knew him thought would die. He had saved three others, in evident distress, from the worst symptoms of the disease. His rivals Kuhn and Hutchinson were reportedly giving up. The College of Physicians met on Tuesday to hear Dr. Redman discuss his old remedies, and Rush knew that they did not work. Delaying an announcement of a cure that clearly promised to be successful was unconscionable. A friend outside of the city had just written to him, confessing that "it is the first time in my life I ever felt my fears set in motion by any general disease." He prayed for Rush to "promote the cause of Humanity and further your masters work on Earth." Rush answered that prayer. As he played his hunch that he had the cure, his gloom was gone. "Hark! a knock at the door!" He closed a letter to his wife and was off for "the delay of a minute seems a year to a patient after a physician is sent for." One of the most enduring therapies American medical history, that would reign for upwards of 50 years, was born.
And Rush did more than cure yellow fever that weekend. No one had a keener sense of the city's crisis than Rush. Other city leaders were still bewildered. What exercised many that Monday was the arrival of the Ship Hope "crowded with 200 diseased Irish." While standing quarantine, some passengers escaped and came to the city, "to the great terror of many of the inhabitants." The mayor asked citizens "to discover" the miscreants. Governor Mifflin already had the militia on guard, to protect the city from an invasion of deserters from a Royalist French warship in New York harbor. Some 80 of them were rounded up and sent by a judge to prison until the French minister, who was then in New York, could determine their fate.
Rush paid no attention to those civic exertions to protect the city from invasion. He knew that the crisis was caring for the sick. Wistar and many others had constant headaches. Rush blamed their incautiously caring for the sick. (He blamed his own headache on too many preventatives, a vinegar headache.) Then Wistar could no longer stand the light of the sun. On Monday afternoon he asked Rush to see his patients, and Rush already had all the patients he could handle.
The city had not yet made provisions to care for the poor. The overseers' resolve to seek out the sick and give them succor failed because most of the overseers themselves began fleeing the city. Rush came to the rescue by enlisting the aid of his African American friends.
Absalom Jones along with Richard Allen, a cobbler by trade but famed as a Methodist preacher, had organized the Free African Society to foster mutual assistance for the city's blacks. Rush wrote to Allen and Jones explaining that their race was immune to the disease. (Evidently Rush did not notice that the autopsies Dr. Mitchell performed were on slaves who he supposed to have had died of yellow fever.) He asked if that "exception... which God has granted you does not lay you under an obligation to offer your services to attend the sick."
In Monday's American Daily Advertiser, writing under the pseudonym of Anthony Benezet, a Quaker emancipationist who had died in 1784, Rush quoted Dr. Lining on how blacks were not infected during the Charleston epidemics, and recalled blacks, not only to their duty to God, but to their obligation to white Philadelphians. They should help those who had "first planned their emancipation from slavery, and who have since afforded them as much protection and support, as to place them, in point of civil and religious privileges, upon a footing with themselves." Allen and Jones did not ignore their benefactor Rush, and called for a meeting of the Free African Society on Wednesday the 4th.
Philadelphia's African American community had its own medical traditions and practitioners, including a cancer doctor to whom whites went to for treatment. Early in the century Cotton Mather in Boston had learned about inoculation for small pox from slaves before he learned about its use in England. Rush endorsed the African practice of powdering a child's body with special herbs before inoculation. At the meeting of the Free African Society "after some conversation," Jones and Allen later wrote, "we found a freedom to go forth, confiding in Him who can preserve in the midst of a burning fiery furnace." They visited a family in a nearby alley. The wife lay dead, the husband ill, two children were helpless. "We administered what relief we could," they recalled, "and we applied to the overseers of the poor to have the woman buried." They visited upwards of 20 families that day and saw "scenes of woe indeed!" They found their mission, later writing, "The Lord was pleased to strengthen us, and remove all fear from us, and disposed our hearts to be as useful as possible." They went to the mayor who agreed to publish a letter in the newspapers directing those in need of a nurse to apply to Jones who would find African Americans to fill the need. Jones' and Allen's Account of the Epidemic
Rush did not attend Jones's and Allen's meeting. He was too busy spreading the good news about his remedy, an effort that was caught short by rumors sweeping the city and even a published attack on him. Many were extolling the remedies of the French physicians in the city. Having just come as refugees from the West Indies, they were assumed to have special insights into a disease thought to be tropical. Rush had tried the West Indian remedies and they had failed. He decided he must convince his colleagues that the fever in Philadelphia was "totally different from yellow fever of the West Indies." It was engendered by local filth and had unique characteristics.
Apparently anticipating that debate, Dr. William Currie discovered, with the help of Isaac Cathrall, that, contrary to Hutchinson's findings, two Frenchmen recently arrived from the West Indies had died of the fever in early August. In the newspaper Tuesday morning an anonymous attack by "Medicus" ridiculed Rush for claiming that rotting coffee caused the disease. "I have been told," Medicus taunted, "that a number of poor people, who live on Passyunk road, gathered a quantity of the damaged coffee, carried it home and are in perfect health. A strong presumption against any noxious exhalations from that source."
The College of Physicians met Tuesday night primarily to hear Dr. Redman on the yellow fever epidemic of 1762.
Rush and Redman had a great deal of respect for each others, and at the meeting they managed to finesse their radically different approaches to the disease. Redman had looked over his day book from the 1762 epidemic and spoke to patients who had survived. He recollected that doctors avoided bloodletting, emetics, laudanum and bark, preferring salts to open and cordials to restore the body. The purge he used was mild: "one ounce of salts, 2 drams of chamomile flower, and 2 drams of snake-root - these steeped together and the decoction mixed with good old spirits or brandy and vinegar." He admitted that in talking about salts, snakeroot, chamomile tea, and lemonade punches, he was not talking modern medicine. Those remedies had been gleaned by Dr. Kearsley, then the city's leading practitioner, from "an old author." But while the ancients had to be given due respect and credit, nothing he said should deter doctors from using modern methods.
After that introduction Rush spoke. He never published what he said, but judging from a letter he wrote to a Trenton doctor that same day, and from what Dr. Wistar recollects Rush telling him, he was quite sanguine. "I set down with great pleasure to inform you that the fever which has ravaged our city for some weeks past is at last arrested in its fatality. The medicine which has performed this office is calomel." He explained the medicines operation by referring to Mitchell's dissections. Calomel expelled the bile and opened the passages from the liver and gall bladder. Then Rush made his gesture to Redman. In his letter to the Trenton doctor, which Rush certainly expected to be published, he did not discard the cures of 1762 altogether. He recommended using calomel and jalap every other day if the fever continued, alternating the new remedies with "infusions of camomile flowers, snake root, bark, wine, &c., on the intermediate days." Redman reduced his talk into an essay which he gave to a printer at the end of the week. In it he endorsed Rush's methods.
Rush's colleagues knew the relative force of calomel and jalap in the dose Rush prescribed compared to other medicines. They understood that Rush was subverting established practice. And while Rush was politic enough to flatter Redman with a mention of the old remedies, in which Rush had completely lost faith, he could not help bragging. He told Wistar that calomel and jalap made the fever that had panicked the city, as manageable as an intermittent, that mild malaria so endemic since the settling of the colonies that people had learned to live with it.
Wistar had missed the meeting. Despite taking preventatives, bark every morning and evening, and following all the rules save one - he swallowed his spittle while in a sick room - Wistar got the fever. By Tuesday afternoon he had "a smart fever and delirium." By a messenger Rush ordered him to take calomel, but he didn't. He had his apprentice William Bache fetch ipecac, which worked several times. His stomach still felt heavy and sore. Then Rush came to him and did not consult. He insisted that Wistar take calomel and jalap. He did and when he was able, Wistar sent word that the purge operated and relieved him, but he didn't tell Rush that his fever returned sharply and he felt miserable.
Hutchinson and Kuhn, Rush's rivals as well as fellow professors at the University of Pennsylvania medical school, were not shy about wanting to assume the role as the city's savior, and even younger doctors sensed the opportunity. Unfortunately for his pretensions, Kuhn got sick with a fever. Not the prevailing fever Kuhn insisted. With Kuhn now unavailable, Hutchinson called in two younger doctors, William Currie and Benjamin Barton. When Currie came Tuesday evening, Hutchinson was sitting up talking with Nathaniel Falconer, the health officer of the port. Hutchinson was lucid enough to describe his own case and gave Currie permission to write about it. Currie's description of symptoms
Like Hutchinson, Currie was a former student of Rush's. The master sensed no rivalry. Indeed he had once cured Currie of a bad fever, and thought of himself as the younger man's friend. Lacking a European medical education, Currie quietly suffered Rush's overt displays of erudition, and now decided not to miss an opportunity to show his own genius.
Hutchinson told Currie that he liked the baths and vitriolic salt tonics. When he felt well, as he did then, he took no medicine but lime juice punch. In the essay Currie would send to the printer at the end of the week, Hutchinson's treatment was held up as a model. Currie did allow that six grains of calomel might be useful as a vomit in some cases, and added that that remedy was suggested by a Delaware doctor.
Like Hutchinson, Currie viewed the epidemic as a limited threat. It was virtually the same as the typhoid fever so deadly in military hospitals and prison ships during the war. Thus it could not be caught by walking the street but only by breathing infected air in a sickroom or touching infected clothing. Hutchinson may have convinced Currie not to be an alarmist like Rush, or he may have felt trapped by the book he had published that spring, An Historical Account of the Climates and Diseases of the United States of America. In it he had assured the world that epidemics in Philadelphia were a thing of the past. (To be fair, Rush thought the same thing at that time.)
Hutchinson's survival might have made Currie's essay a best seller. After Currie left him on Tuesday night, Hutchinson walked downstairs. When he came back up, his nose bled until "he was much debilitated and faint." He took 45 drops of laudanum, got to sleep, and rested well until he awoke "with sickness and great distress." Currie came back at 10 o'clock Wednesday morning and found Hutchinson with a low pulse, and cold and dry skin. His face was bloated and livid. "His mind was considerably deranged - his thirst became insatiable - he cast up all he drank, as soon as his stomach became full, with straining and noise." When he wasn't puking he was hiccupping. No matter what medicine Currie suggested, Hutchinson "obstinately" refused it, claiming that "nothing was the matter." Currie sent his manuscript to the printer anyway. (Then Dobson's printing plant burned down, destroying most of the copies of Currie's essay. Rush blamed the exertions of many to fight the fire for making the fever more virulent.)
On Thursday the 5th Rush forgot past differences and went to Hutchinson. He found the massive doctor "sitting in a chair near the head of his bed, with all his clothes on, as if he had been in his usual health." But he wasn't. Rush saw that he was delirious with a face "suffused with blood." Rush urged "a strong mercurial purge," explaining that it had saved 29 out of 30 who had taken it. Hutchinson refused for the moment, but did send one of his apprentices to Kuhn. "Rush should know," Kuhn replied sharply, "that Hutchinson had 30 stools in three days." He did not need further purging.
Rush was bitter at Hutchinson's refusal and blamed the young doctors, Currie and Barton. It wasn't there fault. Whenever Hutchinson felt better, he took great pains to make everyone believe he was completely out of danger. This was not only a case of medical hubris. It was also a matter of politics. He wanted to keep the legislature in session since the impeachment of the state comptroller John Nicholson was very much Hutchinson's pet. Not that he allowed his comrades in the legislature to visit him and risk getting the fever. That made the Republican floor leader Albert Gallatin (a future Treasury secretary under Jefferson) "very depressed," and almost ready to give up since the legislature was "so much alarmed and so unfit to attend to business."
Although many were obsessed with Hutchinson's case, many others decided not to await the outcome. Thomas Jefferson wrote on Tuesday that "everybody who can, is flying from the city." In the biweekly National Gazette that came out Wednesday, the Republican editor Philip Freneau lampooned those who fled:
On prancing steed, with sponge at nose,
From town behold Orlando fly;
Camphor and Tar where 'er he goes
Th'infested shafts of death defy -
Safe in an atmosphere of stink
No doctors get Orlando's chink.
But the refugees had no regrets. William Lewis wrote to Rush of the absurdity of staying: "A large city with the houses shut up and the streets empty except the french sailors, people of St. Domingo of all colors with their heads tied. A few citizens who you do not know posting along with sponges at their noses and the hearse constantly passing, exhibit such a melancholy picture that I never left Philadelphia with so much pleasure as yesterday nor never found such pleasure in the country as I do today - I am perfectly well, the air sweet and the trees, fields, waters, pastures and c. more beautiful than ever. How great, how pleasing the contrast!"
Still, for those who stayed business was far from being at a complete stand. President Washington scheduled cabinet meetings through the weekend. A 24 gun French ship from the East Indies, "richly laden in silks" worth 500,000 pounds sterling, docked. Some merchants returned to the city on Monday, their summer vacation over, and got to work as if nothing was happening. John Welsh, a clerk in a counting house on South Front Street, wrote to his boss Robert Ralston, who was still in Wilmington, that he was too busy to notice "the malady so alarming,... being engaged all the morning." After a hot humid weekend the wind shifted to the north, Welsh expected that would "expedite" the departure of the fever.
Then on Wednesday he noticed, that it was like "Sunday, little doing, sometime perfectly quiet, so many have fled this scene of death." But Welsh still hoped the change in weather would tell, and he heard that "several persons are likely to recover." Hutchinson was "mending." His neighbor Ebenezer Hazard, secretary of the North American Insurance Company, opined "that the distemper is decreasing very fast." Benjamin Smith remained an optimist, explaining to his father on Wednesday that while "the disorder still continues pretty rife," it was less virulent. Dr. Say said that "in many cases it now exhibits an intermitting appearance." Margaret Morris no longer saw corpses carried past her door.
When Treasury secretary Alexander Hamilton sent a note Friday morning informing the president that he would miss the scheduled cabinet meeting because he feared that he was "in the first stages of the prevailing fever," Washington expressed "extreme concern" but shared the optimism then current. Noting that "the malignity of the disorder is so much abated, as with proper & timely applications not much is to be dreaded," he hoped Hamilton and his wife could still make it for dinner.
Rush was convinced that his medicines were in a large part responsible for the lack of deaths. "Fewer deaths have occurred I believe this day than on several days last week, and yet many hundred people more have the fever now than had it last week," he explained to his wife on Thursday. He also observed that those with the fever who were not treated invariably died. He gave a purge to many going into the country, "to subdue the disease if it should break out." However, Rush was so confident of his ability to control the disease that he no longer recommended that people leave the city. "I now advise them to remain where they are, to avoid going out of their houses, and to send for a mercurial physician as soon as they are infected," he wrote to his wife on Friday, and could even joke about the crisis. "No other metal in a physician's head will do any good now, not even gold any more than lead. My medicine has got the name of an inoculating powder, for it as certainly and as universally deprives the yellow fever of its mortality as inoculation does the smallpox."
With his five apprentices making and distributing pills of calomel and jalap or rhubarb, Rush tirelessly tried to stop the epidemic. He slept four hours a night. He told his wife that "out of 100 persons who have taken [mercury] from me on the first day, not one has died. The deaths which now occur are chiefly of poor people who have no doctors, or of respectable people who are in the hands of quacks or of the enemies of mercury."
As Hutchinson lay dying, Wistar recovered, which Rush counted a major victory for mercurial purges. He tried to elicit a testimonial for his cure. He went to the extreme of suggesting to his languishing colleague that it was he, Rush, who faced imminent death, and he worried about who would carry on his work. "You cannot die now, Doctor," Wistar replied tactfully. "The pleasure of your discovery must like a cordial keep you alive."
For the moment Wistar kept to himself what remedies he thought most beneficial. He appreciated the power of calomel, but as he recovered from a delirium he became conscious of a wonderful cold draft from a window left open in his room. He instructed his students to keep him cool. When the breeze from the window was too hot, the young men took turns fanning their master. To that, Wistar attributed his recovery.
While not a few found comfort in statistics showing decreased mortality, there was no official count of the sick and dead published. So panic was easily fueled by anecdotes. A young woman who nursed the sick in Water Street got sick herself and neighbors refused to take her in. She lay in the street where an alderman found her and "had her sent in a cart to the city hospital, where she was refused admittance, and was near that place found dead in the cart next morning." The report that the Stephens family on Chestnut Street between 2nd and 3rd Streets lost 7 of 10 members stripped John Welsh of optimism, "so victorious is this dreadful disease over the most efficacious administrations of our physicians."
In this atmosphere of hope, confusion, and dread, for many the fate of the city increasingly seemed to hinge on Hutchinson's recovery. On Thursday he lapsed into a coma. The city's gloom increased, though there was still enough political venom in the city to cause the clerk of the not-yet-to-be-impeached John NIcholson to crow: "Dr. Hutchinson is given over by the physicians. I believe he is thus dead or dying, thank God for it." Nicholson's clerk even wanted the comptroller to leave his farm, come to the city and rout the demoralized enemy. Of course the legislature moved quickly toward adjournment, postponing impeachment proceedings.
Then William West, a Quaker member of the Assembly, stood and cited "the duty of a people professing Christianity to humble themselves before the Judge of all the Earth, at all time, and particularly at this awful period." He proposed a law closing the theaters in the state permanently. Hallam's American Company of Comedians did close on August 23, so there could be no pretense of the proposal being a health measure. Every legislator knew what West was up to. In 1789 the Revolutionary War law banning theaters was repealed despite protests from the religious community, including a procession led by the Episcopal bishop William White. What better time to reopen the issue than when god was showing his wrath. No one seconded West's resolution.
Quakers like West might believe, as his co-religionist Margaret Morris explained in a letter, that there was no escape if God's rod was "commissioned to strike us among the rest," but no other legislator wanted to waste time in the city as the fever spread. They adjourned after giving the governor new powers to stop and quarantine ships. There was news of yellow fever in Barbados and other islands. The governor ordered a quarantine of ships from the West Indies and moved out to Germantown.
Hutchinson lived through Friday in a coma. He died Saturday. His wife went into labor that same day, and bore him his fifth child, a girl. Nicholson's clerk gloated. Hutchinson's huge body began to "mortify before he died," and had to be buried in a hurry that night, while his allies in "iniquity... galloped out of town." Hutchinson's friends were inconsolable. His obituary was in newspapers all over the country. Within two weeks a poem about the fallen Republican hero was published. "For five days no two or more persons met when the first interrogatory was not 'How does Hutchinson.'" the young editor Samuel Smith wrote to his sister. "Now he is no more - but I cannot dwell on the gloomy subject." Hutchinson had given Smith courage to stay in the city. Smith was aware of Rush's cures and believed the fever's "virulence has... been greatly subdued," but as he sealed his letter, a carriage waited to take him to Lancaster 60 miles away.
Rush did not view Hutchinson's death as a civic tragedy. "It is remarkable," Rush wrote to his wife, "that he denied the existence of a contagious fever in our city for above a week after it appeared among us, and even treated the report of it with contempt and ridicule. The reason, I fear, was the first account of it came from me."
Rush remained. Before retiring at night he was in the habit of reading psalms in order. He opened the Bible to the 52nd Psalm: "Thy tongue deviseth mischiefs; like a sharp razor, working deceitfully.... God shall likewise destroy thee for ever, he shall take thee away, and pluck thee out of thy dwelling place, and root thee out of the land of the living." It reminded him of Hutchinson. "Poor fellow!" Rush wrote to his wife. "He died as well as lived my enemy."
The next day, Dr. McIlvain, whom he had successfully treated with mercury, told Rush that Kuhn insisted that calomel and jalap only cured remittent fevers, not yellow fever. Rush remarked in his notebook that "there was more malignity in his heart towards me than was in the contagion of yellow fever." With God's help he could save his city. What stood in his way were the jealousy and ignorance of his colleagues.
Note: Modern historians are prone to quote letters written by John Adams in his old age to illuminate historical events that usually Adams never experienced. Although Vice President during the epidemic, he left Philadelphia when Congress adjourned, months before the epidemic started, and he didn't return until Congress returned a month after the epidemic ended. His assertion that the death of Hutchinson saved the Republic from a certain revolution was roundly ridiculed by contemporaries, yet it pops up in histories of the epidemic. Here is link to Timothy Pickering's 1824 review of the publication of some of Adams' letters. Pickering was in Philadelphia during the epidemic and lost a son to it:
A link to Pickering's Review see page72.
Go to Chapter Five
If the talk of the market mirrored the concerns expressed in the newspapers then there was worry about the need to make sure the corpses of fever victims were buried properly, to fill holes in Water Street with quicklime, to shut the tanneries, and don't forget "the Asiatic remedy of myrrh and black peppers." But the lead paragraph in the Federal Gazette that evening was reassuring. The editor was "happy" to pass on "the assurances of several respectable physicians, that the progress of the infectious fever... is considerably abated." Benjamin Smith quoted and endorsed the Gazette's opinion in a letter to his father. He was busy with a ship from Liverpool - the first cargo of the new goods from Britain that flooded the market every fall. Only one person he knew was sick, Richard Stansbury, the lad Rush was treating.
Then something happened on South 2nd Street dashing hopes that all was well. Dr. Hutchinson awoke with a sharp pain in his head. The night before he had dined with Secretary of State Jefferson at an estate along the Schuylkill. Famous as the former ambassador to France's wine cellar was, Hutchinson knew he did not have a hangover. Hours before he had described the fever's symptoms to Jefferson. It "begins with a pain in the head," and could end in death "from the 2nd to the 8th day."
When Rush heard the news he commented knowingly that by going out to see Jefferson and returning in the cool night air, Hutchinson had excited the infectious matter which was in his system. Rush congratulated himself for at least persuading Wistar not to accept Jefferson's invitation. Rush had dined there two weeks earlier and at least three of the secretary of state's guests suffered as the "cool air awakened the contagion influenza."
Hutchinson summoned Dr. Kuhn, considered by many the city's best practitioner, and envied by Rush because Kuhn was rich. Wealth did not preclude his being close to Hutchinson, the city's leading pro-French radical Republican. Kuhn's son-in-law was Benjamin Bache, Benjamin Franklin's grandson and the editor of the city's radical Republican newspaper, the General Advertiser. Within a few weeks Kuhn would jot down the gist of his examination of Hutchinson:
"he had gone to bed about 11 o'clock perfectly well and he indeed never felt better or in higher spirits." A few hours later, at three, he woke "with a most violent headache attended with fever." A few days before, Kuhn had told Margaret Morris that only 9 people had died of yellow fever in the city. So he quizzed Hutchinson sharply, asking several times if he had a chill, a pain in the back or uneasiness in the stomach. "He declared that he had no chill, sickness, or pain any where but in his head, which he described as excruciating." Kuhn noted that his skin was dry, his pulse "not much more frequent and not fuller than in health."
Kuhn suggested that Hutchinson take a lenient purge. The two doctors decided that cream of tartar would be best. Hutchinson's wife, who was in her ninth month of pregnancy, was an uneasy bystander during this consultation. "With great anxiety," Kuhn recalled, she asked him if her husband had yellow fever. Hutchinson saw Kuhn's embarrassment and "immediately answered there was no doubt of it. A week ago he had examined the houses along Water Street." Kuhn did not disagree.
That evening Kuhn returned to his patient. He had had one bowel movement "of a putrid nature." Once the stomach and bowels were evacuated, Kuhn treated putrid fever by using remedies that would "produce a fermentation in the stomach and correct putrefaction." He suggested wine whey and water, or lemonade, and ripe fruit. Once putrefaction was checked, he would "restore tone to the system." Hutchinson indicated he wanted a tonic and chose elixir of vitriol, sulfuric acid in wine which thanks to the zing it imparted to the mouth had been a popular tonic at least since 75 B.C. Kuhn also suggested a cold bath of which doctors with experience in the West Indies spoke so highly. When Kuhn left, Hutchinson had himself splashed with cold water and found it refreshing. He also decided he didn't feel adequately purged. He took more cream of tartar and passed a restless Saturday night.
Neither doctor thought of calomel, the mercury compound Rush was using. In his lectures at the medical school Kuhn cautioned against mercury. It would bring on incessant salivation, with hawking and spitting, "a very disagreeable companion."
That weekend Rush set out to see if calomel could save the city. On Sunday morning he reported to his wife that, "thirty-eight persons have died in eleven families in nine days in Water Street, and many more in different parts of the city." Of his patients, Richard Stansbury probably would not survive the day. Rush thought spots that appeared on his thigh - definitely not mosquito bites, were a mortal sign. He gave the lad 40 drops of laudanum, opium dissolved in wine, to make death easy. Stansbury was "a sweet youth," a little older than Rush's son Richard (a future Secretary of State.) Many of the dead had been boys between the ages of 16 and 19, so he was thankful that his sons had left the city. Richard Spain survived. Stall reported that the blockmaker would get his 8th dose of calomel. He had not yet been purged. His sweats were not natural. At least it was evident that large doses of calomel were not as poisonous as so commonly feared.
The patient Rush devoted most attention to Sunday morning was the wife of Captain Bethel, a ship's chandler on North Front Street. She was Rush's mother's step-daughter from her last marriage. Rush decided to use the new remedies on her and invited Dr. Wistar to observe the power of calomel. She was experiencing the restlessness characteristic of the early stages of the fever. Rush told her to "drink copiously of chicken water," i.e. a very weak broth, and lie in her bed. Still searching for quicker action Rush made pills different from those Stall had been giving Spain, mixing 10 grains of calomel with 15 grains of rhubarb. She took the first dose, and the two doctors did not have long to wait for a reaction. She vomited "a large quantity of bile."
More comfortable with books than with body fluids, Wistar was taken aback by the violence of the reaction, and asked, "whether it gave relief as an emetic or cathartic?" That is, was it intended to induce vomiting or purge the intestines and bowels. Rush answered that while the target was only the stomach, not the seat of putrefaction below, the puking was a good sign showing that the medicine provided "more speedy service." Wistar argued that if relief came from vomiting, a medicine with less bothersome side effects could have been used. Rush ended the discussion by giving Mrs. Bethel another dose. Wistar left and, two months later when this treatment became an issue in a controversy with Rush, Wistar recollected that he thought Mrs. Bethel looked "very unwell."
Rush later told Wistar that he waited until the pill brought on a copious purge followed by a sweat. Then he thought she was "much relieved." That same day, Sunday, Stall's patient had "two copious, foetid stools. His pulse rose immediately afterwards, and a universal moisture on his skin succeeded the cold sweat on his limbs." Rush was still cautious about the cure. That evening he received a note from Samuel Powel, the speaker of the state senate. If Rush could not allay the senators' fears, "it will be impracticable to keep the members in town." Rush scrawled on the back of Powel's note, "I know of but one certain preventative of the disorder, & that is to keep at a distance from infected
persons and places."
Meanwhile Dr. Hutchinson had not been inactive. The cream of tartar inspired three bowel movements that Sunday and the 300 pound man had gone down two flights of stairs and his back steps so that he could do it in the out house. Kuhn thought Hutchinson was too weak for such exertion, and expressed "extreme regret." During the night Hutchinson could not stop his bowels, and had eight more movements. Kuhn thought that very dangerous in a putrid fever and set out to stop it at any costs. He prescribed laudanum. To check possible over sedation from that opiate, Kuhn also prescribed one ounce of bark as a tonic.
Hutchinson passed 10 stools on Monday and had bleeding hemorrhoids. Kuhn was not sanguine, as he explained to Samuel Coates, president of the Pennsylvania Hospital, whom he met in the streets. "What would you think of him venturing down three pairs of stairs, after such a severe illness," Kuhn xplained. He would have whipped one of his own patients for such an act of impudence. Kuhn said he had had great hopes of recovery, but no more, "Hutchinson must submit to his fate." Coates told his friend Rush the news, which seemed to highlight the success of his mercurial purges.
In the letter he wrote to his wife on Tuesday, Rush reported that on Monday he was called to 12 patients, and "eight are out of danger, from the powerful operation of the medicine I mentioned in my letter of yesterday." (That letter is missing.) Rush was ready to announce a cure for yellow fever.
Not that Spain had recovered. Rush later wrote that it was "a few days" before Spain was "out of danger." At least one of the twelve to whom he gave mercury, Stansbury, had died. While prostrated by the medicine, Mrs. Bethel had never exhibited the worse symptoms of the disease. Judging by how soon they were up and about, two other survivors of the trials also had the fever lightly. Neither Dr. William McIlvaine nor the lawyer William Lewis could have had mercury before Sunday, yet by Tuesday McIlvaine credited Rush with saving his life, and Lewis was well enough to leave the city on Thursday, join his family in the country and write a witty letter to Rush.
He had saved one person that all who knew him thought would die. He had saved three others, in evident distress, from the worst symptoms of the disease. His rivals Kuhn and Hutchinson were reportedly giving up. The College of Physicians met on Tuesday to hear Dr. Redman discuss his old remedies, and Rush knew that they did not work. Delaying an announcement of a cure that clearly promised to be successful was unconscionable. A friend outside of the city had just written to him, confessing that "it is the first time in my life I ever felt my fears set in motion by any general disease." He prayed for Rush to "promote the cause of Humanity and further your masters work on Earth." Rush answered that prayer. As he played his hunch that he had the cure, his gloom was gone. "Hark! a knock at the door!" He closed a letter to his wife and was off for "the delay of a minute seems a year to a patient after a physician is sent for." One of the most enduring therapies American medical history, that would reign for upwards of 50 years, was born.
And Rush did more than cure yellow fever that weekend. No one had a keener sense of the city's crisis than Rush. Other city leaders were still bewildered. What exercised many that Monday was the arrival of the Ship Hope "crowded with 200 diseased Irish." While standing quarantine, some passengers escaped and came to the city, "to the great terror of many of the inhabitants." The mayor asked citizens "to discover" the miscreants. Governor Mifflin already had the militia on guard, to protect the city from an invasion of deserters from a Royalist French warship in New York harbor. Some 80 of them were rounded up and sent by a judge to prison until the French minister, who was then in New York, could determine their fate.
Rush paid no attention to those civic exertions to protect the city from invasion. He knew that the crisis was caring for the sick. Wistar and many others had constant headaches. Rush blamed their incautiously caring for the sick. (He blamed his own headache on too many preventatives, a vinegar headache.) Then Wistar could no longer stand the light of the sun. On Monday afternoon he asked Rush to see his patients, and Rush already had all the patients he could handle.
The city had not yet made provisions to care for the poor. The overseers' resolve to seek out the sick and give them succor failed because most of the overseers themselves began fleeing the city. Rush came to the rescue by enlisting the aid of his African American friends.
Despite briefly serving in Congress and in the Army Medical Corps during the Revolution, Rush knew he had no talent organizing men. His black friends did.
Absalom Jones along with Richard Allen, a cobbler by trade but famed as a Methodist preacher, had organized the Free African Society to foster mutual assistance for the city's blacks. Rush wrote to Allen and Jones explaining that their race was immune to the disease. (Evidently Rush did not notice that the autopsies Dr. Mitchell performed were on slaves who he supposed to have had died of yellow fever.) He asked if that "exception... which God has granted you does not lay you under an obligation to offer your services to attend the sick."
In Monday's American Daily Advertiser, writing under the pseudonym of Anthony Benezet, a Quaker emancipationist who had died in 1784, Rush quoted Dr. Lining on how blacks were not infected during the Charleston epidemics, and recalled blacks, not only to their duty to God, but to their obligation to white Philadelphians. They should help those who had "first planned their emancipation from slavery, and who have since afforded them as much protection and support, as to place them, in point of civil and religious privileges, upon a footing with themselves." Allen and Jones did not ignore their benefactor Rush, and called for a meeting of the Free African Society on Wednesday the 4th.
Philadelphia's African American community had its own medical traditions and practitioners, including a cancer doctor to whom whites went to for treatment. Early in the century Cotton Mather in Boston had learned about inoculation for small pox from slaves before he learned about its use in England. Rush endorsed the African practice of powdering a child's body with special herbs before inoculation. At the meeting of the Free African Society "after some conversation," Jones and Allen later wrote, "we found a freedom to go forth, confiding in Him who can preserve in the midst of a burning fiery furnace." They visited a family in a nearby alley. The wife lay dead, the husband ill, two children were helpless. "We administered what relief we could," they recalled, "and we applied to the overseers of the poor to have the woman buried." They visited upwards of 20 families that day and saw "scenes of woe indeed!" They found their mission, later writing, "The Lord was pleased to strengthen us, and remove all fear from us, and disposed our hearts to be as useful as possible." They went to the mayor who agreed to publish a letter in the newspapers directing those in need of a nurse to apply to Jones who would find African Americans to fill the need. Jones' and Allen's Account of the Epidemic
Rush did not attend Jones's and Allen's meeting. He was too busy spreading the good news about his remedy, an effort that was caught short by rumors sweeping the city and even a published attack on him. Many were extolling the remedies of the French physicians in the city. Having just come as refugees from the West Indies, they were assumed to have special insights into a disease thought to be tropical. Rush had tried the West Indian remedies and they had failed. He decided he must convince his colleagues that the fever in Philadelphia was "totally different from yellow fever of the West Indies." It was engendered by local filth and had unique characteristics.
Apparently anticipating that debate, Dr. William Currie discovered, with the help of Isaac Cathrall, that, contrary to Hutchinson's findings, two Frenchmen recently arrived from the West Indies had died of the fever in early August. In the newspaper Tuesday morning an anonymous attack by "Medicus" ridiculed Rush for claiming that rotting coffee caused the disease. "I have been told," Medicus taunted, "that a number of poor people, who live on Passyunk road, gathered a quantity of the damaged coffee, carried it home and are in perfect health. A strong presumption against any noxious exhalations from that source."
The College of Physicians met Tuesday night primarily to hear Dr. Redman on the yellow fever epidemic of 1762.
Rush and Redman had a great deal of respect for each others, and at the meeting they managed to finesse their radically different approaches to the disease. Redman had looked over his day book from the 1762 epidemic and spoke to patients who had survived. He recollected that doctors avoided bloodletting, emetics, laudanum and bark, preferring salts to open and cordials to restore the body. The purge he used was mild: "one ounce of salts, 2 drams of chamomile flower, and 2 drams of snake-root - these steeped together and the decoction mixed with good old spirits or brandy and vinegar." He admitted that in talking about salts, snakeroot, chamomile tea, and lemonade punches, he was not talking modern medicine. Those remedies had been gleaned by Dr. Kearsley, then the city's leading practitioner, from "an old author." But while the ancients had to be given due respect and credit, nothing he said should deter doctors from using modern methods.
After that introduction Rush spoke. He never published what he said, but judging from a letter he wrote to a Trenton doctor that same day, and from what Dr. Wistar recollects Rush telling him, he was quite sanguine. "I set down with great pleasure to inform you that the fever which has ravaged our city for some weeks past is at last arrested in its fatality. The medicine which has performed this office is calomel." He explained the medicines operation by referring to Mitchell's dissections. Calomel expelled the bile and opened the passages from the liver and gall bladder. Then Rush made his gesture to Redman. In his letter to the Trenton doctor, which Rush certainly expected to be published, he did not discard the cures of 1762 altogether. He recommended using calomel and jalap every other day if the fever continued, alternating the new remedies with "infusions of camomile flowers, snake root, bark, wine, &c., on the intermediate days." Redman reduced his talk into an essay which he gave to a printer at the end of the week. In it he endorsed Rush's methods.
Rush's colleagues knew the relative force of calomel and jalap in the dose Rush prescribed compared to other medicines. They understood that Rush was subverting established practice. And while Rush was politic enough to flatter Redman with a mention of the old remedies, in which Rush had completely lost faith, he could not help bragging. He told Wistar that calomel and jalap made the fever that had panicked the city, as manageable as an intermittent, that mild malaria so endemic since the settling of the colonies that people had learned to live with it.
Wistar had missed the meeting. Despite taking preventatives, bark every morning and evening, and following all the rules save one - he swallowed his spittle while in a sick room - Wistar got the fever. By Tuesday afternoon he had "a smart fever and delirium." By a messenger Rush ordered him to take calomel, but he didn't. He had his apprentice William Bache fetch ipecac, which worked several times. His stomach still felt heavy and sore. Then Rush came to him and did not consult. He insisted that Wistar take calomel and jalap. He did and when he was able, Wistar sent word that the purge operated and relieved him, but he didn't tell Rush that his fever returned sharply and he felt miserable.
Hutchinson and Kuhn, Rush's rivals as well as fellow professors at the University of Pennsylvania medical school, were not shy about wanting to assume the role as the city's savior, and even younger doctors sensed the opportunity. Unfortunately for his pretensions, Kuhn got sick with a fever. Not the prevailing fever Kuhn insisted. With Kuhn now unavailable, Hutchinson called in two younger doctors, William Currie and Benjamin Barton. When Currie came Tuesday evening, Hutchinson was sitting up talking with Nathaniel Falconer, the health officer of the port. Hutchinson was lucid enough to describe his own case and gave Currie permission to write about it. Currie's description of symptoms
Like Hutchinson, Currie was a former student of Rush's. The master sensed no rivalry. Indeed he had once cured Currie of a bad fever, and thought of himself as the younger man's friend. Lacking a European medical education, Currie quietly suffered Rush's overt displays of erudition, and now decided not to miss an opportunity to show his own genius.
Hutchinson told Currie that he liked the baths and vitriolic salt tonics. When he felt well, as he did then, he took no medicine but lime juice punch. In the essay Currie would send to the printer at the end of the week, Hutchinson's treatment was held up as a model. Currie did allow that six grains of calomel might be useful as a vomit in some cases, and added that that remedy was suggested by a Delaware doctor.
Like Hutchinson, Currie viewed the epidemic as a limited threat. It was virtually the same as the typhoid fever so deadly in military hospitals and prison ships during the war. Thus it could not be caught by walking the street but only by breathing infected air in a sickroom or touching infected clothing. Hutchinson may have convinced Currie not to be an alarmist like Rush, or he may have felt trapped by the book he had published that spring, An Historical Account of the Climates and Diseases of the United States of America. In it he had assured the world that epidemics in Philadelphia were a thing of the past. (To be fair, Rush thought the same thing at that time.)
Hutchinson's survival might have made Currie's essay a best seller. After Currie left him on Tuesday night, Hutchinson walked downstairs. When he came back up, his nose bled until "he was much debilitated and faint." He took 45 drops of laudanum, got to sleep, and rested well until he awoke "with sickness and great distress." Currie came back at 10 o'clock Wednesday morning and found Hutchinson with a low pulse, and cold and dry skin. His face was bloated and livid. "His mind was considerably deranged - his thirst became insatiable - he cast up all he drank, as soon as his stomach became full, with straining and noise." When he wasn't puking he was hiccupping. No matter what medicine Currie suggested, Hutchinson "obstinately" refused it, claiming that "nothing was the matter." Currie sent his manuscript to the printer anyway. (Then Dobson's printing plant burned down, destroying most of the copies of Currie's essay. Rush blamed the exertions of many to fight the fire for making the fever more virulent.)
On Thursday the 5th Rush forgot past differences and went to Hutchinson. He found the massive doctor "sitting in a chair near the head of his bed, with all his clothes on, as if he had been in his usual health." But he wasn't. Rush saw that he was delirious with a face "suffused with blood." Rush urged "a strong mercurial purge," explaining that it had saved 29 out of 30 who had taken it. Hutchinson refused for the moment, but did send one of his apprentices to Kuhn. "Rush should know," Kuhn replied sharply, "that Hutchinson had 30 stools in three days." He did not need further purging.
Rush was bitter at Hutchinson's refusal and blamed the young doctors, Currie and Barton. It wasn't there fault. Whenever Hutchinson felt better, he took great pains to make everyone believe he was completely out of danger. This was not only a case of medical hubris. It was also a matter of politics. He wanted to keep the legislature in session since the impeachment of the state comptroller John Nicholson was very much Hutchinson's pet. Not that he allowed his comrades in the legislature to visit him and risk getting the fever. That made the Republican floor leader Albert Gallatin (a future Treasury secretary under Jefferson) "very depressed," and almost ready to give up since the legislature was "so much alarmed and so unfit to attend to business."
Although many were obsessed with Hutchinson's case, many others decided not to await the outcome. Thomas Jefferson wrote on Tuesday that "everybody who can, is flying from the city." In the biweekly National Gazette that came out Wednesday, the Republican editor Philip Freneau lampooned those who fled:
On prancing steed, with sponge at nose,
From town behold Orlando fly;
Camphor and Tar where 'er he goes
Th'infested shafts of death defy -
Safe in an atmosphere of stink
No doctors get Orlando's chink.
But the refugees had no regrets. William Lewis wrote to Rush of the absurdity of staying: "A large city with the houses shut up and the streets empty except the french sailors, people of St. Domingo of all colors with their heads tied. A few citizens who you do not know posting along with sponges at their noses and the hearse constantly passing, exhibit such a melancholy picture that I never left Philadelphia with so much pleasure as yesterday nor never found such pleasure in the country as I do today - I am perfectly well, the air sweet and the trees, fields, waters, pastures and c. more beautiful than ever. How great, how pleasing the contrast!"
Still, for those who stayed business was far from being at a complete stand. President Washington scheduled cabinet meetings through the weekend. A 24 gun French ship from the East Indies, "richly laden in silks" worth 500,000 pounds sterling, docked. Some merchants returned to the city on Monday, their summer vacation over, and got to work as if nothing was happening. John Welsh, a clerk in a counting house on South Front Street, wrote to his boss Robert Ralston, who was still in Wilmington, that he was too busy to notice "the malady so alarming,... being engaged all the morning." After a hot humid weekend the wind shifted to the north, Welsh expected that would "expedite" the departure of the fever.
Then on Wednesday he noticed, that it was like "Sunday, little doing, sometime perfectly quiet, so many have fled this scene of death." But Welsh still hoped the change in weather would tell, and he heard that "several persons are likely to recover." Hutchinson was "mending." His neighbor Ebenezer Hazard, secretary of the North American Insurance Company, opined "that the distemper is decreasing very fast." Benjamin Smith remained an optimist, explaining to his father on Wednesday that while "the disorder still continues pretty rife," it was less virulent. Dr. Say said that "in many cases it now exhibits an intermitting appearance." Margaret Morris no longer saw corpses carried past her door.
When Treasury secretary Alexander Hamilton sent a note Friday morning informing the president that he would miss the scheduled cabinet meeting because he feared that he was "in the first stages of the prevailing fever," Washington expressed "extreme concern" but shared the optimism then current. Noting that "the malignity of the disorder is so much abated, as with proper & timely applications not much is to be dreaded," he hoped Hamilton and his wife could still make it for dinner.
Rush was convinced that his medicines were in a large part responsible for the lack of deaths. "Fewer deaths have occurred I believe this day than on several days last week, and yet many hundred people more have the fever now than had it last week," he explained to his wife on Thursday. He also observed that those with the fever who were not treated invariably died. He gave a purge to many going into the country, "to subdue the disease if it should break out." However, Rush was so confident of his ability to control the disease that he no longer recommended that people leave the city. "I now advise them to remain where they are, to avoid going out of their houses, and to send for a mercurial physician as soon as they are infected," he wrote to his wife on Friday, and could even joke about the crisis. "No other metal in a physician's head will do any good now, not even gold any more than lead. My medicine has got the name of an inoculating powder, for it as certainly and as universally deprives the yellow fever of its mortality as inoculation does the smallpox."
With his five apprentices making and distributing pills of calomel and jalap or rhubarb, Rush tirelessly tried to stop the epidemic. He slept four hours a night. He told his wife that "out of 100 persons who have taken [mercury] from me on the first day, not one has died. The deaths which now occur are chiefly of poor people who have no doctors, or of respectable people who are in the hands of quacks or of the enemies of mercury."
As Hutchinson lay dying, Wistar recovered, which Rush counted a major victory for mercurial purges. He tried to elicit a testimonial for his cure. He went to the extreme of suggesting to his languishing colleague that it was he, Rush, who faced imminent death, and he worried about who would carry on his work. "You cannot die now, Doctor," Wistar replied tactfully. "The pleasure of your discovery must like a cordial keep you alive."
For the moment Wistar kept to himself what remedies he thought most beneficial. He appreciated the power of calomel, but as he recovered from a delirium he became conscious of a wonderful cold draft from a window left open in his room. He instructed his students to keep him cool. When the breeze from the window was too hot, the young men took turns fanning their master. To that, Wistar attributed his recovery.
While not a few found comfort in statistics showing decreased mortality, there was no official count of the sick and dead published. So panic was easily fueled by anecdotes. A young woman who nursed the sick in Water Street got sick herself and neighbors refused to take her in. She lay in the street where an alderman found her and "had her sent in a cart to the city hospital, where she was refused admittance, and was near that place found dead in the cart next morning." The report that the Stephens family on Chestnut Street between 2nd and 3rd Streets lost 7 of 10 members stripped John Welsh of optimism, "so victorious is this dreadful disease over the most efficacious administrations of our physicians."
In this atmosphere of hope, confusion, and dread, for many the fate of the city increasingly seemed to hinge on Hutchinson's recovery. On Thursday he lapsed into a coma. The city's gloom increased, though there was still enough political venom in the city to cause the clerk of the not-yet-to-be-impeached John NIcholson to crow: "Dr. Hutchinson is given over by the physicians. I believe he is thus dead or dying, thank God for it." Nicholson's clerk even wanted the comptroller to leave his farm, come to the city and rout the demoralized enemy. Of course the legislature moved quickly toward adjournment, postponing impeachment proceedings.
Then William West, a Quaker member of the Assembly, stood and cited "the duty of a people professing Christianity to humble themselves before the Judge of all the Earth, at all time, and particularly at this awful period." He proposed a law closing the theaters in the state permanently. Hallam's American Company of Comedians did close on August 23, so there could be no pretense of the proposal being a health measure. Every legislator knew what West was up to. In 1789 the Revolutionary War law banning theaters was repealed despite protests from the religious community, including a procession led by the Episcopal bishop William White. What better time to reopen the issue than when god was showing his wrath. No one seconded West's resolution.
Quakers like West might believe, as his co-religionist Margaret Morris explained in a letter, that there was no escape if God's rod was "commissioned to strike us among the rest," but no other legislator wanted to waste time in the city as the fever spread. They adjourned after giving the governor new powers to stop and quarantine ships. There was news of yellow fever in Barbados and other islands. The governor ordered a quarantine of ships from the West Indies and moved out to Germantown.
Hutchinson lived through Friday in a coma. He died Saturday. His wife went into labor that same day, and bore him his fifth child, a girl. Nicholson's clerk gloated. Hutchinson's huge body began to "mortify before he died," and had to be buried in a hurry that night, while his allies in "iniquity... galloped out of town." Hutchinson's friends were inconsolable. His obituary was in newspapers all over the country. Within two weeks a poem about the fallen Republican hero was published. "For five days no two or more persons met when the first interrogatory was not 'How does Hutchinson.'" the young editor Samuel Smith wrote to his sister. "Now he is no more - but I cannot dwell on the gloomy subject." Hutchinson had given Smith courage to stay in the city. Smith was aware of Rush's cures and believed the fever's "virulence has... been greatly subdued," but as he sealed his letter, a carriage waited to take him to Lancaster 60 miles away.
Rush did not view Hutchinson's death as a civic tragedy. "It is remarkable," Rush wrote to his wife, "that he denied the existence of a contagious fever in our city for above a week after it appeared among us, and even treated the report of it with contempt and ridicule. The reason, I fear, was the first account of it came from me."
Rush remained. Before retiring at night he was in the habit of reading psalms in order. He opened the Bible to the 52nd Psalm: "Thy tongue deviseth mischiefs; like a sharp razor, working deceitfully.... God shall likewise destroy thee for ever, he shall take thee away, and pluck thee out of thy dwelling place, and root thee out of the land of the living." It reminded him of Hutchinson. "Poor fellow!" Rush wrote to his wife. "He died as well as lived my enemy."
The next day, Dr. McIlvain, whom he had successfully treated with mercury, told Rush that Kuhn insisted that calomel and jalap only cured remittent fevers, not yellow fever. Rush remarked in his notebook that "there was more malignity in his heart towards me than was in the contagion of yellow fever." With God's help he could save his city. What stood in his way were the jealousy and ignorance of his colleagues.
Note: Modern historians are prone to quote letters written by John Adams in his old age to illuminate historical events that usually Adams never experienced. Although Vice President during the epidemic, he left Philadelphia when Congress adjourned, months before the epidemic started, and he didn't return until Congress returned a month after the epidemic ended. His assertion that the death of Hutchinson saved the Republic from a certain revolution was roundly ridiculed by contemporaries, yet it pops up in histories of the epidemic. Here is link to Timothy Pickering's 1824 review of the publication of some of Adams' letters. Pickering was in Philadelphia during the epidemic and lost a son to it:
A link to Pickering's Review see page72.
Go to Chapter Five
Tuesday, March 27, 2012
3. Preventatives
google.com, pub-5752526349660126, DIRECT, f08c47fec0942fa0
Monday morning Rush learned of five deaths the night before. He expected five more to die that day including John Dunkin, a merchant at the corner of 2nd and Walnut Streets a block and a half from his house. That death was too close for three of Rush's neighbors. Despite cooling clouds after Sunday's rain, Rev. Dr. William White, rector of Christ's Church, the prominent lawyer William Lewis, and the judge Benjamin Chew were all moving their families to the country. A mass evacuation of the city was not unprecedented. In 1776 thousands fled to escape the British army that came to occupy the rebel capital.
There was by no means mass flight from the city, yet. Margaret Morris lived on that same block. She had not needed Rush to tell her that something was amiss in the city. She had seen three coffins carried past her window with no or few attendants. Burials so early and so furtive were a sign of infectious disease. But she trusted that Sunday's rain would, as her son-in-law Benjamin Smith put it in a letter to his father that morning, destroy "those noxious particles which it is generally allowed have of late charged our atmosphere." Plus Margaret had an invalid sister to care for.
With his wife complaining of stomach discomfort, for which her brother Dr. John
Morris prescribed ipecac, Benjamin Smith could not take his family out of town either. He was not inclined to in any case. He wrote to his father that accounts from the city were exaggerated. It was "a very awful visitation;" the disease was so putrid "that in some instances persons still living have been deserted by their assistants on account of the smell;" many were fleeing, and some domestics left behind had been "swept away by the contagion;" one young woman was found dead that morning, "a loathsome object," but all the deaths were near Water Street between Arch and Race. He had only heard of six buried that morning, and there couldn't have been many more, surely not the "60 or 100" of flying reports.
The powers-that-be did what they could to keep citizens calm. In his letter to the governor, Hutchinson did not directly address the panic around him, but he put the disorder in a perspective that suggested that people should stay put and stay calm. He reported that he had discovered 67 people with a fever, most of them non-fatal remittents or influenza. By Monday evening 13 of them were dead. He factored in Dr. Say's experience in Kensington and admitted that "the disorder is spreading" and had reached 2nd Street.
But by his calculations only 40 had died of the yellow fever. (He also couldn't resist impugning Rush's theory on the fever's origin, and noted that Say's reports on the Kensington cases challenged the theory that miasma from rotting coffee was the cause.)
Triumphant at the meeting the day before, Rush did not take exception when Hutchinson read his letter to the College of Physicians Monday night. He would settle that score later. The college adopted both Hutchinson's letter and Rush's directions and sent them to the mayor and governor for publication in Tuesday's newspapers. Rush wrote to his wife that while he hoped the directions would do good, "I fear no efforts will totally subdue the fever before the heavy rains or frost of October," as was the case in 1762.
It is evident from newspapers and letters that preventatives were in vogue before publication of the College's directions. Margaret Morris made "a plentiful use of vinegar, onions, and a little wine between whiles." She burned tar in her rooms and put camphor in her bosom, "and strew wormwood, tansy-rue, and other strong herbs, on the beds, tables and floor of our houses."
The strategy of prevention was simple. Counteract the smells. Today we don't think of odor as being a cause of disease. Then a certain odor was thought to be the disease itself. Charles Brockden Brown lived in a little house on the southern edge of the city near the confluence of two small streams that drained into the Delaware River. From his window he saw "one flat, uniform, unsightly... marsh from which the rays of the sun exhale the most noisome and unwholesome vapors." It was an excellent place to leave in the late summer and Brown left that August for Connecticut. So Brown missed the 1793 epidemic and would not experience the terror of yellow fever until 1798 when he lived in New York City.
In his novel Arthur Mervyn, set during the 1793 epidemic, Brown described the sensation on first encountering an infected corpse: "... a vapour, infectious and deadly, assailed my senses. It resembled nothing of which I had ever before been sensible. Many odours had been met with, even since my arrival in the city, less supportable than this. I seemed not so much to smell as to taste the element that encompassed me. I felt as if I had inhaled a poisonous and subtle fluid, whose power instantly bereft my stomach of all vigour. Some fatal influence appeared to seize upon my vitals, and the work of corrosion and decomposition to be busily begun."
For the English speaking world the last deadly epidemic to register on the broad contours of culture had been the 1665 plague in London. Not surprisingly the weapons of that war were again made ready. Rush observed that a washerwoman's husband who came to the city from New Jersey had a bag of tar and a bag of camphor around his neck, "rue in his mouth and a roll of brimstone between his teeth."
Advertisements and articles in Philadelphia newspapers urged preventatives that sounded much like the nostrums with which Shakespeare was familiar. William Delaney, a druggist on North Second Street, offered "Aromatic Distilled Vinegar," warmly approved by "the most eminent physicians of the city as a useful preventative." With a "grateful and agreeably pungent" odor, it excited "spirits and temper" when "applied to the temple and nose" with a sponge. To make the concoction, as his ad explained, Delaney warmed handfuls of rue, wormwood and lavender in a pot of vinegar for 8 days, then strained it into quart bottles containing an ounce of camphor. Soon competing with Delaney's blend was the Four Thieves Vinegar that had been used by a gang that robbed every house during the 1722 plague in Marseilles without getting infected.
To rue, lavender and wormwood, were added sage, mint and rosemary. It was "digested" for at least three weeks, and garlic as well as camphor were added to the bottles.
As much attention was paid to defeating noxious urban odors at their source. Dirty streets, "if not the cause, [have] very much contributed to the present unhealthfulness of the place," argued one correspondent in a newspaper out on Monday, the day before publication of the College's directions. Another argued that the supposed malignant fever was only the influenza made more malignant by Water Street's houses "half buried underground," its "sailor taverns and huxter's shops, which are the receptacles of all kinds of filth, dirt and nastiness."
The city had no sewage system. Another writer urged that the scavengers hired by the city be required to come more than once a week so households would not store "bones, with some flesh on them, the entrails of poultry, and many other corruptive matters in a barrel, in the yard, and in some cases in cellars, where they putrefy,... sowing the seeds of death."
There was some attention paid to the actual, though entirely unsuspected, sowers of the seeds of death. One newspaper correspondent suggested that fresh pennyroyal, a weed abundant along the Schuylkill, might ward off the fever because a sprig of it was so effective in keeping away mosquitoes (a virtue of the plant that had been known to the ancient Romans.) Not that he blamed the mosquito for the fever. If pennyroyal was so powerful against that pest it "may be a good preventative against infectious disorders."
Another correspondent suggested a way to kill mosquitoes so "distressing" to the sick: pouring a cup of oil in the casks behind most houses that were used to store clean water. A most effective measure to control an epidemic spread by mosquitoes if done by everyone, evidently it wasn't. In his notebook Rush observed on August 26 that mosquitoes were very plentiful, but urged no measures to subdue them.
City and state officials made a show to encourage citizens that the epidemic was manageable. Governor Mifflin announced that he saw no reason to postpone the session of the state legislature scheduled to open on Wednesday. The State house was four blocks away from the contagion. (The governor personally lived a block farther away.)
He also wrote a rousing letter to Mayor Matthew Clarkson calling for "the most vigorous and decisive exertions of the police." The mayor must "omit no lawful measure to prevent the extension, and to destroy the evil." The state would pay for gunpowder to "be flashed through the infected streets."
There were no municipal police forces in 18th century America. When the governor called for exertions by the police, he meant all government officials, aldermen, street commissioners, market inspectors, as well as the city's two constables, who had the power to tell citizens to act. On Wednesday, well prior to its usual monthly meeting, Clarkson convened the city corporation, made up of himself and the 14 other aldermen and 30 common council members, to address the crisis. Twenty-eight of the 45 members attended, about the same as last meeting. As Clarkson explained in a letter he sent to the governor, they prodded the street commissioners to clean the streets "as much oftener as may be necessary;" instructed the officers in charge of the market to see that the market, the meat stalls especially, was cleaned and kept clean; instructed the constables to visit all wharves and report on "any offensive, noxious substances remaining there;" formed a committee to meet with the overseers of the poor to address the needs of those people who generally were the chief victims of an epidemic; and arranged for gunpowder to be flashed in the streets.
The overseers of the poor, a group of 20 men selected to distribute the money raised by the poor tax, met on Thursday and resolved to employ people in each district of the city to scout out the sick poor and alert an overseer. They pledged to provide the "care and attention of one or more physicians, appointed by the board." If necessary the sick person would be sent to a fever hospital, a house they would designate away from the center of the city where victims could get constant care.
The letters of the governor and mayor, and resolves of the overseers were in all the papers that week. The commissioners in charge of the scavengers and night watchmen were not silent either. They published, repeatedly, section XXII of the city code: householders must clean the footway and gutter in front of their houses before the scavengers came. (Federal officials took no action. President Washington lived and worked in a large house on Market Street near the corner with 6th Street. With Congress not in session he did little entertaining, and quietly reacted to the current international crisis trying to keep the country out of the war between Britain and France. Having no responsibility or power to fight the epidemic, he saw no reason to postpone his plan to leave on September 10 so that he could help lay the cornerstone of the Capitol in the new City of Washington.)
Some took exception to the official measures to fight the epidemic, especially to the College's directions. Benjamin Smith feared that quiet, seemingly secret, burials would allow the number of deaths to be exaggerated. An anonymous writer in a newspaper criticized the policy of marking the houses of victims as "unadvised and cruel," causing "unnecessary terror," that "will prevent marketing,... and restrain all commercial intercourse along the wharves."
The house the overseers of the poor found for a hospital did not please either. They chose Rickett's Circus, on the western outskirts of town, 13th and Market Streets, where a month before Rickett's equestrian exhibition had entertained hundreds from President Washington on down.
No characterization of the overseer's first seven fever patients has been written. They could have been unfortunates found in the streets, or house servants sent by families fearful of harboring the fever in their house. There were few people living near Rickett's Circus. The financier and former U.S. Senator from Pennsylvania, Robert Morris, had workmen building a colossal marble mansion at 10th and Market Streets, but he still lived next door to the President, But there enough residents scattered at the end of the city to fuel a small riot. Angry neighbors threatened to burn down the so-called hospital after three of the seven patients died. The overseers quickly agreed to shut down operations there. Carey's account of the crisis at Rickett's Circus
On Saturday a group of overseers rode out to Bush Hill, the large estate of William Hamilton about two miles northwest of the city. It had not been occupied since Vice President John Adams stopped renting it the year before. The owner was in Britain and the overseers got permission from the mayor and governor to take the house to accommodate the poor. Bush Hill was surrounded by a pine forest, not angry neighbors.
By week's end the official measures bolstered the confidence of many. Samuel H. Smith, a young Republican printer wrote to his sister, as a small cannon was being hauled through the streets and fired, that "the force of the disease" had been spent. Everyone infected had had contact with the Water Street victims. "Since proper precautions have been taken, the disease has assumed a much more harmless shape, and little, if any danger, can be rationally entertained, except where a person unnecessarily exposes himself to entering sickrooms, attending funerals, and touching or very nearly approaching the infected body." Hutchinson had explained to him that in the past two weeks only 8 people had been buried in the Arch Street church burying ground, hardly a high number for that time of year. Before 3 out of 4 victims had died, now 1 out of 3. Seventy had died and at that moment 70 had the disease. While it was true that people had fled, it was mostly families with children who could not be trusted to take proper precautions. Smith noticed "no visible diminution of the inhabitants."
Mayor Clarkson told the press that the number of deaths in August was quite in line with the usual number. The 40 who died of fever could easily have died of something else. Another writer urged citizens to look at other excesses of the season as the cause for any greater mortality, "...the quantity of melons, and other green trash of the same kind, that are at present devoured with so much keenness."
Such brave talk impressed enough state legislators to form a quorum on Wednesday, but they promptly adjourned on Thursday until Monday. One legislator from the city explained in his diary, "owing... in particular as a young man by the name of Fry is lying dead at the west end of the State House." The thought of getting a whiff of the boy, the son of the door keeper of the state House of Representatives, was too much for most members.
No one was becoming more familiar with this mortal stench than Rush, and it had him out of sorts. He had visited Fry's son on Monday. Rush saw no amelioration of the city's crisis. He wrote in his notebook that there was "great mortality from want of caution among friends and nurses." He also observed that he "felt burning in stomach after entering into infected room." When Rush's sons said they were afraid that they would catch the infection from the clothes he wore while visiting patients, he agreed and sent the boys to Trenton to stay with an uncle. A niece took baby Ben and his nurse maid out to the farm of one of Julia's cousins just outside of town. One of Rush's five apprentices, Johnny Stall, moved into the house. The doctor needed help. The knocks on his door began at 5:30 in the morning.
He was so busy that it was not until the end of the week that he was able to defend his theory of the fever's origin. In reply to Hutchinson's letter, "R" explained in Friday's American Daily Advertiser, that three of the Danish seamen ill in Kensington, whom he had treated, "received the seeds of the disease on board their ship, while she lay at or near Race-street wharf." He added that "it is no new thing for the effluvia of putrid vegetables to produce malignant fevers. Cabbage, onions, black pepper, and even the mild patotoe, when in a state of putrefaction, have all been the remote causes of malignant fever."
Rush was usually not shy about signing what he wrote in the newspapers. But at this time, he knew he was debating a point that was not really the burning question. Explaining how the fever began was important, but the task at that moment was to cure it. As with so many viral diseases, even today there is no cure for yellow fever. We do have a vaccine to prevent it. Treatment consists of trying to keep the patient quiet and taking supportive measures short of drug therapy. So in retrospect Rush's great contribution in 1793 was recognizing the existence of an epidemic and understanding how devastating it could be. He scarcely recognized that as a contribution. No one was thanking him for his perspicacity. One friend later wrote that when Rush told him to fly from the contagion, thus possibly saving his life, still he hated Rush for destroying confidence in the city.
There was no greater city booster than Rush. His many calls for reforms over the years were always couched in language lauding the city as one destined to lead the world. His inability to fill the role of civic protector seemed almost to paralyze the doctor. It was not like Rush to let his opponents lull the governor - a man of 1776 like himself - and mayor into a sense of optimism when he saw the city in mortal danger. Simply put, he could not act until he had a cure.
On Thursday, August 29th, at the nadir of his depression, he wrote an uncharacteristically gloomy letter to his wife. Rush usually did not dwell on the negative, and had a palliative for every problem. He began this letter worrying about how to pay for her board, adding "providing my life be spared - for to live a week now in Philadelphia as I now live is to be the subject of a miracle." After crossing that out, he promised to tell her if he got the fever so she could come to him, agreeing that it would be as wrong for her to desert him as it would be for him to desert his patients at the present moment.
He did not conceal the terrors of the disease from her. One patient, the stonecutter William Stiles who lived on South 3rd Street, "exhibited signs of the plague before he died." Some doctors apprehended that it was the plague, but Rush knew it wasn't, though "it comes nearer to it in violence and mortality than any disease we have ever before had in this country." He listed its various symptoms: "Sometimes it come on with a chilly fit and a high fever, but more frequently it steals on with headache, languor, and sick stomach. These symptoms are followed by stupor, delirium, vomiting, a dry skin, cool or cold hands and feet, a feeble slow pulse, sometimes below in frequency the pulse of
health. The eyes are at first suffused with blood, they afterwards become yellow, and in most cases a yellowness covers the whole skin on the 3rd or 4th day. Few survive the 5th day, but more die on the 2nd and 3rd days. In some cases the patients possess their reason to the last and discover much less weakness than in the last stage of common fevers. One of my patients stood up and shaved himself on the morning of the day he died. Livid spots on the body, a bleeding at the nose, from the gums, from the bowels, and a vomiting of black matter in some instances close the scenes of life."
He chronicled his frustrating search for a cure. "The common remedies for malignant fever have all failed. Bark, wine, and blisters make no impression upon it. Baths of hot vinegar applied by means of blankets, and the cold bath have relieved and saved some. Mrs. Chaloner owes her life to the former remedy. She caught it from her husband, who caught it in Water Street near the place where it originated. He too is upon the recovery. This day I have given mercury, and I think with some advantage. Dr. Wistar and myself consult much together, and I derive great support and assistance from him in all my attempts to stop the progress of this terrible malady. He is an excellent man, and rises in his humanity and activity with the danger and distress of his fellow citizens. I have advised all the families that I attend, that can move, to quit the city. There is but one preventative that is certain, and that is 'to fly from it.'"
The idea to wrap patients in blankets soaked with vinegar came from a 50 year old book by an obscure British army surgeon. Rush tried cold baths after he talked to Dr. Edward Stevens, who had just arrived from the West Indian island of St. Croix, where he had treated yellow fever cases. Bathing was not common in the United States and bathtubs were rare. So by cold baths, Stevens meant standing the patient in a tub and having cold water poured over the body. In one patient Rush injected bark "into the bowels every four hours." He had "buckets full of cold water" thrown "frequently" upon his patients. Three out of four died. He recollected his success in treating Polly Bradford with the mercury compound calomel, and tried that once again.
He was "baffled" by such "malignity" and "obstinacy" which he had never before observed in any disease. "Heaven alone bore witness to the anguish of my soul in this awful situation," he wrote a few months later. "But I did not abandon a hope that the disease might yet be cured. I had long believed, that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy." Indeed in an address he gave in 1787 on the objectives of the newly formed College of Physicians he alluded to the Millennium: "Many disorders, once deemed incurable, now yield to medicine. No wonder then that a general expectation prevails - that a revolution is soon to take place in favor of human happiness." Thanks to America's republican institutions he hoped that American physicians would take a leading role in the new discoveries.
Not that Rush commenced a haphazard search through the pharmacopeia of the day. Fame in his day was won by the promulgation of theories. A naval doctor named Lind who suggested limes as a preventative for scurvy labored in obscurity, while John Brown was the medical tyro of the western world. So Rush tried a new theory dictating a bold departure from accepted practice.
Despite the weak state of his patients, he would deplete them further with double the common dose of the strongest purgative, calomel. A few months later he wrote that he decided upon that course after re-reading the monograph of the doctor who inspired one of the treatments he had discarded, a vomit followed by the bark. What impressed Rush on a second reading of Dr. John Mitchell's 1747 essay on an epidemic in Virginia was not his remedies but his analysis of the disease.
For ages doctors had noted that a profuse sweat often marked the favorable climax of a fever. This favorable sweat had a special character which doctors called "natural," that is, it did not arise from any morbid paroxysms of the system. Indeed some schools of medicine held that only nature could bring on this natural sweat and that medicine was only to be used to support the patient until the "crisis." There were guides alerting physicians as to when the crisis could be expected in various fevers. Rush thought medicine could induce the crisis and the curing natural sweat.
Mitchell had performed autopsies on some of the slaves who had died in the epidemic and found the walls of the stomach coated with the putrid matter which he envisioned as arising from the fermentation of miasmata which permeated all the systems of the body. It was as if the body were sweating poison internally. Not until those poisons were removed could "sweat break out of its own accord."
Mitchell's reasoning was novel. His essay had never been published. Rush got a copy of it from Benjamin Franklin just before he died in 1790. Franklin had gotten it in answer to a
question he had posed to Cadwalader Colden, the Lieutenant Governor of New York who had written about New York City's 1742 yellow fever epidemic. Most doctors used herbal teas to induce a natural sweat, not further depletion which promised only the cold clamminess to be avoided in fevers. Indeed at the meeting of the college, Hutchinson had mentioned the rapid death of a patient of his who developed a spontaneous diarrhea. However, Rush found Mitchell's argument persuasive. As Rush would soon quote to his colleagues, "an ill-timed scrupulousness about the weakness of the body is of bad consequence in these urging circumstances."
However, Mitchell had not used a purge as strong as calomel. Rush noted that in his dissections, Mitchell often found the gall bladder and intestines filled with bile. Evidently in those cases his purges had not been strong enough. Rush had begun his career in Philadelphia as an opponent of using mercury to prepare patients, especially children, for inoculation with small pox. He thought other purges as efficacious in assuring the patient got a light case of the pox and none had mercury's side effects. Rush gained more respect for mercury, for cases other than syphilis for which it was a wonder drug, during the war. Rush worked with an army surgeon, Dr. Thomas Young of Boston, who treated bilious fevers with a dose of 10 grains of calomel
and 10 grains of jalap or rhubarb, the Mexican and Russian roots which were powerful purgatives in their own right. Young gave the dose once or twice a day until it procured a large evacuation of the bowels. Rush had argued that the large doses were unsafe but after seeing their effects, he could not consider them more dangerous than cream of tartar or Glauber's salt, a sodium sulphate compound discovered by a German doctor.
On Thursday, Rush gave doses of calomel and jalap to the Danish sailors and thought it helped them. He discussed the matter with Dr. Wistar, whose library he had been consulting and whose brain he had been picking. Both agreed that the evident excess of bile meant that the disease primarily affected the liver and so purges were in order. However, to avoid violent evacuation from an already depleted patient, Wistar wanted to use mercury as an ointment to be rubbed on the skin over the liver. That might stimulate that organ to expel poisonous bile.
Given the power of the disease they faced, much more powerful than common bilious fever, Rush wanted quicker action. He gave his apprentice Johnny Stall pills of 10 grains of calomel and 10 grains of jalap, as well as mercury ointment, and told him to give doses every 6 hours to Richard Spain, a block maker on 3rd Street with a case so malignant that a neighbor had angrily insisted that Rush instruct the family to prepare for rapid burial of the corpse. Rush had first seen him on Wednesday. That Friday Spain lay "without a pulse, and with a cold sweat on all his limbs." By the accepted canons of medicine further depletion would be tantamount to murder. Rush also gave Richard Stansbury, a Quaker teenager as badly off as Spain, calomel and jalap. By Saturday morning the boy had had 20 and the blockmaker 30 grains of calomel. Both were less delirious and had good pulses. Rush continued the dose through the day. By night Spain had a sweat.
Judging from the letter he wrote to Julia on Sunday morning, Rush was once again energized. Like a good Christian, when he was feeling all-powerful, Rush preached humility. "O! the littleness of greatness! Thrones, titles, splendid and even commodious houses, wealth, friends - what are they all when viewed through the medium of a relentless and desolating fever? Help me, my dear Julia, by your prayers to `be always ready.' I have cut out much work for my divine master, to be performed in months or years to come, but if he means to have it completed by other hands, 'his will be done.'... If I survive the present dangers to which I am exposed, what offering of gratitude will ever equal the infinite weight of my obligations to my gracious deliverer? You must help me to be more humble, more patient, more devout, and more self-denied in everything."
Go to Chapter Four
There was by no means mass flight from the city, yet. Margaret Morris lived on that same block. She had not needed Rush to tell her that something was amiss in the city. She had seen three coffins carried past her window with no or few attendants. Burials so early and so furtive were a sign of infectious disease. But she trusted that Sunday's rain would, as her son-in-law Benjamin Smith put it in a letter to his father that morning, destroy "those noxious particles which it is generally allowed have of late charged our atmosphere." Plus Margaret had an invalid sister to care for.
With his wife complaining of stomach discomfort, for which her brother Dr. John
Morris prescribed ipecac, Benjamin Smith could not take his family out of town either. He was not inclined to in any case. He wrote to his father that accounts from the city were exaggerated. It was "a very awful visitation;" the disease was so putrid "that in some instances persons still living have been deserted by their assistants on account of the smell;" many were fleeing, and some domestics left behind had been "swept away by the contagion;" one young woman was found dead that morning, "a loathsome object," but all the deaths were near Water Street between Arch and Race. He had only heard of six buried that morning, and there couldn't have been many more, surely not the "60 or 100" of flying reports.
The powers-that-be did what they could to keep citizens calm. In his letter to the governor, Hutchinson did not directly address the panic around him, but he put the disorder in a perspective that suggested that people should stay put and stay calm. He reported that he had discovered 67 people with a fever, most of them non-fatal remittents or influenza. By Monday evening 13 of them were dead. He factored in Dr. Say's experience in Kensington and admitted that "the disorder is spreading" and had reached 2nd Street.
But by his calculations only 40 had died of the yellow fever. (He also couldn't resist impugning Rush's theory on the fever's origin, and noted that Say's reports on the Kensington cases challenged the theory that miasma from rotting coffee was the cause.)
Triumphant at the meeting the day before, Rush did not take exception when Hutchinson read his letter to the College of Physicians Monday night. He would settle that score later. The college adopted both Hutchinson's letter and Rush's directions and sent them to the mayor and governor for publication in Tuesday's newspapers. Rush wrote to his wife that while he hoped the directions would do good, "I fear no efforts will totally subdue the fever before the heavy rains or frost of October," as was the case in 1762.
It is evident from newspapers and letters that preventatives were in vogue before publication of the College's directions. Margaret Morris made "a plentiful use of vinegar, onions, and a little wine between whiles." She burned tar in her rooms and put camphor in her bosom, "and strew wormwood, tansy-rue, and other strong herbs, on the beds, tables and floor of our houses."
The strategy of prevention was simple. Counteract the smells. Today we don't think of odor as being a cause of disease. Then a certain odor was thought to be the disease itself. Charles Brockden Brown lived in a little house on the southern edge of the city near the confluence of two small streams that drained into the Delaware River. From his window he saw "one flat, uniform, unsightly... marsh from which the rays of the sun exhale the most noisome and unwholesome vapors." It was an excellent place to leave in the late summer and Brown left that August for Connecticut. So Brown missed the 1793 epidemic and would not experience the terror of yellow fever until 1798 when he lived in New York City.
In his novel Arthur Mervyn, set during the 1793 epidemic, Brown described the sensation on first encountering an infected corpse: "... a vapour, infectious and deadly, assailed my senses. It resembled nothing of which I had ever before been sensible. Many odours had been met with, even since my arrival in the city, less supportable than this. I seemed not so much to smell as to taste the element that encompassed me. I felt as if I had inhaled a poisonous and subtle fluid, whose power instantly bereft my stomach of all vigour. Some fatal influence appeared to seize upon my vitals, and the work of corrosion and decomposition to be busily begun."
For the English speaking world the last deadly epidemic to register on the broad contours of culture had been the 1665 plague in London. Not surprisingly the weapons of that war were again made ready. Rush observed that a washerwoman's husband who came to the city from New Jersey had a bag of tar and a bag of camphor around his neck, "rue in his mouth and a roll of brimstone between his teeth."
Advertisements and articles in Philadelphia newspapers urged preventatives that sounded much like the nostrums with which Shakespeare was familiar. William Delaney, a druggist on North Second Street, offered "Aromatic Distilled Vinegar," warmly approved by "the most eminent physicians of the city as a useful preventative." With a "grateful and agreeably pungent" odor, it excited "spirits and temper" when "applied to the temple and nose" with a sponge. To make the concoction, as his ad explained, Delaney warmed handfuls of rue, wormwood and lavender in a pot of vinegar for 8 days, then strained it into quart bottles containing an ounce of camphor. Soon competing with Delaney's blend was the Four Thieves Vinegar that had been used by a gang that robbed every house during the 1722 plague in Marseilles without getting infected.
To rue, lavender and wormwood, were added sage, mint and rosemary. It was "digested" for at least three weeks, and garlic as well as camphor were added to the bottles.
As much attention was paid to defeating noxious urban odors at their source. Dirty streets, "if not the cause, [have] very much contributed to the present unhealthfulness of the place," argued one correspondent in a newspaper out on Monday, the day before publication of the College's directions. Another argued that the supposed malignant fever was only the influenza made more malignant by Water Street's houses "half buried underground," its "sailor taverns and huxter's shops, which are the receptacles of all kinds of filth, dirt and nastiness."
The city had no sewage system. Another writer urged that the scavengers hired by the city be required to come more than once a week so households would not store "bones, with some flesh on them, the entrails of poultry, and many other corruptive matters in a barrel, in the yard, and in some cases in cellars, where they putrefy,... sowing the seeds of death."
There was some attention paid to the actual, though entirely unsuspected, sowers of the seeds of death. One newspaper correspondent suggested that fresh pennyroyal, a weed abundant along the Schuylkill, might ward off the fever because a sprig of it was so effective in keeping away mosquitoes (a virtue of the plant that had been known to the ancient Romans.) Not that he blamed the mosquito for the fever. If pennyroyal was so powerful against that pest it "may be a good preventative against infectious disorders."
Another correspondent suggested a way to kill mosquitoes so "distressing" to the sick: pouring a cup of oil in the casks behind most houses that were used to store clean water. A most effective measure to control an epidemic spread by mosquitoes if done by everyone, evidently it wasn't. In his notebook Rush observed on August 26 that mosquitoes were very plentiful, but urged no measures to subdue them.
City and state officials made a show to encourage citizens that the epidemic was manageable. Governor Mifflin announced that he saw no reason to postpone the session of the state legislature scheduled to open on Wednesday. The State house was four blocks away from the contagion. (The governor personally lived a block farther away.)
He also wrote a rousing letter to Mayor Matthew Clarkson calling for "the most vigorous and decisive exertions of the police." The mayor must "omit no lawful measure to prevent the extension, and to destroy the evil." The state would pay for gunpowder to "be flashed through the infected streets."
There were no municipal police forces in 18th century America. When the governor called for exertions by the police, he meant all government officials, aldermen, street commissioners, market inspectors, as well as the city's two constables, who had the power to tell citizens to act. On Wednesday, well prior to its usual monthly meeting, Clarkson convened the city corporation, made up of himself and the 14 other aldermen and 30 common council members, to address the crisis. Twenty-eight of the 45 members attended, about the same as last meeting. As Clarkson explained in a letter he sent to the governor, they prodded the street commissioners to clean the streets "as much oftener as may be necessary;" instructed the officers in charge of the market to see that the market, the meat stalls especially, was cleaned and kept clean; instructed the constables to visit all wharves and report on "any offensive, noxious substances remaining there;" formed a committee to meet with the overseers of the poor to address the needs of those people who generally were the chief victims of an epidemic; and arranged for gunpowder to be flashed in the streets.
The overseers of the poor, a group of 20 men selected to distribute the money raised by the poor tax, met on Thursday and resolved to employ people in each district of the city to scout out the sick poor and alert an overseer. They pledged to provide the "care and attention of one or more physicians, appointed by the board." If necessary the sick person would be sent to a fever hospital, a house they would designate away from the center of the city where victims could get constant care.
The letters of the governor and mayor, and resolves of the overseers were in all the papers that week. The commissioners in charge of the scavengers and night watchmen were not silent either. They published, repeatedly, section XXII of the city code: householders must clean the footway and gutter in front of their houses before the scavengers came. (Federal officials took no action. President Washington lived and worked in a large house on Market Street near the corner with 6th Street. With Congress not in session he did little entertaining, and quietly reacted to the current international crisis trying to keep the country out of the war between Britain and France. Having no responsibility or power to fight the epidemic, he saw no reason to postpone his plan to leave on September 10 so that he could help lay the cornerstone of the Capitol in the new City of Washington.)
Some took exception to the official measures to fight the epidemic, especially to the College's directions. Benjamin Smith feared that quiet, seemingly secret, burials would allow the number of deaths to be exaggerated. An anonymous writer in a newspaper criticized the policy of marking the houses of victims as "unadvised and cruel," causing "unnecessary terror," that "will prevent marketing,... and restrain all commercial intercourse along the wharves."
The house the overseers of the poor found for a hospital did not please either. They chose Rickett's Circus, on the western outskirts of town, 13th and Market Streets, where a month before Rickett's equestrian exhibition had entertained hundreds from President Washington on down.
No characterization of the overseer's first seven fever patients has been written. They could have been unfortunates found in the streets, or house servants sent by families fearful of harboring the fever in their house. There were few people living near Rickett's Circus. The financier and former U.S. Senator from Pennsylvania, Robert Morris, had workmen building a colossal marble mansion at 10th and Market Streets, but he still lived next door to the President, But there enough residents scattered at the end of the city to fuel a small riot. Angry neighbors threatened to burn down the so-called hospital after three of the seven patients died. The overseers quickly agreed to shut down operations there. Carey's account of the crisis at Rickett's Circus
On Saturday a group of overseers rode out to Bush Hill, the large estate of William Hamilton about two miles northwest of the city. It had not been occupied since Vice President John Adams stopped renting it the year before. The owner was in Britain and the overseers got permission from the mayor and governor to take the house to accommodate the poor. Bush Hill was surrounded by a pine forest, not angry neighbors.
By week's end the official measures bolstered the confidence of many. Samuel H. Smith, a young Republican printer wrote to his sister, as a small cannon was being hauled through the streets and fired, that "the force of the disease" had been spent. Everyone infected had had contact with the Water Street victims. "Since proper precautions have been taken, the disease has assumed a much more harmless shape, and little, if any danger, can be rationally entertained, except where a person unnecessarily exposes himself to entering sickrooms, attending funerals, and touching or very nearly approaching the infected body." Hutchinson had explained to him that in the past two weeks only 8 people had been buried in the Arch Street church burying ground, hardly a high number for that time of year. Before 3 out of 4 victims had died, now 1 out of 3. Seventy had died and at that moment 70 had the disease. While it was true that people had fled, it was mostly families with children who could not be trusted to take proper precautions. Smith noticed "no visible diminution of the inhabitants."
Mayor Clarkson told the press that the number of deaths in August was quite in line with the usual number. The 40 who died of fever could easily have died of something else. Another writer urged citizens to look at other excesses of the season as the cause for any greater mortality, "...the quantity of melons, and other green trash of the same kind, that are at present devoured with so much keenness."
Such brave talk impressed enough state legislators to form a quorum on Wednesday, but they promptly adjourned on Thursday until Monday. One legislator from the city explained in his diary, "owing... in particular as a young man by the name of Fry is lying dead at the west end of the State House." The thought of getting a whiff of the boy, the son of the door keeper of the state House of Representatives, was too much for most members.
No one was becoming more familiar with this mortal stench than Rush, and it had him out of sorts. He had visited Fry's son on Monday. Rush saw no amelioration of the city's crisis. He wrote in his notebook that there was "great mortality from want of caution among friends and nurses." He also observed that he "felt burning in stomach after entering into infected room." When Rush's sons said they were afraid that they would catch the infection from the clothes he wore while visiting patients, he agreed and sent the boys to Trenton to stay with an uncle. A niece took baby Ben and his nurse maid out to the farm of one of Julia's cousins just outside of town. One of Rush's five apprentices, Johnny Stall, moved into the house. The doctor needed help. The knocks on his door began at 5:30 in the morning.
He was so busy that it was not until the end of the week that he was able to defend his theory of the fever's origin. In reply to Hutchinson's letter, "R" explained in Friday's American Daily Advertiser, that three of the Danish seamen ill in Kensington, whom he had treated, "received the seeds of the disease on board their ship, while she lay at or near Race-street wharf." He added that "it is no new thing for the effluvia of putrid vegetables to produce malignant fevers. Cabbage, onions, black pepper, and even the mild patotoe, when in a state of putrefaction, have all been the remote causes of malignant fever."
Rush was usually not shy about signing what he wrote in the newspapers. But at this time, he knew he was debating a point that was not really the burning question. Explaining how the fever began was important, but the task at that moment was to cure it. As with so many viral diseases, even today there is no cure for yellow fever. We do have a vaccine to prevent it. Treatment consists of trying to keep the patient quiet and taking supportive measures short of drug therapy. So in retrospect Rush's great contribution in 1793 was recognizing the existence of an epidemic and understanding how devastating it could be. He scarcely recognized that as a contribution. No one was thanking him for his perspicacity. One friend later wrote that when Rush told him to fly from the contagion, thus possibly saving his life, still he hated Rush for destroying confidence in the city.
There was no greater city booster than Rush. His many calls for reforms over the years were always couched in language lauding the city as one destined to lead the world. His inability to fill the role of civic protector seemed almost to paralyze the doctor. It was not like Rush to let his opponents lull the governor - a man of 1776 like himself - and mayor into a sense of optimism when he saw the city in mortal danger. Simply put, he could not act until he had a cure.
On Thursday, August 29th, at the nadir of his depression, he wrote an uncharacteristically gloomy letter to his wife. Rush usually did not dwell on the negative, and had a palliative for every problem. He began this letter worrying about how to pay for her board, adding "providing my life be spared - for to live a week now in Philadelphia as I now live is to be the subject of a miracle." After crossing that out, he promised to tell her if he got the fever so she could come to him, agreeing that it would be as wrong for her to desert him as it would be for him to desert his patients at the present moment.
He did not conceal the terrors of the disease from her. One patient, the stonecutter William Stiles who lived on South 3rd Street, "exhibited signs of the plague before he died." Some doctors apprehended that it was the plague, but Rush knew it wasn't, though "it comes nearer to it in violence and mortality than any disease we have ever before had in this country." He listed its various symptoms: "Sometimes it come on with a chilly fit and a high fever, but more frequently it steals on with headache, languor, and sick stomach. These symptoms are followed by stupor, delirium, vomiting, a dry skin, cool or cold hands and feet, a feeble slow pulse, sometimes below in frequency the pulse of
health. The eyes are at first suffused with blood, they afterwards become yellow, and in most cases a yellowness covers the whole skin on the 3rd or 4th day. Few survive the 5th day, but more die on the 2nd and 3rd days. In some cases the patients possess their reason to the last and discover much less weakness than in the last stage of common fevers. One of my patients stood up and shaved himself on the morning of the day he died. Livid spots on the body, a bleeding at the nose, from the gums, from the bowels, and a vomiting of black matter in some instances close the scenes of life."
He chronicled his frustrating search for a cure. "The common remedies for malignant fever have all failed. Bark, wine, and blisters make no impression upon it. Baths of hot vinegar applied by means of blankets, and the cold bath have relieved and saved some. Mrs. Chaloner owes her life to the former remedy. She caught it from her husband, who caught it in Water Street near the place where it originated. He too is upon the recovery. This day I have given mercury, and I think with some advantage. Dr. Wistar and myself consult much together, and I derive great support and assistance from him in all my attempts to stop the progress of this terrible malady. He is an excellent man, and rises in his humanity and activity with the danger and distress of his fellow citizens. I have advised all the families that I attend, that can move, to quit the city. There is but one preventative that is certain, and that is 'to fly from it.'"
The idea to wrap patients in blankets soaked with vinegar came from a 50 year old book by an obscure British army surgeon. Rush tried cold baths after he talked to Dr. Edward Stevens, who had just arrived from the West Indian island of St. Croix, where he had treated yellow fever cases. Bathing was not common in the United States and bathtubs were rare. So by cold baths, Stevens meant standing the patient in a tub and having cold water poured over the body. In one patient Rush injected bark "into the bowels every four hours." He had "buckets full of cold water" thrown "frequently" upon his patients. Three out of four died. He recollected his success in treating Polly Bradford with the mercury compound calomel, and tried that once again.
He was "baffled" by such "malignity" and "obstinacy" which he had never before observed in any disease. "Heaven alone bore witness to the anguish of my soul in this awful situation," he wrote a few months later. "But I did not abandon a hope that the disease might yet be cured. I had long believed, that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy." Indeed in an address he gave in 1787 on the objectives of the newly formed College of Physicians he alluded to the Millennium: "Many disorders, once deemed incurable, now yield to medicine. No wonder then that a general expectation prevails - that a revolution is soon to take place in favor of human happiness." Thanks to America's republican institutions he hoped that American physicians would take a leading role in the new discoveries.
Not that Rush commenced a haphazard search through the pharmacopeia of the day. Fame in his day was won by the promulgation of theories. A naval doctor named Lind who suggested limes as a preventative for scurvy labored in obscurity, while John Brown was the medical tyro of the western world. So Rush tried a new theory dictating a bold departure from accepted practice.
Despite the weak state of his patients, he would deplete them further with double the common dose of the strongest purgative, calomel. A few months later he wrote that he decided upon that course after re-reading the monograph of the doctor who inspired one of the treatments he had discarded, a vomit followed by the bark. What impressed Rush on a second reading of Dr. John Mitchell's 1747 essay on an epidemic in Virginia was not his remedies but his analysis of the disease.
For ages doctors had noted that a profuse sweat often marked the favorable climax of a fever. This favorable sweat had a special character which doctors called "natural," that is, it did not arise from any morbid paroxysms of the system. Indeed some schools of medicine held that only nature could bring on this natural sweat and that medicine was only to be used to support the patient until the "crisis." There were guides alerting physicians as to when the crisis could be expected in various fevers. Rush thought medicine could induce the crisis and the curing natural sweat.
Mitchell had performed autopsies on some of the slaves who had died in the epidemic and found the walls of the stomach coated with the putrid matter which he envisioned as arising from the fermentation of miasmata which permeated all the systems of the body. It was as if the body were sweating poison internally. Not until those poisons were removed could "sweat break out of its own accord."
Mitchell's reasoning was novel. His essay had never been published. Rush got a copy of it from Benjamin Franklin just before he died in 1790. Franklin had gotten it in answer to a
question he had posed to Cadwalader Colden, the Lieutenant Governor of New York who had written about New York City's 1742 yellow fever epidemic. Most doctors used herbal teas to induce a natural sweat, not further depletion which promised only the cold clamminess to be avoided in fevers. Indeed at the meeting of the college, Hutchinson had mentioned the rapid death of a patient of his who developed a spontaneous diarrhea. However, Rush found Mitchell's argument persuasive. As Rush would soon quote to his colleagues, "an ill-timed scrupulousness about the weakness of the body is of bad consequence in these urging circumstances."
However, Mitchell had not used a purge as strong as calomel. Rush noted that in his dissections, Mitchell often found the gall bladder and intestines filled with bile. Evidently in those cases his purges had not been strong enough. Rush had begun his career in Philadelphia as an opponent of using mercury to prepare patients, especially children, for inoculation with small pox. He thought other purges as efficacious in assuring the patient got a light case of the pox and none had mercury's side effects. Rush gained more respect for mercury, for cases other than syphilis for which it was a wonder drug, during the war. Rush worked with an army surgeon, Dr. Thomas Young of Boston, who treated bilious fevers with a dose of 10 grains of calomel
and 10 grains of jalap or rhubarb, the Mexican and Russian roots which were powerful purgatives in their own right. Young gave the dose once or twice a day until it procured a large evacuation of the bowels. Rush had argued that the large doses were unsafe but after seeing their effects, he could not consider them more dangerous than cream of tartar or Glauber's salt, a sodium sulphate compound discovered by a German doctor.
On Thursday, Rush gave doses of calomel and jalap to the Danish sailors and thought it helped them. He discussed the matter with Dr. Wistar, whose library he had been consulting and whose brain he had been picking. Both agreed that the evident excess of bile meant that the disease primarily affected the liver and so purges were in order. However, to avoid violent evacuation from an already depleted patient, Wistar wanted to use mercury as an ointment to be rubbed on the skin over the liver. That might stimulate that organ to expel poisonous bile.
Given the power of the disease they faced, much more powerful than common bilious fever, Rush wanted quicker action. He gave his apprentice Johnny Stall pills of 10 grains of calomel and 10 grains of jalap, as well as mercury ointment, and told him to give doses every 6 hours to Richard Spain, a block maker on 3rd Street with a case so malignant that a neighbor had angrily insisted that Rush instruct the family to prepare for rapid burial of the corpse. Rush had first seen him on Wednesday. That Friday Spain lay "without a pulse, and with a cold sweat on all his limbs." By the accepted canons of medicine further depletion would be tantamount to murder. Rush also gave Richard Stansbury, a Quaker teenager as badly off as Spain, calomel and jalap. By Saturday morning the boy had had 20 and the blockmaker 30 grains of calomel. Both were less delirious and had good pulses. Rush continued the dose through the day. By night Spain had a sweat.
Judging from the letter he wrote to Julia on Sunday morning, Rush was once again energized. Like a good Christian, when he was feeling all-powerful, Rush preached humility. "O! the littleness of greatness! Thrones, titles, splendid and even commodious houses, wealth, friends - what are they all when viewed through the medium of a relentless and desolating fever? Help me, my dear Julia, by your prayers to `be always ready.' I have cut out much work for my divine master, to be performed in months or years to come, but if he means to have it completed by other hands, 'his will be done.'... If I survive the present dangers to which I am exposed, what offering of gratitude will ever equal the infinite weight of my obligations to my gracious deliverer? You must help me to be more humble, more patient, more devout, and more self-denied in everything."
Go to Chapter Four
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